Kids and Health Care: A Simple Focus Works Best
School health care programs tend to do better when they focus on basic, clinic-like services.
A growing number of school administrators, principals and public health officials conclude that the best way to reach uninsured children and teenagers is to offer free medical care at school. Education professionals see the matter simply as a necessary tool for making sure that kids are well enough to focus on their studies.
In 2003, at least 44 of the 50 states in the U.S. supported in-school medical care. But the tool isn't cheap -- and remains controversial in many places.
First, the cost issues: In most cases, school-based "mini-clinics" will require a registered nurse or nurse-practitioner, a mental-health counselor and at least a part-time doctor. This can mean $100,000 in personnel costs before the first exam takes place. In most states, the state government makes money available to school districts (which usually operate at the county level) to set up the programs. But this money is tight.
Nationwide, there are an estimated 1,500 school-based health centers at the middle-school to high-school levels. Most of these -- as many as four out of five -- don't qualify for federal money because they don't have governing boards or other oversight structures.
So, many school districts partner with local hospitals or health care systems to arrange medical professionals on a part-time basis. In some cases, these MDs and nurses volunteer their time; in other cases, state education grants or public health grants pay them (or the hospitals where they normally work).
Beyond these arrangements, many schools and school districts solicit private donations to keep their clinics open, equipped and staffed.
One principal in a mid-western state says, "We have enough kids who need medical care that we could keep the clinic busy 24/7. The key to keeping open even for school hours is finding grant money. Luckily, our district has a grant-writer on staff who looks for money and helps file the applications. And I've got a few parents who volunteer their time for grant-writing."
In many school districts, one clinic at a high school or junior high will serve several schools in a geographic region. Many of these clinics offer an impressive list of services -- from physical exams to immunizations, blood tests to counseling.
In most cases, no insurance is necessary. Students only need to make an appointment and have parental permission.
Therein lies the second big issue: the controversy of parental permission.
In many school districts, both the students who use school clinics and their families are worried about privacy issues. School districts set clinic policies to reflect local preferences but privacy -- especially with regard to sex, drinking and drug use -- is an issue everywhere. Kids worry that clinic staffers will report their behavior to parents...and parents worry that the clinic staffers will co-opt their parental authority.
At the high-school level, sex is an unavoidable reality. Clinics usually make information about pregnancy, contraception, sexually-transmitted disease and sexual abuse available to any student who asks; in many cases, though, the school clinic will not be allowed to hand out contraceptives or do more than refer students to other facilities for treatment.
And most medical professionals are bound by confidentiality standards -- regardless of where they're seeing patients. The exceptions to these standards usually aren't related to reporting to parents: They are related to matters of sexual or physical abuse. If the providers see evidence of such abuse, they're obligated to report to state health authorities.
