• Overview: Facts about School-Based Health Services
• Improving Access to Health Care
• School-Based Health Services and Maine's Legislators
• The MCA's School-Based Health Initiative
• Problem Behavior Prevention and School-Based Health Centers: Programs and Prospects
• American Academy of Pediatrics Report on School- Based Health Centers
• Maine School-Based Health Center Evaluation Project (I of 2)
• Maine School-Based Health Center Evaluation (2 of 2)Project
• Child Health
• Starting a School-Based Health Center
• School-Based Health - Fast Facts
• School-Based Health Centers In Maine
• Stories: Case in Point
• Resources
• National Assembly on School-Based Health Care

School-Based Health

The MCA's School-Based Health Initiative

The Maine Children's Alliance's School-Based Health Initiative is a research and advocacy project aimed at substantially improving access to quality health care for all Maine children, including the children and youth who currently lack health insurance and the children who are insured but do not have access to adequate physical, emotional and dental services.

Problem Statement

While most Maine children and youth are in good health and many have access to adequate health care services, there are a great many who do not. There are approximately 21,000 children without health insurance in Maine¹, and there are insufficient resources to provide for the health care needs of many of the others that are insured. School-based health centers (SBHCs) can provide an effective way to deliver appropriate health care services to all school-aged children.

An estimated 11,000 children and youth are eligible for, but unenrolled in MaineCare². There are many problems involved in getting these children enrolled. Universally available health care services through SBHCs would help to enroll and provide services for these children.

We know that 90% of the uninsured children have parents who work³. Their parents often cannot afford, are not eligible for, or have employers who do not offer health benefits for family members. As health care costs continue to increase, the number of businesses providing health insurance and the number of workers who are able to afford health insurance continues to decrease, thereby adding to the problems of health care access for children and youth.

There is a special need for services for youth. We know that adolescents are less likely to have health insurance⁴ and have the lowest utilization of health care services of any age group.⁵

Finally, the insufficient availability of health care professionals and transportation services in various geographic areas makes it very difficult for many people with health insurance to find and get the health care services they should have. Maine needs to find new ways to provide health care for children and youth. School-based health centers can increase the capacity of the health care system to meet the health care needs of all school-aged children in Maine.

There are a number of barriers to widespread availability of these centers and a lack of general public support for establishing SBHCs. The Maine Children's Alliance's School-Based Health Initiative sets forth a plan for addressing those barriers and increasing support for SBHCs throughout the state of Maine.


Need

"...We need to start thinking of health and education as interlocking spheres. After all, isn't school the best place for a primary health care facility - available, convenient, confidential, and responsive not only to the adolescent, but to the family?" -C. Everett Koop, M.D., Former U.S. Surgeon General ⁶


School-based health centers attend to the unmet health care needs of all children and youth. They are particularly appropriate in the health care of adolescents because they have the lowest utilization of health care services of any age group and are the least likely to seek care at a provider's office. School-based health centers help overcome some obstacles to accessing good health care by:

• Providing services regardless of insurance status
  
• Providing prevention and early intervention services that would otherwise not be available
  
• Being available where the students are
  
• Eliminating transportation problems
  
• Providing qualified staff
  

Difficulties

Community members who have information about SBHCs understand many of the benefits for children, families, schools, communities, businesses, and health care practitioners. Nonetheless, many sectors of the community may also have concerns about SBHCs including:

• School boards and school administrators who may be concerned about a potential increase in cost to the local school.
  
  
• Community members who equate health centers with pregnancy counseling and condom distribution and may have concerns about the agenda of SBHCs.
  
  
• Health care providers who may be concerned that centers will compete with their private practices and may provide less satisfactory service outside the medical home'.
  
  
• Insurance companies that do not want to increase their costs by covering school-based health visits while simultaneously covering managed care costs with a primary care provider.
  
  
• Business leaders who are concerned that their health care benefit costs will rise, and the cost will have to be passed on to employees.
  

Financing the start up and ongoing support for SBHCs presents another barrier for the development of centers in all school systems.

This initiative is directed at resolving these problems and creating a common willingness to support widespread availability of health care services in schools. Along with the various issues stated above, there is a need for another source of funding that would cover the children who are currently uninsured. Public health funding has historically been short sighted in Maine and is a necessary adjunct in financially supporting the development of new SBHCs and their ongoing fiscal needs; policy makers frequently disagree about the public health cost of providing services to uninsured children and youth. Also, changes need to be made to allow private insurance coverage for services received in the SBHC.

Project Goals and Objectives

The goals of the School-Based Health Initiative are:

1. To increase the awareness of issues regarding access and quality of children's health in Maine by:

• Collecting information and coordinating a central warehouse of SBHC information and data which will allow for research, documentation, and publication of health care access issues and trends and making this information accessible via the Maine Children's Alliance web site.
  
  
• Publishing information on SBHCs through the Maine Kids Count Data Book, policy briefs, and other publications.
  
  
• Disseminating information at all levels to build a common understanding and a constituency for SBHCs.
  
  
• Convening stakeholders and decision makers to eliminate barriers to support for SBHCs.
  
  
• Creating a coalition of statewide, multi-issue stakeholders to develop a common agenda to actively support SBHCs.
  

Dissemination of information is a key Kids Count activity that the Maine Children's Alliance has refined over the past nine years. Professionally designed and orchestrated public awareness campaigns have resulted in wide coverage of the annual release of the Maine Kids Count Data Book, with continuing opportunities for radio and TV appearances, meetings with editorial boards, as well as speaking engagements at the state and local level before groups ranging from social workers to Rotaries. Follow-up releases of Kids Count issue papers, studies released jointly with other organizations, and the annual spring release of the national Kids Count Book provide opportunities to discuss the status of Maine's children over a period of months.

2. To increase access to a coordinated health care system for Maine children with and without health insurance by:

• Analyzing available data and increasing community-based support for increased availability of SBHCs.
  
  
• Developing and carrying out, with project collaborators, a major statewide campaign, reaching from communities to the Legislature, to resolve the multifaceted problems of SBHCs and increase broad based support for them.
  
  
• Providing information and analysis to support expanding eligibility for health insurance for all children and their families.
  

3. To measure results for children by combining Maine Kids Count capacity to provide information with the organizing and advocacy strengths of the Maine Children's Alliance to tackle a pressing children's issue by:

• Providing a focus within Maine Kids Count regarding SBHCs.
  
  
• Organizing advocates, policy makers, and other key stakeholders in the community around health care access issues to support increased availability of SBHCs.
  

This project will go beyond Kids Count's data collection and publication and The Maine Children's Alliance public awareness activities to mount a multifaceted advocacy campaign in collaboration with other organizations and individuals.


¹ Maine Kids Count 2004 Data Book. Page 4.
² Ibid.
³ Ibid.
⁴ Health Insurance Coverage: 1997. Poverty and Health Statistics Branch, Housing and Household Economic Statistic Divisions, U.S. Census Bureau.
⁵ Current Population Reports, Series P-25, No. 519, No. 917, No.1130 [table 2 in each] U.S. Bureau of the Census.
⁶ School-Based Health Centers Effectiveness. The Picture of Health: State and Community Leaders on School-Based Health Care. Making the Grade. Robert Wood Johnson. 1999.
⁷ Access to Health Care Part 1: Children (Vital and Health Statistics, Series 10, no. 10). National Center for Health Statistics, Center for Disease Control, US Dept. of Health and Human Services. 1997.

Print  |  Email