Effect of School-Based Health Centers on Education

by Olivia Spadola

If you were to travel by the T from Boston College in Chestnut Hill, Massachusetts to East Boston, you would pass through quaint neighborhoods in Brookline, by expensive restaurants on Newbury Street, and beyond the touristy Quincy Market. Soon you would enter a domain where the average family income is many thousands of dollars less than it is in Chestnut Hill. Outside the Maverick T stop in East Boston, you would see chain food restaurants, trash filled streets, and sidewalks inadequately cleared of snow—immediate indicators of the economic inequality between here and the higher income districts around Boston.

I pick up my eight-year-old mentee from a brick building surrounded by high fencing and rows of government housing beyond that. Despite all efforts to improve her mathematics and reading skills, my mentee’s high tally of sickness-related absences from school hinders her progress. I worry that a lack of access to adequate healthcare will increase her chance of falling behind in schoolwork, contracting an illness, or engaging in high-risk behaviors. Continued strides made in healthcare will, in the best case, help to dissipate the inequalities between these ten T stops for children, like my mentee, from kindergarten all the way through high school.

In “Healthier Students Are Better Learners: A Missing Link in School Reforms to Close the Achievement Gap,” Charles E. Bash (2011) examines the health problems affecting school-aged youth and ultimately determines that “health problems … disproportionately affect low-income minority youth as measured by incidence, prevalence, and educationally relevant consequences” (p. 593). For instance, the three vaccines recommended for adolescents (Meningococcal conjugate, Tdap, and HPV) are often difficult for some teenagers to receive because of a lack of healthcare, missed opportunities, or disorganization of immunization records (Daley et al., 2009). Though contraction of an illness such as meningococcal disease, pertussis, tetanus, or a sexually transmitted disease is not common, it could be detrimental to the completion of a student’s high school career. Educators and administrators would most likely agree that we do not need any additional factors to contribute to the statistic indicating that one third of all students in the United States do not graduate from high school on time (“Health, Well-Being,” 2011). As a less severe example, consider the common flu and its effects on absenteeism. If medical preventive measures increased (through flu shots or mist), days of missed school could decrease while the high school retention rate could ultimately increase. However, as Foy and Hahn (2009) find in their research, there is a lack of awareness for preventative measures among low-income and often uninsured youth, leading to absenteeism among student populations that is not favorable for students or schools. “In our school-based health center, reduced missed school days is a secondary goal which is beneficial to the student, the working parent, and avoids loss of the school district’s attendance based state funding of approximately $32 per student per day,” explain Foy and Hahn (2009). Access to vaccines is clearly important so that students are prevented from illness that may inhibit their school attendance. In turn, school systems will see the benefit as well.

How would you get to a doctor’s appointment if you did not own a car and did not have money for public transportation? Additional factors involved with healthcare access include the ability to physically travel to medical centers as well as the ability to pay for insurance or medical needs. In The Working Poor, David Shipler (2004) raises the concern that accessibility to follow-up appointments and primary care doctors is limited when parents are working multiple jobs or long hours. Shuttles often run to and from hospitals around areas like East Boston, but for a single, working mother who has to pick her three children up from school and then work an extra shift at his or her job, options such as these are not always feasible. Office hours at the doctor’s office from 9-5 do not fit every schedule. Despite our desire to believe in equal opportunity outlined in the “American dream,” it cannot be disputed that families with higher incomes simply have more money to put towards healthcare, medical appliances, or transportation. For families with financial difficulties, there are limited options to take a child to an appointment.

The School-Based Health Care Policy, initiated by the W.K. Kellogg Foundation, funds and advocates for the attainment of affordable and accessible healthcare where financial restrictions are present (“Policy Program,” 2011). By addressing preventive care for children and adolescents through vaccinations on site in schools, a policy such as this one not only makes the preventive measures easily attainable and affordable, but also acts as a safety net when the vaccines would not have previously been administered (Daley et al., 2009). In a 2007-2008 study sampling 1,000 randomly selected school-based health centers, researchers found that most people financed the vaccinations with Medicaid or State Child Health Insurance Plans (Daley et al., 2009), proving that most children attending school where the centers were being implemented were already covered by government-funded insurance policies because their parents could not pay for private insurance. Government-purchased vaccines make immunization possible for uninsured individuals through the School-Based Health Care Policy, provided that children qualify for this type of insurance and can rely on their parents to file the correct forms to obtain it (Daley et al., 2009). Opposition to the implementation of vaccination in schools rests on the argument that those with access to private insurance will seek vaccinations at school-based health centers more for the ease of convenience rather than the issue of access, causing problems with parent-communication and consent with school-based vaccination centers (Daley et al., 2009). Because of these valid arguments, schools would have to be meticulous and patient when receiving consent forms from parents and only providing government-funded vaccines to those who qualify. As Daly (2009) explains in his research: “If, in the future, SBHCs [school-based health centers] take a greater role in vaccination delivery for students with all types of insurance, it will be important that these efforts are coordinated with PCPs [primary care physicians] in the community” (p. 451), a minor inconvenience for schools in comparison to the number of students who could access vaccines and be prevented from contracting illnesses.

As demonstrated in their intent to provide vaccinations to uninsured individuals and make vaccinations physically accessible to all, the mission of the School-Based Health Care Policy Program is to level the playing field in healthcare accessibility by making school-based health care “financially stable, available, and accessible to children and families, and supported as a consumer-centered model of quality care throughout the United States” (“Policy Program,” 2011). Families that are either unaware of the care they need to provide or cannot physically or financially attain it may feel immense pressure to keep their children healthy even though they do not have the resources to do so. An example I see firsthand is how the nine-year-old that I tutor lacks access to optic care. She has voiced complaints about not being able to see long-distance, but when I ask her about having had an eye examination, she gives me a puzzled look. I assume that either her family’s insurance does not cover an eye exam or eye exams for the children have been overlooked because of more pressing needs. With the implementation of school-based health centers, some of the responsibility to provide healthcare for children will be taken from the hands of parents and placed in the hands of healthcare providers at schools. Although, as Basch (2011) explains “it is neither reasonable nor realistic to expect that, on their own, schools can close the gaps in education or eliminate health disparities among the nation’s youth” and that families, communities, health care systems, legislators, media, and economic policy all play essential roles, 50 million students spend the majority of their day at school. Thus, schools represent social institutions with significant power to shape the youth generation (p. 594). Still, the implementation of school-based health centers does not mean that parents will lose control over their children’s health. In fact, they will have an easier time attaining the health care that they need for their children. In their study, Foy and Hahn (2009) found that not only do government funded school health centers help parents attain care for their children, but they also do so in a more timely fashion, helping children “stay in school and improve academic outcomes, increase the use of well child services, improve immunization rates, and reduce the use of expensive emergency room visits.” Whereas low-income families would normally wait for five hours in an emergency department that treats patients based on acuity, school-based health centers give children an opportunity to receiving primary care. In a study conducted in California at a school-based health center, first-graders were not allowed to come to school if they did not have a complete physical examination; however, between 2004 and 2008 when health centers were opened in schools, the mean number of days that first graders were excluded from school decreased (Foy & Hahn, 2009). This statistic indicates that these first-graders lacked access to a physical examination but were likely to complete them were they given the resources to do so. Even though this is just one application to a small population of students, we might draw the conclusion that availability of physical examinations in schools makes it much more likely for children to receive treatment annually. As access to eye exams improves education by ensuring that students can see in the classroom, physical examinations ensure that minor health concerns are addressed to optimize school attendance.

School-based health centers increase attendance by not only catching illness early and addressing minor medical problems but also by treating students with chronic medical problems such as asthma.  In a study completed from 1980 to 1999, disparities in access to asthma specialty care and follow up care for asthma were found between various racial and cultural groups (Shields, Comstock, & Weiss, 2004). Latinos were 39% less likely to see an asthma specialist than whites, demonstrating “important differences in the process of care experienced by racial/ethnic subpopulations within a Medicaid population, which may help explain differential outcomes” (Shields et al., 2004). For whatever reason this disparity exists, school-health centers are trying to address the problem that one portion of the population is receiving better healthcare than another. Similarly, in an experiment that tracked follow-up care at hospitals in seven inner-city areas, data showed that minority children face greater barriers in obtaining healthcare access (Shields et al., 2004). Again, because of various unidentified socioeconomic factors, a section of these cities’ populations was unable to receive follow up care. Increasing the treatment of asthma and related illnesses in patients in school-based health centers likewise decreases the number of hospital visits per child. Simply put, healthy children means educated children because of the decrease in absenteeism. Students with chronic medical conditions will not miss as much school when they are able to receive medical care in the educational setting.

Many schools offer guidance about safe sexual practice, substance use, and healthy relationships, but this guidance may merely skim the surface of the many factors that may impact a student’s future (Basch, 2011). Untreated traumatic stress, aggression, violence, hunger and food insecurity, homelessness, and risky sexual behavior that children face, especially in underprivileged neighborhoods like East Boston, contribute to disciplinary consequences, absenteeism, and disengagement from the learning community (“Education and Health”). The school-based health centers not only provide physical health funding, but also mental health funding (“Policy Program,” 2011). Schools should be receiving money to put towards students’ mental health care in addition to their physiological needs.

Another important mission of the school health centers is to bridge the gap between medical professionals, teachers, and parents (Basch, 2011). A combination of insight from the three can provide comprehensive care for a child. Similar to how Lisa Delpit proposes that teachers have a real understanding for cultural and racial backgrounds of students by collaborating with parents, it could be wise for schools to take a real interest in students’ lives at home and professionally address these problems (Gresham & McCage, 2008). The following is from an article that discusses how a certain amount of school involvement is crucial to reducing disparities in students’ health:

Linkages between categorical health curricula (eg, dealing with violence and teen pregnancy prevention) can optimize the use of curricular time by recognizing that reducing susceptibility to these different problems requires learning and practicing the same set of mental and social-emotional skills (eg, self-regulation, dealing with social pressure, communicating assertively but not aggressively) (Basch, 2011, p. 596).

The article discusses how only a professional health coordinator is aware of available resources needed in addressing the impact that certain stressors have on a student’s emotional well-being. School-based health centers increase access to professional counseling and take an interest in the mental health of children because it will undoubtedly affect their abilities to focus and perform well in the classroom.

How is standardizing the accessibility to healthcare beneficial to academic success of children? The effectiveness of education is optimal when inequalities are minimized. Biases and prejudices concerning religion, culture, or race hinder students’ abilities to learn. Similarly, the unfavorable aspects that recognition of inequalities presents, such as stereotypes, can develop from healthcare inequality. Our daily lives show us how understanding and appreciating our differences, whether racial, ethnic, or religious, is crucial to the functioning of any workplace or institution. Though we should be culturally competent of children’s varying beliefs just as we should of their religion or race, it is in the school’s best interest to provide equal care access for all. Underprivileged areas deserve school-based healthcare centers because they are as deserving of equal healthcare as high-income communities are. With equal levels of care for all students, they will have a decreased level of unhealthy competitiveness but will still be able to embrace cultural differences not related to socioeconomic status. A child’s healthcare can be more successful with school-based health centers because income and financial standing will not affect the amount or type of care a child receives. Reducing the disparities in healthcare would contribute to decreased absenteeism in school and a more beneficial educational setting. It would be in the best interest of my mentee’s school, and other schools similar to it around the world, to implement school-based health centers so that receiving healthcare is no longer a privilege, burden, or obstacle for her and students like her but a right and a contributing factor to their academic success.

References

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Gresham, M., McCage, C. (2008). Education Matters. New York: Pearson Education,
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Shields, A. E., Comstock, C., Weiss, K. B. (2004). Variations in Asthma Care by
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