School-Based Health Centers

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Bringing Health Care to Children Where They Are and When They Need It

By Adria Cruz, CAS School Health Services Manager

Healthier children make better students, many experts agree. However, there are several barriers that prevent children from being the healthiest they can be, especially in underserved communities.

Low health literacy, linguistic barriers, a complex health care system, lack of health insurance, lack of financial resources − coupled with an inability to schedule appointments quickly, or during convenient hours, and long waiting times − affect parents’ ability, and sometimes willingness, to seek care for their children.

School-based health centers address all of these hurdles by bringing comprehensive primary health care to children where they are and when they need it.

The Children’s Aid Society operates five school-based health centers in its Manhattan Community Schools as well as two licensed Mental Health clinics in CAS Community Schools in the Bronx, with a School-Linked model for medical and dental care to the nearby Children’s Aid’s Bronx Family Center.

By bringing and connecting a caring team of nurse practitioners, physicians, medical and office assistants, social workers, psychiatrists, dentists, dental assistants, dental hygienists, and health escorts to the school building, Children’s Aid not only helps eliminate the above-mentioned barriers, but also promotes an environment where students and their parents can become better health care consumers, by accessing preventive, rather than emergency, care.

This easy access to providers allows parents and children to develop a different type of relationship with the health care establishment, becoming comfortable enough to ask questions of their physicians, and less apprehensive about medical, mental and dental health care.

Among the services provided in our school-based health centers are: complete physical exams, immunizations, laboratory tests, acute care (asthma, diabetes, etc), first aid, reproductive health, counseling and mental health services, dental care and, most recently, orthodontic care.

In addition, Children’s Aid Society’s school-based health centers connect parents of uninsured children to enrollment counselors who assist them in applying for public health insurance and help them navigate the health care system outside of the school building, once they obtain insurance.

Our school-based health centers serve over 90% of the school population, and generate over 30,000 visits a year; many of these visits prevent costly hospitalizations. We estimate that in school year 2009-2010 alone, our school-based health centers prevented at least 150 visits to the emergency room; we treated about 153 patients with serious asthma symptoms that required nebulizer treatment. Only one of those 153 treatments required referral to the emergency room. Also our school-based health centers played a central role in fighting the H1N1 epidemic, by providing accurate information and administering over 1,600 vaccines.

Sources of funding for school-based health centers in New York include state and city Departments of Health, Office of Mental Health, funds from the Health Care Reform Act (HCRA) and Medicaid revenue. We hope to receive revenue from the State Health Insurance program, which has been recently approved by the state legislature and is pending approval by the Governor.

Also, thanks to the Patient Protection and Affordable Care Act there is hope of more support for school-based health centers. Section 4101 of that Act authorizes the school-based health centers program, making it eligible for federal funds for the first time. We are hopeful the availability of these federal funds will help the expansion of this effective program to many more schools around the country.