To build new facilities, Oakland and Los Angeles are tapping a combination of voter-approved bond money, fees from Medi-Cal and health insurance reimbursements and philanthropic dollars. Health advocates hope these efforts spur similar initiatives around the state.
California lags behind many other states in the number and scope of school-based health services, despite evidence that children who use school health centers have better health and education outcomes. Out of nearly 10,000 schools in the state, only 176 school health centers exist for more than 6 million children.
Eight centers will be built in Oakland ? added to seven existing ones. Some of the operating costs will be covered by a $15 million grant from New York-based Atlantic Philanthropies and $6 million from Kaiser Permanente awarded last fall.
Construction is being underwritten by a bond measure approved by Oakland voters in 2006. Los Angeles Unified is building 17 health centers, complementing the 32 it established over the last several decades.
More than four years ago then-Gov. Arnold Schwarzenegger announced a plan to add 500 health centers at elementary schools throughout California, but not a single clinic was established as a result of his pledge.
The initiative foundered because of the state's failure to pass its own health reform legislation, its deepening budget crisis, and lack of follow-through from the governor's office and state Legislature, experts in health policy said. After approving the School Health Center Expansion Act in 2008, lawmakers declined to appropriate any money for the program.
Last month the state earned a D+ for children's health coverage in the 2011 California Report Card issued by the Oakland-based advocacy organization Children Now. Health educators worry that school-based health care is unlikely to be high on Sacramento's policy making agenda anytime soon, even though public health officials are convinced of its importance. Gov. Jerry Brown mostly ignored health issues in an otherwise detailed policy platform during his 2010 campaign.
"We continue to believe in the benefit of additional school health clinics and would hope resources to support this program would be available in the future," said Al Lundeen, spokesman for the California Department of Public Health.
In California, only half of school districts even have a school nurse, according to the California School Nurses Organization. At schools that have them, nurses typically rotate on a part-time basis from school to school and are able to meet only the most immediate health needs of students.
School health centers in California could get an additional boost from the federal health reform law, which includes $200 million for construction of school health centers nationwide, the first time Washington has provided funds for this purpose. Local school districts and health providers can apply for up to $500,000 for new construction, equipment or renovation of existing facilities.
The need is greatest among high school students, the population least likely to visit a doctor's office, experts say. Focus groups in Alameda County showed that students prefer to use school health centers because they are free, confidential and usually operated by youth-friendly staff.
A mountain of research has underscored their effectiveness. The American Journal of Public Health reported this fall that school health centers improve students' mental health while reducing pregnancy and sexually transmitted disease rates. The centers also help promote better eating habits, increase immunizations and lower Medicaid costs. Recent studies show improvements in the grade point averages of students who use mental health services in school clinics and in the attendance of students who took advantage of their medical services.
At Oakland High School, the services offered by its health center are scattered among four different classrooms. Medical services are provided in several tiny rooms. The exam room is barely larger than a closet. But all the services soon will be brought together under one roof in a much larger facility under construction in the shell of the abandoned auto shop in front of the school. It will be named Shop 55 as a reminder of its prior history.
Tenth-grader Bethany Saetern feels much more comfortable going to the health center than a regular doctor's office.
"Everyone is in their comfort zone," Saetern said, referring to its casual atmosphere. "They ask you if you need anything, they help you a lot in school, with life and everything."
When she started falling behind on class assignments, she got extra help from the counselors at the health center, and "my grades are going up," she said.
Like many school health centers, medical services at Oakland High are provided by a community-based clinic, in this case Asian Health Services, in conjunction with the East Bay Asian Youth Center. As a "federally qualified health center," the community clinic is key to the financial viability of the school facility because it can collect patient fees from students with health coverage and enroll uninsured low-income students in programs like Healthy Families and Medi-Cal.
So far this school year, nearly half of Oakland High's 1,650 students have used one or more of its services, according to health center director Susan Yee.
Some communities resistant
As Oakland expands, some communities have resisted school health centers, fearing they will provide birth control and abortion advice without parental permission. Under California law, these are classified as "sensitive services." Health care providers, whether on or off school campuses, are barred from sharing information with parents about the care their children may have received, at least not without their permission.
Dr. Suzanne Nguyen, who works at the Oakland High clinic, says these arrangements are essential for public health reasons alone. "By providing confidentiality and ease of access in an environment they feel they can trust, we are able to successfully combat those public health diseases that are out there, like Chlamydia, gonorrhea and HIV."
She said she regularly has been able to keep pregnant girls from dropping out by carefully managing their class schedules, scheduling doctor's appointments so they don't interfere with schoolwork and, if necessary, providing mediation with upset parents.
"We want to be a safe haven for them," she said.
The school clinics reinforce a push by Oakland's superintendent of schools, Tony Smith, to turn schools into community-based institutions that provide a range of services ? not just educational ones.
In addition to the benefits to students, school districts have a financial reason to offer on-campus health services: Schools receive funds from the state based on each day a student attends classes.
Each year, for example, California children miss 847,000 days of school because of dental problems alone. Health advocates say absentee rates could be drastically reduced if students didn't have to leave campus for medical appointments.
But with the state still facing a grim budget future, local communities will have to come up with their own funding mechanisms to treat chronic conditions on school campuses,
That is what happened in Alameda County in 2004, when voters approved Measure A, which raised sales taxes by a half-cent and now provides $1 million each year for health programs in 17 schools. In San Francisco, the school district and city jointly invest about $7 million in 17 wellness centers and other health programs at each of its high schools and six of its middle schools, in part through the Public Education Enrichment Fund approved by voters in 2004.
Now health advocates are hoping funds from the federal health reform law for school health centers will help spur further growth in California.
"What we would really like to see is that school health centers become part of how health care is delivered to kids, so when you think of schools, you think of the library, the gym, and the health care center," said Serena Clayton, executive director of the California School Health Centers Association.
California Watch is a project of the Center for Investigative Reporting. Contact Freedberg at firstname.lastname@example.org