School-Based Health Centers Serve More Than Just Students

By Chris Richard

When Compton’s Dominguez High School celebrated the opening of a new campus wellness center last month, it was a timeless moment.

The marching band blared and thundered. Drill teams members pranced and whirled, just as they’ve been dancing and high-kicking on high school campuses for generations.

But the scene in the wellness center itself offered a glimpse of what the future could be for school medical services in California.

There was a student in for routine blood work. In the next cubicle, a mother had brought her young son, who had the flu. And neighborhood resident Jonetta Stewart, 76, had come seeking relief from frequent vertigo and headaches.

Physician’s assistant Rachel Damicali checked Stewart’s blood pressure. It was very high.

Dimacali says she sees a lot of variety in her fast-paced days.

“My last patient was a 4-year-old kid, and now I’m seeing Jonetta for her blood pressure management,” she said. “So, we see a whole range: from chronic disease to urgent care visits to just physical exams.”

Just in time for the implementation of President Obama's health care overhaul coming Jan. 1, a handful of California schools are starting to open campus-based wellness centers like the one at Dominguez, offering free and low-cost services not just to students, but to entire neighborhoods, to people of any age.

It's part of the health overhaul's emphasis on development of so-called “medical homes,” in which providers agree to give each patient wide-ranging medical services, with an emphasis on preventive care.

"This is better than a doctor's office" says Jim Mangia, CEO of St. John's Well Child and Family Center, which runs the Dominguez wellness center.

“This is comprehensive medical, dental health, mental health, enabling services, care coordination, case management, social workers," Mangia added. "So this is a doctor’s office on steroids.”

Los Angeles Unified School District is one leader in embracing school centers. The district will have 14 of them within the year, says Kimberly Uyeda, Los Angeles Unified’s director of student medical services. To determine where to place the centers, district officials used computerized maps to identify “hot spots” for social and health ills including exposure to violence, poverty, obesity and high rates of sexually transmitted disease, Uyeda said.

Uyeda points out that students are often affected not only by the health and wellness of their families, but also by that of the broader community. “So if we don’t either address ... the families and the communities, we’re only going to get so far with students.”

Money is a big issue

The school board has built the centers from bond funds. But money to keep the clinics operating is harder to come by.

The nonprofits that run the wellness centers bill Medi-Cal and other public insurance programs for the services they provide. But startup costs of up to a half-million dollars per clinic can be harder to recover. Health care advocates are lobbying Congress for support.

L.A. County Supervisor Mark Ridley-Thomas is a strong backer. As a state senator, he wrote the legislation establishing a state grant program. At the Dominguez High School opening, he vowed continued support.

“The more school-based health clinics that we build, the better this community and this broader area will be.”

Los Angeles Unified would like to keep building, too. Someday, the district would like a center on every high school campus.

Alex Briscoe, director of the Alameda County Health Care Services Agency, said it’s important to proceed carefully. Privacy is a key concern.

“If adolescents think their parents or their friends’ parents are going to be in the waiting room when they come in," Briscoe says, "they’re not going to seek these services that have a huge stigma around them, like mental health, like alcohol and drugs, like reproductive health.”

Protecting the privacy of patients could be as simple as providing separate entrances, waiting and treatment rooms for students and the public, Briscoe said. Alternatively, the centers might only be open to the public after school hours, he said.

If such precautions are followed, Briscoe said he’s very excited about the potential for expanded services.

“We think that schools can be a center of community building if you have things that people need there,” he said.

“And comprehensive health services is a really good one.”

Listen to Chris Richard's report: