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| 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."
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.
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