Chapter 2

(Page 8)
The Model: What Is School-Based Health Care?

Delivering health services in schools is not a new idea. What is new is delivering comprehensive care on-site—bringing students direct treatment for a broad range of physical and mental health problems through school-based health centers.
Though the health centers in the School-Based Adolescent Health Care Program (hereafter referred to as the Program) vary in many respects, they share features that, taken together, clearly distinguish them from other health programs.

1. The Program’s school-based health centers are located in the schools. Why locate health centers in schools? Because that is where young people are. “Health services need to be where students can trip over them,” said Philip J. Porter, M.D., director of the Program. “Adolescents do not carry appointment books, and school is the only place where they are required to spend time.”

School-based health centers make getting health care easy. Students can remain where they are most comfortable, rather than having to travel off campus to unfamiliar providers. They don’t need to have insurance. In short, the centers give students a “medical home.”

Also, by being on campus, health center staff participate in health education programs, organize sports clinics and health fairs, serve on crisis-response committees, work with guidance counselors on drop-out prevention, offer clinical back-up to schools’ day care centers and train faculty in adolescent health and development.

2. The Program’s school-based health centers are operated by health professionals. Students receive care from multidisciplinary teams of professionals, including nurse practitioners, physicians, social workers, nurses and health educators. Moreover, each school-based health center in the Program is a unit of a larger health care institution, such as a health department, academic health center or community health center. With the backing of these parent organizations’ staff and facilities, the health centers provide a much wider range of services than the average school health program can.

3. The Program’s school-based health centers provide comprehensive services. From diagnosis and treatment of disease to counseling for students and families, Program health centers address a broad spectrum of health problems. When off-campus referrals are required for special lab work, radiology or medical consultation, the health centers, through their sponsoring institutions, provide access to specialists and hospital care.

“By offering on-site care, referral and follow-up, school-based health centers can provide long-term solutions to serious problems,” said Debra Delgado, the Program’s associate director.

4. The Program’s school-based health centers are not funded by school systems. Because every Program health center is part of a health care institution, they all obtain their funding primarily from third-party reimbursement, private and public grants, and local government support, not school district funds. The schools’ traditional health-related services, such as counseling, school nursing, and drug and alcohol prevention programs, are integrated with the health center, and their effectiveness is enhanced by this connection to a comprehensive system of care.

“The beauty of this system,” said Julia Graham Lear, Ph.D., co-director of the Program, “is that school-based health centers provide comprehensive on-site, professional care at no cost, or very low cost, to those who badly need it.”

The Growth of School Health Services

More than a century ago, the first school health services were developed to screen students and keep those with contagious diseases out of the classroom. Gradually services broadened, and in 1902, New York City established the first school nurse service that actually provided care and follow-up to children in schools.

Over the years, school health programs have kept their focus on disease prevention. Today, the nation’s schools employ 26,000 school nurses to assure that students are fully immunized, that their vision and hearing problems are addressed, that they are sent home when they are sick and that they are referred to outside providers for basic health care.

During the past 30 years, health providers grew more aware that adolescent problems were being neglected and saw the potential to address them in schools. Recently, government agencies, including health and education agencies, began to see the importance of integrating services. Out of these converging trends, school-based health centers emerged.

The Department of Pediatrics at the Cambridge City Hospital in Massachusetts began providing the first comprehensive health services to pre-school and elementary school students in four local grade schools during the mid-1960s. By the mid-1970s, similar services had been established in high schools in Dallas, Texas, St. Paul, Minnesota, and Cambridge, Massachusetts.

Today, more than 300 school-based health centers are operating around the nation, and the number is growing each year. The Program health centers featured in this book represent one of many models that have evolved.

Conclusion (Page 34)

The Wave of the Future

By any measure, school-based health centers clearly work. Whether you count the number of students who visit them; the number of parents, educators and health providers who support them; the number of problems they address; or the number of dollars they save, the tally is success.

But the numbers tell only part of the story: School-based health care centers provide many benefits that are simply immeasurable. Ask the student whose eyesight was saved, the young man who decided not to move out of his mother’s house, or the young woman who stayed in school and overcame her substance abuse.

“School-based health centers provide more than just health care,” said Laura Secord, R.N., F.N.P., manager of the Ensley High School health center in Birmingham, Alabama. “We provide healthy caring—an ongoing experience that builds self-esteem, builds relationships and builds students’ ability to care for themselves. That is the difference that school-based health care makes. It gives us a chance to develop a daily relationship with the young people we serve. And that relationship builds a bridge to help them finish school and become contributing members of society.”

The Next Step

Still, school-based health care is not panacea, said Leslie Morris, M.S.W., M.P.H., health center coordinator at Snyder High School in Jersey City, New Jersey. “We are limited in our ability to turn problems around, especially at the high school level,” she said. “We really need to get these health centers into elementary schools.”

Indeed, placing health centers in grade schools is the wave of the future. The earlier students’ problems are addressed, the less likely they are to burgeon into serious, deep-rooted, costly conditions in the future.

“We all own a part of these problems, and we all have responsibility for solutions,” said Mary Baca, a community leader in Denver. “Without these services, it’s Russian roulette for the kids—it’s life or death.”

With the stakes so high, school health services cannot afford to remain entrenched in the past. “We are still addressing problems as if this were the 1940s, when the major problems were chewing gum, running the halls and the dress code,” said M. Joycelyn Elders, M.D., U.S., Surgeon General-designate, who has supported school-based health care.

“Our teachers, children and future depend on our dedication to turn things around,” according to Antonia Novello, M.D., U.S. Surgeon General. “Some will tell us that it can’t be done or that it might be beyond hope. But I know in my heart that isn’t true."

The Robert Wood Johnson Foundation’s School-Based Adolescent Health Care Program has worked in all kinds of communities, all across the country. As the Program comes to a close, it leaves our communities and our nation with a powerful new solution to the many health problems that face undeserved children and teenagers.

“I don’t know what the future holds,” said Philip J. Porter, M.D., director of the Program, “but I know who holds the future. You can have school-based health care if you want it. You don’t have to wait until someone decrees it or writes you a million-dollar check. All it takes is wanting better health care for young people in your community. The local health resources are there. You can integrate them at your school. You can make it work.”