2017.03.07 14:00 G: Gerald Klaas J: Jim Schultz M: Mark St. James K; Ken Dukek - CEO CCH M: Mary - QA C: Carly - Attorney Ken: sthe sbhc... design why resourc is C not access to care, issue with tht Why we open prim care, that is abot phys and metnal ww2 sgrants. P and metn... the buld in imm and physical.. last month, exclusion .. some kids other issues, them and that provider.. OR stat auth over 14.. access to med care counseling side.. if younger, parents know.. 16.. title X.. federal and state dollars... hav eto follow those... not only that , coul also be hit with civil alawsuit...conscious about that what look at fed an state with SBHC, haven't read... have heard about it rational enquireer.. any resource has to come from state or endorsed by state... Mary: I brought those .. they passed out meeting I went to... they're hope is to reach out to LGBTQ population.. that view of have to be accessible we dont' do any endorsements... if I have issue, I'll contact the state, provde acess point that wil be unfettered, whether on Physical (P) or Mental (M) side. M: does address LGb... kids want gender changes... I red your goals.. has to be parental consent... are parents involved? K: Well beyond where we are at the health center... Our info.. betetr form than waht ahave access to on Interne... we're onot hosting, supporting... trying to get them to go into in a trying to make sure info out there Share some commonalities.. don't want kids committing suicids... M: saw goals.. by 2017... creat youth advisory... K: started with 6... just went to Salem.. youth advisory committee... interact with other kids... so adults get feedback.. M: The YaC up since Oct 2015 K: don't want teen prgnancies... common ground... ours is really about getting info about J: we agree.. up to speed ,... mental health... want those to be accessible concern for the poort, access toquality care... difference is in means to accomplish don't want to be depresed and commit suicide.. some things offer could increase ideation... K: such as J: abortion.. escort.. to abortion... facility.... K: no SBHC ... in Gold Beach... didn't do primary care until 2014... in public health setting not see those things... tools and resources to prevent... and victims of rape other element that peopel don't see... victims of crime... people can make person choices... not doing anything like that... J: when I wnt to Oregon Health website.. vrochure about what SBHC do... if someone comes in qwho is preg or thsinks... they can be transport... the document ssaid trans to health clinic... billed to parents ch K: violate fed law M: my question.. page OHA.. 2016... 23 induced abortions... Curry county... K: a few things... the emancipation doesn't have much to o I'm not aware of what you're talking about when a youth comes in and asks to be confidentila not bill...federal Title X Say 17 comes in and wants tobe we're not lining up a van.... our goal is population health, not individual health STI, pregnancies... Personal choice is at appropriate age... that could happen anywhere, in county since 2005, sjuvenile dire for 9 years. not aware of single case... J J -- conversations... but not facilitation K: practiitioners wouldn't share J: one of poitns.. is confidentiality .. end run around parents I have two daughters... emotional or medical aftermath K: not all of our parents have that conversation.. nto all kids go home and have that some could impact emotionally or physicall...only a couple rooms there... if doing referral.. going to refer our own... we're a primary care clinic here... can refer We're not going to line up a van and send sombod dwo C; if you have 17 year old.. what is ed or qual K: MH praction or LC SW all licensed... M: if want confidential... on school time K: we don't have a play in that.... Our biggest problem is billing... M; funding from state and federal... K: Currey county doesn't... State... less than when conf.. we eat that... we recognize... the 17 year old... I wish I could tell you stories... sometimes shocking.. .want to go beat parents... or I"ll be in jail... J: We understand parents not that way that puts part of matrix p on pressure on decisions... from pareents and significant others K" I see these not threats but opportunities to get out , having opp to have that conversation with kids... I was paretn.. 4 kids...onewas really challenging... I look for opportunites.. to pas off morals and values.. taht as marine ... dathly afreaid of me... only to ap part... some things def go to mom .. dad.. that's what happens... I see good opp. not much we can do... Sean asked , can you remove certain materials.... get into that where it goes... J: the Rational Enquirer... we think there is a distortion of religious argument, we think that if not neutral... 1st Amendment.... there is nothing morally neutral to claiming that sex has no meaning.... not morally neutral claim if literature is an implied notion... other than desire, age , consent ponly things that limit choices people can stay within and still get into enourmous trouble... the Chlamydia 15-19 1400% in 4 years.... M: as nurse in emergency room... women can have stD and not know it... does have quoted stories on how to have ... K; State's perspective is stories by kids for kids... we follwo tose. and and again our goal is resources... for everyone... J: PP is behind.. not the boogeyman.. conservative point have issue with PP point of view what they call comprehensive sex education. is in their minds opposed to abstience I know the state says.. encourages abstience... you can get HPV through or arounda condom... dome of these sTD's cannot be stopped by the ways we tell them to protedct one out of 4 teens now have we feel making sexual health of teens worse, by not prvideing no other criteria than seire age and consent.. M: as they ge tolder go down sky high 15 to 19.. we're pushing K: I'd have to look at data sets.. Imight look otheways.. i hear what you're saying... not drawing correlation... this we have.. other relations... alcohol , drugs and age J: lack of supervios K: seriousl drug and alc ,in this county that provid reomvoe inhibithiosn to make those I think we'r ereaching a diff kdi... than that todone I wish more would, maybe we could reduc first time alch and marjiuana I'dealth with .. first kd as proc through court, als get to prim cara all hav STD's ... chang prners... who's parents.. J: we agree... K: I hear what you're saying... gotta do it by the lette of the alw if the state says 15 things... as communicating... my K; OHA provides grant... eahc local HA for coujty has control over SBHC..c an do or cotnract... Coos is contracted... inour County. we run the one... up north.. Coast community health.. doign small scholl no sbhsc oner eq is have to work with.. do you have the spce.. .dont' get itno practicee.., 1. N 2. N K; to be healthy,... get ready for shcool physicals ... we did give 10 dol to evy kid to hgih school.. to boosters club... 3. ..we dont' knooow what they come in for... migh come in C headache... 4. 6. no menu.. .no invasive services.. no crash cart all lic prov ... giving advice... lic... prescribption... 7: Behavior... any child over 14 can consent... if on parents want conf... ORS... addictions and behavior halth... ... .can consent .... on medical (12 ?? ) K; more kids on behavior than phusicalll for 5 on B hav e1 on Phy more kids connected on physical halth... comein want ankle... parent 5 kids don't knowwhat shots do... state says allthese things doesn't make anymoney.. .prob 40K to do that...also in demand. also a demand.... M: School nurse... what she do? K: you know nurse at par level... nurse practioner... order X rays, prescribe... more diff for school nurse to get to hospital As public health auth follow up on all STD's or prob is fam docs.. getting out in timely fashion.. no fiff than TB.. sometimes quarantine.. M: could fall out of clinic to priv doc K: if go to family doc.. .and STD.. reported to us... primary as PH agency... population... why... jneed OR Health authority... pull "SBHC.... 32. how to run SBHC..." gender dysphoria... issue treatment paln.. kids , comples... lat... short term .. focused, get into counseling.. goal is.. determine what's wrong to ident treat gaol work on... M: I was ... no.. we as therapists. can't so far outside our scope... more like coping skills... I don't have a spwecialty in this.. . help process thorugh... go.. not 9. Can't opt out .. 12 and up... school admin.. tell during parent M: for 3 years.. never met.. every admin.. I went to all every day to staff in I talked to Alice every day.. all those.. they know... come to meetings... K: Parents should have good convesation.. kids can't J: whether opt out or not... can't K: if come in we cannot deny... service... kids sense of emergency... not sameas us... can carry become baggage... M: not a lot of walk ins . ost schedule MH all sched .. kido needs to fill out packet consent, ins.. phone nunbers... bring with.. some if... if not filled out .. do mom day know you're heare... if tell.. don't want them out... we sign them up for other cost. then appointment take this packet hoem or fill out with parent. school coundellors.. or hav fill as much as can.. K: Oregon health plan.. maybe M: if after c session wants to bring mom in.. knows,.. can go back .. go back.. rebill... goal is to try to get involved... talk about each time... try to get back.. if solid no.. then can .. J: don't want to exacerbate.. good to hear... 11. M: form when child goe in.. contract BHSD what info grade level.. teacher.. tehn we can go back to check... verify... only BH school an enrolled in BH.. most referrals.. school administratiors... every kid has form on file... first time.. what school... who counselor at school so once disenrolled... now continues... K; only 10 hours a week... therapist.. physically. 2 days. 10 hour days... schools space in school... school gave me rom in Azala.. don't have to check out.. least amount school possible missed.. j K: 4 days a week.. 5 hour sessions... 20 horus a week.. building open.. 12. K: reports with the state... Mary part of people work on it... public information... youth advisory committee take to get involved in these things... do presentation.. video on kids put together video.. highlight at the state.. done mby the kids.. trying to move closer want them to do the legwork.. 13. K; metrics on number of clients... internal quantitative reports. reports to coordinatess.. if one year.. screen not alcohol.. drpression.. metric.. part of visit... most providers.. make sure quantitaveie care CCH care model.. treat whole person.. physcal, mental and addiction.. not a med if a family doc... HPV series... K: can request at any privder... not a big secret thing... M: give otu free in crescent city K: some education when people come clinic... based on issue.. proven to reduce... Generally won't if not a patien of ours... In order have to be Nexflanon.. 362 for unit... cost to install is 1000... we're not eating 1 K.. by a patient.. M: when a public health .. you ahve to assigned, as we're your primary care doctor... K: don't do those.. measles.. mumps... J: would not be done.. unless they wer your patients... K: not the purpose... all have to be soteed.. and maintaine.small firdge amount of small.. Pretty concerned about risk.. obviously.. psych patients.. same by primary care... will if benzo diazapine.. with opiod... who prescribing... when that far in... don't want to take that risk diff if our atient.. my prov talk to me 2 fam nurse practionsienr 12 psyc nurse pra dr. Amsten. me officer... M: esp if abuse or alcohol prob... K; 14 credential companies... medicare, commercially allowable rate... out of network costs... don't want o do that... very big... J: let me follow.. brochure a couple years ago reference to teens being trained in some way.. some sort of .. K: not that I'm aware of... someone wanted to intern M: YAC doesn't see records... advocate for clinic... hold event .. pass out fee stuff M: not seeing who's going in... C: not answer phone or reception.. M: all on Fridays... what do next month for parent teacher conferences... no kid ever walk in... be seen by the act J: something that PP had input or training... thing underlies the concern.. if counselor might give advice of a moral nature... perspective to offer... 1. parents. 2. the kids (if agree..) 3. people who give dollars... (have a perspective) 4. the counselor.. what willbe offered.. ehter the literature.. teh people who hold the money have all the power.. K: not in our case.. any good counselor, not prduct or theme... motivational interviewing identify what core issue is.. not leading them.. helpign them ... not to say.. you dshould do this... why do you feel that way... what doyou think you could to do not trigger... any good therapis.. help you solve your provlem musch liek MH ill live in our communit , sometimes become crisis patient.. should we box up and put inn hospitall.. does that solve/ their issue is find their triggers... network istuation.. whereber how contrl people will amke decisions... things to do J: I would say moral conernds would dictate what is a problem area or not.. K: certainly.. we have good moral fiber or characterm maybe complaint about not open enough we gain nothing by going in a particular direction 65 emp now.. ne programm .. as juvenil director for 9 years.. still a lack of services and mental health.. biger problems we go through exhaustive process. broght in 20 people from out of state.. higgher q person.. J; what about adding material...? what if RE.. encourages sexuality... would y be willing.. they lim K: they limit what we can some folks form JW faith .. set up in Gold beach.. talk to I don't have a problem with them .. federal.. have to be separated... be careful.. every Monday.. they're there down the hall.. we have limitations what we can have.. or what we can post.. I don't know.. what the state a.. if anything mandatory... ? Jessica Duke at State..