Seven grantees based in the greater Washington metropolitan.
A little-known public-health experiment – a “still growing movement” one expert called it – has quietly spread across the nation.
For the last 40 years, more than 2,000 school-based health centers, SBHCs, have opened their doors to serve underserved communities. With a grant program ran by the US Department of Health and Human Services, school health center operators plan to expand their services or open new centers, including several grantees based in the greater Washington area.
In July 2011, 278 recipients received grants from the first $95-million disbursement of a $200 million-funded grant program. Montana and Wyoming are two states that will be breaking ground on their first student-based health centers thanks to the grant program, which was a part of President Obama’s Affordable Health Care Act (Sec. 2511).
Seven grant recipients are located in the metropolitan area and a northwestern Virginia city. The Blue Ridge Medical Center operating in Arrington (population: 708) was the sole Virginia recipient and second largest grantee in the area with a $402,000 grant.
Of the seven grantees, Maryland’s Montgomery County government was the largest recipient in the area with a total grant amount just $16,000 shy of the maximum $500,000.
“We were thrilled to be recognized as a strong provider of safety-net services through school-based health centers,” Joan Glick, M.S.,the the acting director of Montgomery County’s school-based health centers, said.
Glick defined “safety-net providers” as health operators who provide services for families and children that are uninsured, underinsured, or insured but lacking access to treatment.
Since 1997, when the first two school-based health centers in Montgomery County opened, Glick has been involved with SBHCs.
Broad Acres and Harmony Hills elementary schools were Montgomery County’s first two SBHCs. The high free-and-reduced-meal (or FARM) rates at both schools, among other factors, played a role in placing health centers at the two schools.
At that time, Glick, a trained pediatric nurse practioneer, worked as a school nurse in Montgomery County. When the centers opened up, they were looking for a nurse practioneer. She eventually accepted the once-empty position and worked at both schools.
Glick said the grant money is being used to build a new SBHC – referred to as a “linkages-to-learning health centers” at the elementary school level in Montgomery – at Highland Elementary School that will open next fall.
Unity Healthcare, one of the two D.C.-based grantees, plans to use the grant to purchase new equipment for dental services and hand-held survey devices to record patient-satisfaction. Unity operates three school-based health centers in the district, all high schools: Ward 6’s Eastern, Ward 7’s Woodson and Ward 8’s Ballou.
Eastern High School is the oldest Unity Healthcare-operated SBHC with its 2000 debut. However, during a 2011 reshuffling, Eastern’s student body was limited to ninth-graders only, shrinking the number of students enrolled with the center.
“When we were at full capacity at Eastern,before it started winding down to be renovated and relaunched, we had 80 to 85 percent of kids enrolled,” Dr. Danielle Dooley, Unity’s medical director for adolescence health services in SBHCs, said.
Dr. Dooley added that it took several years to build up student-patient enrollment.
With only 300 ninth-graders at Eastern, Unity-run school heath center has a third – about 80 students – enrolled with the health center, Sabrina Scott, the school-based health center manager for Unity, said.
At Ballou, 400 out of the 1,000-plus student body is enrolled in the school health center; a quarter of Woodson students are enrolled with the center there, Scott said.
For school-based health centers, the “best measure” of a center’s success is the percentage of student enrollment, which can also demonstrate parents’ acceptance of the centers, John Schlitt of the National Assembly of School-Based Healthcare, NASBH, said. Schlitt is NASBH’s vice president of policy and government affairs.
Most school-based health centers will not see students unless their parents or guardians have signed a consent form, he added.
“I’ve seen 80 to 100 percent,” Schlitt said, “It’s generally well beyond 50 percent. In some instances, a student may never take the enrollment form home, but in most communities, SBHCs have a really good track record in getting parents to sign their kids up.”
Scott, Unity Healthcare’s school-based health center manager, said they do outreach for the health centers on back-to-school nights and hold separate open houses specifically for the centers. The last open house was held at the Woodson SBHC last Friday.
“On our staff, we have medical doctors and nurse practitioners,” Scott said, “They’re able to do a lot more than a school nurse can do and they provide comprehensive care.”
Yet, Schlitt said that SBHCs do not replace school nurses. Without nurses,a SBHC would start to “deal with things that aren’t a good use of its time“, he said.
“They shouldn’t have to deal with all of the ‘bumps and bruises’ of the school population when they should really be dealing more with primary medical issues.”
Like other school-based health centers, Unity ‘s SBHCs provide a range of medical and social services. They can provide immunizations, acute illness management for chronic-disease sufferers, physicals, STD treatments, and dental work.
And all of this takes place within the confines of a student’s own school, making a missed day of school because of a mere hospital visit inessential. However, specialty care, such as surgeries, are referred out of SBHCs.
“I really doubt anyone’s every done a sutra before in a school-based health center,“ Schlitt said, “I could be wrong, but I doubt it.“
One of school-based health centers founding principle is to help solve health-related problems that are a barrier to a student’s learning, like poorly managed asthma, for example, which is one of the leading causes of school absenteeism.
Studies have shown an association between SBHCs and improved academic performance.
The findings of a study about SBHCs conducted in Seattle and published in a March 2010 issue of the Journal of Adolescent Health showed an significant association with academic improvements over a two-year period (2005-2007).
The Seattle-based authors studied more than 2,000-plus ninth graders who initially used a SBHC in 2005. In the study’s conclusion, the authors limited the result of improved academic performance (i.e. higher GPA and improved attendance rate) to higher at-risk youth who use specific SBHC services.
“We found medical use was most strongly associated with increases in attendance and mental health use was more strongly associated with increases in GPA,” the authors write in the study’s “Discussion” section.
With more studies in the works or receiving final edits for publication, the “movement” carries on with its expansion.
Come September, in addition to the grant-funded school health center at the Silver Spring-located Highland, Takoma Park’s Rolling Terrace Elementary School will also be opening a SBHC. The two new SBHCs in Montgomery County will join the six already operating in the county, primarily at elementary schools but also at Northwood High School.
In 2013, if the county budget allows, four more SBHCs will open, Glick said.
“With healthcare reform, if it moves ahead as President Obama wants it to, there will be many more people who will have insurance and needing access to care,” Glick said, “And school-based health centers are where the kids are.”
“We want to be able to provide them with services in a family-friendly, student-sensitive environment.“