School-Based Health Centers

Hi guys, this is my first time posting on the PRIME blog, and so I wanted to shift gears and post a little bit about a topic that is near and dear to my heart... (Its a long one - read it when you have time :)

As many of you know, I spent the last five years teaching in the Oakland Public Schools. When I first came to Oakland High School, there were no health services on campus to speak of, and if a child so much as needed a band-aid, they were going to get sent home (unless the teacher had bought some on her own). In the five years I was there, I had the privilege of seeing a transformation in the role of the school as health care provider and educator for under-served youth - we brought on a full time health-educator, and even a first-aid nurse. In the last few years I was in Oakland, I became very involved in a committee whose goal was to implement a school based-health center on campus.

The model of a school-based health center has been around for over 20 years, and in many ways it is part of a greater vision for the 'School as Village', a concept proposed by many, including Hillary Clinton during her time as First Lady. The idea is that schools should be transformed into full-service community centers that provide not only traditional education, but also mental and physical health services, career and college support, leadership development, and training for parents in a variety of areas ranging from healthy eating, and computer skills to education on navigating college applications and FAFSAs with their children. Many of these services currently receives some level of government support, or are delivered by non-profit organizations that rely at least in part on grants from their state, county, and local government. Therefore, the 'School as Community Center' model centralizes the provision a many related government services to high-need populations.

In California, there are currently more than 150 School-based health centers, many of which are at the elementary school level. Their mission is to provide standard primary care, and often times mental health services to children at the school (who opt to use the clinic). At the high school level, reproductive health services are also a major facet of the health clinics. These health clinics are a safety net to some of our most vulnerable patients, low-income children.

In 2006, Governor Schwarzenegger set a goal of expanding the number of school-based health centers to 500. Unfortunately, California is one of only nine states that do not provide direct state funding for school-based health centers. Instead, school based health centers must rely on a hodge-podge of different funding sources including 'government grants, private donations, in-kind support, and third-party reimbursement from public programs such as Medi-Cal, Healthy Families, Family PACT, and Expanded Access to Primary Care to provide services.' This may not always be the case, as in September of this year; the Governor signed Senator Ridley-Thomas’ SB 564, the School Health Centers Expansion Act. This act creates a state-grant program for school-based health centers, and once implemented will be the first-time direct state assistance will be provided to school health centers. Such funding is absolutely imperative, if the Governor is serious about expanding the number of school based health clinics to 500 or more. SB 564 is a follow-up to AB 2560 of 2006, which established a Public School Health Center Support Program to collect data and provide technical assistance to support new and existing school health centers. Unfortunately, the significance of the new bill may remain symbolic for the time being as the Governor himself as admitted that the budget is tight, and there is no money to start awarding these grants at the present time, however, he wanted to create a mechanism and framework for providing school based clinics with assistance when monies became available.

At Oakland High, the vision for our wellness center was born from many other models that already existed in the Bay area, one particularly exemplary model being at nearby Berkeley High, where a single trailer had grown into a full service health center in a permanent structure with a full-time medical staff. Of course, Berkeley had the privilege of a more ample support from their City's own Health and Human Services Department. Our own clinic was to be funded by a more modest grant from the county Department of Public Health. So, while our funds we more limited, our goals were no less lofty. We were inspired by what other schools in similar communities were able to offer, and strove to provide quality primary care that could be accessed by all 2000 of our students.

As of the 2007-2008 school year, a preliminary health center had been opened in a large classroom that had served as an auto shop many years ago. We were offering a significant (though limited) amount of counseling and psychological health services, as well as sex education and reproductive health services. The school nurse and two school psychologists are at the center of this developing institution and the other services are contracted out to local non-profits and clinics who send staff to provide their services on site. In 2008, we also received additional funding to create a new structure for the health clinic, an approved blue prints that included space for a lab, and several exam rooms. The new center, when it finally opens, will integrate health services with a wide range of academic support, college preparation, employment opportunities, and leadership development. Gardening and cooking classes also aim to improve eating habits amongst teenagers. The idea is that by providing kids with productive ways to engage in their community, we will decrease violence, drug and alcohol use, and unsafe sex, which are all major contributors to diminishing health amongst youth. It is an ambitious project, and one that is still in its infancy, but I hope to visit Oakland High and see their progress this spring.

In the meanwhile, here are some of the important questions and concerns that both proponents and opponents of school based health centers have raised:

How do we determine which schools are best suited for a school-based health center?

How do we optimize the size and nature of the clinic?
(A large full service clinic in some schools, as opposed to a small one-stop shop with more limited services in another)

How do we engage the support and guidance of the community in developing such clinics?

In the case of elementary and junior high students (and to a lesser degree high school students), how do we reconcile issues of patient confidenitality with the right of the parent to be involved in their minor's health care decision-making?

For more info on school-based health clinic in Cali and around the country:

http://www.chcf.org/topics/view.cfm?itemid=133488
(the linked pdf on this page is an excellent, though extensive report)

gov.ca.gov/images/page/health/SchoolBasedHealthCenters.pdf

http://www.schoolbasedhealthcare.org

http://www.schoolhealthcenters.org/

Happy Studying!
Arthi