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Juszczak: School-Based Health Centers Play a Vital Role

Amy, 16, came into the school-based health center at her high school complaining of frequent urination and extreme thirst. The nurse practitioner at the school-based health center tested her blood sugar and found that it was 445 — more than three times a normal level. After contacting Amy’s mother, the school-based health center sent her to the emergency room. She was hospitalized and diagnosed with diabetes.

Amy’s school-based health center not only played a vital role in diagnosing a significant health condition, it helped her manage her diabetes. The staff also set her up with mental health counseling, treated her asthma and helped her to get her insurance reinstated when it was canceled. The school-based health center has been instrumental in coordinating Amy’s medical care so that she can stay in school, learning.

All children and adolescents deserve access to the care they need to thrive. Unfortunately, a study by Yale University researchers published recently in the journal Health Affairs found that diabetes affects a young person’s ability to finish high school and future wage-earnings potential. High school dropout rates are 6 points higher for diabetic students, and they can expect to lose more than $160,000 over their working life.

The researchers warn that waiting until the onset of clinical symptoms might be too late to mitigate or reverse the negative effects of the disease on human capital and workplace success. They recommend a stronger push for in-school prevention and screening efforts to reduce the number of undiagnosed cases of diabetes.

The American Diabetes Association estimates that one in six children are pre-diabetic, making school-based health centers the ideal location to find and evaluate those at risk. School-based health centers are a cost-effective investment, proven to reduce inappropriate emergency room use, increase use of primary care and reduce hospitalization rates, particularly for hard-to-reach populations.

But limited funding makes it more difficult for school-based health centers to reach patients like Amy.

Across the country, more than 2,000 centers provide high-quality, comprehensive medical care, mental health services, social services and youth development to 1.7 million students. A majority of them manage their patients’ chronic conditions and provide preventive care that includes nutrition counseling and obesity prevention. These services are offered without concern for a student’s ability to pay and in a location that meets children and adolescents where they are: at school.

The school-based model is recognized as a vital component of the health care safety net for kids. Health and Human Services Secretary Kathleen Sebelius has said: “I can’t think of a better way to deliver primary care and preventive care to not only students but their families than through school-based clinics.”

The 2010 health care law provided $200 million in funding for construction, renovation and equipment for school-based clinics. The first two rounds of grants — awarded in July and December of 2011 and totaling more than $109 million — were disbursed to 323 community and academic health centers, hospitals and public health departments across the country.

The money is being used to build new and expand existing facilities, as well as to purchase mobile health units and specialized equipment for telehealth and dental services in schools. The Health Resources and Services Administration estimates that the capital infusion will enable school-based sites to expand service capacity by 50 percent.

While it is wonderful that more communities will have school-based clinics (and existing clinics will have better equipment), centers are still in critical need of federal support for operations. In addition to receiving capital funds, school-based health centers also became a federally authorized program through the 2010 law. The authorization allows for federal funds to be used for training, management and operation of programs and salaries for health professionals. Until funds are appropriated, however, there remains no federal operations support for school-based health centers.

Federal funding for operations will build the capacity of school-based health centers to provide prevention activities and diabetes screenings, allowing them to catch students even earlier. We are asking that the $50 million be allocated this year to ensure that students such as Amy don’t fall through the cracks — hurting their health and their ability to succeed in school and in life.

Linda Juszczak is president of the National Assembly on School-Based Health Care.

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