|By CHRISTINA HOAG, Associated Press|
Now, Barrales, who does not have health insurance, can walk a couple of blocks to
"This is something so necessary here. A lot of people don't have insurance, and they don't have the means to go to
The clinic is one of 14 new "wellness centers" that the
While a smattering of school clinics across the nation have long been open to the public, more are looking to expand their patient base to reap revenue that can subsidize the care often given for free to youngsters as well as fill a dire larger need for community health care access.
"The more folks you're seeing, the more revenue you're generating," said
About 1,800 school-based centers, which are usually run by a nonprofit or public health care provider in school-owned buildings, operate across the country. They provide a combination of primary care, mental health counseling, dental and vision screenings, and health education and prevention to youth who may have grown up with few, if any, doctor visits.
Around since the 1980s, school health clinics received a shot in the arm from the federal Affordable Care Act, which earmarked
The federal funding, though, does not cover operational expenses, and more providers are looking to become financially sustainable in an era of shrinking public money and increasing competition for private donations that typically fund school clinics. Some clinics have closed in recent years.
With health care reform approaching, school-community health centers are also ramping up to enroll people in public insurance programs that will become available.
"We're looking at long-term sustainable plans," said
One Los Angeles Unified school center that has served the community for a long time has been successful doing that, she noted.
About four school-based health centers have opened to the general public in California's
Other clinics are choosing a more limited model that serves school staff, who have private insurance, and students' families.
"It's about building income so you can see as many people as you can," she said. "We don't need a big margin but we do need to be able to cash-flow this."
Carmichael said the agency already has a waiting list of schools wanting clinics, but she noted that she'll have to see how the first program works first. "The need is so great, but how do you pay for it?" she said.
Advocates say the combo clinics make sense because neighborhood schools are convenient locations to reach underserved people, especially in rural areas, but accepting community patients has some caveats.
Safety is a concern because schools do not want strangers wandering around their grounds. A health center open to the public typically needs two entrances _ one from the school for students and another street entrance for adults, and may require longer hours, as well as different equipment and staff, such as internist, to deal with adult health problems.
Security issues have prevented a number of clinics in
Another key issue is privacy for adolescents, who may be seeking contraception, pregnancy tests or treatment for sexually transmitted infections and might shy away from going to a place where they could run into someone they know.
"It's a little tricky," he said. "The staff will keep the two groups separate. We want the kids to enjoy true privacy."
Experts say the combo clinic is an efficient way of delivering low-cost health care, but note that the school-based health center's primary mission is kids. School clinics often serve a role in student health education and even provide professional role models for kids who lack exposure to career paths , said
"Historically, the health care system has not treated children well because the truly interesting money is in adults. These programs were driven by that gap in care for kids," she said. "You don't want to lose that."
For working-class immigrant communities like
Kids said they'll now be able to try out for school sports teams because they'll be able to get the required physicals their parents can't afford, while parents said they can get help for asthma, diabetes and general stress without worrying about how they'll be able to pay.
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