Funding Failure: Are healthcare & education really that different?

In this week's edition of Education Week, Mark Lieberman asks "Are We Asking Schools to Do Too Much?" His informative article goes on to highlight that since the 2008/2009 recession, school funding has been precipitously reduced while at the same time we've asked those same schools, teachers, counselors, and administrators to do more. Not surprisingly this tension has been increased during the Covid-19 pandemic as we've expected schools to again expand their roles in supporting our children, our families, and our communities.

As he points out, "Schools have remained in operation during the pandemic as sites for mental health services, virus testing, meal distribution, voting, and vaccines. This summer, President Biden called on school leaders to host pop-up vaccine clinics at school buildings—even as they must support students academically and emotionally, navigate whiplash-inducing health guidance, retain and bolster burned out employees, expand technology access, and protect people from the still-spreading coronavirus."

Despite the reference to President Biden's call-out ot school leaders, this isn't limited to the United States. We're seeing the same challenges in Canada and Australia. At the same time we are asking more from our educators, we are pushing front-line healthcare workers - doctors, nurses, pharmacists, lab technicians, etc. - to work longer hours and support more critical patients facing the ultimate cost as "the norm." This of course is leading to significant burn-out amongst all of these critical heroes, and jeopardizes all of our long-term health, wellness, and future prosperity.

While not the explicit focus of his article, Mr. Lieberman is correct in that we are expecting our schools and education institutions to serve as the '1st line of healthcare defense' for not only our children but our families and communities, something far outside their mandate or their funding. Unfortunately while we are asking them to move beyond their primary mandate of educating our youth, the communication and connections between the education sector and the healthcare sector are few and far between, save the great work being done in School Based Health Centers, where they exist.

One of the challenges in healthcare of course is the limited availability of resources for mental and behavioral health, as well as social determinant challenges. Yet rather than adequately funding healthcare institutions whose mandate (should?) includes the provision of mental/behavioral health services, we're now instead passing that burden onto the schools - at least for our youth - and neglecting to fund them appropriately to provide such services. In other words, we're simply "kicking the can" to another under-funded sector.

Furthermore it is unlikely that the mental / behavioral health and social-determinant needs of our youth will stop with the child themselves. Many of the issues our kids face are born from social determinant issues and family dynamics in their homes and outside of school. Little Tommy is a bully to Mary because of what's happening to Tommy at home. And what's happening to Tommy at home is the result of his parent(s) socio-economic and general health & wellness situation.

Are we expecting the school counselor to now engage mom and dad in ways to help them resolve their social-determinant issues? Do we expect the school counselor to help dad find a way to afford his blood-pressure medication so as to be better equipped to support Tommy?

We don't need to consider if schools can provide those services to our youth and their families that would classically be part of "healthcare." They already are doing so. But there comes a point where the educational institution or those in its employ reach a limit on what they can do for the youth or the family. But because of the lack of coordination, the educators or counselors are forced to throw their hands in the air, and declare "there's nothing more we can do." If lucky, the youth or family might then turn to the healthcare sector who starts from square 1 in the process. What a waste!

This leads to not only sub-optimal outcomes for each of us as people, as well as significant waste and redundancy. And when both of these sectors are facing significant financial pressures, it seems like there is a great opportunity for collaboration to drive more efficient delivery of services and care, and improved outcomes if they were to collaborate.

As referenced we do see examples of this where school based health centers are established as primary care clinics within the 4-walls of the school. Staffed by the local hospital or health system, but operating on school grounds, there is a forced level of cooperation and collaboration. But like many primary care clinics and institutions everywhere, mental & behavioral health resources are limited. Furthermore, its not typically the primary care clinic that engages with social determinant challenges; that's left for social workers from the government, or "care coordinators" (ironically) from the local health system or payer. But how often does the local health system or insurer's care coordinator contact the school counselor or teacher to ask about any screenings the school may have already done for things like anxiety, depression, suicide risk, risky behaviors, or other things that truly impact "clinical outcomes?"

If we truly want to be "Patient Centric" in healthcare we need to cross the boundaries of "healthcare" and engage at all of the points of service that support the "patient" (person). And a great place to start is the educational institutions supporting that same "patient." But when we as healthcare providers are not funded to adequately address the mental or behavioral health issues a youth face, or to engage in their homes to address the entire family dynamic and social determinant issues, are we not in the same place as the schools as described by Mr. Lieberman? Are we not simply "Passing the buck" when in fact, there's no buck to be passed?