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Illinois School Board Journal
September/October 2007
John Dively is an assistant professor of education administration at Eastern Illinois University in Charleston; Karen Berg is policy director for the Illinois Maternal and Child Health Coalition, the parent organization for the Illinois Coalition for School Health Centers.
Closing the achievement gap requires three strategies, according to education researcher Richard Rothstein: 1) raising the quality of instruction; 2) expanding the definition of schooling to include crucial out-of-school hours; and 3) implementing social and economic policies that will enable students to come to school ready to learn. Without including strategies two and three, he wrote, "The influence of social class characteristics is probably so powerful that schools cannot overcome it, no matter how well-trained are their teachers and no matter how well-designed are their instructional programs and climates."
One element of Rothstein's third strategy is the relationship between health care opportunities for at-risk populations and the persistence of the achievement gap. Several studies reinforce the premise that students can't learn to their full potential if they are not healthy — particularly as they deal with issues like asthma, dental care, hearing loss, mental health and vision problems.
Educators already address the connection between student health and academic achievement in various ways, including school nurses, lunch and breakfast programs, health education, improved nutrition guidelines and overall student wellness programs. But a more comprehensive method is available: a school-based health center (SBHC).
A SBHC is a partnership between a school and a health organization to provide on-site services that promote health educational success in a school community. Since the first such center in Illinois was formed at Chicago's Austin Academy in 1982, 49 other Illinois schools have added centers. Approximately 60 percent serve high schools, with the rest serving elementary and middle schools.
The number of school-based health centers in the U.S. has expanded rapidly from 120 in 1988 to more than 1,700 in 2006. They are present in 44 states and serve nearly 2 million children. SBHCs have high student usage rates, school administration support, and evidence of improvement in attendance, tardiness and reading pass rates.
The research results are mixed in demonstrating definitive positive effects on outcomes such as pregnancy prevention, graduation rates, promotion, drop-out rates, disciplinary referrals and suspensions and various measures of academic achievement. But a report on the Dallas (Texas) schools written in 2003 by Kathy Williams, as cited by Sara Geierstanger of the University of California, San Francisco, et al in 2004, indicates a positive link between SBHCs and standardized test achievement.
In writing about the Williams' study, Geierstanger said, " … intuitively, school health programs recognize that their work has a positive influence on academic performance and that healthy children make better students."
Providing services
In cooperation with a local health organization, schools determine the types of services they will provide. Depending on the needs of a particular school, these services may include:
In addition, clinics may decide to provide direct services or refer students to appropriate agencies with respect to mental health services, substance abuse services, case management, nutrition education, reproductive health education and health promotion. In many SBHCs, medications can be prescribed and filled in cooperation with a local pharmacy and, in some cases, the prescription will be delivered to the school.
For many Illinois school communities, pregnancy testing, sexually transmitted disease testing and treatment, and family planning are critical components of the SBHCs. However, some schools have chosen to omit these services in order for the SBHC to receive broad community acceptance. In such cases, referral arrangements with off-campus agencies have helped address this medial need.
Convenience
The convenience of health clinics in the school setting is especially beneficial, according to parents, students and staff. Typically, after students have been enrolled in the program by their parents or guardians, they can access the SBHC either by making an appointment or on a walk-in basis. Faculty and staff are also entitled to receive comprehensive services.
The benefits are multiple. Parents appreciate not having to leave work to take a sick child to the doctor or to fill a prescription. Schools and students lose less instructional time. Moderately ill teachers, who otherwise may need to choose between going to the doctor or coming to school, can do both. Students who do not have transportation or access to health care no longer face these obstacles.
In some situations, members of the community have access to the program. That would be especially true if the SBHC were part of an overarching "community school" concept. Such schools also open their doors to more community involvement by making facilities available to the public even when school is not in session. However, a school could have an SBHC, and even have it open to the public, without being part of a total "community school" concept.
Who pays?
Most SBHCs are structured so the school district bears no financial responsibility except for utilities and providing a location within the school. Staffing requirements for medical services and the billing of health insurance, Medicaid, Illinois' All Kids, etc., are the responsibility of the health care provider. Students are responsible for any co-pay requirements. Services can be provided to students who lack the ability to pay through a financial assistance program based on family size and income.
A student's encounter with an SBHC is often a first encounter with any health care provider. Thus, the centers are in a unique position to link these children and adolescents to the health care system.
Centers are cost-effective because they play a vital role in providing preventive services that reduce potential for engagement in high-risk behaviors at an early age, thus preventing the need for acute care in the future. Research shows that Illinois SBHCs provide a savings of more than $5.5 million a year to the state by reducing emergency room visits and asthma-related hospitalizations, as well as by providing immunizations.
Public support
A study led by Lake Research Partners, a national public opinion and political research firm based in Washington, D.C., shows that two-thirds of American voters support SBHCs. Additionally, voters are surprised to earn that SBHCs do not have a steady source of funding.
Illinois appropriates approximately $4 million to support 41 SBHCs. However, funding has remained level since 2000. This spring, the Illinois General Assembly passed SB715 (the School Health Center Act) that calls on the Illinois Department of Human Services to provide funding that would build capacity at existing centers and open 20 new centers over the next five years. Additionally, the U.S. Senate is considering the School Health Clinic Establishment Act (SB600) that would create a federal program and authorize grant funding for the operation and development of SBHCs.
It should be obvious that schools, acting alone, cannot close the achievement gap. This contention should not be read as an excuse to evade or minimize the schools' responsibilities in this regard. Rather it is merely a reminder that, standing alone, all the curricular and pedagogical programs, initiatives, reforms and restructurings will never be sufficient to compensate for all the variables that contribute to student achievement.
For comprehensive information about SBHCs, please contact the Illinois Coalition for School Health Centers at 312-491-8161 or visit http://www.ilmaternal.org/.
References
David A. Albert, Joseph M. McManus and Dennis A. Mitchell, "Models for delivering school-based dental care," Journal of School Health, 2005
Susan Black, "A lens on learning: Early vision screening can set children on the path to achievement," American School Board Journal, 2002, retrieved May 25, 2007, from http://www.asbj.com/2002/11/1102inprint.html
Susan Black, "Can you hear me now? Hearing loss can mean learning loss, but schools can help," American School Board Journal, 2003, retrieved May 25, 2007, from http://www.asbj.com/2003/05/0503research.html
Sara P. Geierstanger, Gorette Amaral, Mona Mansour and Susan R. Walters, "School-based health centers and academic performance: Research, challenges and recommendations," Journal of School Health, 2004
Nancy B. Harold and Rena D. Harold, "School-based health clinics: A vehicle for social work intervention," Social Work in Education, 1991
Illinois Coalition for School Health Centers, "Reducing Costs, Improving Health: Costs and Benefits of Illinois School Health Centers," 2006, retrieved June 5, 2007, from http://www.ilmaternal.org/ICSHC/Publications.htm
National Assembly on School-Based Health Care, "Capitol Hill briefing explains school-based health centers' roles as first responders to students in crisis," 2007, retrieved June 3, 2007, from http://www.nasbhc.org/Jan07/nationalrelease1%2025.pdf
Richard Rothstein, "Class and the Classroom: Even the best schools can't close the race achievement gap," American School Board Journal, 2004, retrieved May 25, 2007, from http://www.asbj.com/2004/10/1004coverstory.html
Richard Rothstein, "The achievement gap: A broader picture," Educational Leadership, 2004
Richard Rothstein, "Using social, economic and education reform to close the black-white achievement gap," Teachers College Press, 2004
Richard Rothstein, "Wising up on the black-white achievement gap," Phi Delta Kappan, 2004
Richard Rothstein, "Reforms that could help narrow the achievement gap," WestEd, retrieved September 15, 2006, from http://www.wested.org/online_pubs/pp-06-02.pdf
John J. Schlitt, John Santelli, Linda Juszczak, Clare Brindis, Robert Nystrom, Jonathan D. Klein, David W. Kaplan and Michelle D. Seibou, "Creating access to care for children and youth: School-based health center census 1998-1999," National Assembly on School Based Health Care, 2000
Lani S. Wheeler, Sarah L. Merkle, Lynn B. Gerald and Viriginia S. Taggart, "Managing asthma in schools: Lessons learned and recommendations," Journal of School Health, 2006
Kathy Williams, Final evaluation of the 2002-2003 youth and family centers program, Dallas, Texas, Dallas Independent School District Division of Evaluation and Accountability, 2003
Kathleen Vail, "Depression: Ready or not schools must fact children's mental health problems," American School Board Journal, March 2005, retrieved May 25, 2007, http://www.asbj.com/specialreport/0305SpecialReports/S3.html