The Doctor Is "In" At Many Schools Today
By Debi Martin-Morris
AUSTIN, Texas -- Carol Ann Bonds, a former school principal in Holland, Texas, recalls once when a fourth-grader was sent to her office for misbehaving. When she asked him why he acted the way he did, he told her that his teeth hurt.
He didn't need a reprimand. He needed a dentist. The student was rushed to the school's health clinic next door that Bonds had just opened. "The doctor took one look inside that boy's mouth and saw teeth that had rotted to the gums," said Bonds, now superintendent of the school district in nearby Rogers, 60 miles north of Austin. The boy was taken immediately to a dentist and given the care he needed -- free of charge.
That was 1994.
Today, at a growing number of schools, the doctor is "in." School-based health centers have attracted attention largely because of controversies over the distribution of condoms, with critics charging that the school clinics are more interested in birth control than Band-Aids and vaccinations.
Supporters, however, fear the disputes have overshadowed one of the more important new strategies for reaching children needing health care. What's clear is that the numbers of school nurses and doctors are increasing -- even in rural areas where the clinics serve not just students but the wider community.
At last official count the number of school-based clinics had gone from 31 in 1984 to over 600 in 1994, and experts estimate that the growth has accelerated since then, according to Advocates for Youth, a Washington-based organization supporting the movement. Most are in elementary and high schools, with a smattering in middle schools.
Educators are learning first-hand that sick childen can't concentrate in school, said Julia Graham Lear of Making the Grade, a Washington-based organization behind many of the efforts.
She points to the problem of many children having no access to health insurance. There are nearly 10 million without insurance, or 14 percent of all children, according to recent Census Bureau figures in a report by the Washington-based Children's Defense Fund.
Most of the clinics aren't free to students, but the costs are less than a typical visit to the doctor because nurses and physician assistants do most of the work. They can treat all the routine problems, such as strep throat, ear infections, headaches and fevers. They can also suture wounds as well as give immunizations and physicals, said Lear.
"The most rapid growth," said Lear, "has occurred in the last five years without much initiative from government. This movement is definitely driven by community groups." While taking the initiative, community groups have also tapped state and federal funds. Other money has come from private sources such as The Robert Wood Johnson Foundation, which has put $40 million into the development of school health centers nationwide.
"And if parents don't like these clinics, they don't have to participate," said Lydia Verheggen, director of health care policy for Citizens for a Sound Economy, a fiscal watchdog group in Washington.
Yet this very question of parental approval -- particularly when clinics dispense contraceptives -- has provided the political sparks in the expansion of school-based clinics. Over 85 percent of school health centers offer "reproductive health" or birth control services of one kind or another, according to Advocates for Youth.
For example, a three-year-old survey by the nonprofit group found that 39 percent prescribe oral contraceptives, and nearly as many provide "abortion counseling" or information to students. Aside from those inside schools, some clinics have been set up nearby, under private auspices, usually to provide family planning in places where the practice is controversial in schools, according to those on both sides of the debate.
Critics such as Wanda Franz, president of the National Right-to-Life Committee, say the clinics have a hidden agenda that includes referrals to abortion clinics, often through intermediaries. "That seems to be the thrust of it. They're primarily concerned with reaching students with reproductive services and information," said Franz, also professor of child development studies at West Virginia University.
Kate Fothergill, who directs a support center for school health clinics at Advocates for Youth, acknowledged that the original impetus of the movement was to help prevent teen pregnancies with counseling and contraceptives. But she added that in their expansion, the clinics have concentrated on primary health care.
"They are not sex clinics," she said, estimating that reproductive health accounts for just under a third of services provided. Fothergill said there are no reliable data on how often students are steered to abortion clinics by the centers.
In Texas, Bonds said that when her school district sought funding for two school-based clinics, "I promised my community that we would not offer birth control services, and that's how we diffused the matter." For one mother in Holland, Texas, having a nearby school-based clinic has meant that her children get better health care and miss less school.
Pati Jarolik has three children, each in a school with a clinic. Her 16-year-old, Niki, has asthma; 14-year-old Matthew has attention-deficit/hyperactivity disorder, and 11-year-old Mary has mitral valve prolapse, a heart condition. They pay $10 per visit to the clinic, a rate set according to their ability to pay.
"When my youngest, Mary, needs to go to the dentist, I call the school nurse at the clinic to make sure she gets antibiotics because bacterial infections can go straight to the heart," said Jarolik. "The school nurse also helps when Mary has chest pains or feels light-headed. She can go to the nurse and get checked out, to see if it's serious."
Jarolik used to drive 45 minutes to get to the nearest doctor. When the school district in Holland opened a clinic in 1994, the drive was cut in half, and now her children no longer miss classes to get check-ups.
Despite its fast growth, the school-clinics movement faces obstacles that go beyond the continuing controversy over contraceptives. One is getting and keeping qualified staff. Nurse practitioners, the core of many clinic operations, are often headed to higher-paying jobs in hospitals and nursing homes, said Lear of Making the Grade.
But as in many public endeavors, the obstacle most often cited is funding. Most clinics must patch together the support of various sponsors, including hospitals and charitable organizations, said Lear. She cited the case of a local school district in Pueblo, Colo., that couldn't get state money but managed to start a clinic after the Park View Episcopal Medical Center stepped forward to help.
Even with the fiscal crunch, Lear and other advocates expect the numbers of school-based clinics to continue growing. This is partly because the injuries and illnesses that affect children at school -- such as depression, HIV infection and violence among youths -- are growing at least as rapidly.
School Clinics Find Varied Sources of Support
With one in seven children in America lacking medical insurance, clinics based in public schools are attempting to fill in the health care gap. They usually aren't free, but they're almost always affordable, say those involved in the movement.
In Texas, the state with the highest rate of medically uninsured children, school clinics in Rogers and Holland charge on a sliding-scale fee, in accordance with ability to pay.
A grant from the Children's Miracle Network, which sponsors 24-hour television fund-raising specials, allows the two clinics to provide dental work to students who can't afford it. "The family then does community service to repay us," said Carol Ann Bonds, school district superintendent of Rogers who started the clinic in Holland while serving as a principal there.
In Denver, Colo., managed care giant Kaiser Permanente has begun offering primary care and mental health services for $3 a month to 1,300 uninsured school children, using the school health clinics as the primary provider of services.
"We are subsidizing most of the cost of the care for these children. It is part of our social mission," said Carmella Gutierrez, a Kaiser spokeswoman. "These kids are going to have to go somewhere, and we want to be the ones to help."
In San Jose, Calif., where the estimated cost per visit is $81, the nine schools clinics are free -- courtesy of their sponsors, the Good Samaritan Charitable Trust and community groups, among others.
Copyright ©1997 American News Service
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