Elizabeth Dickson, MSN, RN, is a fellow in the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at University of New Mexico. Earlier in her career, she worked at a school-based health center (SBHC). This post is part of the “Health Care in 2014” series.
As a public health nurse, I have worked with children in schools for much of my career. From 2009 until 2013, I worked at a SBHC in New Mexico that was located in an alternative high school in southern Albuquerque. Although small, many students at this school came from families of mixed immigration status and had experienced high levels of street violence, alcohol and drug abuse and overdose, suicide, poverty and food scarcity, minimal health care access, and high teen pregnancy rates.
These kids saw and experienced more than many outsiders of the community could have imagined. The SBHC was open one day a week during school hours and employed a staff that included a nurse practitioner, a physician assistant, public health nurses, administrative staff and mental health counselors. I worked with an incredible team that provided many health services and screenings, including mental health support, in the limited time that we had.
Working at this SBHC opened my eyes to the possibilities of just what it could provide, especially to kids who have very little access to health care services. New Mexico holds some staggering statistics that gravely affect children’s health. It is rated 50th among the states for child well-being (New Mexico Voices for Children, 2013). It has one of the highest poverty levels in the country; approximately 31 percent of the state’s children live in poverty (New Mexico Voices for Children, 2013). And it has one of the highest teen pregnancy rates in the country (Kost & Henshaw, 2013). I witnessed what much of the research literature has documented, and I know the SBHC can be the bridge for many kids who are in poverty and at risk for tremendous health problems.
SBHC clinics provide much of the needed preventive and primary care service right at school, with clinical providers whom the kids know and trust. They “reflect the convergence of public health, primary care, and mental health care in a setting that students can easily access” (Zimmerman, Campisteguy, Parks, & Richardson, 2011).
The services SBHCs typically provide include but are not limited to well-child checks; health screenings for conditions like asthma, diabetes, and obesity; dental care; vision and hearing checks; mental health screenings and counseling for conditions such as depression and suicidality; and reproductive health services. And they can provide extensive health education and referrals to community services. They are often the entry point to care that many students may not otherwise see. When kids are healthy and can receive the health care they need to stay in school, they are absent less and do better in school. Individuals, families, and entire communities benefit. (New Mexico Alliance for School Based Health Care, 2013).
But despite well-documented success, SBHCs still struggle to raise enough funds from government, grants, and billable services to maintain the services they currently provide. The SBHC community is still waiting to receive funds authorized by the Affordable Care Act of 2010 for operational funding for SBHCs. Here in New Mexico, legislation will be proposed in 2014 to restore funding to SBHCs that was lost in 2009.
While some SBHCs can bill for services directly through their sponsoring organization, many cannot. Existing funding and revenue levels often limit the number of hours and days that an SBHC can operate and restrict services to preventive—as opposed to clinical—care. This despite the fact that the return-on-investment for SBHCs in New Mexico has been estimated at approximately $6 for every $1 spent (Ginn, Wubbenhorst, & Gluck, 2013).
This investment is often in preventative care, though, and its effect is difficult to measure. The impact comes down the road, in a generation of healthier adults with fewer physical and mental health problems, who are contributing more to their communities and to the greater economy. SBHCs can be the bridge many children need to a healthy and successful adulthood; they not only diagnose and treat students, but they also promote and encourage the kind of healthy behaviors we know make a huge difference.
My personal experience at an SBHC, and the potential I saw there to make a difference in health and health care, changed my professional focus and led me to pursue a doctorate in nursing and health policy at the University of New Mexico. As a fellow of the RWJF Nursing and Health Policy Collaborative at the University of New Mexico, I am hoping to focus my doctoral research interests and policy advocacy on the youth of New Mexico. I plan to study ways to advance public health policies, including those that support SBHCs, and that best support our youth, their families, and our New Mexico communities.
Learn about the National Alliance of School Based Health Centers.