By Sally Lemke, MS, RN
Here’s a devastating fact for youth living in underserved neighborhoods: Poor health can translate into poor school attendance, lower educational achievement and a shorter life.
Now here’s a better one: School-based health care offers this group a chance to beat the odds.
Offered through safety-net clinics, school-based health centers provide primary, preventive and mental-health services to the children and youth who can’t otherwise access quality health care. The centers are powerful tools for addressing health equity, because they not only increase access to care but also promote educational attainment.
Research shows that kids in schools with health centers are 22 percent more likely to have had a health care visit in the past year. As an administrator for three school-based health centers serving five schools and 1,400 students on Chicago’s West Side, I see the benefits directly.
A new ninth-grader at one school who reported frequent visits during the school day to the emergency department for breathing problems was able to receive a correct diagnosis of asthma in a Chicago area in-school health center. From there, the student started on daily medication and missed fewer school days.
A 12th-grader who had been receiving care in the school health center since sixth grade said that without the mental-health care she received, she would have dropped out of school.
School-based centers connect kids with needed services
While numbers have grown over the years, among the 125,000-plus primary and secondary schools in the U.S., only slightly more than 2,300 have a school-based health center. According to the Illinois Department of Public Health, there are 66 school health centers in Illinois, 32 of which are in Chicago.
According to the national School-Based Health Alliance, more than 80 percent of students ages 12 to 18 in schools with clinics receive age-appropriate screenings and care for important childhood issues such as mental health, immunizations, oral health and asthma.
U.S. children miss more than 13 million school days yearly due to asthma, according to the School-Based Health Alliance. But studies show that kids with asthma in schools with health centers miss far less school than their asthmatic peers in schools without clinics.
One study showed that urban high school students were 21 times more likely to access mental-health services in a school health center than a free-standing center.
The experience of a recent Chicago high school graduate exemplifies the challenges youth with mental-health issues face in accessing care. After numerous hospitalizations for depression and psychosis with no help from his grandfather guardian, this student found his way to one of our school health centers. Through assessment and care coordination by school health center clinicians, the student successfully engaged in much-needed psychiatric follow up and was linked to supported living. He was able to graduate on time.
If the symbiotic impact of good health on education and education on good health, and of both on society, is clear, it is curious why more school systems have not opened school-based health centers.
It’s true that a school-based health center costs more to operate than a traditional health center. Start-up and operational costs often surpass revenue generated. School health centers serve students regardless of ability to pay, and the majority of those served are Medicaid-insured or have no insurance.
Most school health centers rely on grant funding from governmental and private sources, with federal funding comprising a little more than 50 percent of school health center operating budgets nationally.
But school health centers increase access to health care for our nation’s most vulnerable kids while containing health care costs and improving surrounding communities. In the long run, this saves money.
It’s time for school-based health centers to receive more attention. They are simply a smart investment.
Act would provide federal support for health centers
Those who work and advocate for education and health care have a duty to join forces and address the serious threats to this model of safety-net health care. Legislators need to understand the intersection of health and education, and support legislation that will fund and support school health centers.
Through maintaining the Affordable Care Act — which has expanded insurance coverage for vulnerable children and provided a source of revenue for school health centers — and supporting Medicaid policies that promote school health, legislators can bolster their financial sustainability.
The Hallways to Health Act is a comprehensive bill that would provide federal support for school health centers. The bill was first introduced in 2016 and reintroduced in February of last year, with no action on it since then. Legislators have the opportunity to support a sensible model of healthcare proven to keep children healthy and on track academically.
In 1994, former U.S. Surgeon General Dr. Joycelyn Elders said, “We can’t educate children who are not healthy, and we can’t keep them healthy if they aren’t educated.”
By providing access to quality health care where children and youth spend the majority of their time — in schools — we are giving them a chance to achieve better health and academic success. We are giving them a chance to close the unacceptable life expectancy gap that many face.
We want that for all children.
Sally Lemke, MS, RN, is director of the Rush’s school-based health centers and an instructor in the Rush University College of Nursing. She originally published this editorial in The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education.