School-Based Health Clinics

 

Q. I can understand people's concerns about school clinics being a way to sneak condoms to teenagers behind their parents' backs, or refer them for abortions to avoid all the problems of teenage pregnancy. Those are political hot potatoes. But let's face it: sex is going on among our youth, and STD's, pregnancy and abortion are rampant in our high schools. Besides, there are tons of OTHER health issues of low-income teenagers that aren't being addressed the way the health system works now. So what's wrong with school-based health care?

 

            A lot of people, including a lot of physicians, would say nothing is wrong with school-based health clinics. They support them when they are positioned in areas where the current medical needs of low-income, uninsured adolescents aren't being met by their own parents.

 

At last count there were more than 1,100 school-based health clinics in place in American schools. Each one tends to employ a school nurse or public-health nurse, a nurse practitioner, a mental health counselor, and a receptionist, offering students confidentiality, convenience of appointments, and, through Medicaid and other managed care programs, often little or no expense. Though the clinics are geared toward low-income teens who have no health-care alternatives, all students are eligible for clinic services. Often the clinics lead school-wide participation in wellness activities such as screenings and health fairs.

 

But you're right. The controversies swirling around school-based health clinics go far beyond reproductive health care issues to:

 

• The undermining of parental authority, replacing it with governmental employees in charge of a child's health status in a "captive audience" type setting.

 

• Parents sign blanket consent forms for their child to visit the clinic for routine purposes. They probably do not realize that they are giving away their parental rights and power of attorney status to clinic and school personnel, and will be neither informed nor their consent sought for much more serious procedures or prescriptions that may happen later.

 

• Promises of reductions in the teenage pregnancy and STD rates if taxpayers allow a clinic in their school have almost always fallen far short. School clinics advocates themselves admit that kids do not decrease their risk-taking activities, including sex, despite having the clinic supposedly promoting better health practices to them. Though it is hard to get reliable statistics, it appears that the presence of a clinic greatly increases the abortion rate at any given school.

 

• There is a real possibility of massive data collection and mental-health profiling on students and their families, with a high risk of incorrect "profiling" with all the problems that causes, and invasions of privacy.

 

• There will be high pressure on the school system to identify children as being "at risk" medically or psychologically so that the school system can get more Medicaid funding for medication or disability services, leaving the child with a lifelong "label" that may not even be correct.

 

• Medicaid dollars aren't limited to medical care; they can also pay for psychological services like bogus self-esteem "group work," social work, nursing, hearing and vision screening, transportation and educational hardware and software, all at taxpayer expense but with little taxpayer oversight, since Medicaid oversight is so lax and this funding skirts the school board accountability process

 

• There will be scant local school-board or legislative oversight, because the funding is through Medicaid. That virtually guarantees spikes in health-care costs, even though the local school district won't show those extra costs on its books.

 

• There are often non-government organizations such as foundations involved as "partners" that donate money for start-ups. Taxpayers will typically have to pick up the costs in later years when the grants run out. While nothing nefarious is suspected, it is important to note that many of the start-up donors are hospitals or foundations affiliated with companies that employ the type of personnel the clinics will be staffed with, and sell the very same health-care products as the school-based health clinics will be dispensing.

 

 

Bottom line: health care is the job of moms and dads, not schools. Clinics end-run parents. They block our chance to nurture our own children's bodies. They enable the weak parents among us to neglect our children even more. They push us out of the loop. They go behind our backs.

 

It is excellent public policy to find ways to serve the medical needs of disadvantaged teenagers. But is that the job of the schools, when the "solution" appears to be creating so many more problems? It could be argued that school-based health clinics are just one more example of "mission bloat," in which we're forcing our schools to take on yet another distraction to keep them from fulfilling their academic mission. And that's enough to make taxpayers . . . sick!

 

 

Homework: See the chapter, "The Health Education Connection" in the book, Government Nannies by Cathy Duffy. For a well-documented article by a physician on Medicaid and its spiraling influence on school operations, including school-based health clinics, see:

 

http://edaction.org/2000/000606.htm