June 2000 • Volume 6 • Number 6
School-based health centers provide safety net for adolescents
Adolescents are the only age group in the United States with rising death and disease rates. Many engage in behaviors with serious health risks while clinging to their privacy and autonomy -- a combination that causes youth to fall through cracks in the health care system.
One solution is to catch kids where they fall: at school. Holley Galland, M.D., on the faculty at the Louisiana State University family practice residency in Baton Rouge, said school-based health centers can provide preventive services, ongoing treatment and counseling to youth who otherwise might not get appropriate health care.
"These centers were started to give kids access," said Galland, medical director for Health Care Centers in Schools, a not-for-profit organization that operates the eight centers in her area. "School-based health centers are often located in the areas where the need is greatest, so the kids come from families where they might not have someone at home to supervise; they might not have insurance."
An estimated 1,300 schools across the country house health centers for students and families, and more than half the states provide support for school-based health centers, according to Making the Grade, a grant program that supports community-state partnerships to establish the centers. The program's Web site (http://www.gwu.edu/~mtg/sh/intro.htm) spells out common features of comprehensive school-based health centers:
Holley Galland, M.D., examines a patient at a school-based health center.
- They are located in schools.
- Parents must provide written consent for children to enroll.
- An advisory board of community representatives provides oversight.
- Centers work cooperatively with school nurses, counselors, coaches, teachers, principals and staff to ensure the health center is an integral part of school life.
- A qualified health provider (hospital, health center, health department, group medical practice, etc.) takes responsibility for providing clinical services.
- A multidisciplinary team of nurse practitioners or nurses, clinical social workers, physicians and other health professionals cares for students.
- Centers provide a comprehensive range of services that meets the health needs of young people in the community.
Galland said the centers offer plenty of opportunities for FPs to get involved. "The wonderful thing about school health centers is they're a microcosm of family medicine," she said. "Kids usually come for acute medical problems, mental health crises or relational problems -- everything from fighting to not getting along well with their parents. They come in with a vague generalized problem, and you can help pinpoint it. So often a child will present with a stomachache, but it's really a psychosocial issue."
One of the toughest challenges is keeping parents in the loop, particularly when they work several jobs, abuse substances or just don't take an interest, Galland said. "We have parent liaisons to make sure parents are involved. They know where parents can go when we're closed. And I call or write a parent note for about 50 percent of the children I see. At the elementary level, we try to have a parent there for the first visit to the center."
Although critics of school health centers bemoan the lack of a personal physician, Galland said her centers strive to reinforce existing doctor-patient relationships and provide primary care for adolescents without physicians of their own. "It's very important to have a link with an ongoing primary care provider. If they have doctors, we try very hard to make sure they go to those doctors; we stay in touch with those doctors," she said. "The last thing we want to do is sever a good relationship with a doctor.
"But we also offer continuity, screening, immunizations, acute and chronic care, collaborative care with mental health providers and patient education. These are all things we focus on."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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