One year ago today, I was on a plane from New Mexico back to
m home in North Carolina. I was sitting next to a man explaining what
school-based health centers (SBHC) were, fresh out of the School Based Health Alliance National
Convention, looking to spill the brim of everything I had just learned…to test
myself maybe, to see what I held on to. I remember giving him the standard
first couple of lines…”***SBHCs are
essentially doctors offices on the grounds of schools ***they see all students,
but primarily serve students who are uninsured and underinsured ***they keep
students in their seats longer and learning.”
At this point, I can almost guess the next 2-3 questions…
- What types of services do they provide (code for: are they sex clinics?)?
- Who funds them?
- What about the school nurses?
Having been through this conversation many times over the
past 8 years I’ve worked in and around SBHCs, I have developed a pretty
consistent response, tailored to fit the tone of the person questioning:
Centers actually
provide acute and primary care, core services that the majority of their
patients aren’t already receiving, mental and behavioral health, oral and
visual health and they have a focus on prevention: immunizations, well child
visits, sports physicals, etc. But they also play a key role for students who
have chronic illnesses that impact their time in school, like asthma and
illnesses related to being overweight or obese. And for folks in North Carolina, it is against the state law to provide
contraceptives on the grounds of a school campus, so let’s be clear that is not
happening.
Funding
collaboratively through billing Medicaid, CHIP or private insurance, private
grants and sometimes some state funds, depending on where they are located. In
2010, SBHCs were also authorized underneath the Affordable Care Act and
received $200 million for capital costs, though fell short on providing
operational funding.
And school nurses are
our biggest allies, well, in places where school nurses exist.
I’ve found that an information gap about school nurses has
grown, maybe generationally. Many people
think that school nurses are in every school, most if not all days of the week,
and are providing counseling, dispensing medicine, and being a catch all for
the students. The reality is that, in Wake County, NC, the 4th
largest school district in the country, there is a school nurse to student
ratio of 1: 2500 students. That translates into each school nurse spending 1-2
days a week at each school…and because of tightening restrictions within the
school system, “we basically just put ice on things and if it is more serious
than that, we call their parents” according to school nurse I talked to last.
Fortunately all school districts are as strict and, despite being overworked
and under resourced school nurses make magic happen. And when there is a SBHC in that school, they
collaborate to keep students in their seats and healthy.
So I looked at this man, having already plotted my next points
and he said with equal parts disapproval and disbelief:
“Sounds like
socialized medicine to me.”
