The Oakland Unified School District wants to be the first major urban school district in the nation to guarantee universal access to primary health care to all its students.
A patchwork of funds – an $18 million initiative funded primarily by the City of Oakland, Alameda County and Kaiser Permanente – is going a long way towards helping the school district reach that goal by the end of the year.
Nine new school-based health centers providing primary care to students were opened or will open between 2010-2012, for a total of 26 throughout the district.
“The greatest challenge of education is the concentration of poverty in urban school districts,” said Alex Briscoe, Director of Alameda County Health Care Services Agency, adding that Oakland schools are a prime example of that challenge.
That kind of poverty, and the health problems that accompany it, can also have a direct impact on how students learn.
“Teachers know that they cannot teach if kids are not in class because they are sick, or their asthma is out of control,” said Serena Clayton, Executive Director of the California School Health Centers Association.
But the concentration of poverty in urban schools also means that a majority of OUSD students qualify for Medi-Cal. When the County opens health centers on or near school campuses, they are reimbursed for most of the services they provide.
Students get services including mental health counseling, physical exams, sports physicals, first aid, vaccinations, dental screenings and treatment, STD screening and treatment and health education about nutrition, fitness, puberty and sexual health at the clinics. Clinic staff also enrolls students in insurance programs and refers them to providers off-site.
Twenty years ago, studies showed adolescents among the least likely to have access to health care and having the lowest rates of primary care use of any age group in the U.S.
“You’ve got to put it where they’ll trip over it,” Clayton said.
That’s what schools, public entities and non-profits have done over the past three decades, starting with teen health centers in high schools that offered preventative health services. Healthy Start began making grants to hundreds of schools for school-based services in the 1990s.
Now there is a more unified effort to provide comprehensive primary care on or near school campuses. All 26 school-based health centers in Alameda County are built and funded through the county, but run by community health clinics.
“They are not just a clinic in a school, they are part of a broader healthcare system,” Briscoe said.
Serena Clayton says school-based health centers provide a unique value to the healthcare system. “They can monitor chronic disease on a daily basis,” Clayton said. “They can do education in a way no one else can—in a classroom 1-on-1 with students.”
Gone are the days of a school nurse sitting in an office waiting to give a student a band-aid. “We have one of the lowest school nurse ratios in the country,” Clayton said. Today, school nurses are integrating into school-based health centers.
The Oakland-based Native American Health Center is involved in six school-based health clinics, two of which they run. Nurse practitioner Bonnie Trinclisti runs the Native American Health Center’s Adolescent Program. Over the past twenty years, she’s seen Oakland’s school-based health centers grow from four nurse stations to 26 clinics.
She spends half her time administering the program and half her time meeting kids in 15-minute blocks at the school-based health centers. “I do primary care—a lot of reproductive health,” said Trinclisti.
“The biggest barrier to care for kids is their parents,” Trinclisti said. She says it is difficult for parents to take a day off of work to take their child to the doctor off-site. But once kids are in middle or high school, they don’t need a parent with them at their appointments.
Providing mental health services is the biggest challenge at the clinics. “You can’t get anybody to pay for them,” Trinclisti said. “Mental health is more needed than any other single support for kids in schools.”
The unmet needs for mental health services and dental access have been the largest complaints about the health care system over the years, Serena Clayton said. Recently, there’s been more funding for dental programs, primarily for prevention, screening, varnish and sealants.
School-based health centers, Clayton said, are the epitome of the principals of health care reform—to transform the way health care is delivered through inexpensive preventative care. Little of the funding for school-based clinics, however, came from the Affordable Care Act.
The Affordable Care Act did provide $100 million for significant and pressing capital needs to improve delivery and support expansion of services at school-based health centers in 2011. The Health Resources and Services Administration awarded a total of $1.2 million in Alameda County to the Oakland Unified School District, Alameda County Health Care Services Agency, Native American Health Center and Tiburcio Vasquez Health Center.
“Right now it’s a little drip in a big ocean,” Bonnie Trinclisti said.
A $399,260 grant to the Alameda County Health Care Services Agency covered some furniture and equipment expenses. A $423,098 grant went to Oakland Unified School District to add an additional portable to the clinic at Oakland Technical High School, doubling their square footage.
The grant will also make it possible for an East Oakland-based community clinic, La Clincia De La Raza, to switch to electronic health records (EHR) at the five school-based health centers they run. All clinics will be expected to switch to EHR by the time health care reform is fully implemented in 2014.
The development of school-based health centers is more of a locally funded effort with $14 million of the $18 million initiative in Oakland coming from voter approved school bonds, Alex Briscoe said.
Serena Clayton originally hoped that the Affordable Care Act would support ongoing operations at the clinics. Support for those expenses are included in the legislation but the funding was not approved.
“It’s like an empty shell that’s sitting there,” Clayton said of the ACA.
She is holding out hope that the next $100 million to be released in the spring will be authorized to fund ongoing operations.
In the meantime, people like Bonnie Trinclisti will continue to piece together whatever funding is available, mostly from Medi-Cal reimbursements and billing for services.