Periodically, I get an email or press release from a well-intentioned organization telling me why I should be writing about school-based clinics, and I make a mental note to myself or file the email and say, yes, this is something I don’t know that much about, and there’s probably a good story – or stories – there, including how the clinics will be affected by Health Policy.
Well, this week I (and many of you) got a press release from the Department of Health and Human Services telling me quite a bit about funding for school clinics and Health Policy. Before I tuck it away or put it on the never-ending “to do” list, it’s worth sharing some thoughts and some resources.
First of all, school-based clinics are not the same thing as the “school nurse” some of us remember – the lady (and it was a lady in those days) who kept us company when we ran a fever or had a tummy ache and were waiting for our mom (and it was mom in those days) to pick us up, take us home, and tuck us in. These school-based clinics are where about 790,000 patients get their health care – sometimes including dental care. The $95 million in awards announced this week (July 14) will allow for a 50 percent expansion to cover another 440,000 patients.
Here’s the list of clinics getting the grants. For more details, here’s the HHS press release and background from the Health Resources and Services Administration, an under recognized federal health agency. The HRSA page includes a link to an eight-page national school clinic census that provides a lot more detail on what services are offered in what setting and to what populations).
As usual, there are politics and funding fights. As Jane Norman of CQHealthbeat reported, the new grants go for the physical plant – not for medical care itself. The law allows for Congress to also appropriate money for care and operating expenses, but Congress hasn’t done so, given the current budget pressures. Republicans have backed repealing the clinic expansion, saying there isn’t money right now. HHS says the clinics getting the new expansion funding, however, have to show they have a way of paying for the other clinic expenses.
If someone has reported on these clinics, or seen good stories, please comment and share the links below. But some of the questions I’d ask of any clinic, in the context of Health Policy, would include:
What questions do you have about Health Policy and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of Health Policy. If you have questions or suggestions for future resources on the topic, please send them to email@example.com.
- How early do they open and how late do they close? (i.e. how easy is it for working parents to stop by the clinics?)
- What kind of wellness programs and preventive care do they offer? What is their approach to childhood obesity?
- Are those that serve adolescents getting caught up in any of the abortion/abstinence/contraceptive politics? (HRSA has some data on how many clinics offer some of these services to teens.)
- What kind of outreach are they doing for immunization?
- What kind of relationship do they have with other health providers in the community, including specialists? As regions and communities develop interoperable health information technology, are the school-based clinics linked in?
- Who are the health care providers – doctors, nurses, nurse practitioners? Do state laws allow them to practice “at the top of their license” or are they unable to fully use their training? Is there a move underway to change that?
- How do they care for young people with chronic diseases (asthma, diabetes, etc) and how does this compare to the sometimes fragmented and uncoordinated care people get elsewhere? Are they keeping their patients well enough to avoid unnecessary emergency room visits (and how solid is the data they have to support that?)
- How do they integrate primary care and mental health care? (The clinics also do some substance abuse counseling, I do not know how or where they refer for further treatment or counseling or what kind of follow up they can provide.)
- What role do they anticipate in 2014, when more people have access to health insurance and Medicaid?
- All these questions, I suppose, could add up to one bigger question. Can we think of school-based clinics as medical homes? And if so, what can we learn from them?
A panel at the 2007 Urban Health Journalism Workshop explained school health programs, while a field trip at the 2008 Urban Health Journalism Workshop allowed journalists to visit school-based clinics.