School-Based Health Centers

School-Based Health Centers

By: Julie Scales

03/06/2001

OVERVIEW

Youth are expected to be the picture of health. However, today's youth face more complicated lifestyle choices, e.g. tobacco use, alcohol consumption, unhealthy diets, sexual behavior and drugs, than previous generations. Those choices can lead to unhealthy lifestyles as an adult, possibly resulting in heart disease, addiction, cancer, obesity and many other chronic conditions.

Additionally, there are many obstacles preventing youths from getting the health care services they need. These include lack of money or insurance, inconvenient health facilities, lack of information about health care agencies or doctors, and parents who are unable to miss time from work to take their children to a doctor's appointment. Often, students must miss a day from school to get a routine physical exam.

School based health centers are typically organized by a local hospital or health center. They provide health care to students early to prevent or treat common health problems of young people as well as chronic conditions. Nurses, physicians and mental health professionals provide annual physicals, treat asthma, offer family counseling and work with school staff to address student problems. School based health centers require a signed parent consent form before students can be provided services, and health centers provide care regardless of a students' ability to pay.

The number of centers (SBHCs) have grown substantially over the past decade, from a mere 200 in 1990 to over 1,300 in 2000. This is an unprecedented increase of 600 percent. Currently, SBHCs are found in 45 states and the District of Columbia. The five states with no centers are: Idaho, Nevada, North Dakota, South Dakota and Wyoming.

School-based health centers provide:

Access to health care - SBHCs give access to all children who have parental permission, regardless of insurance coverage or ability to pay.

Regular preventive care - SBHCs eliminate financial concerns and difficulty in access.

Higher Attendance Rates - SBHCs treat acute and chronic health problems immediately and return children to class as soon as possible.

Most SBHCs are located in the school or on the school grounds. Ideally, the center is made up of several licensed professionals who work concurrently with the school nurse, counselor, teachers, parents and the community. SBHCs are supported strongly by parents for several reasons: parents know they will not have to miss work to care for minor problems and they are encouraged knowing their child will receive prompt attention from health providers trained at working with youths. SBHCs also receive high marks from school administrators and teachers because their focus can return to educating healthy children who are ready to learn.

FUNDING

Currently, 33 states - Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, Texas, Vermont, Washington, and West Virginia- provide grant support to school-based health centers. Forty-three states permit them to bill Medicaid for patient care and in twenty-two states the centers are providers within Medicaid managed care networks.

2000 STATE ACTION

Colorado enacted S 20. The new law includes children under the age of 21 in the definition of clinic services provided by school-based clinics under the Colorado Medical Assistance Act, thereby exempting such services from the physician-on-site rule for purposes of reimbursement under Medicaid.

Florida enacted S 2628 which amends subsection 8 of the Florida Statues, regarding school health services programs, to state that the Department of Health, in cooperation with the Department of Education, may adopt rules necessary to implement this section and the rules may include standards and requirements for developing school health services plans, conducting school health screening, meeting emergency health needs, maintaining school health records, and coordinating with education programs for exceptional students. Additionally, it adds subsection 7 to the Florida Statutes, regarding funding for school health services stating that services provided by a comprehensive school health program must focus attention on promoting the health of students, reducing risk-taking behavior, and reducing teen pregnancy.

New Mexico enacted SJM 57. The new law implements a resolution requiring the Department of Health and Human Services to act as lead agency in partnership with the Grant county community health council and representatives on the following objectives: completely assessing and evaluating the health care delivery system for children in Grant county and to develop strategies to ensure a more effective and equitable system of reimbursement for all Grant county health care providers, including school-based health centers.

Vermont enacted H 842. The new law is an appropriations act establishing the Vermont Tobacco Prevention and Treatment Program. It is comprehensive and research based using tobacco settlement funds to include the following programs: community-based programs, school-based programs, tobacco cessation programs, counter-marketing activities, enforcement activities and surveillance and evaluation activities.

Table 1.
Laws On School-Based Health Centers as of 12/31/2000

STATE	Statute Citation and Funding Amount	Programs Eligible/ Statute Description	Target Population
ALABAMA (2)	Education Trust Fund appropriates $4,496,234	Immunization programs	Pre-school children and students
ARKANSAS (1)	Arkansas Code Annotated 6-18-703, School Based Health Acts 1006 and 1342 of 1997.--Department of Health, budgeted $974,174	---	---
CALIFORNIA (2)	Education Code Section 49423	Administration of medication in public schools	---
COLORADO (2)	Colorado Medical Assistance Act, budgeted $18,019	---	Children under 21
CONNECTICUT (1,2)	§19a-2a CT General Statutes (Powers and Duties of Commissioner of Public Health); budget line item in Biennial Appropriations Act. NOTE: School-based health clinics are not explicitly authorized in statute--$3,837,119 §10-212a (1998) §19a-125 (1998)	13 elementary, 6 K-8, 12 middle school and 18 high school SBHCs are funded with State General funds. Five additional projects are funded as expanded school health projects. Projects meet the standard model of service for level IV or V (SBHC) or level II or III (ESH) projects. Administration of Medication In Schools Adolescent Health Council	Pre-K-12th grade
DELAWARE (1,2)	Delaware Code Title 14 State Budget Act DE Code §14:1310 authorized a school nurse per 40 units or one school nurse per facility--$ 616,749 §9909 (1998)	Delays mandatory requirement that all kindergarten enrollees have documented lead screening. Twenty-three SBHCs are funded by state general funds. They are restricted for use only by vendors and their subcontractors that contract with the Division of Public Health to operate these centers. Delaware Health Children Program	--- All students attending the participating school districts are targeted (K-12th grade).
FLORIDA (2)	Florida Statutes, section 381.0057 Florida Statutes, amends section 381.0056 regarding school health services programs. Adds subsection 7 to section 381.0057.	Funding for school health services School health services programs may adopt rules and the rules may include standards and requirements for developing school health services plans, conducting school health screening, meeting emergency health needs, maintaining school health records, and coordinating with education programs for exceptional students. Funding for school health services must focus attention on promoting the health of students, reducing risk-taking behavior, and reducing teen pregnancy.	---
HAWAII (1)	$9,934,000	School Health Nurse and Aid Program; School Health Services Program; Athletic Health Care Specialists.	School health nurses, aides, and other services are for K-12. Athletic health care is for high school athletes only.
ILLINOIS (2)	Public Act 91-719. School Code sections 10-20.34 and 34-18.21 §105 ILCS 5/2-3.114	Allows non-certified registered professional nurses to administer medication to students. School district may access federally funded health care resources if they provide EPSDT services to Medicaid eligible children. Federal Goals 2000 Funds	--- ---
IOWA (1)(2)	Iowa Acts Chapter 208, Section 14, $280,228 Medical Assistance Funding for EPSDT throughout school systems Funded as part of the School Foundation Aid Formula. No separate categorical funding	Family planning services - funds will be used to provide adolescent pregnancy prevention grants --- ---	--- Pre-K-12
KENTUCKY (1)	KRS 210 KRS 156.497 - (Statue) 704 KAR 4:010 - (Administrative Regulations)-- $39,626,000	Evaluate the access of children and youth to mental health and substance abuse services and prevention programs within the region including those provided by schools Family Resource and Youth Services Centers. Promote the flow of resources and support to families. These services include health services or referrals, alcohol and drug abuse counseling, family crisis, and mental health counseling. These centers provide coordination of services, not providers.	--- Family Resource Centers,- through age 12. Youth Services Centers target those over age 12.
MAINE (2)	Public Law 669	Requires unlicensed school personnel to be trained before administering medication to students in public schools and approved private schools.	---
MARYLAND (1)	Sec 7-415 Education Article - School Health Program for Baltimore City and Caroline County--$80,286 §15-304 (1998)	School Health Pilot Program. School-Based Outreach Program	K-12
MICHIGAN (1)(2)	MCL 380.1178 Section 1302-1304, Act 352 of 1996-- $2,892,300	Administration of medication in school. Adolescent health clinics--school based or alternative sites.	--- Adolescents
MINNESOTA (1)	Minnesota Statutes 121A.16 - 121A.19 $1,550,000 for Health Screening Aid	All school districts. Early childhood screenings to detect and solve conditions interfering with young children's growth, development and learning. Assist parents' awareness of physical health, development and learning readiness.	Children aged 3.5 to 5 years.
MISSISSIPPI (2)	Mississippi Code, Section 41-79-5	School nurse intervention program repealed.	---
NEW HAMPSHIRE (2)	Tobacco Use Prevention Fund and Tobacco Control Program, School-based programs $250,000	Prevent the initiation of tobacco use.	Students of all ages.
NEW MEXICO (1)	1996 HB 2 funds for six statewide staff to provide support and consultation to school health services personnel. 1996 HB 2 provides funding, both placed in Department of Health budget-- $850,000	School-based programs that provide primary physical and mental health services and link to community health service delivery systems.	Children and students in pre- K- 12.
NEW YORK (2)	§2511 Sec. 9 (1998) §398-d Sec. 1 (1998)	Children's Health Insurance Plan Child Welfare Services Community Demonstration Projects	---
OREGON (1)	$1,464,244 State General Fund (Biennium) **Note: OR also receives a Robert Wood Johnson Foundation Grant that is being used to expand services to kids younger than high school age--$300,000 biennially.	School-based health centers must offer primary health care, health promotion, acute and chronic disease treatment, mental health and reproductive health. (All must offer reproductive health information and referral; dispensing of birth control devices is optional.)	Grades 9-12
PENNSYLVANIA (1)	PA Public School Code of 1949, Article XIV (School Health Services) and Article XXV--$39,279	Eligible costs associated with the provision of mandated medical, dental and nursing services by school districts or joint school boards.	All children attending public and nonpublic schools, grades K-12.
SOUTH CAROLINA (2)	General Revenue Fund $2,000,000 to school districts for health insurance	---	---
TENNESSEE (1)(2)	--- TCA 49-3-359 (C) requires school systems to provide health services to all students.--$8,378,000	Coordinated School Health Improvement Act of 1999 - implement a coordinated school health program School nurses; Tennessee does not provide categorical funding. Instead, Tennessee has a comprehensive formula that includes these services for grades K-12 in a set of components earmarked for general classroom use.	--- K-12 students.
VERMONT (2)	Section 9503 H 842 establishes the Vermont Tobacco Prevention and Treatment Program $1,200,000 for school based programs. Vermont Tobacco Prevention and Treatment Program established by section 9503 of H 842. NOTE: Establishes comprehensive and research based programs in several areas including school based programs.	--- ---	--- ---
VIRGINIA (2)	---	Students may self-administer asthma medications.	---
WASHINGTON (2)	---	Public school districts or governing boards of private school must adopt policies designating employees who may administer oral medications.	---
WEST VIRGINIA (1)	West Virginia Code Sec. 18-5-22 Health clinics-- $500,000, School nurses in state school aid formula.	School nurses employed by local school districts may be paid out of state school aid formula funds.	Grades K - 7

The above data is from a state revenue survey from NCSL's School Health Finance Project. The survey collected information on state appropriations for school health services during FY 1998. The data was self-reported by legislative staff in the various states. If a state isn't highlighted it is because the data was not reported. (2) Information is from a state statute search and highlights laws that have some kind of involvement with SBHCs.

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School-Based Health Centers

Table 1. Laws On School-Based Health Centers as of 12/31/2000

Table 1.
Laws On School-Based Health Centers as of 12/31/2000