Readin’, writin,’ math and, now, medical care

The unorthodox scenario is becoming reality for a small but growing number of school districts in Georgia forming school-based health centers. Not your traditional school nurse stations, these urgent care-type facilities run by doctors and nurses on school grounds are aimed at keeping kids healthier and from missing school for relatively minor ailments. Grants and other revenue sources cover the centers’ operating costs, with the schools providing the space.

At a time when schools have police officers patrolling hallways, offer free and reduced meals and after-school care as well as other services not directly related to classroom learning, some question whether it’s appropriate for schools to take on yet another role in the lives of children: medical provider.

“In order for us to help students be successful academically, they have to be in class and they have to be healthy,” said Harvey Oaxaca, principal at Lake Forest Elementary in Sandy Springs, which is expanding services at its health center. “We’re preparing students to be successful long-term. If you start off healthier, you’re going to end up more successful.”

Doug Craig, chairman for the Georgia Libertarian party, questioned whether schools should be conduits for student health care.

“I’ve heard very few parents saying, ‘I’d really like to have a miniature hospital at our school,’” he said. “Their (schools) number one job is not … to provide medical care, but to teach a kid how to read, how to write, those kind of things.”

Georgia has at least six school-based health care centers, with up to four more expected to start up this coming school year. Dozens more could be on the horizon as more schools explore establishing such centers, which typically operate as partnerships between districts and local health care providers, such as hospitals or other health centers.

To start the health center at Lake Forest Elementary – among the latest to open – education leaders sought a partnership with the Urban Health Program at Emory University and Family Health Centers of Georgia.

Oaxaca says the school realized many students were missing multiple school days due to lack of health care access. As a school that serves students predominantly living at or below the poverty level and with language barriers, education leaders say a simple trip to the doctor could take multiple days.

So the school brought the doctor to students. Since the center opened in August, the student absentee rate has decreased from 5.1 to 4.1 percent, Oaxaca says. The number of students sent home due to illness also decreased by half, from about 400 to 200 students. Close to half of the 980 students at the elementary school have used the health care center.

Fulton County school board members recently approved expanding the center, allowing younger siblings of students to be served – in addition to students and staff.

To get the center going, Emory, which has spearheaded formation of such centers in Georgia, helped find grant money and the medical providers to run the facility, as it has for others. A pediatrician is on staff as well as a nurse practitioner and a clinical social worker.

Dr. Veda Johnson, a pediatrician and director of the Urban Health Program at Emory, said it typically takes $250,000 to start a student-based health care center, and about $200,000 a year to keep it going. Centers are funded through a combination of grants, reimbursements for services and some federal funding. The school’s only cost, basically, is the cost of providing the space.

Students with some type of health care coverage can access the centers, but those who don’t have it aren’t turned away either. Parents have the option of paying on a sliding scale, based on their income.

Such centers are typically in low-income areas. Besides Fulton, in metro Atlanta there are also centers at Whitefoord Elementary, Coan Middle (recently merged with King Elementary) and Crim High school in the Atlanta public school system.

Dr. Veda Johnson, a pediatrician and director of the Urban Health Program at Emory, said some 30 communities in Georgia have received grants to explore forming school-based health centers. She expects up to four to open in Georgia in the coming school year but declined to say where because the parties are in negotiations.

“Education is a pathway out of poverty,” Johnson said. “Education is often a direct predictor of health … If you truly want to improve the health of children, you’ve got to help improve their academic achievement as well.”

“We work in tandem with the school because we have a shared vision — improving the academic success of children.”

Craig, the Libertarian chairman, had another concern: “Another signal I hate sending to our children is that government is the answer to everything. I don’t like having a small child thinking the government is no longer responsible for my education but also for feeding me. Now all of a sudden it’s making sure I get a Band-Aid on my knee.”

School-based health care centers have been around since the late 1960s, with close to 2,000 now operating across the U.S., but they're still relatively new in Georgia. The Affordable Care Act appropriated $200 million for 2010 through 2013 to support grants to improve and expand services at school-based health centers, according to the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services.

One issue that has sparked controversy in some communities, providing reproductive health care at school-based health centers, hasn’t cropped up in Georgia because schools aren’t allowed to provide such care, Johnson noted.

At Whitefoord Elementary on the east side of Atlanta, most students and staff have used its health center – which provides medical, dental and other health-related services — since its founding in the mid-1990s. School absences are low and kids don't have to go home for minor ailments, said Principal Timmy Foster.

“If nothing else, students say, ‘My mom says I need to go to the health center’ if they’re not feeling well,” Foster said. “Parents are more likely to send their kids to school because they’re able to see the doctor during the day.”

For Gwenneika Lawson, Whitefoord’s health center has helped her son, now 13, deal with his asthma. Her other three children, who attend the school, have also received top-notch care at the facility.

“When they get sick, they can just go to the (center), and I don’t have to stop what I’m doing and come to the school unless it’s a real emergency,” Lawson said. “It’s a good thing to have it inside the school.”