A School-Based Clinic for Elementary Schools in Phoenix, Arizona

Article excerpt

Many children lack adequate health care as documented by the growing number of children not covered by family employee-sponsored insurance. According to the Children's Defense Fund,[1] the number of children without health insurance rose by 806,000 in 1993 for a total of 9.4 million. Dwindling federal support for Medicaid translates to lower income thresholds to qualify for health care assistance. In Arizona, if a family of four earns more than $5,590/year and is not on AFDC or food stamps, they will not qualify for government assistance through Medicaid. The gap between $5,590/year and a family able to afford health insurance continues to widen. Likewise, some families with health insurance or Medicaid fail to use health care services appropriately as well. Issues of education, transportation, chemical dependency, high deductibles, copayments, and inconvenience interfere with appropriate health care for children.

As a result of inadequate health care, children's ability to learn is compromised. Some children stay home from school and do not receive needed medical care. As a result, these children may experience prolonged school absences. In addition, delayed access to medical care may result in more serious (and more expensive) sequelae. Some sick children go to school due to unavailability of sick child care or lack of leave benefits for working parents. Once in school, they not only fail to attend to the learning process, they may expose other children to contagious illnesses.

Demographic changes in family structures and family roles portend the wisdom in rethinking the way health care is delivered to children, especially to children of the urban poor. Advantages exist to using schools as a delivery site since "schools are the one institution in society that has assured contact with children and youth and their families."[2] The National Health and Education Consortium (NHEC) found that "elementary school-based health centers can be a cost-effective strategy for addressing children's health and educational needs; that they can reach children and their families in a way most other community-based agencies and institutions cannot; and that the elementary school years are the time when active intervention can yield comprehensive, life-long benefits for children."[3]

The John C. Lincoln Elementary School Health Program represents a collaborative effort of a community hospital, a school district, and a private pediatrician's office to ensure all children attending five elementary schools had access to health care. The population served included five elementary schools in Phoenix, Arizona. The schools had an average enrollment of 856 (range 578 to 1,076) in 1994-1995. The schools were part of an inner-city school district with an enrollment of 24,813. The five schools had an average mobility of 52%. To qualify for the free lunch program, a family must have an income less than 200% of the federal poverty guidelines. Four of five schools were significantly higher than the school district with regard to number of children on the free lunch program (Table 1).

PROGRAM PLANNING

The John C. Lincoln Elementary School Health Program began providing health care services to children in January 1994. The program provided health care services to children with no medical home, children who did not have Medicaid or private health insurance. Some children with health insurance do not receive health care due to the family's inability to afford the deductible or copayments the insurance policy required. Also, some children on Medicaid (in Arizona, a managed care model) were not receiving services due to a variety of factors such as transportation difficulties, confusion about who their provider was, and family dynamics that resulted in failure to seek health care services appropriately. To ensure health care services were available to all children, eligibility for care was made simple. An eligible child was one the school nurse felt needed health care services and was not likely to receive those services elsewhere. …