SILVER SPRING, Md. – For many students at Broad Acres Elementary School, health care used to be a luxury. Their parents couldn’t afford it, so they went without.
But that was before a 1996 grant from the nonprofit Robert Wood Johnson Foundation, which helped pay for the school’s first comprehensive health center.
Today, more than 90 percent of Broad Acres’ students, ranging in ages from 3 to 11, take advantage of the school’s health center, school officials said. Students are provided with a wide range of medical care, from dental work to physical examinations, regardless of their ability to pay.
It’s as if the doctor’s office has come to school.
“School is where the kids are, and the idea was to bring health care to where they are,” said Jane Koppelman, deputy director of Making the Grade, a national organization that advocates for the school-based centers.
Nationwide, the number of school-based health centers has doubled in the last four years, totaling more than 1,150 this fall, according to a study released by Making the Grade. The centers’ numbers are on the rise in Maryland, too. Forty-three are operating throughout the state – up from 38 in 1996, Koppelman said.
About 16,000 Maryland students were enrolled in school-based health centers last year, according to a survey of 36 of the centers.
Maryland’s newest health centers opened in 1997. In addition to Broad Acres, facilities opened last year at Harmony Hills Elementary School in Montgomery County and Easton middle and high schools in Talbot County.
The oldest centers in the state were created in the mid- 1980s by the Baltimore Health Department to provide health care for some of the city’s most impoverished students.
Now, 31 of Maryland’s 43 centers are located in Baltimore City and Baltimore County.
To sign up, all parents have to do is fill out an enrollment form. No child is forced to join.
“The centers give parents easy access to health care,” said Anne West, a nurse practitioner at Broad Acres. “Even if they have insurance, it’s hard for them to take a day off work.”
At Broad Acres, for example, the center serves a low-income community. More than 90 percent of the nearly 500 students receive free school lunches, a program for children from low- income families, said school nurse Ladys Lux.
The majority of students come from immigrant families, where English isn’t spoken at home, said Irm Pichot, the nurse manager at Broad Acres. Their parents often have jobs that don’t provide medical insurance for themselves or their children.
“These people are the working poor,” said Ilene Sparber, one of the center’s program managers.
At Broad Acres, the health center focuses on physical and mental health. Doctors and nurses treat asthma and earaches, while social workers and therapists identify learning disabilities and problems at home.
The students enrolled at the center visit for routine check- ups and preventative care and are examined by a full-time nurse and part-time doctors.
Services at the various centers around the state include immunizations, treatment of minor injuries, referral and case management of children with acute and chronic illness, and prescriptions and dispensation of medication.
Mental health services, especially in high schools, include individual counseling, group counseling, health education and programs to combat against smoking, drinking, drugs and unprotected sex.
In Maryland, more than half of the health centers are in elementary schools, but 21 percent of them are in high schools. Some have drawn criticism because of their reproductive counseling programs.
David Lam, executive director of Maryland Right to Life, an anti-abortion group, said his organization opposes any kind of abortion counseling in schools.
“Abortion counseling and referral shouldn’t be a part of a school-based clinics,” Lam said. “Abortion is not health care.”
Donna Behrens, project director for Maryland Making the Grade, maintains that “reproductive health care is a part of health care.”
She added, “Nothing’s going on in school-based health centers that isn’t going on when my adolescent daughter goes to the pediatrician.”
Studies have shown that nearly 10 million children are uninsured nationwide. About 160,000 children in Maryland were uninsured in 1996, according to the state Department of Health and Mental Hygiene.
The health centers are typically located in communities where parents would have difficulty accessing care or don’t access it when they need it. Local jurisdictions lobby for their own centers, asking both public and private sources for support. The onus is on them to finance the centers.
Most centers are supported through public and private grants. Broad Acres, for example, receives assistance from the Maryland State Department of Education, the Department of Health and Mental Hygiene and the Governor’s Office of Children, Youth and Family.
Other support comes from the Children’s National Medical Center, the University of Maryland, College Park, Montgomery County Public Schools and the Robert Wood Johnson Foundation.
At Broad Acres, between 30 and 40 percent of the children are uninsured, Behrens said. Their care is paid for by the center.
Students who do have health insurance are asked to let their providers pay for it.
What about complaints from some managed care organizations, that they’re being forced to pay for some services twice: once to the school health center, and again to a primary care provider specified under an insurance program? “On its surface, it may look like double-dipping,” Behrens said. “But when you take the circumstances into account, we’re saving them money” by focusing on prevention and early intervention, which would cost managed care organizations more in the long run. -30-