School-Based Clinics
Health Care as Easy as “Raising Your Hand”

About two years ago, an ill 9-year-old elementary school student asked if he could visit one of the four school-based health clinics set up by the Houston Department of Health and Human Services.

The clinic pediatrician learned during the visit that the boy had vomited several times the previous two days and had lost six pounds within the last two months. He administered a urine test that came back positive for ketone and glucose, a strong indication that the boy had developed Type I diabetes. Immediately, the clinic called 9-1-1 for an ambulance and paramedics rushed the boy to a hospital emergency room where he received insulin.

“It was a life-threatening situation,” said Ved P. Aggarwal, M.D., a pediatrician who rotates one day a week at each of the four clinics. “Any further delays and the child could have gone into a diabetic coma.”

Although this incident is one of the more dramatic examples of an intervention at a school-based clinic, it does point to the importance of addressing the unmet health care needs of medically underserved children before they result in serious complications or illnesses.

Fevers, headaches, colds, tummy aches, earaches, respiratory illnesses and urinary tract infections – those are the more common ailments Aggarwal tackles day to day at the clinics that the health department and the Houston Independent School District established in 1996 as part of the School-Based/Linked Health Program.

The program enables the department to provide medical and dental services that are easy to access and affordable to children living without health insurance in underserved Houston communities. It also offers medical checkups, hearing and vision screenings, growth and development assessments, and immunizations.

Getting an appointment is as easy as raising a hand to ask for permission to seek a referral to the school-based clinic. Each child pays a nominal $2 per visit. Free services are provided for children enrolled in Medicaid.

A student must first see the school nurse when feeling ill while on campus. The school nurse can refer the student to the school-based clinic if the parents have signed a consent form for medical care. If it is a medical matter that can wait, the student will see the pediatrician at the assigned clinic day for the school. If the problem is more urgent, the nurse either refers the student to his or her own family doctor or to a hospital in case of an emergency.

If a health condition can’t be treated at the school-based clinic, the pediatrician can refer a student to a specialist. The pediatrician later can receive feedback on any health problem.

The program also provides necessary medications at no cost to a student’s family.

“Children can make their own decisions whether they want to go to the doctor,” said Leonora I. Lartson, M.D., the program’s administrative supervisor. “They don’t have to wait for their parents to say ‘You are sick; let’s go to the doctor.’ The school-based clinics empower children to take care of their own health.”

What’s more, the program goes beyond health care for students. The program’s clinics also provide medical care to each student’s younger siblings and feature a strong health education component that extends to the parents. Two full-time school district social workers offer counseling, deal with social problems experienced by both students and parents, conduct home visits and accompany children who are bussed to two of the department’s dental clinics.

The school-based clinics are located in Easter Elementary on the northeast side, Elrod Elementary and McNamara Elementary in the southwest and Bonner Elementary in the southeast side of Houston. Last fiscal year, the clinics provided care to 549 students during 1,022 medical visits. That same year, dental visits among 485 students totaled 1,287.

Dental care consists of head and neck examinations, radiographs, fluoride, sealants, fillings, stainless-steel crowns, extractions and space maintainers.

Previously, a dental hygienist provided health education including nutrition information and taught children how to brush their teeth correctly. The program recently incorporated a more comprehensive approach to health education with the hiring of a senior public health educator dedicated to making presentations to students and parents on a wide range of health topics.

The idea of setting up a school-based health program arose as a response to inadequate health-insurance coverage and decreased access to community health care for children living in poverty. In 1993, the department and school district conducted a community needs assessment to evaluate health services for Houston children ages 6 to 14. The survey demonstrated a need for clinics located directly in the schools.

Forty-five schools applied for the program and the school district ultimately selected four.

“The schools were chosen because they are in underserved communities with large numbers of economically disadvantaged children lacking health insurance,” Lartson said. “If not for the school-based clinics, these children might not receive any health care. So it became important to have the clinics not outside the school, but within the school where health care would be easily accessible.”

By helping to keep children healthier, the school-based program contributes to a reduction in absenteeism and removes barriers to academic success. Families also experience less of an economic hardship because parents do not have to take time off from work to take children to medical and dental appointments.

“Health education is the backbone of the program,” Lartson said. “If you don’t provide health education, you won’t change unhealthy habits.”

The program’s health education component – combined with medical and dental care – results in a holistic approach to children’s health care, Larston said.

“In turn, this approach helps the program pursue the goal of ensuring that each child has the benefit of being in good health.”

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©2006 Texas Medical Center

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