Obama-care supporting quiet boom in new school-based health centers

If all goes as planned, the big modular building tucked into a corner of Jefferson Elementary, in southeastern Fresno County, will be open by Christmas - just in time for the beginning of flu season.

The new school-based health center was created with the help of a grant authorized under the Affordable Care Act - one of more than a dozen awarded to California districts in the past two years to shore up the state's badly frayed social safety net.

There's always been involvement of schools in providing health care because they have to be," said Serena Clayton, executive director of the California School Health Centers Association. "When people say schools shouldn't be in the health care business - the reality is they are. They have hundreds of kids spending six or seven hours a day on their campus. They have illnesses, they get hurt - by default, schools have to deal with it."

Typically established as a partnership between a local educational agency and a health care provider, school-based health care centers have become an increasingly important part of the medical system nationally as well as in California.

Even during these tough economic times, support for the program has grown: Currently 18 states provide direct funding for school clinics and 10 have increased their investment over the past 10 years, according to the National Assembly on School-Based Health Care Centers.

Currently California does not provide direct support but that hasn't stopped the growth. In 2000, there were 108 school health centers - today there are more than 200 with 17 more in the works.

Part of the recent spike is the result of a little known provision in the Affordable Care Act, which set aside $200 million over four years for the construction, renovation or upgrade of school-based health care centers nationally.

One of those projects is underway at Jefferson Elementary, envisioned as a partnership between Kings Canyon Unified and Adventist Health - but others are being planned in El Monte, San Diego, Alameda and Stockton.

The new clinics come as districts are cutting back on the traditional school nurse. According to a 2009 study by the National Association of School Nurses, California placed 42nd nationally with an average of one nurse per 2,187 students. Federal guidelines suggest one school nurse for every 750 students.

Hard-hit by the recession, Fresno County suffers with one of the state's highest unemployment rates of close to 14 percent. The county also has one of the highest rates of uninsured children in the state at about 11 percent.

Jefferson Elementary, located in the city of Reedley, has a student population of about 400 - nearly 96 percent qualified as socioeconomically disadvantaged and about 80 percent English learners. Putting a health care clinic on that campus - which can also serve the rest of the community - was a natural fit, said Mary Ann Carousso, the district's Administrator for Student Services.

"The goal is really to just provide health care where the children are - and the children are at school," she said.

Planning began even before the federal grant money had been established. Former Gov. Arnold Schwarzenegger had an interest in expanding the school-based health care network as part of his unsuccessful reform bill that fell apart in 2008.

When Congress included money for school centers in the reform bill, Kings Canyon was well-positioned and received its award last summer. The actual building arrived in sections earlier this month and contractors are working to complete the inside now.

Carousso said the district is close to securing a final agreement with Adventist Health, which has been involved in each step of the plan. The clinic would operate under Adventist's hospital license and would be able to perform a variety of services.

The primary mission of most school-based centers is to improve the overall health of the district's children through health screenings and prevention activities. Most can provide primary care including substance abuse counseling, nutritional education and case management.

Carousso said they are interested in having the clinic staffed with a physician assistant or nurse practitioner as well as nurses and clerical staff. And once the clinic is open, the district will have taken a big step in improving student performance.

"Sometimes now it's the office health aide who is acting like the family physician to determine how sick a child is," she explained. "You see that enough and you realize that services need to be more readily available to our parents because we need the kids well and we need them learning."

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