Problem Identification:
A strategic determination should be made to determine the organizational entity’either the Health Department or the Baltimore City Public School System’that should be responsible for administering school-based health programs.

Recommended Action:
Consider transferring the administration of the School Health program to the Baltimore City Public School System.

Cost Savings, Organizational

Functional/Operational Area:
School Health Services

Estimated Annual Impact:
Cannot be Estimated

Estimated Implementation Cost:
Not Determined

Barriers to Implementation:
The Baltimore City School System’s administrative capacity to manage this function.

Projected Implementation:

Next Steps:
A small working group, possibly led by the new organizational unit described in Recommendation 5-B, should examine the management of school-based health programs in other large cities, evaluate the capacity of the Baltimore City Public School System to assume management responsibility for this function, and make an informed recommendation to the Health Commissioner.

The Department’s School Health program is responsible for providing health assessments to Baltimore public school children that do not have primary medical care providers. Annually, over 146,000 visits occur at these school-based centers. The Department’s administration of the School Health program costs nearly $17 million each fiscal year, representing more than 11 percent of the Department’s annual operating budget. There is no question that the Department’s School Health program is responsible for the delivery of critical services to some of the City’s most important clients’its children. The need for service is illustrated by the fact that the Department’s FY2000 budget included the replacement of 14 permanent school health care positions that had been vacant with contractual workers to provide added coverage. This move enabled the Department to hire three contractual workers for every two permanent positions that were replaced.

A central focus of the Greater Baltimore Committee/ Presidents’ Roundtable Management and Efficiency Review effort has involved evaluating the services currently provided by the City and determining the most appropriate organizational structures and delineation of responsibilities to ensure the delivery of the most effective and efficient services. A common theme that has emerged across each of the six project teams is that City departments must focus their service efforts on core functions. While the Greater Baltimore Committee/Presidents’ Roundtable Health Department project team found that the Health Department was effectively managing the School Health programs, the issue remained that the responsibility for the administration of School Health programs might be more appropriately vested with the Baltimore Public School System providing it were able to demonstrate a capacity to assume these duties. This recommendation advocates considering the appropriateness of the current division of responsibilities and revisiting this issue on a regular basis.