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WHAT WORKS IN EDUCATION The George Lucas Educational Foundation
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How School-Based Health Care Can Contribute to Closing the Achievement Gap

Some strategies to close the achievement gap are widely discussed -- lowering class sizes and paying educators a bonus to work in a low-income environment, for example. Others are not. For instance, you rarely hear about efforts to close the gap by providing school-based healthcare. But in Colorado's Montrose County School District RE-1J, that's what they're trying.

After the district took on Richard Rothstein's Class and Schools (which considers the influence of out-of-school factors such as health, safety, and more on student achievement) for their book club, staff realized that there were gaps in access to healthcare for low-income and Hispanic students in their community that corresponded to gaps in academic outcomes. In examining the healthcare challenges that low-income families faced, including a limited number of primary care facilities in the area that took new Medicaid patients, they came up with an idea: Bring healthcare to school.

What is a School-Based Health Center?

While all school-based health centers (SBHCs) look different, they share some common characteristics. They are located on school grounds, working with the school to become an integral part of it. They provide a comprehensive range of services that meet the physical and mental health needs of young people in the community, working with a qualified health provider (such as a hospital, health department or medical practice) and employing a multidisciplinary team of providers (such as nurse practitioners, physicians, social workers and/or other health professionals) to provide care to students with the written consent of parents.

SBHCs benefit not only a school and its students, but the surrounding community. For example, they reduce inappropriate emergency room use and Medicaid expenditures related to inpatient, drug and emergency department use. Adolescents are significantly more likely to go to a SBHC for mental health services than a community health center or HMO, and SBHCs decrease absenteeism and tardiness among adolescents who receive counseling services in them. They have also been shown to reduce hospitalization and increase school attendance in children with asthma.

The Montrose Clinic

In Montrose, staff chose an elementary school with a high free and reduced-price lunch population located in the center of the community as a potential site for the district's first SBHC. They surveyed parents at the school, finding that 41 percent of respondents had no medical home and 49 percent had no medical insurance. They also surveyed teachers, finding that 100 percent regularly saw students who could benefit from a primary care facility. Teachers particularly saw need for mental health services, to help kids deal with issues ranging from anger management to incarcerated parents.

After proving the need for an SBHC, the district found community partners and grants from private foundations willing to support its operation. And today Montrose boosts a school-based health clinic staffed with a pediatric nurse practitioner, mental health therapist, promotora (a family outreach staffer) and school health tech. It provides a wide range of services, including individual, group and family counseling; sick visits; well visits; sports physicals; ADD management; and depression management. It gives flu shots and does splinting, wraps and some wound care. Staff works with children on nutrition and physical activity. A dental hygienist comes in regularly to do cleanings and fluoride and sealant applications. Partner institutions have taught parenting classes.

The clinic is located on an elementary school campus but open all aged 0 to 18. Children are served regardless of whether their family can pay, though there is a sliding fee scale based on family size and income for those who are uninsured and the promotora works to get eligible families enrolled in Medicaid or CHP+ [a Colorado public health insurance plan]. A partnership with a local pharmacy helps reduce the cost of medicine for uninsured children.

The Impact

Since opening in October 2007, the clinic has grown significantly. It initially served 30 patients a month. Now, it can serve 30 a week. County commissioners (initially opposed to the idea of a SBHC) are very supportive now that they have seen the clinic's impact on the Medicaid costs they are charged with. The community as a whole has been so pleased that it opened a second school-based clinic -- this one able to serve adults as well as children -- in another town.

While it is difficult to measure the impact of the clinic on student achievement given the indirect nature of its work and the fact that the clinics are just one part of a broad strategy to improve outcomes, the district is tracking standardized test score and other academic outcomes (like dropout rates). Time will tell if their comprehensive approach to closing the gap really works.

February 2011 is National School-Based Health Care Awareness Month. You can learn more about it by visiting this Web site.

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