Health Clinics in Schools

Primary health care clinics are becoming increasingly common in the U.S., and many of these clinics are based in public schools. There are about 1,100 school-based clinics in 45 states and Washington, D.C. These clinics often serve not only the school population but also the community around them, providing affordable health care to people who might not otherwise have access to care.

History

• According to the Robert Wood Johnson Foundation (RWJF), the first school health clinic started in 1967, when a Massachusetts pediatrician sent a nurse practitioner to provide care in a local elementary school. Other areas in Massachusetts and then other cities throughout the nation followed suit in the next decade. These clinics were made up of nurse practitioners and social workers, as well as part-time physicians and counselors.

Need

• The need for greater health care in schools became apparent in the mid-1960s, as low-income children continually received less medical care, according to RWJF. Providing that care in schools made sense because of location and because students often told their teachers about problems, including depression and abuse, that a health clinic could address

  As these clinics grew, they served a greater percentage of students in the school for a wide range of problems beyond fevers and sore throats; health care providers dealt with mental health issues, sexually transmitted diseases and pregnancy, especially as more clinics opened up in middle and high schools.

Popularity

• Intermountain Healthcare, a nonprofit health organization in Utah and Idaho, runs or provides funding to several school-based clinics. More than a quarter of the almost 27,000 clinic visits to the seven Intermountain clinics were at the three school-based clinics. An Intermountain foundation provides funding to two other school-based clinics, which together served about 4,000 people in two areas.
  These clinics are open to the surrounding community as well. Many of these school clinics offer not only primary care but also urgent care and dental care. Doctors and dentists work once a week, and psychologists come in to meet the mental health needs that are outside of a social worker's purview. Health care providers can refer patients to specialists when needed.

Target Population

• Most of these clinics are in low-income areas and focus on people who don't have health insurance or have many other options for care. Intermountain's 2009 annual report says about 60 percent of clinic patients said they would go to the emergency room, while another 13 percent said they would not seek care.

  At Read Elementary and Middle School in Bridgeport, Conn., more than two-thirds of the students are minorities; many come from homes in which English is not the first language and the parents are unemployed. A majority of the school's students are enrolled at the health clinic and can get primary care, including pregnancy tests, Pap smears and mental health care at the clinic. The students most likely would go without such care without the school clinic.

Money Matters

• Intermountain funds its clinics, and the city of Bridgeport pays for its school clinics, but most are funded by grants and partnerships among hospitals, school districts and local governments. Many have negotiated special contracts with Medicaid so clinics can be reimbursed for the care for low-income children.

  Patients pay for services on a sliding fee scale, depending on their incomes.