Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, July 10, 1993 TAG: 9309030353
SECTION: EDITORIAL PAGE: A7 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Often, this amounts to no more than a room with a couch where ill students may lie down to wait for a parent or other adult to pick them up and take them home, or maybe to a doctor.
Increasingly, however, schools are opening their doors each morning to chronically ill children. They are sick from drafty houses, from poor sanitation, from unbalanced diets. And they rarely, if ever, see a doctor or other health-care professional - except in a hospital emergency room, should they become acutely sick.
Their families can't afford such luxuries as taking them to a primary-care doctor for regular checkups. Medical insurance? Get serious.
Barriers to health care are also barriers to education. As a recent report by the Carnegie Foundation for the Advancement of Teaching concluded, health problems can stunt not only children's physical growth but also their academic growth. More than one third of America's youngsters enter kindergarten unprepared to learn, and unable to learn, largely because of health problems.
Should public schools in Virginia be playing a broader role in the arena of students' health? The answer is: Yes ... but.
The State Board of Education is now considering a venture into school-based health clinics at the elementary-grade level. Real health clinics, not just a room with a couch and a bottle of Bayer. To be called ``Family Resource Centers,'' they initially would be established in about 16 of the state's school divisions - mostly rural and poorer school divisions, including several in Southwest Virginia.
Under the plan, each clinic would have at least one full-time staff member. The clinics would be open longer than the regular school-day schedule, to make them more accessible.
Not all communities are as fortunate as, say, Roanoke, where the extraordinary Comprehensive Health Investment Program (CHIP) was launched in 1988 specifically to improve health care for poorer children. A cooperative effort of area public-health departments, Total Action Against Poverty, private doctors, other health-care providers and private businesses, CHIP has provided hundreds of children - many, the children of working-poor families - with a ``medical home.'' It has ensured that they routinely see doctors and dentists, are immunized against disease, are screened for hearing and vision problems, and are provided the other basics of primary health care that can keep children out of hospital emergency rooms.
But while this excellent program has been expanding to other parts of the state, it has not expanded to cover all who need it, not even all who need it in its home-base Fifth Planning District. In areas CHIP hasn't reached, and other health-care programs have been insufficient, school-based health clinics might well fill a void.
This, however, is not axiomatic. A Charlottesville pediatrician recently reminded State Board of Education members that school-based clinics cannot replace ``medical homes'' with a primary-care physician for children - the provision of which is the basic goal of CHIP and similar endeavors in other communities. ``Medical homes'' for 200,000 Virginia children without health insurance is also the stated goal of an initiative launched by Gov. Douglas Wilder in 1991.
Dr. Michael Dickens, president of the Virginia Pediatrics Society, asked: With state funds sorely limited, would it not be better to expand programs such as CHIP rather than spend $3.6 million in the 1993-95 biennium to create school-based clinics? Might school-based clinics have the undesirable effect in some communities of interfering with the a program of care that's been started for a child in a ``medical home''?
For his efforts, Dickens was in essence accused by one board member of avarice, of trying to protect the financial interests of doctors. That's unfair: He and other Virginia pediatricians were instrumental in pushing for a law, passed by the 1992 General Assembly, that requires each school district to have a school-health advisory board to help develop better community-based health services for schoolchildren. They also have pushed long and hard for state funding for school nurses.
Moreover, Dickens' hard questions are precisely the kind that state school officials ought to be asking about the school-clinic proposal. America's disgrace is not only that millions of young children do not get even basic preventive care, but also the context in which this is true - a nation that leads the world in health-care spending.
In other words, the difficulty is less that too few health-care dollars are spent than that they are spent inefficiently. Maybe school-based clinics would help fill a void in some communities. If there are better ways, however, frittering away more health dollars would be as unconscionable as the situation the dollars are intended to ease.
by CNB