In order to be successful in school, children must be able to see and hear and must be free of troubling health problems. Our experience with community schools confirms the idea that locating health services within a school provides easy access for students who are not receiving health care elsewhere. However, many problems, such as working with children who lack health insurance and typically end up in the emergency room for episodic care, have to be overcome. More and more of these children and their parents in our schools are recent undocumented immigrants who fear dealing with the health care system. An even larger number of children are simply from “working poor” families in which parents work off the books or for employers that do not or cannot provide health insurance. For those families who are enrolled in public health insurance plans (most typically Medicaid), having that insurance card in hand does not necessarily provide access to care if the family does not know how to negotiate the health care system. Adolescents raise another issue altogether. It has been well documented that adolescents are the largest group of uninsured children. They generally want help with issues they do not want anyone to know about, such as birth control, sexually transmitted diseases, and depression and suicidal thoughts. However, they can, and do, access school-based health centers (SBHCs) for these health needs. The goal of SBHCs is to improve the overall physical and emotional health of children and adolescents. They do this in two important ways—by providing prevention services and by providing direct health care. The majority of school-based clinics are started by a health care provider who has approached a particular school and formed a relationship with the school’s administrators. Such SBHCs are organizationally external to the school system, administered by local health care facilities such as hospitals and community health centers. Once the clinic is in the school, constant outreach to administrators, teachers, and parents must be maintained to remind them that the health center is on-site. The biggest challenge such providers face is the integration of the health services with the activities of the school.
Trend and effects of high-deductible health insurance plans in the health care system: financial access problems in management of cognitive impairment
