School-based health clinics popping up in Valley districts

The Fresno BeeDecember 8, 2013 

Federal Affordable Care Act dollars intended to support school-based health centers are bankrolling clinics that offer low or no-fee services to kids at several Valley districts.

The clinics are springing up at elementary and middle schools -- and this week, Fresno Unified trustees are set to sign off on a proposed clinic at the new Rutherford B. Gaston Middle School.

Health centers give students a convenient and cheap place to get vaccines, routine checkups and prescriptions when they feel under the weather. Advocates say setting up health clinics at schools makes access easy for busy families and rural communities. And there are other advantages: healthier kids avoid missing class and schools get to keep more state funding, which is based on how many students attend school each day.

"(School clinics) are fast-growing," said Karin Temple, Fresno Unified's assistant superintendent for operational services. "It's becoming the new model for providing health services."

Districts are embracing the idea because some students fall through cracks in the health-care system: They might not be signed up for an insurance plan or have a doctor nearby.

"There have been districts that were interested in having more services for their students so this isn't necessarily a new phenomenon," said Serena Clayton, executive director of the California School Health Centers Association. The Affordable Care Act "gave school districts resources to do something they've been wanting to do for a long time."

A growing trend

Between 2010 and 2013, the federal health-care law provided $200 million in grants -- $30 million to California alone -- to expand school clinics. Now there are 226 centers at schools across the state, up from 150 in 2007.

Districts like Fresno Unified and health-care groups like United Health Centers of the San Joaquin Valley tapped into the grants to build new facilities and buy medical equipment.

Fresno officials say the district got $277,000 to purchase exam tables, blood pressure machines and other supplies to stock a clinic at southwest Fresno's Gaston Middle. That school and clinic are under construction and set to open by August.

In partnership with doctors and physician assistants from Clinica Sierra Vista, children up to age 19 will be able to get sports physicals, shots and mental health care services at the Gaston clinic.

"It becomes a one-stop shop," said Diane Torna, Fresno Unified's health services director.

Youngsters who need dental care or birth control can get referrals. Students will need a parent's signature to use the clinic -- but once they have permission, state law allows kids to seek out family planning referrals without additional consent.

Ruben Chavez, chief administrative officer at Clinica Sierra Vista's Fresno office, said students get care whether or not they can pay for it. The health-care group is considered a "safety net" provider, which means it gets federal grants to help cover patients' costs.

School clinics are also cropping up in nearby towns like Kerman and Raisin City.

On Wednesday last week a group of kindergartners sat in the nurse's office at Kerman-Floyd Elementary's new 2,000-square-foot clinic. Five-year-old David Leon held an ice pack to his lip, which he had bumped before lunchtime.

Health aide Daniela Espinoza helped one student use his asthma inhaler while keeping her eye on another youngster who had vomited in the lunch room.

A team of health assistants and a physician milled about in the hall of the clinic, which opened its doors to school kids and the public in September.

The center is operated by Valley Health Team, which got $500,000 for construction from the federal government. The space is compact -- it's housed in an old computer lab building -- but there's enough room for a nurse's office, a lobby, exam rooms and a lab.

Like most schools, kids head to the nurse's office when they get hurt or feel sick. But if they come down with a more serious illness or need emergency care, Dr. Ronald Dominguez is on site to help.

Dominguez sees 22 patients each day on average, ranging from kids who need stitches to adults with sinus infections.

"We had one boy who had cut his finger at home," said Principal Kathy Goodlad. "He came, got it stitched and went right back to class. Instead of missing the whole day of school, altogether he only missed about an hour."

Raisin City, a tiny agricultural town southwest of Fresno, and Parlier, a city east of Selma that's home to many migrant workers, will each get a similar clinic in the coming months.

United Health Centers received $435,000 in one-time construction grants through Obamacare to build school clinics in the two Valley towns. The organization said it picked those spots because there's a shortage of doctors and the number of students in those areas is growing.

Expanded insurance coverage under the federal health-care law could create a more extreme shortage: more people will be covered, but they could be forced to drive miles from home if they don't live close to a clinic.

"Really, nothing is close, as far as health care," said David Phillips, director of community development and public relations for United Health Centers. "The closest thing (to Raisin City) would be an emergency room in Fresno."

History of success

Samah Hussein takes her four young daughters to Pinedale Elementary's health clinic when she can't get an appointment with her family's regular physician.

She took 4-year-old Deena in last week to get medicine for an infection; she came back for a second visit when 9-year-old Yasmeen caught a bug.

Quick visits to the clinic are especially helpful during winter months, when her primary doctor's schedule tends to fill up.

Going to urgent care is too expensive, she said, and Pinedale is close to home. She's comfortable there, and she gets fast answers to questions when her kids are ill.

"A clinic like this, you come in, you get the care that you need, and then you're on with your day," she said. "I don't have to spend three to four hours or so much money just to see the doctor."

The center at Pinedale has been operating for 20 years. Last year it had more than 4,000 visits, including children from outside Clovis Unified.

It operates like a regular pediatric clinic: a nurse practitioner immunizes children and does physicals, seeing about 30 patients each day for routine services. Only small details -- like an old metal school bell fixed to the lobby wall -- betray that the clinic is attached to a schoolhouse.

Pinedale nurse practitioner Annamarie Brown said that besides keeping kids healthy, the clinic pays off in other ways.

For example, state dollars for schools are based on how many students attend class each day; healthier students miss fewer days. On average, she said, the clinic saves about 1,190 attendance days each year, or about $40,500 annually in state dollars.

And there are other benefits: Kids who are in school instead of home sick miss out on fewer lessons each year. Data from the Centers for Disease Control and Prevention show healthy kids get better grades.

But health clinics face challenges, Brown said, like making sure parents bring their kids in for follow-up appointments.

Paying the bills can be a struggle, too. Clovis Unified keeps the lights on and covers other costs like paying janitors and providing a facility. But families who come in without insurance can strain the clinic's annual budget. The clinic operates in the red, but Brown said she'd rather give free services to low-income families than turn them away.

"If they need an antibiotic that is $4, I would rather (the clinic) spend that $4 to give them amoxicillin," she said. "I will see them for free to get them in school the next day."

Clayton of the California School Health Centers Association said there's no state funding stream dedicated to clinics on school sites. Clinics like the one in Clovis often get some district money to pay for operations. Others, like the one in Kerman, are largely funded through client fees.

Now that schools have used up the one-time federal grants, securing long-term funding to keep the clinics open is Clayton's biggest goal.

"California is the one state that has a large number of school-based health centers, but no state funding," she said. "You can take it so much further if you have state dollars to combine with the local dollars."

The reporter can be reached at (559) 441-6412, or @hannahfurfaro on Twitter.

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