Back To School: School Based Health Clinics Can Be a Model of Quiet Success


There’s been a lot of discussion and some contrived controversy this year over student access to medical services through their schools: the Seattle mother upset that her teen daughter got an abortion without telling her, the school in Massachusetts that considered offering condoms to all elementary school children who requested one, and now the Denver public school introducing birth control services to students in 6th through 12th grade.

It seems that these stories about in-school clinics are exactly the kinds of efforts to address real sexual health issues that the far right likes to turn into a crisis public relations disaster, and every time a new initiative is announced, they do just that. So imagine my surprise to learn that Minnesota has been offering such services via School Based Clinics (SBC) quietly for over 35 years.

From Minnesota Medicine:

The absence of patients presents a perfect opportunity for a nonstudent to get an inside look at Edison’s school-based clinic (SBC), one of six in the Minneapolis district operated by the Minneapolis Department of Health and Family Support. Together, the clinics serve more than 2,000 high school students a year (350 alone access the SBC at Edison). The tiny classroom-sized clinic consists of a waiting area, an exam room, a consultation room for mental health counseling and patient education, and a galley area where blood is drawn and medications are stored in locked cabinets. The clinic is staffed by a full-time registered nurse, a part-time nurse practitioner, a half-time licensed mental health counselor, and a nutritionist who comes in once a week. Teens can walk in or make appointments for issues ranging from sore throats and ankle sprains to depression, asthma management, nutrition, sexually transmitted infections (STIs), and other reproductive health issues.

Edison’s SBC is one of 18 such clinics in the state. Concentrated primarily in the Twin Cities metro area, the clinics provide a comprehensive spectrum of health care services. Through their affiliations with qualified health providers (for example, private medical practices, health care systems, or a public health department), the clinics employ multidisciplinary teams to address adolescent health concerns. Team members include, but are not limited to, nurse practitioners, registered nurses, physician assistants, licensed social workers, physicians, and chemical dependency counselors. Nurse practitioners, physician assistants, and physicians who work at the clinic can prescribe or dispense a limited number of drugs such as antibiotics, asthma medications, and over-the-counter drugs; they can dispense birth control, including pills and condoms; and they can provide sports physicals and immunizations. Licensed therapists and social workers offer ongoing mental health counseling to adolescents in need of services, while health educators counsel students on issues ranging from nutrition to family planning and pregnancy. School-based clinics, which are located in the school or on school grounds, serve a particular school’s student population—typically teens.

According to Minnesota Medicine, the first SBC was launched in 1973 to help combat a rising teen pregnancy rate.  Within three years the pregnancy rate had dropped 40 percent, and that emergency care and hospitalization rates for teens decreased dramatically as well.  One original SBC program, Health Start, in St. Paul, Minnesota, even served as a case study in how reproductive care in schools can decrease the incidence of teen pregnancy.

Unlike the hyperbolic stories we’ve been hearing from the media regarding the various school-based clinics in other states, Minneapolis parents have been overwhelmingly supportive of their SBCs, expressing high satisfaction in annual surveys. The parents in the area can either grant their children full access to all services, access to all services except mental health and reproductive health care, or deny all access, and according to the article nearly 95 percent of the parents allow full access, citing the “convenience and accessibility” of the centers as an asset to keeping their teens healthy.

It’s almost ironic that the Minnesota SBCs have had so little in the way of protest or criticism from the anti-choice movement in the state, considering the prospect of expanding funding for them turned into a lightening rod during the recent healthcare reform debate.  Advocating vocally against expansion was Minnesota representative Michele Bachmann, who dubbed them “sex clinics” and famously claimed that the schools would take your 13 year-old daughters out for clandestine abortions.

Via Huffington Post:

Last night on the House floor, Rep. Michele Bachmann (R-Minn.) spoke to Congress about “school based health clinics” (SBHC), labeling the clinics discussed in current House health care legislation as “sex clinics.”

The conservative congresswoman suggested that if health care reform passes, the nation’s schools might begin offering abortions to students. Bachman’s interpretation of the health care reform bill holds that the legislation is designed to bring Planned Parenthood into educational facilities. According to Bachmann,

“The bill goes on to say what’s going to go on — comprehensive primary health services, physicals, treatment of minor acute medical conditions, referrals to follow-up for specialty care — is that abortion? Does that mean that someone’s 13 year-old daughter could walk into a sex clinic, have a pregnancy test done, be taken away to the local Planned Parenthood abortion clinic, have their abortion, be back and go home on the school bus that night? Mom and dad are never the wiser.”

Of course, these clinics have been in existence for nearly four decades in her home state, yet Rep. Bachmann seems to be unaware of their presence or their effects on the community.  Or even that they don’t, in fact, provide abortions.

In spite of criticism from the right wing, which it seems is against most forms of advancing healthcare for the vulnerable in any case, the federal government has taken notice of the advances in care happening in SBCs, and has made it a key component of the new healthcare reform law.  Bringing healthcare to teens, making it easy to obtain, and focusing on preventing infection and pregnancy will all help reduce greater healthcare costs down the road for these students, Minnesota SBC administrators firmly believe.

Despite the challenges, proponents of SBCs and school-linked clinics believe these programs can serve as models for health care reform. “Accessibility, preventive care, building trusting relationships with kids, reaching them where they are—those are all important aspects of health care reform,” explains Chris Johnson, M.D., medical director of the Park Nicollet Foundation, which operates school-based and/or school-linked clinics in St. Louis Park, Wayzata, Burnsville, and Brooklyn Center. “As we look at improving health care in the United States, we are constantly thinking about new ways to make primary care more affordable and accessible, and strengthening school-based clinics presents a great opportunity for meeting those objectives.”

Federal lawmakers have taken note of the success of SBCs. Section 4101 of the recently passed federal health care reform act “directs the secretary [of Health and Human Services] to award grants to support the operation of school-based health centers.” It also authorizes $50 million per year for SBC facilities and equipment through 2013.

“Providers will tell you that if kids are sexually active, they should have protection from STIs and unintended pregnancies, and as a doctor, I know that one of the best ways to meet that need is by bringing the services to kids’ doorstep,” [Christopher Reif, M.D., a family physician who served as medical director for St. Paul’s school-based clinic program from 1988 to 2000 and now directs clinical services at the University of Minnesota Community-University Health Care Center] says. “I’m hopeful about the future. I’m hopeful about the fact that for the first time, the federal government is showing support for these clinics.”

Brigid Riley, MPH, the Executive Director of Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting (MOAPPP) agrees with Reif’s assessment.  When asked about the role SBC’s have played in providing teen reproductive healthcare in the cities, Riley responded by email:

“We know that the care young people receive at their school-based clinic addresses the whole teen – the approach used by these clinics is often far more comprehensive than the care provided by a primary care provider. The staff LIKE teenagers, and are dedicated to guiding them toward healthy life decisions.

School-based clinics provide the care that mainstream clinics won’t handle confidentially – they are picking up the tab for the major health plans’ inability to address teenage sexual health.

If the school-based clinics go away, we lose a critical partner in helping build responsible teenagers.”

As Minnesota’s history with implementing SBCs has proven, teen health, especially reproductive health, can be cared for in a responsible, affordable and accessible environment, and all without the media storm that seems inevitable these days when discussing teens and sex.

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