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February
is National School-Based Health Center Awareness Month!
By: Marcia
Groves-Bixby, MPH
February 2003
February 2003,
marks the first National School-Based Health Center Awareness Campaign.
In 1,400 school-based health centers nationwide, children can receive
primary care and behavioral health services. Since their inception in
the late 1960's, these centers have tried to meet the challenge of providing
support to the community, the schools, the student and their families.
Read more about the ABC's
of School-Based Health Centers and National
Awareness Month.
History of School-Based Health Centers (SBHCs)
SBHCs' ideology goes back to the late 1960's and early 1970's. The first
organized school clinics were developed by pediatricians in Dallas, Minneapolis-St.
Paul and Cambridge, Massachusetts. These early efforts shaped the model
and a small circle of policy entrepreneurs began advocating the school
clinics. Around 1978, the Robert Wood Johnson Foundation (RWJF) and "Making
the Grade" provided further interest in developing school health
clinics by providing funding initiatives. In 1994 the federal government
provided another funding source, the Healthy
Schools, Health Communities Program through the Bureau of Primary
Health Care.
Read
more about two clinics that were established using this funding.
Between 1970 and 1989 another catalyst for the early development of SBHCs
stemmed from organizations such as the Children's Defense Fund publicizing
teen pregnancy rates. Public Health officials were looking for solutions.
At this time Joy Dryfoos, who is often considered the "mother"
of the SBHC movement, wrote a series of articles promoting family planning
through SBHCs. In the early 1990's U.S. Surgeon General, Joycelyn Elders,
promised to reduce teen pregnancy by distributing condoms in school-based
health clinics.
SBHCs have confronted a multitude of barriers in their development and
implementation. These barriers have caused ebb and flow along the continuum
for SBHCs. Teen health care raises issues around sexuality and reproductive
health. Religious organizations and conservative Christians take offense.
Issues are further complicated by parental consent and notification. Another
great barrier is funding issues. When national health care was proposed
during the Clinton administration, advocates imagined school health centers
playing an important role. But like most public health clinics, SBHCs
were not wired for billing for services. Further complicating billing
for services, is the fact that SBHC clientele reflect the usual crazy
quilt of insurance coverage. The Spring, 2000 issue of ACCESS reported
on the distressing news that more School-Based Health Centers were closing.
The general consensus among SBHCs was they were all experiencing the same
barrier-financial support.
What is Happening Today
SBHCs are seeing a resurgence of interest. States are logging a higher
incidence of uninsured children. "For the first time in two years,
school-based, low-cost health clinics will again open in the Tucson area
to provide vital medical care to children who have none." There the
long-term vision is to bring the SBHC concept back to its glory days of
the mid-90's.
SBHCs in California have long been recognized as filling the void in low-income
communities. In southern California, school clinics are moving beyond
providing basic services such as inoculations and vision tests to become
primary health-care centers for students and sometimes their families.
School-based health clinics were established 15 years ago in the Los Angeles
Unified School District, which has 27. "If the clinic wasn't there,
they wouldn't get care or would travel to a county hospital," said
Margaret Lee, director of special projects at the county Department of
Health Services. "We have research that shows that school-based clinics
relieve the burden on trauma centers and emergency rooms."
It was recently concluded in a study analyzing health care utilization
at three school-based health care centers in the Bronx, New York City
that SBHCs provide access to health care for children and adolescents,
and SBHCs are frequently the only source of regular care for children
without medical coverage. The researchers further state that recent studies
also demonstrate SBHCs can reduce Medicaid costs.
Gail B. Gail, President, National Assembly on
School-Based Health Care describes the role of the SBHC. SBHCs
provide quality health care services for people that fall through the
cracks of traditional and public supported services in Massachusetts.
She concludes: "School-based health centers (SBHC) are part of the
Safety Net and have emerged in the Commonwealth as a valuable means of
providing health services for school children." As the number of
workers insured by their employers dwindles, recession continues, jobs
are lost and an increase in chronic and urgent health problems is seen
in school-age children, the necessity of SBHCs becomes more apparent.
She implores: "As the new budget cycle begins, it is crucial for
both Executive and Legislative branches of state government to recognize
the role that School-Based Health Centers play in the promotion of healthy
educational environments."
Karen Berg, Project Director, Illinois Coalition
For School Health Centers reports: Maintaining connections
among schools, communities and families is critical for protecting children's
health and safety. Across the country, millions of children go to school
every day with the need for health care services. In 1,400 schools nationwide,
children can receive these health services from school-based health centers.
Schools are an ideal setting in which to provide primary care and behavioral
health services, especially to those who would otherwise have no access
to health care. School children today experience the harmful effects of
major public health concerns, including poor nutrition, tobacco use, violence
and unintentional injury, substance abuse, and chronic diseases such as
asthma, obesity, and dental caries. School health centers are an important
strategy for enhancing access to high quality health care for all children.
In these centers, students can get regular check-ups, immunizations, asthma
care, counseling, health education and other essential services. School
health centers support schools by providing prompt attention to health
concerns thereby keeping students in the classroom and school personnel
relieved of the need to provide services for which they are not trained.
Parents value the centers because their children can receive services
at school while they remain at work.
Jayne Van Ness, a parent in Peoria, Illinois,
states, "The in-school health program has been a Godsend. My chronic
asthmatic son was able to receive treatments in school-reducing his lost
school days and my lost work time."
Join the Effort to Support School-Based Health
Centers!
February 2003 marks the first National School-Based Health Center Awareness
Campaign. What you can do to support School-Based Health Centers:
To learn more about School-Based
Health Centers, please contact the National Assembly on School Based Health
Care at www.nasbhc.org
or info@nasbhc.org.
Additional Readings:
School-Based
Health Centers: A National Definition
The
School Nurse / School-Based Health Center Partnership
References:
"Back to School: A Health Strategy for Youth", James A. Monroe,
Elizabeth H. Kilbreth and Kathryn M. Langwell, Health Affairs, Volume
20, No. 1, PP. 122-136.
ACCESS, Spring 2000, pp 1-4.
"School-based health clinics making a comeback", Arizona Daily
Star, Carla McClain. August 19, 2002.
"School Clinics Offer Primary Care", Los Angeles Times, Annette
Kondo. October 8, 1991.
"Comparing Frequent and Average Users of Elementary School-Based Health
Centers in the Bronx, New York City", Journal of School Health,
Raymundo S. Barquin, Mayris P. Webber and David K. Appel, April 2002, Vol.
72, No. 4., pp 133+
"Financing the Safety Net for Children and Youth in Massachusetts",
Gail B. Gail.
Marcia Groves-Bixby, MPH is a graduate of the
Master of Public Health program at Northern Illinois University in Dekalb,
Illinois. Marcia also has an associate's degree in early childhood education,
B.A. in therapeutic recreation and holds Illinois Teacher Certification.
As a Sales Consultant for School Health, she works closely with schools,
school nurses, public health departments, special education co-ops, Head
Start programs and early childhood education centers.
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