Photo courtesy of Janet Wells	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
To address the needs of the nation's 11 million uninsured children, communities are putting health care where the kids are—in schools. At Berkeley (Calif.) High School Health Center, Amy Balding, RN, performs first aid, dispenses medications, treats an array of injuries and sometimes, just listens.

Three months after Mary Hagedorn, Ph.D., PNP, RN, opened a clinic on the elementary and middle schools' campus in Fountain, Colo., a single mother with four asthmatic children walked through the door.

"The mom didn't have insurance and worked three jobs, so she didn't qualify for Medicaid. These four children were receiving care at the emergency room when they had asthma attacks," recalled Hagedorn, director of the Fountain School Based Health Program and vice president of the Colorado Association for School Based Health Care. "She was getting billed by the ER, but didn't have any money."

Each of the children was averaging two to three absences a month from school due to asthma, said Hagedorn, who assessed each child, switched their medications, tested them for allergies and did some education with the family.

"Now, it's four years later, and they have not had any more ER visits, and the asthma has been very well controlled. One child had perfect attendance last year, and the others were absent just once every one to two months. The mother said that without us, she would not have known what to do for health care," Hagedorn said. "Parents call us their 'angels of mercy' for providing services that weren't there before."

Comprehensive care

Hagedorn's clinic is part of a nationwide movement to address the needs of an estimated 11 million children in America with no health insurance, according to a recent article in Health Affairs, published by Project HOPE. Efforts to reach these children, who often live in poverty, have been only partially successful.

For teenagers, "access to health care is especially tricky," according to the article. "Teens face problems-substance abuse, reproductive health needs and depression-that are difficult to face and can land them in serious trouble. However, ignoring the problems of adolescents can lead to even bigger troubles: 1 million unintended pregnancies a year, 3 million sexually transmitted diseases, more than 4,000 suicides and flashes of school violence."

In response, communities are putting health care where the kids are-in schools, especially in low-income neighborhoods. About 1,500 health centers in schools in 45 states serve an estimated 2 million students-a more than tenfold growth since 1990, when 150 centers covered about 140,000 children.

These health centers are designed to deliver comprehensive primary, preventive and acute care. Most are staffed by nurse practitioners, as well as nurses, mental health care providers and licensed practical nurses. Some centers include physicians on a regular schedule; some are training sites for medical students. Many centers have lab facilities for routine blood tests.

Two nondescript portable buildings nestled between classrooms and the athletic fields in downtown Berkeley, Calif., house the Berkeley High School Health Center, part of a county coalition of 11 school-based health centers. The center-easily identifiable by the colorful artwork emblazoned with public health-related messages on the outside walls-has a small reception area, two exam rooms, a quiet room with cots, a lab, counseling rooms with a sound-screening machine outside the doors and offices.

Physicians assistants staff the clinic four days a week and medical residents from nearby Children's Hospital and Research Center at Oakland come in twice a week to do sports physicals and internal medicine. Social workers and mental health counselors also are on staff.

Next Page