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Health centers and “full-service community schools”

By Katy Murphy
Monday, December 5th, 2011 at 8:38 am in health, high schools, initiatives, OUSD central office, students.

Skyline High School's new health center
photos by Roy Manzanares, courtesy of Oakland Unified

Oakland Superintendent Tony Smith’s vision of full-service community schools is taking shape on some campuses, thanks to a school-based health center initiative that has picked up steam (and millions of dollars in funding) since 2008.

Oakland Unified’s 12th health center opened this week, at the 1,900-student Skyline High School. The Native American Health Center (NAHC) will operate services at the clinic. The renovated portable building includes two medical exam rooms, a laboratory and three confidential consultation rooms.

new Skyline High School health center

Skyline’s renovations were funded by a 2006 school bond measure (Measure B) and seed money from a 2008 Kaiser Permanente donation. Atlantic Philanthropies also donated millions to the OUSD effort to expand health and mental health care to its students.

Other OUSD campuses where students can get check-ups, consultations, mental health counseling and — in some cases — dental care: Calvin Simmons, Castlemont, McClymonds, Havenscourt, Frick, Urban Promise Academy, Madison, Roosevelt, Oakland High, Oakland Tech and Fremont.

Every OUSD student is eligible to receive health care from these clinics. Here are some statistics from an evaluation done during the 2009-10 school year, when there were half as many health centers as there are now:

  • The centers at McClymonds, Roosevelt, Oakland High, Oakland Tech, Fremont and Castlemont provided nearly 23,944 visits to 3,913 students (roughly 10 percent of students in the district).
  • They served 59 percent of students enrolled in the schools where they were located.

Skyline High School health clinic

Centers will open at Elmhurst and West Oakland Middle by January. Next fall, another is scheduled to open at the new Downtown Education Complex.

What kind of a difference has it made to have a health center at your school?

Do you think such services are becoming more important than ever in light of recent Census statistics on child poverty? What benefits have you seen or experienced?

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  • OUSD Parent

    Do you know if it’s the goal for OUSD to open these centers at every middle and high school campus? What about elementary schools? If not all schools, what is the criteria used to decide which schools get the centers and which don’t? It sounds great but my kids OUSD school doesn’t even have a nurse let alone a full blown health center. Can’t we start with baby steps and provide all schools with the minimum health support and then grow it from there?

  • Nextset

    Very interesting.

    This has the effect of compensating for the unfit slum parent who cannot be relied upon to maintain even the most basic medical and dental education & attention for their slum children. And I have generally called for the urban schools to step in in these areas so their kids have a chance at upward social mobility.

    I posted an article recently about dental hygiene/dental care being a new boundary for middle class membership:

    http://globalguerrillas.typepad.com/globalguerrillas/2011/12/are-you-part-of-the-global-middle-class-let-me-see-your-smile.html

    The other elephant in the room is venereal disease. The stats on this in adolescent blacks is off the scale. The clinic can perhaps diagnose and treat to rampant STDs. I am pessimistic about AIDS – when you diagnose it the mortality table for the child goes to a different page – you can’t bring them back to the normal page.

    Getting a grip on the sanitation and behavior of the students is the trick. I doubt the clinic is there to do the classroom training the students need to have. All of them. To get control of the STD rates of underclass children you need some exposure to the losers and what happens to them, combined with the classroom training on the facts of the diseases, that they are there risk factors, and risk control up to and including discrimination in who you involve with (you might call this a form of abstinence). And then we have the rape issue – how to control the risk factors for that.

    It’s a daunting task. Opening the clinic by itself is not going to fix the problem – you can’t knock the numbers down by offering to fix the kiddies after they’ve gone out and started spreading diseases.

    And then we have the HONDAs, Hypertensive, Obese, Non-compliant, Diabetic, Alcoholics. If the clinic and the health educators don’t have enough to do controlling the bugs they have the Diabetes problem and all the related obesity & lifestyle issues. Brushing and Flossing, handwashing, etc also. Perhaps the clinic and related classroom training can discuss the pros and cons of Branding, Tattooing, Piercing (with the black issue of Keloid formation), recreational drug/alcohol/S&M and other unwholesome practices.

    You know, things the middle class learns from Mommie & Daddie.

    I do see a problem. If the Clinic is forced to be politically correct – all Public School operations seem to have to be – are they even allowed to express disapproval of such lifestyle choices – do they have to tell the kiddies that it’s OK to keep it real? Is it ok to tell the kiddies they should probably avoid certain people – not even talk to them perhaps – if they make such lifestyle choices?

    I think it’s great the clinic has opened. I hope that the school will get nose to nose with the students in mandatory health and sanitation classes about how they differ from middle America and how they can get out of high risk status and stay in a better mortality table.

    I wonder what Piedmont does about these issues?

  • Nextset

    Another issue, what parent permission or presence is required to exam and treat students? I believe they can get abortions, birth control and related things without parental notification or permission – what about STD treatment and anything else? I’ve heard of teens left on a gurney in ER hallways with acute injuries because the parent’s haven’t arrived. Let’s say Latifah has a Keloid problem after ear piercing – or Tyrone has an infection from a branding wound. Can the clinic treat them, dispense narcotics, antibiotics or whatever else without the parent coming in? And what about STD reporting. If a student is diagnosed with Syphilis there is an immediate report required to County Health which may send an interviewer out to confront the patient about who did it. (We should be so lucky, not sure if they still are funded to do this.) Guess who’s coming to dinner – the health dept! And then you have the sex crime reporting laws…

    I recently talked to a 15 year old who tried to kill himself. In the attempt he overdosed on drugs which to his surprise not only didn’t kill him but put him into Grand Mal seizures for days. (If he’d grabbed the Tylenol instead and taken the same dose and gone to bed he’d be dead – there was a lack of research here.) He has permanent scarring from the 5 point restraints. Adolescent medicine is an exciting field. The clinic could well get into a situation where they need to restrain and §5150 commit a child. Are they ready for that? I hope they are up for whatever is required.

    Operating a clinic in a school is not going to be as easy as many would like it to be. I think the time has come and it is needed. But the experience will not be without ups and downs and need for Administration support for the tough times and unpleasant judgment calls.

  • On the Fence

    I’d like more information about what the health centers actually do. What were those 23,944 visits for (immunizations, mental health, clearance to play sports, family planning/ob/gyn)? How do they staff these clinics given that they address both mental health and primary care issues? Will the grants run out and if so, how much will it cost the district to run these facilities? How many sessions of counseling or therapy are provided?

    When they say that all OUSD children are eligible to receive services, do they mean for free? If one has alternative health coverage (MediCal, Kaiser, other) would one have to utilize that first? Do they bill insurance for any of the services? Any info. would be great.

  • Christopher Scheer

    Katy — inside the OUSD filter wall, we can’t see flickr-hosted photos, fyi.

    Here’s a Skyline Oracle article about the new health center:

    http://www.skylineoracle.com/news/2011/12/06/native-american-health-center-now-open/

    Nextset: If somebody overdoses at our school, they will not be sent to the health center, we will call 911 just anybody else does. This is not a trauma center or an ER, just a health center with certain appropriate services.

  • Christopher Scheer

    OUSD blocks flickr, Katy.

    Here’s a link to Oracle story on the new health center:

    http://www.skylineoracle.com/news/2011/12/06/native-american-health-center-now-open/

  • Parent stuck in OUSD

    I don’t know what I think about this. My child’s school has not had a librarian for two years. The parents pay for all our extracurricular activities, including the PE teacher, and quite a bit of the non-extracurricular activities. The district pays for: the teaching and administrative staff, the facility cost of operation (except for the cleaning of certain areas that the maintenance guy says are not in his contract to clean, like the library and teacher’s room) and, of course, all the testing materials.

    Yet some schools are getting millions of dollars to build, staff and manage health care centers for kids who already have access to FREE health care if their parents would just fill out the paperwork and then take them to the doctor and/or dentist. In California, no low income child is without complete health coverage and dental care. None.

    In light of school closures, increasing class sizes and decreasing staff and huge decreases in services that are educational, I think it’s absolutely wrong and irresponsible that the district is taking this on. It’s very misplaced good intentions by people who are supposed to be educators, not social workers and medical professionals. Schools cannot and should not be expected to parent children.

  • Katy Murphy

    OUSD’s filter blocks lots of sites, doesn’t it? I noticed it’s allowing Twitter now, so maybe Flickr won’t be far behind. Thanks for the link to the Oracle story.

    And On the Fence: I’ve sent your excellent questions to the school-based health center’s program manager at OUSD and to Troy Flint. One of them, hopefully, will either answer them directly on the blog or to yours truly.

  • livegreen

    Does MediCal & other State funds help reimburse OUSD? What about the ongoing Operational costs – are their State / Fed reimbursements of Free Clinics (which this is) the District is or is not taking advantage of?

    Because OTF is right: we know from history that when the grants run out, if it’s not sustainable, this could all be an enormous waste of taxpayer money.

  • Katy Murphy

    I don’t believe OUSD is paying for many ongoing operational costs, and I know that state/federal reimbursements are a key part of the funding model, but the question of long-term sustainability is an important one. I don’t know, for instance, what percentage of those ongoing costs are currently funded by private grants.

    Here’s a link I found on the California School Health Centers Association on the financing of these centers.

  • Jetaway

    As a teacher at an Oakland school with a medical center, I find it very helpful. There are so many times where my instruction is interrupted because of student health needs for which I am not trained to deal with. Students cannot learn when they are ill. While I agree that the primary responsibility for students are their parents, when they are in my classroom they are my responsibility. What a gift to have a health clinic that can take some of the weight of my job off my shoulders. Also, I can’t tell you how many times students miss an entire day of school simply to go to the dentist. If their appointment is here on campus, they miss less school as a result.

  • KGutierrez

    I celebrate the opening of this school-based health center and many others in Oakland Unified School District. As a former recipient of school-based health services and current specialist in youth development and youth organizing, I believe they are critical to the holistic welfare of students, who otherwise do not have regular access to basic healthcare.

    From my personal experience, I know I wouldn’t have had the same positive health outcomes in my adolescence if it weren’t for my high school’s health center. I utilized the center’s free, comprehensive services and learned to take preventive health measures– many of which I still apply today. My mother was grateful for my school-based health center and had full confidence in the care I was receiving. Had it not been for my health center, my mother would have found herself still jumping from provider to provider and paying exorbitant out-of-pocket fees for my care.

    The health center developed my own commitment to the public health field and in my line of work, I continue to see how many young people are dedicated to their health centers and their community’s access to care. Again, this is a proud moment for OUSD.

    The link between health and education is inextricable. School-based health centers uphold this in the fullest.

  • Katy Murphy

    As promised, here’s the district’s response to your questions about school-based health centers. Mara Larsen-Fleming, program manager for the health centers in OUSD, emailed me promptly with the below Q and A:

    What were those 23,944 visits for (immunizations, mental health, clearance to play sports, family planning/ob/gyn)?

    Of the nearly 24,000 school-based health center visits in 2009-10, 37% were for mental health, 25% were for medical services (such as sports physicals, chronic disease management, family planning and primary care services), 27% were for first aid, 5% were for health education, and 7% were for group visits (e.g. a support group for grief or trauma).

    How do they staff these clinics given that they address both mental health and primary care issues?
    School-based health centers provide a combination of medical, mental health, health education and youth development services. Each school-based health center uses a slightly different staffing model, depending on the lead agency for the health center, as well as the needs of the site. A school-based health center is commonly staffed by a Director, Medical Provider (e.g. Nurse Practitioner, Physician Assistant or Doctor), Medical Assistant, School Nurse, Health Educator(s), Mental Health Clinician/Intern(s), and/or Case Manager(s).

    Will the grants run out and if so, how much will it cost the district to run these facilities? For the current school year, how much is OUSD contributing to the ongoing operational costs of these facilities?

    OUSD’s health centers are sustained by a public-private partnership between the District, County, City, community-based organizations and philanthropic partners. Services are not only funded by private grants, but also by County Measure A and Tobacco-Master Settlement Funds (TMSF), as well as third party (insurance) billing conducted by the lead agency. In addition to voter-approved Measure B facilities bond dollars to build/renovate the health centers, OUSD primarily contributes District Medi-Cal reimbursement funds, which must be reinvested in health services, as well as some funding for custodial services.

    How many sessions of counseling or therapy are provided?

    The number of sessions depends on the severity of the case. Our overarching goal is to reach as many students as possible with the limited resources that we have. When appropriate, students are referred to community providers for ongoing care.

    When they say that all OUSD children are eligible to receive services, do they mean for free? If one has alternative health coverage (MediCal, Kaiser, other) would one have to utilize that first? Do they bill insurance for any of the services?

    Yes. All services are provided at no out of pocket cost to students or their families. Depending on the need, students with another primary care provider may be referred back to their medical home. This is done for a few reasons, 1) school-based health centers believe that continuity of care is good practice and do not want to compete with a student’s primary care provider, 2) school-based health centers want to keep space available in the schedule to serve students without insurance or other healthcare options, 3) in order to maintain services, school-based health centers need to make sure that at least a portion of the healthcare they provide is reimbursable.

  • Livegreen

    Thank you Katy. Q: Referring to post #7, how does OUSD plan to serve schools and children that don’t have the Medical Centers but also have a sizeable # of poor students & families? What r they doing to build and renew non-medical educational facilities for ACADEMIC programs. (I don’t doubt the benefits of the Health Clinics, I’d just also like to hear their Facilities plans for ACADEMICS, esp. for schools in the #7 situation).

  • Hmakesyouthink

    Awesome job OUSD!

  • another interested parent

    Katy, how about an OUSD answer to #7′s thoughts? What about all of the schools who don’t even have a school nurse on site? Will they get some kind of health services as well? The school my kids attend has several diabetic children and many autistic children and there is no full-time or part-time nurse nor is there a mental health professional. None of the full service sites are close to my kids’ school and I bet they aren’t staffed or sized to serve elementary kids either.

  • Katy Murphy

    It’s a good question, and I sent a follow-up question about that last night. Will post the response when I get it.

  • Katy Murphy

    From Mara Larsen-Fleming (on the question of how OUSD children will be served if they attend a school without a health care center):

    Great question. Our focus has been to get the new health centers up and running. Our next task is to determine which sites without health centers can be connected to nearby sites with health centers. There are also a number of school-based health centers that already serve the broader community. For example, Youth Uprising at Castlemont and the Chappell Hayes Health Center at McClymonds serve any adolescent living in Alameda County. The Hawthorne Clinic in the Fruitvale also serves children and families in the broader community. In service of the mission to develop Full Service Community Schools, we will be working with all schools to make sure they are aware of health and wellness resources that may be available to their students and families, as well as working to develop partnerships and resources where there are gaps.

  • On the Fence

    Thank you for submitting all of these questions, Katy. I was glad to get the answers so promptly from Ms. Larsen-Fleming, too.

    I find myself most aligned with Parent Stuck in OUSD #7 who is unsure that these health services are the best use of monies for our public schools or tax dollars, in general. I am not in favor of OUSD’s push to turning the public schools into one-stop social service agencies, ala “full service community schools.”

    Firstly, I do not beleive that OUSD has fulfilled it’s primary obligation of providing a quality basic education for its students. So I am reticent to have any resources or attention diverted to this new task. Adding salaries and building infrastructure in unsuccessful institutions seems like an added waste.

    While I don’t doubt that it is convenient for parents to have health care at the school sites, I am not sure that our communities can afford to fund this convenience. There have been recent studies showing that the average Californian is paying a larger proportion of their income for health care. We are already paying for infrastructure that is in place to provide free or reduced cost care in our county facilities via tax dollars. The operating costs for these existing clinics, including facilities and salaries are already high. Many of us also pay for our own private health insurance, with larger copays and less employer subsidy than ever before. Therefore, I cannot fathom creating (and paying for) another tier of infrastructure within the schools to duplicate these services.

    I do see the use of providing teens with access to certain types of care that they would otherwise forgo to their detriment, such as family planning/std screening, but would hope that a single NP could provide such services, or refer out for more complicated issues, rather than create full clinics with admin, and multiple paid staff members.

    I do not doubt that the people involved in these health centers are well intentioned, however, I am not convinced that the costs of creating another layer of health care outweighs the benefits. Furthermore, I do not support the general direction toward “full-service community schools,” and would rather OUSD commit to simply providing quality academic institutions with sufficient safety and discipline.

  • On the Fence

    Oops: That should be; “I am not convinced that the benefits of creating another layer of health care outweighs the costs”

  • Nextset

    Hmmm. Some of this reminds me of prison issues. If you have a defendant surviving on kidney dialysis I think they go to Vacaville because the Med Center is there.

    So when OUSD establishes a school with a med center, are the medically fragile students across the district going to be transferred there? It would seem to make sense. Students with Diabetes, Students with renal failure, students with AIDS, students on blood thinners, etc might really need to have nurses and physicians available. They may want it, their parent may want it, the school may think it would be safer to place them there. So are the med center schools now going to collect the medical cases? I would expect so no matter what the posturing is at the inception.

    It would just make sense.

    It is not going to be an easy thing to get into this. And if they run out of funding and try to stop providing this care the students involved and their families would have become accustomed to a higher level of service and care from the school. They would feel terrible to lose it. The chronic medical cases will crowd out the normal kids. It’s inevitable.

    Their work is not going to be providing band-aids and checking off forms for sports. I could see them hooking up with a teaching hospital to bring in medical residents for training and exposure to serious adolescent medicine as a concentration. The psych cases alone… Are they going to have a staff psychologist? Mental Health problems kill. They are real – from Schizophrenia which may require more dosing and lab work to dangerous depression which may need more talk therapy. And then there are the dual diagnosis kids.

    I think it’s a good thing but there are going to be problems of adjustment. They will need to the support and goodwill of the administration to deal with what they will have to deal with. And they will have to be protected from unreasonable expectations. For one thing in a little time their students won’t get healthier, they will get sicker as more of them are Dx’ed and the Medical Cases transfer in for the service. They will soon find they cannot fix or transform their patients to be what they are not, so their “cure” rates are not going to be as rosy as projected.

    I hope everybody sticks with them.

  • Nextset

    On The Fence: You assume OUSD has any intention of running “schools” that teach basic ed and prepare all their students for industry, military or higher ed. This is a frequent assumption. People who believe this are bewildered by OUSD goings on. It’s just easier if you work with the hypothesis that they have no intention of actually teaching and are there as holding pens for the proles who above all are to be kept pacified. Then it’s easier to understand what happens.

    Back to the thread – providing health care is a basic jail function. It is not the function of a real school who will not permit “students” on the property who are not fully prepared for the school day. In other words – a real school will refer a medically impaired child back to the parent and refuse to allow that child back on the property without medical clearance (including that the condition is stable). Hang around a real school and say you are suicidal or depressed – or in renal failure – you are gone. Their mission does not include outpatient services.

    A real school won’t let a kid on the premises not properly dressed, much less one with deportment problems or who cannot keep up with the standards of the school. Those they flunk out. Telling a child and it’s family that they are getting Fs and they should continue to expect to get all Fs will produce a transfer. It was done at my schools growing up. Worked like a charm. If a student was too ill to attend regularly they transferred to an alternative school.

    What OUSD is doing is a logical step on a progression. And I think adolescent medicine is facinating. What we are seeing is the blurred line between a real school and a holding center. You are not going to see these clinics in a white school. They are an experiment in the minority holding camps.

    I support them because jails and holding camps need medical facilities. In such places the institution assumes the role of parent and operates at the base level.

  • Katy Murphy

    Today, the federal government announced it was giving $14 million in Affordable Care Act dollars to 45 school-based health centers across the country. Oakland’s getting $423,000 for its clinic at Oakland Tech and for electronic health care records at centers run by La Clinica de La Raza.