Editorials, Letters to the Editor & Articles
School-Based Health Centers work for Kids, Families and Communities
Ever tried to overcome a blazing headache to concentrate on work? Remember the day when it took every ounce of will-power to stop worrying for just a few minutes about a stomach pain to finish a task before calling the doctor's office?
Often we ask our adolescents, who have much less experience than most adults, to show the same dedication to their school work. And in most cases, we provide them with fewer resources than would be found in a workplace about same size as their schools.
Employers know healthy workers are a major component of an efficient and safe work place. Many large employers are able to provide a nurse or other health care professional, sometimes even a treatment center to help workers remain focused on their work and cope effectively with health problems. Even without an employer's support, most adults know when they need help to resolve a health problem.
When it comes to our children, however, it's a much different story. Overall, adolescents have the lowest utilization of health care services of any age group: youngsters are not even certain of their needs, or where and when to obtain health care.
Some communities are developing health centers in their schools, centers where adolescents can be diagnosed and treated, where they can learn to manage chronic illnesses or receive counseling on issues such as substance abuse. Nationwide, about 1,500 school health centers are operating. In all Maine schools attended by the state's 130,000 adolescents, 26 school-based health centers serve about 16,000 students, largely in urban areas.
School-based health centers make lots of sense. They are easily accessible, even in rural, sparsely populated areas - everyone attends school. Unique adolescent developmental issues and concerns are familiar to school health center staff members, who tailor services to meet the special needs of their young clients.
The Maine Children's Alliance, an advocate for the state's children, youth and families, believes school health centers offer several important advantages: 1) increased access to a school health center leads to increased utilization of health services; 2) increased access also improves both long- and short-term treatment results; and 3) early diagnosis and treatment in a school health center can help adolescents avoid serious health situations and the resulting costs of emergency room treatment or hospitalization.
As expected, funding for school health centers is a major problem. Schools, just like every other public agency, must deal with the demand for fiscal austerity. Traditional revenue sources cannot provide the resources necessary for school health centers to maintain appropriate staff, offer comprehensive services, and operate effectively.
Funding problems may be surmounted, however, if school health centers were eligible to receive payments from insurance companies and other sources of reimbursement for medical services. And those sources of funding may be willing to reimburse school health centers if they could be shown that reimbursement would improve access to care among adolescents and that long- and short-term contributions to good health made by the school centers resulted in cost savings or were at least cost neutral.
To examine the adolescent health care situation, the Maine Children's Alliance convened representatives of the school health centers, commercial insurance companies and the state Bureau of Health. All agreed on the importance of teenagers receiving timely and quality health care services. And the commercial insurers - Aetna Health Inc., Anthem Blue Cross and Blue Shield, CIGNA HealthCare of Maine, Inc., and Harvard Pilgrim Health Care - all agreed to a three-year pilot project in which they would reimburse for school-based health services consistent with their existing contracts. Further, the commercial insurers will provide technical support to the school health centers to help them become self-sustaining facilities.
Participants in the Maine Children's Alliance discussion also believe the pilot
project should be evaluated. Indeed, does school-based health care really provide the advantages that seem so apparent? Does reimbursement of the costs improve quality and utilization? Does early diagnosis help avoid the development of serious medical problems? Do school health centers reduce emergency room visits and hospitalization? Are school health center costs mitigated by short- and long-term improvements in adolescent health?
The evaluation is underway. Stay tuned. Even in a period of tight public health budgets, Maine may be ready to make a huge difference in teen health. And that will have a huge impact on the health on tomorrow's adult population and the future cost of their health care.
(Elinor Goldberg is executive director of the Maine Children's Alliance, an organization that works for improvements in public policy affecting all children in the state. It publishes annually the respected Maine Kids Count Data Book, a comprehensive source of information about the status of Maine children. The Alliance board of directors includes Mane business, education, human services, and government leaders.)
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