Caroline Cournoyer is GOVERNING's deputy web editor.E-mail: firstname.lastname@example.org
For every 10 children, there’s one who lacks health insurance. But every kid gets sick. When students with health coverage catch one of the many infections lurking in classrooms, their parents likely take them out of school to go to the doctor. Depending on the problem, they’re quickly back in class -- healthy and ready to learn. But when students without health coverage get sick, they’re less likely to seek help, which results in unresolved health problems that hinder their school performance in the short term and strain the already strapped health-care system in the long term.
But that’s not the case everywhere. In more than 2,000 schools throughout the country, students can get free comprehensive medical, mental health and sometimes dental care without ever leaving school property. School-based health centers (SBHCs) are fully staffed clinics located in or on school property. Each one is different, but most offer a full range of services, including primary care, mental health and social services. Most are in schools that serve the neediest students and are funded by state governments, the feds and private foundations. A variety of players -- such as community health centers, hospitals and local health departments -- typically manage the centers, but always in cooperation with the schools. SBHCs began in urban school districts, but have gradually spread to rural areas where faraway clinics and poor public transit make health care less accessible for students from low-income families.
Having a full-service health clinic in schools has many benefits. First, it helps close the health-insurance gap. But perhaps more important, students are reportedly more willing to seek help for sensitive issues like depression, suicide attempts, weight problems and pregnancy prevention at health centers inside school walls. SBHCs save parents the hassle of taking time off from work; and with onsite stocks of commonly prescribed medications available at no charge, they also save money and time usually lost in trips to the pharmacy. Studies show that having a school-based health center also improves students’ attendance, the dropout rate and classroom behavior. In Massachusetts and Texas, students’ absences were cut in half after receiving SBHC services. In Texas, students who received in-school mental health help had 85 percent fewer discipline referrals, according to the National Assembly on School-Based Health Care (NASBHC).
Of all the services, those for mental health are in highest demand, say advocates and practitioners. Students and schools are increasingly seeking them out as cyberbullying remains a big issue and as new or recently revised anti-bullying laws call on principals and teachers to provide bullied students help. Traditional school counselors tend to specialize in academic help; they lack the education and experience to offer assistance with mental health issues.
School-based health centers sprang up in the early 1970s, but it wasn’t until national private foundations started pouring money into them that governments took notice, says John Schlitt, NASBHC’s vice president for policy and government affairs. In the mid-1990s, states began creating government-sponsored grant programs for SBHCs, hoping to give economically disadvantaged students greater access to health care. More than a decade later, SBHCs appeared on the federal radar and earned a place in President Obama’s health-care law.
The 906-page Patient Protection and Affordable Care Act (ACA) contains many controversial provisions -- most of which will soon be reviewed by the U.S. Supreme Court. One provision not buried in controversy is a $200 million appropriation to fund new and existing school-based health centers. By the end of 2011, more than $100 million of that had already been awarded to more than 300 SBHCs in more than 40 states and the District of Columbia.
Neighborcare Health, a community health center in Seattle that runs six SBHCs, received $500,000 in ACA grants that it’s using to expand its dental services, upgrade outdated medical equipment and remodel an existing health center so it can operate at capacity. Every public high school in Seattle now has an onsite health center. That’s because the city makes the centers a priority by funding roughly 60 percent of every SBHC’s budget through a families and education tax, according to Colin Walker, school-based program manager of Neighborcare Health.
Advocates and practitioners agree that the biggest barrier to starting and operating these health centers is money. Right now, SBHCs are only in roughly 2 percent of the nation’s public schools, says Schlitt of NASBHC, because until recently, there just hadn’t “been the level of financial support for this model, and that contributed to a smaller scale-up.”
Finding funding is a constant battle for school-based health centers, as they offer virtually free services to every student -- and sometimes school staff, parents and community members. The recession undoubtedly squeezed SBHCs’ budgets, but, “much to our surprise, the cuts at the state level have not been as dramatic as they could be,” Schlitt says. And despite the cuts, Walker adds, services haven’t been impacted at the centers run by Seattle’s Neighborcare Health.
Even though SBHCs dodged the worst of the recession and have a new federal funding source, they may continue struggling. The ACA grants can only be used for capital needs like construction, renovation and new equipment -- not for operational expenses. The health law authorized $50 million for operational costs, but didn’t appropriate any of the funds.
Also, since the economy tanked, states have made Medicaid reimbursement more difficult. That means the centers have to look elsewhere to break even. “When you’re seeing kids regardless of their ability to pay, an organization has to be robust or creative in how they search for funding,” says Walker.
Luckily, virtually every entity that applied for the new federal SBHC grants received at least a portion of the funds. Unlike the rest of the federal health law, advocates argue, school-based health centers are a nonpartisan solution to a pervasive problem.
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