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School-Based Centers Changing Student Care

Posted on: Monday, 21 November 2005, 03:02 CST

By Pullin, Jeff

The role of health care in West Virginia public schools is changing drastically.

For years, school nurses traveled from school to school in counties, examining students on occasion. Health exams were sporadic, and medical personnel were few.

But during the past 10 years, some West Virginia schools recognized the need for better health care within the walls of their institutions. Community health care organizations moved into some institutions and set up shop in the school, and now the school- based health centers are becoming increasingly common in West Virginia.

In most cases, schools partner with community health centers to provide acute care within the educational environment.

"We are not there to take the place of the school nurse," said Becky King, co-coordinator for West Virginia School-Based Health Assembly. "School nurses and county nurses are very important in West Virginia schools. But we are offering services you would often find if you were visiting your family doctor."

The program began in 1994 under the supervision of the West Virginia Bureau for Public Health's Office of Community and Rural Health Services. Combined with state funds and grants from the Claude Worthington Benedum Foundation, the three-year project created six SBHCs. Since then, the initiative has grown to 46 schools in 18 counties.

"I think one of the key factors is that children in West Virginia schools needed more access to health care," said Eileen Barker, School-based Health Assembly co-coordinator. "Students spend a number of hours in school. Many of these kids live in areas where the nearest medical center may be 50 miles away. Parents and students had to take time from work and school just to go to the doctor."

So doctors now are in the schools, Barker said.

Different Schools, Different Clinics

Many of the schools that have health clinics are in rural areas of the state, which is good news for families who otherwise would travel significant distances to see their physicians.

One of those health clinics is at Riverside High School in Kanawha County. It is operated by Cabin Creek Health Center and serves the school's more than 1,200 students and faculty.

"One of the advantages is that we can see the students and parents don't necessarily have to leave work and come and get them," said Frances Smaltz, family nurse practitioner at Riverside High School. "Students can often receive care and go back to class without missing a day of school."

Riverside is staffed with two nurse practitioners, a physician, a psychologist and two medical assistants. While the school-based clinic sees about 30-40 students a week, it also sees more than just children.

"We are unique in that we see community patients and school patients," Smaltz said. "We probably see about 20 patients a day who are members of the community."

In Fayette County, the school-based health system, operated by the New River Health Association, is in four public schools, ranging from elementary to high school. The organization also has two schools in Nicholas County.

"It is just like a doctor's office," said Teri Harlan, school health director for New River Health. "We provide acute care, mental health, wellness education and dental care."

In the Oak Hill area, the organization is looking to put a new clinic at Oak Hill Elementary. If that happens, students in that area will have access to health care from kindergarten to high school graduation.

"I'm a big dreamer," Harlan said, laughing. "We are also looking to purchase a mobile dental unit to travel from school to school."

In those health clinics, nurse practitioners and physician assistants are primary caregivers, but they are supervised by a physician.

"We began in 1994, so we are one of the first school-based health clinics in the state," Harlan said. "We have been able to expand throughout the community and even been able to provide care to parents and other children who don't have clinics in their schools."

In addition to providing acute care, many SBHCs are able to provide quick analysis of illnesses because many lab tests can be performed in the office. Most SBHCs send those lab samples to their parent health clinic, but the goal is to not have a student travel from office to office.

"And it keeps them in school," Harlan said. "They don't have to miss a day of school for a half-hour appointment."

Built to Suit

In Cabell County, the two high schools - Cabell Midland and Huntington High School - were built in the late 1990s. When planning for the schools, officials worked to provide each school with space for health clinics.

"Every day we see about 40 students here at Cabell Midland," said Michelle Linville, clinical coordinator for the program, which is operated by Valley Health Systems. "We can provide lab work, mental health exams, oral health, immunizations and nutritional health."

The health system, which also reaches into three high schools in neighboring Wayne County, also takes advantage of nearby Marshall University.

"Many nursing students get training here in our school clinics," Linville said. "It is also good training for medical students."

In fact, incorporating SBHCs into new school plans seems to be a common trend, said King.

"School-based Health Clinics are in all shapes and sizes," she said. "When McDowell built an addition onto its school, it built a clinic for the students. Many schools are taking it into consideration when they build."

Financing

Because many SBHCs are acute care facilities, they do bill for many of their services. King said it is required to keep the facilities running and hopefully to build new ones.

"Services are designated by community leaders," she said. "Leaders plan and survey the needs of the students. Because we often provide acute care, mental and oral health, we do have to bill for those services."

School clinics rarely bill for first-aid services unless they require offsite X-rays or lab work. But SBHC employees work with students and families to ensure everyone is cared for regardless of economic status or level of insurance coverage.

"At the beginning of the year, we send out information to parents about the program, and they have to give the school permission to treat the child," Linville said. "When they give permission, we also ask for insurance information."

But what about students who do not have insurance? SBHC employees said they often spend time finding coverage for their students.

"Finding insurance coverage is a big part of it," Harlan said. "We do try to help the parents apply for insurance, such as CHIP (Children's Health Insurance Program) and Medicaid."

As a matter of fact, more than 55 percent of students treated in West Virginia SBHCs either have Medicaid or CHIP coverage. Thirty- four percent had private insurance, and 9 percent had no coverage.

"Children are never turned away," Barker said. "The goal is to provide care, whether they can pay or not. We have other funds in place, which help us keep these clinics going."

Other sources of funding include $900,000 annually from the state budget, donations from non-profits, including the Claude Worthington Benedum Foundation and Sisters of St. Joseph Foundation and support from community leaders.

"It isn't just about money," Barker said. "It is also about providing staff, services and space. It is those in-kind services which keep these clinics going."

The occasional struggle for funding is overshadowed by the benefits of the clinics, King said. The organization touts its success in decreased school absenteeism, fewer emergency room visits and reduced parental time off from work associated from health care visits.

SBHCs also provide outreach programs within the schools, promoting dental care, nutrition and mental health.

"There is a lot of good progress here," King said. "As an assembly, we continue to work on sustainability plans and to continue to expand. We see this is an opportunity to get children on the right track and help them become healthy adults."

Copyright State Journal Corporation Oct 21, 2005

Source: State Journal, The

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