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About School Health Centers in California |
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What is a School Health Center?
School health centers are usually located directly on a school campus and provide primary care like any health clinic. Staff vary in size, and typically includes nurse practitioners, nurses, mental health providers, as well as part-time physicians and medical students. Services may include: primary care, mental health, health education, and/or dental care, all at no or low cost.
The first school health centers in California opened in 1987 in Los Angeles, San Jose and San Francisco. Today, California has 153 school health centers.
School health centers are effective because they put health care where the kids are. They:
- offer quality services in a safe, familiar, and accessible location
- improve academic performance
- support families
- expand access to health care without increasing costs
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Why Does California Need School Health Centers?
There is nothing more basic to a child's ability to succeed in school and in life than good health. Yet many children and youth in California are not getting the health care they need, even when they are insured.
Despite progress in providing children with health insurance, California still has an estimated 800,000 children under age 18 who lack health insurance. (1) |
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These children are eight times less likely to have a regular source of health care; (2) five times more likely to rely on emergency rooms for services (3) and four times more likely to delay or go without needed surgical or dental care. (4)
Even when children and youth are enrolled in an insurance plan, many do not have access to quality services or a consistent source of primary care. (5) In 2000, more than 70% of adolescents ages 12 to 21 enrolled in a Medi-Cal managed care plan did not receive at least one comprehensive well-care visit with a primary care practitioner or an OB/GYN. (6)
This inability to access care results in many children and youth coming to school everyday suffering from conditions that seriously impact their ability to learn and to succeed. Conditions include: |
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- Mental health issues. Approximately 20% of youth ages 9 to 17 have some “diagnosable disorder,” and 9% to 13% are afflicted with a “serious emotional disturbance, with substantial functional impairment.” (7)
- Chronic Disease. In 2003, 14.8% of children had been diagnosed with asthma at some point in their lives. (8) Asthma is the reason for one in six pediatric visits, results in 14 million missed school days, and is the third-ranking cause of hospitalizations for kids under 15. (9, 10, 11)
- Childhood Obesity puts children at risk for physical and emotional problems and threatens to reduce life expectancy for the first time in modern history.(12) Across the nation, the percentage of overweight children has tripled in the last three decades. (13) More than 70% of 5th, 7th, and 9th graders do not meet California state standards for all-around physical fitness. (14)
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"Despite enormous time, energy
and the number of sources being billed, 52 percent of California's clinics
recoup 50 percent or less of their budget from all billing sources. Although
there has been modest growth in the number of clinics over the last two
years, there have also been some closures primarily due to lack of funding."
Georgiana M. Coray, RN, DNSc and Cary Joel, RN, MS, "Update Of California
School-Based And School-Linked Health Centers," June 2000
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- Reproductive Health Issues. In 2001, more than 53,000 teens gave birth in California, (15) with 70% of teen mothers dropping out of high school. (16)
- Dental Health Issues result in an estimated two million missed school days per year nation wide and contribute to low self-esteem and difficulty eating and speaking and 23% of children do not have insurance for dental services. (17)
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How do school health centers meet the needs of underserved and uninsured children?
School health centers offer quality services in a safe, familiar, and accessible location.
School health centers are usually located directly on school campus and provide primary care like any doctor's office or health clinic. Staff vary in size, and typically includes nurse practitioners, nurses, mental health care providers, as well as part-time physicians and medical students in training. Services include: primary care, mental health, reproductive health, and dental care, all at no or low cost. The centers also provide screening and treatment or referral for a variety of health issues, including diabetes, vision and hearing loss, tuberculosis, asthma, cancer, hepatitis B and STD and HIV infections. Services are tailored to fit each community reflecting language and cultural diversity and health education programming responds to the school community's needs. |
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School health centers are effective because they put health care where the kids are.
School health centers are uniquely situated to bring health care professionals and educators together to address the often complicated and interrelated needs of at-risk children, youth and families. They provide a safe place for students to talk about troubling issues, whether suicide, grief, depression, academic performance, substance abuse, sexuality or relationships with peers, family, teachers or others. Medical services can be connected with mental health services, classroom education, group interventions, and other campus projects, clubs or activities. |
| "In the absence of alternatives,
schools are called upon to accept responsibility for students to succeed
not only academically, but also emotionally and physically . . . . School-based
health centers help schools and communities fill this gap."
University of California,
San Francisco
Institute for Health
Policy Studies
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A national multi-site study found a significant increase in health care access by students who used school health centers: 71% of students reported having a health care visit in the past year compared to 59% of students who did not have access to a center. (18) School health centers have also been demonstrated to attract harder-to-reach populations and do a better job getting them crucial services. Two studies found adolescents were 10-21 times more likely to go to a school health center for mental health services than to the community health center network or a HMO. (19, 20)
School health centers improve academic performance.
It is well accepted that healthier children make better students and research evidence supports a connection between health status and academic performance. Students, teachers, and providers alike say that school health centers are making a difference in academic achievement because they take health problems out of the classroom and into the hands of qualified medical professionals. Research shows that school health centers have a positive impact on absences, dropout rates, disciplinary problems and other academic outcomes. (21) |
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School health centers support the family
School health centers play an important role in helping families manage the physical and mental health care needs of their children. In addition to the important benefit of keeping parents in the workplace, the clinics strengthen the connection between school and the family so that they can work together more effectively to meet a child's educational needs. Parental consent is required for students to enroll for center services, with growing numbers of parents taking advantage of |
| "We deal with kids who have been
abused, who have attempted suicide, who are depressed, who are grieving,
who have post-traumatic stress, who are in gangs. Big, big things."
Jan Marquard, Director, School Health Service
Northeast Valley Health Corporation, San Fernando
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| the opportunity for easily accessible health services for their children. Many school health centers, particularly those in elementary schools, offer services to the entire family. Those that serve only students often have parent education programs. |
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School health centers expand access to health care without increasing costs.
Research shows that investments in school health centers yield comparable savings through reduced use of high cost services, thereby increasing access without increasing overall Medicaid expenditures.(22) Studies have also found that school health centers reduce inappropriate emergency room use, (23, 24) inpatient, drug and emergency department use, (25) and hospitalization among children with asthma. (26, 27) |
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What type of school health centers does California have?
California has 153 school health centers, of which 42 are in elementary schools (27%); 14 are in middle schools (10%); 58 are in high schools (38%); 16 are on mixed-grade campuses (10%); and 23 are “school linked” or mobile vans (15%) that serve multiple schools. We are second only to New York in the number of health centers in the state.
School health centers can be found throughout the state in urban (51%), suburban (35%) and rural (11%) areas. Students in more than 800 schools in California can access a school health center. |
| "This kid has a vision problem,
this kid has a hearing problem, this kid has attention-deficit disorder.
Health providers in the schools can get them early in the game, instead
of waiting until the fifth, sixth, seventh grade and they're reading at
a second-grade level."
Beth Greenwood,
Director of Nurses
Shasta Community Health Center, Redding
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California 's school health centers reach the state's most vulnerable children and contribute to the reduction of health disparities. In school districts with school health centers, 21.5% of the children live in families with incomes at or below the federal poverty compared to 15.3% of the children in districts without health centers. School health centers tend to be located in schools with greater proportions of Latino and African American students. Youth in these ethnic groups are more likely to have higher rates of violent injury, poor nutrition, physical inactivity, use of certain substances, and sexually risky behavior. They are also less likely to have health insurance or to have access to health and mental health services that address these risk factors.
How are school health centers operated and financed?
Many different types of organizations run school health centers. The most common are:
• School districts
• Federally Qualified Health Centers (FQHCs)
• Non-FQHC community health centers
• Hospitals
• County health departments
Other organizations that run school health centers include community-based organizations and private physician groups.
Important sources of third-party reimbursement are the Child Health and Disability Program (CHDP), Medi-Cal, Family PACT and Healthy Families. Although many clinics bill these programs, the majority (52%) recover less than 50% of their operating costs from all billing sources. School health centers expend considerable effort to obtain grant funding from state, local and private sources. The types of comprehensive care available at many school health centers would not be possible without the enhanced funding from these sources. |
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| References |
(1) The 100% Campaign analysis of data from the UCLA Center for Health Policy Research, 2001 California Health Interview Survey.
(2) Families USA , Medicaid: Good Medicine for State Economies, 2004 Update
(3) Ibid.
(4) L. Dubay, G.M. Kenney, “Health Care Access and Use Among Low-Income Children: Who Fares Best?,” Health Affairs, 2001
(5) Chung PJ, Schuster MA. Access and quality and child health services: Voltage drops. Health Affairs. Volume 23, number 5. pp 77-87.
(6) California Department of Health Services. Medi-Cal Managed Care Health Plans; Results of the HEDIS® 2000 Performance Measures for Medi-Cal Members, December 2001.
(7) The Center for Mental Health Services within the U.S. Department of Health and Human Services reports that Children Now. (2000). California : State of Our Children 2000: How Young People are Faring Today. Oakland , CA : Author
(8) California Report Card, 2005: An Assessment of Children's Wellbeing. Children Now. Oakland , 2005. Retrieved on March 6, 2006 from http://publications.childrennow.org/assets/pdf/policy/rc05/ca-rc-2005.pdf
(9) Families USA , Medicaid: Good Medicine for State Economies, 2004 Update using data from the American Lung Association.
(10) Helping Our Kids Breathe Easier: Policy Solutions in the Fight Against Childhood Asthma. The California Endowment. Health in Brief. May 2004, V3: Issue 1.
(11) California Asthma Public Health Initiative. Retrieved on March 2, 2006 from http://www.dhs.ca.gov/cdic/caphi/default.htm
(12) California Report Card, 2005: An Assessment of Children's Wellbeing. Children Now. Oakland , 2005. Retrieved on March 6, 2006 from http://publications.childrennow.org/assets/pdf/policy/rc05/ca-rc-2005.pdf
(13) Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, 1976-1980 and 1999-2002
(14) California Report Card: An Assessment of Children's Well-Being. Children Now. 2005
(15) Center for Research on Adolescent Health and Development. No Time for Complacency: Teen Births in California . Retrieved March 14, 2006 from http://teenbirths.phi.org/.
(16) California Dept. of Education: Teen Parenting in California . Retrieved on March 6, 2006 from http://www.cde.ca.gov/ls/cg/pp/teenpregnancy.asp
(17) Dental Health Foundation. Mommy, It Hurts to Chew. The California Smile Survey: An Oral Health Assessment of California's Kindergarten and 3rd Grade Children. February 2006.
(18) Kisker EE, Brown RS, Do SBHCs improve adolescents' access to health care, health status, and risk-taking behavior? J Adol Health 1996;18:335-343.
(19) Juszczak L, Melinkovich P, Kaplan D, Use of health and mental health services by adolescents across multiple delivery sites. J Adol Health 2003;32S:108-118.
(20) Kaplan DW, Calonge BN, Guernsey BP, Hanrahan , MB . Managed care and SBHCs. Use of health services. Arch Pediatr Adolesc Med. 1998 Jan;152(1):25-33.
(21) Geierstanger SP, Amaral G. School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington , DC : National Assembly on School-Based Health Care; 2005.
(22) Health Foundation of Greater Cincinnati , The. (2005). A Prescription for Success: How SBHCs Affect Health Status and Healthcare Use and Cost – Executive Summary. Cincinnati , OH : Author.
(23) Juszczak L, Melinkovich P, Kaplan D, Use of health and mental health services by adolescents across multiple delivery sites. J Adol Health 2003;32S:108-118.
(24) Santelli J, Kouzis A, et al. SBHCs and adolescent use of primary care and hospital care. J Adol Health 1996; 19: 267-275.
(25) Adams EK, Johnson V., An elementary SBHC: can it reduce Medicaid costs? Pediatrics 2000 Apr;105(4 Pt 1):780-8.
(26) Webber MP, Carpiniello KE, Oruwariye T, Yungtai L, Burton WB, and Appel DK . Burden of asthma in elementary school children: Do SBHCs make a difference? Arch Pediatr Adolesc Med. 2003; 157: 125-129.
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