Louis Freedberg/California WatchSusan Yee, director of the Oakland High School Wellness Center, stands in front of the new health center under construction.
Two of the state’s largest districts are undergoing a major expansion of health centers on school campuses after promised help from Sacramento never came.
To build new facilities, Oakland and Los Angeles are tapping a combination of voter-approved bond money, fees from Medi-Cal and health insurance reimbursements and philanthropic dollars. Health advocates hope these efforts spur similar initiatives around the state.
California lags behind many other states in the number and scope of school-based health services, despite evidence that children who use school health centers have better health and education outcomes. Out of nearly 10,000 schools in the state, only 176 school health centers [PDF] exist for more than 6 million children.
Eight centers will be built in Oakland – added to seven existing ones. Some of the operating costs will be covered by a $15 million grant from New York-based Atlantic Philanthropies and $6 million from Kaiser Permanente awarded last fall.
Construction is being underwritten by a bond measure approved by Oakland voters in 2006. Los Angeles Unified is building 17 health centers, complementing the 32 it established over the last several decades.
Nearly five years years ago, then-Gov. Arnold Schwarzenegger announced a plan to add 500 health centers at elementary schools throughout California. But not a single clinic was established as a result of his pledge.
The initiative foundered because of the state’s failure to pass its own health reform legislation, its deepening budget crisis, and lack of follow-through from the governor’s office and state Legislature, experts in health policy said. After approving the School Health Center Expansion Act in 2008 [PDF], lawmakers declined to appropriate any money for the program.
Last month the state earned a D+ for children’s health coverage in the 2011 California Report Card [PDF] issued by the Oakland-based advocacy organization Children Now. Health educators worry that school-based health care is unlikely to be high on Sacramento's policy making agenda anytime soon, even though public health officials are convinced of its importance. Gov. Jerry Brown mostly ignored health issues in an otherwise detailed policy platform during his 2010 campaign.
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“We continue to believe in the benefit of additional school health clinics and would hope resources to support this program would be available in the future,” said Al Lundeen, spokesman for the California Department of Public Health
At the state’s largest district, students in Los Angeles have significant health problems that damage their ability to learn, according to the Los Angeles Trust for Children’s Health [PDF]. About 105,000 students have asthma. More than one-third are obese or overweight. A high proportion of students have been diagnosed with depression and post-traumatic stress disorder.
School health centers in California could get an additional boost from the federal health reform law, which includes $200 million for construction of school health centers nationwide, the first time Washington has provided funds for this purpose. Local school districts and health providers can apply for up to $500,000 for new construction, equipment or renovation of existing facilities.
The need is greatest among high school students, the population health surveys show are least likely to visit a doctor’s office. Focus groups in Alameda County indicate students prefer to use school health centers because they are free, confidential and usually operated by youth-friendly staff.
A mountain of research has underscored their effectiveness. The American Journal of Public Health reported this fall that school health centers improve students’ mental health while reducing pregnancy and sexually transmitted disease rates. The centers also help promote better eating habits, increase immunizations and lower Medicaid costs. Recent studies show improvements in the grade point averages of students who use mental health services in school clinics and in the attendance of students who took advantage of their medical services.
At Oakland High School, the services offered by its health center are scattered among four different classrooms. Medical services are provided in several tiny rooms. The exam room is barely larger than a closet, offering little privacy for students or staff. But all the services soon will be brought together under one roof in a much larger facility under construction in the shell of the abandoned auto shop in front of the school. It will be named Shop 55 as a reminder of its prior history.
Tenth-grader Bethany Saetern feels much more comfortable going to the health center than a regular doctor’s office.
“Everyone is in their comfort zone,” Saetern said, referring to its casual atmosphere. “They ask you if you need anything, they help you a lot in school, with life and everything.”
When she started falling behind on class assignments, she got extra help from the counselors at the health center, and “my grades are going up,” she said.
At John Marshall High School in Los Angeles, the new health center is housed in a simple one-story building painted beige with brown trim. With a waiting room, two examination rooms, a laboratory, two counseling offices and a reception area that holds medical records, it is twice the size of the school's previous health center, which for 10 years was squeezed into a classroom portable.
Principal Daniel Harrison said the health center, which is operated by the Asian Pacific Health Care Venture, a nonprofit community health clinic, “is not a luxury; it is essential.” For many of his students, “they either see a doctor here or they don’t see a doctor at all, period.”
Some communities resistant
As Oakland and Los Angeles expand, some communities have resisted school health centers, fearing they will provide birth control and abortion advice without parental permission. Under California law, these are classified as “sensitive services.” [PDF] Health care providers, whether on or off school campuses, are barred from sharing information with parents about the care their children may have received, at least not without their permission.
Harrison, the Marshall High principal, said parents at Huntington Park High, where he previously taught, were mostly recent immigrants who opposed the idea of providing condoms and other reproductive health services to students. As a result, that school has no clinic.
Community resistance, however, has not been a problem in most urban areas. At Marshall High, many students come from rougher neighborhoods in East Hollywood, with a heavy dose of medical marijuana storefronts and billboards advertising their wares, neighborhood bars, and prostitution. For parents and students alike, Harrison said the need for the services its health center provides is self-evident. “It is in your face,” he said. “No one would say ‘stay away from the clinic because it could teach your kid something too soon.’ ”
At Oakland High, Dr. Suzanne Nguyen said that “by providing confidentiality and ease of access in an environment they feel they can trust, we are able to successfully combat those public health diseases that are out there, like chlamydia, gonorrhea and HIV.”
Louis Freedberg/California WatchA new wellness center is under construction at Oakland High School.
Nor can she avoid the reality of teenage pregnancies. She said she regularly has been able to keep pregnant girls from dropping out by carefully managing their class schedules, scheduling doctor’s appointments so they don’t interfere with school work and, if necessary, providing mediation with upset parents.
“We want to be a safe haven for them,” she said.
Like many school health centers, medical services at Oakland High are provided by a community-based clinic, in this case Asian Health Services, in conjunction with the East Bay Asian Youth Center. As a “federally qualified health center,” the community clinic is key to the financial viability of the school facility because it can collect patient fees from students with health coverage and enroll uninsured low-income students in programs like Healthy Families and Medi-Cal.
So far this school year, nearly half of Oakland High's 1,650 students have used one or more of its services, according to health center director Susan Yee.
The school clinics reinforce a push by Oakland’s superintendent of schools, Tony Smith, to turn schools into community-based institutions that provide a range of services – not just educational ones.
Expansion in Los Angeles
A similar expansion of health centers is under way in Los Angeles, using $28.5 million from voter-approved bond measures for school construction. Two new centers have been built (the clinic at Marshall High and a mental health clinic at Caroldale Learning Community), and 15 more are in the design phase. All are expected to be open by December.
At David Starr Jordan High School in Watts, the health center is part of a larger neighborhood revitalization that will include new housing, businesses and redevelopment projects. Part of the ambitious $1 billion plan involves tearing down the troubled Jordan Downs housing project, building 2,100 mixed-use housing units and turning Jordan High into what officials describe as a “model high school.”
“Our wellness center will be the hub of a whole renewal of a community,” said Rene Gonzalez, the Los Angeles Unified School District’s assistant superintendent of student health and human services.
In addition to the benefits to students, school districts have a financial reason to offer on-campus health services: Schools receive funds from the state based on each day a student attends classes.
Each year, for example, California children miss 847,000 days of school because of dental problems alone. Health advocates say absentee rates could be drastically reduced if students didn’t have to leave campus for medical appointments.
But with the state still facing a grim budget future, local communities will have to come up with their own funding mechanisms to treat chronic conditions on school campuses.
That is what happened in Alameda County in 2004, when voters approved Measure A [PDF], which raised sales taxes by a half-cent and now provides $1 million each year for health programs in 17 schools. In San Francisco, the school district and city jointly invest about $7 million in 17 wellness centers and other health programs at each of its high schools and six of its middle schools, in part through the Public Education Enrichment Fund [PDF] approved by voters in 2004.
Now health advocates are hoping funds from the federal health reform law for school health centers will help spur further growth in California.
“What we would really like to see is that school health centers become part of how health care is delivered to kids, so when you think of schools, you think of the library, the gym, and the health care center," said Serena Clayton, executive director of the California School Health Centers Association.