SEATTLE — The exam room at Cleveland High School’s Teen Health Center has the basics: a blood pressure monitor and various scopes hang on the wall. Paper covers the exam table. But its equipment also reflects the realities of adolescent health problems. One cupboard holds pap smear kits, another has a birth control teaching kit. In the lab room there’s acne medication, a centrifuge and a tank of liquid nitrogen for freezing warts.
The clinic is one of hundreds that have opened in schools around the country in the last 20 years to treat teenagers, the age group least likely to get preventive health care. That neglect can let small problems grow into big problems, leading to missed classes and other problems.
Started in the mid-1970s, there were about 120 clinics in the country by 1988, when King County’s Health Department, which runs the one at Cleveland, opened Washington state’s first clinic.
In 2005, over 1,700 clinics served around 1.7 million students with physical examinations, immunizations, lab testing, medications, dental care, health education and other services, according to the National Association of School-Based Health Centers, which had its national convention in Los Angeles last week.
But even in 2005, 18 percent of adolescent males and almost 15 percent of adolescent females didn’t receive any health care services, according to the Centers for Disease Control and Prevention.
At Cleveland, which serves one of Seattle’s poorest areas, almost half of the students used the clinic last year. Mental, reproductive and general health each make up about one-third of the services students receive.
LaQuaveous Benning-Dillon, a 16-year-old sophomore, uses the clinic for a variety of services, sometimes dropping by just to say “Hello.”
The clinic’s nurse practitioner, Pat Tilden, “is always looking after me — telling me to get some new glasses,” Benning-Dillon said. He broke his last pair, which he got through the clinic.
On their own, adolescents don’t use health care very effectively.
“If it isn’t burning, itching, stinging, etc., they’re probably not going to get on those two buses to see their doctor — if they have one,” said T.J. Cosgrove, a board member of the national organization, who manages several Seattle-area school-based clinics.
Adolescents receiving services outside of school are not necessarily getting comprehensive care, said Dr. Leslie Walker, chief of adolescent medicine at Children’s Hospital in Seattle.
They need preventive care, including health education and mental health services, and must be assured confidentiality, Walker said.
“If it wasn’t confidential, I wouldn’t be going,” said Dion Abdullah, 18. Abdullah and his girlfriend, Nahstassia Botts, 19, use Cleveland’s clinic for birth control services.
Many of Cleveland’s students have had only irregular care and don’t have adequate health habits or knowledge.
“It’s amazing to me the number of students who come in with birth control pills and no idea how to use them,” Tilden said.
Because many lifelong health habits are formed during adolescence, the clinic targets long-term unhealthy behavior such as smoking and obesity.
Many students using Cleveland’s clinic don’t have a doctor in the community or cannot get to one during the day, said Tilden.
No direct link has been established between health centers and improved academic performance, according to the national assembly. But Cleveland’s principal, Wayne Floyd, has no doubt that the school’s clinic improves grades.
“If they’re hungry or have an ailment they can’t focus in class or don’t come to class,” Floyd said.
Several studies indicate that access to clinics reduces emergency room visits and hospitalization for students, according to the national organization.
But money is a constant struggle. Clinics get money mostly from state and local government, but also from private grants, businesses and managed care reimbursements. Reimbursement rates are generally low, and many services offered by clinics aren’t reimbursed at all.
In the ’90s, Connecticut required all Medicaid managed care companies to reimburse clinics for services.
Most commercial providers don’t recognize the clinics as health care providers, according to Joanne Eaccarino, president of the Connecticut Association of School-Based Health Centers.
“What they’ll say is that we’re not open 24-hours a day, 365 days a year, but to our knowledge neither is anyone else, even an emergency room,” Eaccarino said.
States have taken a more active role in paying for and promoting school-based health centers over the past decade.
Washington state announced plans this year to fund four clinics for at least five years.
Last year, California’s Gov. Arnold Schwarzenegger proposed 500 new school clinics. The plan, however, was killed by budget problems.
In 2007, Congress authorized — but didn’t allocate — $50 million in federal grants for clinics for 2009-12.
Moving into health care’s mainstream means school-based health centers will have to clarify what their purpose is and likely standardize which services they offer, said Julia Graham Lear, director of the Center for Health and Health Care in Schools at George Washington University.
Discussions following Schwarzenegger’s proposal revealed disagreements among clinic advocates, such as what level of dental care should be provided, said Serena Clayton, chief executive of California’s School Health Centers Association.
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