Louis Freedberg, California Watch | This article appeared on page C - 1 of the San Francisco Chronicle | http://bit.ly/fonBkr
Brant Ward / The Chronicle - Tenth-grader Kendall Walton takes an eye test during a sports physical at the Oakland High School Wellness Center.
Sunday, January 16, 2011 - Two of the state's largest school districts are undergoing a major expansion of health centers on school campuses after promised help from Sacramento never came.
To build new facilities, Oakland and Los Angeles are tapping voter-approved bond money, fees from Medi-Cal and health insurance reimbursements, and philanthropic dollars. Health advocates hope the 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 are healthier and perform better in school. Out of nearly 10,000 schools in the state, 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 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 past 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 advocacy organization Children Now, in Oakland.
Health educators worry that school-based health care is unlikely to be high on Sacramento's policymaking agenda anytime soon, even as 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.
Few school nurses
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.
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.
At Oakland High School, the services offered by its health center are scattered among four classrooms. Medical services are provided in several tiny rooms. The exam room is barely larger than a closet.
Under one roof
All the services 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 history.
Tenth-grader Bethany Saetern feels 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. Now, she said, "my grades are going up."
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.
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.
Care boosts funds
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.
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.
California Watch is a project of the Center for Investigative Reporting. Contact Freedberg at firstname.lastname@example.org.