Universal Care for Children: Are School-Based health centers the answer?

Last week, Peninsula Community Health Clinic announced an agreement with the Central Kitsap and Bremerton School Districts to open school-based clinics at Esquire Hills Elementary, Fairview Middle School and Mountain View Middle School this fall.  The clinics will be funded and staffed by the PCHC organization and the schools are sponsoring the clinic space. 

School based health centers (SBHC’s) are an integral part of healthcare delivery for children and adolescents in this country.    SBHCs deliver a variety of services, to include medical, oral, nutritional, case management for chronic conditions, and mental health services.  Because these clinics are located where children spend a significant portion of their day, obstacles to accessing healthcare, like transportation and scheduling issues, are minimized.

Studies demonstrate that students with asthma who have access to SBHCs had fewer emergency room visits and lower hospitalization rates.  Mental health services decrease school absences by as much as 50% among those with 3 or more absences in a six-week time period and an 85% decrease in school discipline referrals. 

SBHC’s generally use one of three staffing models.  The primary care model involves a nurse practitioner or physician assistant who provides basic health services.  The second model is geared toward the mental health needs of students and consists of a mental health professional such as a social worker or psychologist. Finally, there is a hybrid primary care-mental health model staffed with both types of health professionals plus a case manager or nutritionist.   

The most common conditions being managed at school are acute illness, comprehensive health assessments, prescriptions for medications, vision and hearing screens, sports physicals and reproductive health services.  In Washington State, a single, unemancipated minor may receive medical treatment without parental consent in the following areas: birth control services and prenatal care at any age, mental health disorder or substance abuse treatment at age 13 or older, and testing or treatment for sexually transmitted diseases at age 14 or older. 

This decision to open school-based clinics is a step in the right direction to improve access to healthcare for staff, students and families.  However, as a local pediatrician and more importantly, a parent to four children in one of the affected school districts, I would like more information.  

1)     Communication is essential for continuity between students, families and community health professionals.  Will parents always be informed when their children seek care at one of the school-based clinics or only in certain circumstances? Will PCHC collaborate with community clinicians directly for shared patients? 

2)     What should a parent do if they already have an established relationship with a primary care physician?

3)     Will those students who establish medical homes at school-based clinics be connected with available health care resources in the community during weekends or extended school breaks? 

4)     CEO Jennifer Kreidler-Moss commented that one “purpose of the clinics is to put more trusted adults in kids’ lives.”  Who are these trusted adults?  Is there are policy about chaperoning children when they are evaluated and examined by health professionals? Where can parents get more information about those clinicians who will have access to our children?

5)     And finally, what is the scope of available reproductive health services that will be offered to middle-school aged children in the school-based clinics?  

School based clinics will accept all insurances.  Parents with children in the Central Kitsap and Bremerton Schools will be provided consent forms at the beginning of the school year, in order to have their children seen at the school clinic.   In addition, parents need to provide their insurance information, so children will not have to pay for their care prior to being seen. 

Again, I support any endeavor, including school-based clinics, that brings us one step closer to universal care in Kitsap County.  School-based clinics can address the needs of underinsured or uninsured children by reducing obstacles families face accessing healthcare services.  Peninsula Community Health Services is the right organization to provide this outreach in the schools, employing 62 health professionals and already serving 29,000 patients across the region.  I applaud their efforts to bring care to patients who need it most.