School-based health centers improving access for youth: School settings a boon to student health
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* Charlotte Tucker

During a recent office visit, Robert Wolverton, MD, provided a young woman with emergency contraceptives, helped her restart regular birth control, evaluated a rash she was concerned about and investigated the cause of her ear pain.

Some doctors discourage patients from discussing multiple problems during one appointment, Wolverton said, but that recent patient was like many he sees at the Teen Wellness Center at T.C. Williams High School in Alexandria, Va. She had health concerns and she wanted to handle them quickly and confidentially.

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Chrystal Christmas, a coordinator at a school-based health center at a high school in Las Cruces, N.M., checks the throat of a visitor during an open house event in 2008.

Photo by Shari Vialpando, courtesy The Las Cruces Sun-News/AP

“It’s about breaking down barriers to care,” Wolverton said, discussing the treatment provided by the Teen Wellness Center, a new school-based health center that opened in August.

Nationwide, the number of school-based health centers is climbing, according to Linda Juszczak, DNSc, MPH, MS, CPNP, executive director of the National Assembly on School-Based Health Care. The City of Alexandria has had a wellness center for adolescents for more than a decade, but the previous center was located in a trailer off school property that students had a hard time accessing, Wolverton said.

The new center is one of more than 1,900 school-based health centers nationally operating in 48 states and territories. Such centers provide access to primary health care, mental health services, immunizations, sexually transmitted disease testing and a host of other services to about 2 million children and youth, regardless of ability to pay.

The centers are an attractive option for young patients seeking health care, as no patient will be turned away because she or he is not able to pay, said Terri Wright, MPH, director of APHA’s Center for School, Health and Education. In some places, school-based health centers open their doors to adults during non-school hours and bill third-party payers for their care as a way to make ends meet, Wright said.

The growth of school-based health centers such as the one in Alexandria may speed up in the near future, thanks to the health reform law passed last year.

The Patient Protection and Affordable Care Act includes two provisions for school-based health centers — language authorizing a federal school-based health centers grant program, and an emergency appropriation that would provide $200 million for centers over four years. The Health Resources and Services Administration recently sought applications for construction and the purchase of equipment for school-based health centers using funding provided for in the Affordable Care Act. The maximum grant award is $500,000 per application.

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Henry Lopez, right, director of the Health Resources and Services Administration’s Office of Special Population Health, speaks with Oliver Babirye, a student in an LPN program in Alexandria, Va. Babirye and her fellow students served as tour guides at a February event celebrating a new Teen Wellness Center at T.C. Williams High School.

Photo by Charlotte Tucker

Margaret Kirk, one of the mental health counselors at the Alexandria Teen Wellness Center, said having her office in the school means significantly fewer cancellations. If a student with a scheduled appointment does not turn up, she can go find her or him in class.

The T.C. Williams High School center is open to any city resident between the ages of 12 and 19. Though it is located in the high school, the center is open to all teens, regardless of where they attend school, as long as they can prove they live in the city.

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Kasey Gill checks a patient at a school-based health center in Tioga, La., in 2006.

Photo by Tia Owens-Powers, courtesy The Town Talk/AP

Wright said school-based health centers provide access to medical care for students who might otherwise go without. By keeping children and adolescents in school, school-based health centers reduce absenteeism and give students a place where they can feel comfortable seeking care.

Wolverton and other staff members, including a nurse practitioner, two mental health counselors and a nurse assistant, are paid by the city, and the center is run by the Alexandria Health Department.

Alexandria City Public Schools provides the space for the center, which is adjacent to the career counseling center and just down the hall from the more traditional school nurse’s office. Wright said one critical design aspect of the center is a door to the outside so that community members can enter without going through the school.

“That external entrance is crucial,” she said. “If they did not have it, it is unlikely that center would serve anyone outside the school population. Principals don’t want strangers walking through their building, so they put an external door so young people from the community can also use that health center. That was brilliant.”

The center, which is open from 10 a.m. to 5 p.m. year-round, includes two exam rooms and a laboratory that can do pregnancy tests and 15-minute HIV tests, as well as offices for mental health and health education. Pamphlets in English and Spanish that feature topics ranging from birth control and STDs to dating violence and gangs hang on the walls.

Studies have shown that students who used school-based health centers had a 50 percent decrease in absenteeism and a 25 percent decrease in tardiness two months after receiving school-based mental health counseling, according to the National Assembly on School-Based Health Care.

The T.C Williams Teen Wellness Center requires written parental consent for treatment of minor illnesses, immunizations and physical examinations required for schools and participation in activities such as sports and employment. However, Virginia law permits a number of services to be offered without parental consent, including pregnancy testing; diagnosis and treatment of sexually transmitted diseases; reproductive health services, including the provision of birth control methods; and mental health and substance abuse counseling.

Staff at the Teen Wellness Center are adamant that they will not discuss a student’s treatment at the center without the student’s permission.

And that’s the way students like it. Brianna Tarbush, 16, said she has visited the Teen Wellness Center for immunizations and she said her fellow students are much more likely to seek help with medical issues if they know their concerns will be private.

“It makes them want to go more, knowing that they don’t have to worry about it,” she told *The Nation’s Health.*

Itzel Romero, a senior at T.C. Williams High School, said she likes that she does not have to miss school to go to a doctor’s appointment and that she feels like she can create a bond with her doctor.

“I can talk about anything with him,” she said. “He’s more easy to talk to than parents sometimes.”

For more information on school-based health centers, visit [www.nasbhc.org](http://www.nasbhc.org/).

*   Copyright The Nation’s Health, American Public Health Association