Reforms being considered by Congress could bring the single biggest expansion of school health clinics in the 35-year history of the movement, advocates for the centers say.
Health reform bills in the U.S. Senate and the U.S. House differ somewhat in their provisions for school-based health centers, but if either becomes law millions of federal dollars for starting and equipping the clinics would become available and services provided at them could be reimbursed through Medicaid or the Children’s Health Insurance Program. That would be a major financial boost for many of the operations.
Experts say there now are about 2,000 of the clinics in schools nationwide, part of a slow but steadily developing trend that began in the 1970s. State or local governments or private foundations have funded most.
The clinics, which typically are operated in a school or on school grounds, provide primary care and other health services to children who otherwise might not get them. Children of parents who provide consent are signed up for services each year when they enroll for classes.
Wichita clinics only ones in Kansas
Supporters say they can reduce emergency room visits and costs and are widely popular with students, parents and school officials, though the clinics generally are operated by agencies independent of local school boards. About 70 percent of the school clinics nationwide also offer mental health services.
“It’s common sense that children who are healthy are more teachable children. They’re in school more, they do a better job,” said Donna Behrens of the Center for Health and Health Care in Schools at the George Washington University School of Public Health and Health Services.”
In Minneapolis, Minn., the school clinics have existed for 20 years and can be found in all but one of eight city high schools. Most are run by the city health department but work closely with school nurses, providing important back up.
“The fact that they’re able to provide students a full range of services without them having to leave the campus of the high school is very important,” said Mary Heiman, a school nursing manager for the Minneapolis district who acts as chief liaison for the schools in their dealings with the clinics. “Appointments are made during the school day around their schedules.”
Heiman said the clinics provide everything from routine sports physicals to mental health counseling and though each is staffed a little differently there are laboratory technicians, social workers and nutritionists available.
She said the clinics have been a popular feature of the city’s high schools since 1988 and that it “was very difficult” when budget cuts last year forced closing of the clinic in the only high school that now doesn’t have one.
The clinics have flourished in some states such as Maryland, Kentucky, New York and California, but they’ve barely gained a toehold in Kansas, which is one of only seven states that has seen little or no school-based clinic activity, said Linda Juszczak, executive director of the National Assembly on School-based Health Care.
GraceMed, a safety-net clinic operation in Wichita, now has three facilities in or near schools, but GraceMed’s Chief Executive David Sanford and others said they are the only known facilities in the state.
Some of the nation’s oldest school clinics are found in Kansas City, Mo. Juszczak said a consultant, Dr. Daryl Lynch, a pediatrician at Children’s Mercy Hospital, oversees the state program for them.
As in the case of Wichita’s school clinics, many across the nation are part of larger safety-net clinic operations. Federally designated safety-net clinics already are eligible for Medicaid reimbursements for services rendered. But not all safety-net clinics are federally designated, so provisions in the health reform bills that would allow school clinics to use Medicaid is seen as a major boost.
“Including Medicaid and CHIP reimbursement is an important step for moving school-based health centers from models to mainstream,” Behrens said.
“For us, on a scale of 1 to 10, this is a 10,” Juszczak said of the reform provisions. “This is the biggest thing that’s happened for a long time. There is no federal program for school-based health clinics. This would be an entirely new thing.”
-Mike Shields is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at mshields@khi.org or at 785-233-5443, ext. 123.