Care at School Health Clinics Flourishes, but Foundation Support Dwindles

Scott Ramsey is leading the typical life of a freshman at North Carolina State University: He’s studying hard and making sure to leave plenty of time for his favorite athletic activity — roller hockey. But that doesn’t mean he or his family have forgotten that he nearly died when he was a junior in high school.

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Just minutes after Scott set a school record for chin-ups at McMichael High School in Mayodan, N.C., he suffered a heart attack and stumbled to the gym floor.

He was given cardiopulmonary resuscitation by medical professionals at the school’s own health-care clinic, and was later transferred to two hospitals before he fully recovered. Scott’s father, Dan Ramsey, says that if McMichael hadn’t had a professional health-care operation on the premises, his son would almost certainly have lost his life in the school gym.

While full-scale health-care clinics in the schools were once a rarity, now more and more students are gaining access to the same kind of professional care that rescued Scott Ramsey. More than 1,150 in-school clinics exist today, double the number just four years ago, according to a study by Making the Grade, a project that received $17.5-million from the Robert Wood Johnson Foundation in 1993 to encourage states to find ways to finance the clinics.

The school clinics treat ailments as mundane as ear infections and upset stomachs but also as complicated as alcohol abuse and mental health. Many rely on the services of social workers, medical technicians, and doctors who specialize in serving adolescents — an age group that experts say often gets far too little treatment, either because family finances are tight or because the teen-agers are leery of admitting to health concerns.

While the Robert Wood Johnson Foundation was the first major grant maker to pour money into developing the clinics, numerous other grant makers and government agencies have begun to pay for such medical units — in part because they say they have been impressed by their achievements.

Several studies — including an evaluation by Congress’s General Accounting Office in 1994 — have found that students who go to schools with clinics are better able to deal with chronic health problems like asthma and make far fewer trips to hospital emergency rooms than those who attend schools without the clinics.

The Robert Wood Johnson Foundation has a long history of trying to improve health-care for children. In 1978, it created the National School Health Program, which helped put nurse practitioners in the schools. Four years later, the foundation made grants to encourage the consolidation of health-care services for poor kids, so that their parents wouldn’t have to take them to too many different places to receive treatments and so that they could get better-quality care.

Several of the grantees ended up creating in-school health clinics — an idea that Robert Wood Johnson officials say proved to be especially effective. As a result, in 1986, the foundation created the School-Based Adolescent Health Care Program, the first major grant-making program to focus on creating such health clinics in schools across the country.

Now that the clinics have become so numerous, many of the grant makers that have supported the clinics hope that state governments, local school districts, or local hospitals will start paying for them and keep them running for the long term.

The W. K. Kellogg Foundation, which has put $4-million into school health centers in Detroit, has given $500,000 to the 940-member National Assembly of School-Based Health Care to help centers learn to operate without private grants.

The school clinics — which each typically cost $150,000 to $250,000 a year to run — have won endorsements from numerous medical professionals.

“I’m very much in favor of clinics in schools for kids,” says former U.S. Surgeon General C. Everett Koop. Often teen-agers feel too old to see a pediatrician whose waiting room is full of wailing babies, says Dr. Koop, but their parents deem them to be too young and healthy for a regular internist.

Adolescents fall through the cracks, Dr. Koop says. “They don’t have very good health care.”

Nevertheless, the push for school clinics has not been free of resistance.

In the late 1980s and early 1990s, as the number of clinics grew, so did opposition to them. The controversy centered primarily on whether the clinics were providing contraception and reproductive health-care services. Critical opinion articles appeared in national newspapers, some of the clinics received bomb threats, and some opponents spread false rumors that abortions were being performed at the school clinics.

In addition, some opponents said they feared that the school clinics were inappropriately interfering in the relationships between parents and their children.

Today, much of that criticism has been quelled — but it has not disappeared entirely.

Here in North Carolina, which has clinics in 39 schools, ranking it among the 10 states with the largest number of such units, the clinics play a big role not only in helping to make sure kids are physically healthy, but also in tending to their emotional and psychological needs. Many of the clinics collaborate with social-service organizations to provide a wide range of help to youngsters.

For instance, at Grimsley High School, in Greensboro, the Family Life Council sponsors a program called “Wise Guys” that is aimed at young people who teachers think are likely to start abusing drugs and alcohol or get involved in inappropriate sexual activity or violence. It also runs a group for teen-age mothers to share their feelings and frustrations. In addition, the Guilford County Area Mental Health Program offers six hours a week of therapy to youngsters at the school.

It has been easier, school officials say, for such groups to bring their expertise to the students, rather than relying on students to trek elsewhere.

No matter how effective the clinics are reported to be in dealing with the complexities of adolescent health, they are facing new challenges to their financing. Foundations like Robert Wood Johnson, which is phasing out its support of individual school clinics, are now working to help clinics develop new sources of revenue to insure their existence.

“As with other health-care provider organizations, sustainable funding remains an issue,” says Denise Chuckovich, the president of the National Assembly on School-Based Health Care. While the number of clinics is growing, she said, “traditional sources of support for school-based health centers have declined, requiring centers to find new funding sources.”

One way many of the centers have survived is to start billing Medicaid and commercial insurance companies for the services they provide to youngsters who have coverage, the survey conducted by Making the Grade found.

Many of the clinics are also receiving increased support from local hospitals, especially non-profit institutions that are required to demonstrate to government authorities that they are providing services that benefit their cities and towns.

Some clinics are optimistic that businesses will be another area of support. Eugene Cochrane, a vice-president and director of health services at the Duke Endowment, which has spent more than $2-million on a dozen school health centers in North and South Carolina, hopes that more businesses will start paying for the clinics. He believes that businesses have a financial incentive: They will save money if parents don’t have to leave their jobs to take their kids to doctors and hospitals for care.

Julia Graham Lear, director of Making the Grade, predicts that the clinics will eventually have an easier time winning the financing they need. “We’re seeing a new development of private dollars,” she says. “The idea has a lot of resonance out there.”