Meeting the Healthcare needs of children one school at a time
I think many of us accept the idea that the environment we grow up in impacts the person we become. Think back to the Nature vs Nurture theory from Sir Francis Galton in the mid-1800 that our intelligence and character traits came from hereditary factors. Contrast that to earlier philosopher John Locke, who believed we are all born a “blank slate” and our traits are developed through learning and personal experiences.
Something we may not think about is how much our social surroundings and access to quality healthcare impacts the person we become mentally and physically. Many of us live in the same communities in which we were born and raised. I’ve met people that live in the same neighborhood as their parents and grandparents. Which, I’m sure, is where we get the phase “product of our environment”.
Imagine if that environment doesn’t have access to quality healthcare. Social determinants of health are conditions in the places we live, learn, work, and play that affect our health and quality of life risks and outcomes. If we grow up in an environment that doesn’t instill a healthy lifestyle, through exercise, healthy diet, and regular health checkups, how do we expect to learn this as adults?
As a child I grew up in a single parent home with three siblings. Our mother routinely worked multiple jobs or worked full-time and went to school with the hope of making a better life for us. Either way it left very little time for her to be home, so my brother and I carried a lot of the household chores.
One thing neither of us could do is take one of us to the doctor if we were sick. Living rural and not having much time, a runny nose and mid-grade fever was something we just let ride until it passed. I remember a time in the third grade I broke my arm and my mother had to wait a couple hours to find someone to take us to the nearest hospital. While we waited, she made a joke about it interrupting her day, which made me very upset for causing her hardship. Of course, she then felt terrible for the joke and apologized profusely. Going to the doctor was something we just didn’t do unless it was truly serious. I’m sure being low income and the cost of the visit had to be part of the decision, but scheduling an appointment, taking time off from one of her jobs had to be hard. To this day my siblings and I still rarely go to the doctor.
Years later, while working within the Arkansas Medicaid program I learned of a program “School Based Health Centers” (SBHC) ?and thought “What a fantastic idea! this must be new.” When I found out this program actually started in the late 1960’s early 1970’s, I thought “how did we not have this when I was in school?” I thought this was such a good idea, to put health centers inside the school and have more than a school nurse on hand. To provide actual healthcare options to students who in many cases wouldn’t go to the doctor and to have the option for regular physical and mental checkups is awesome.
This is now a growing and maturing program across the US. Every state participating has a “School-Based Health Alliance” website providing information about the participating schools and services as well as other information and resources. The School-Based Health Alliance of Arkansas ?is a great example from my state.
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Through this program, many schools provide Mental health, dental, vision and even the option for Tele-med visits along with traditional medical health care. They will do annual wellness screening, sports physicals, and other routine physical checks that contribute to better all-around health of the child and reducing time out of school.
Looking at Social Determinants of Health and how living in a rural community or in a low-income household or community can contribute to limited access to health care offerings or the ability to access health care, these School Based Health Centers are a terrific step in bridging that gap. I believe we need more focus and support because although they are growing there are still a lot of schools without them. This could be due to limited state funding, donations, or limited care givers or resources in the area.
Although these started so long ago, it was only in a few cities around the US and had a very specific health focus. In the late 1990’s the School Based Health Alliance was formed and they do an annual census tracking the number of participating states and schools. In 1998-99 reported 1,135 SBHCs across the US due to investments from the Robert Wood Johnson Foundation “Making the Grade” program, a multiyear, multisite investment of over $23 million between 1994 & 2001. At the same time state governments were also getting behind the SBHCs. Through grants and Medicaid expansions in the 1990s states were able to establish programs. Although the majority of these were in urban schools, they were growing and the SBHCs were changing to meet the need of their specific populations.
It’s been a long road and great progress has been made, but as much as we’ve gained there is still a lot to do to get access to quality health care, both physical and mental, to all Americans. I did a quick review of the schools listed on the Arkansas SBHC alliance website and several, venture to say many, of the school districts around where I live in rural central Arkansas are not participating schools, so those families are still challenged to where and when to seek out healthcare and possibly missing out on mental health treatment.
School Based Health Centers are proving to be an amazing asset to the communities they serve and are an effective way to provide health care to children that may not have access any other way. If the children are our future, then I urge you to share this and find your state SBHC alliance website to see if your schools are participating. If not, what are you waiting for?