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School-Based Health Centers: Necessitating a Lens of Integration, Rejecting a Lens of Isolation

By Dylan Balter '19, Staff Writer

· Dylan Balter

Turn left and you enter a hallway: one filled with the cheerful laughs, serious conversations, excited screams, and natural chaos of a middle school cafeteria.  This sense of joyful cacophony is initially familiar and nostalgic, a marker of the childhood experience. However, if you walk further down the hallway and make a right, you encounter a novel phenomenon: the Rales Health Center, a school-based health center nested in the educational walls of KIPP Ujima Village Academy, a Baltimore City Public Charter School.    

According to the National Association of School Nurses, 25% of schools lack school nurses, and 35% of schools employ mere part-time, not full-time, nurses due to budgetary constraints.  Due to a $5 million grant from the Norman and Ruth Rales Foundation, the Rales Health Center has the privilege and flexibility of eschewing this norm: this school-based health center boasts two nurses, a pediatrician, a nurse practitioner, a case manager, and additional administrative staff, all of whom are conveniently stationed across from the bustling cafeteria and work with students daily.

Enter the door to the Rales Health Center, and you first observe students in the waiting room.  One may have fallen during recess, another may need to check her blood glucose level so as to manage her diabetes, and yet another may be avoiding the chaotic cafeteria by eating lunch with the staff.

While the Rales Health Center views its mission as integrating health and education, this encounter unearths a more dynamic integration of health care into the community, as it seeks to integrate health and education within the center, to integrate school-based health centers and primary care beyond the center, and to define such integration as fostering holism and bolstering a sense of community at large.

This multi-faceted approach of integration is new and crucial; however, the reception of this approach has placed greater emphasis on its purely health-based facets rather than the holistic nature of all facets.

The dominance of the biomedical model has driven disproportionate research on the effects of school-based health centers on student health outcomes.  For example, one prospective cohort study analyzed the association between the presence of school-based health centers and perceived student health satisfaction, concluding that students in schools with school-based health centers reported higher levels of health satisfaction, increased physical activity, and increased intake of nutritious food than students in schools without such centers.  Another study focused on the health outcome of asthma, with findings that demonstrated statistically significant lower asthma hospitalization rates for students with access to school-based health centers in comparison to students without access to such centers.    

These findings are pivotal; they demonstrate a direct link between school-based health centers and improved health.  Moreover, such findings provide a financial argument for the proliferation of such centers, as school-based health centers can contribute to lowering health care costs through allowing decreases in hospitalizations and emergency department visits.  

Yet while salient, health outcome findings fail to highlight the true integrative benefits of school-based health centers.  In addition to enhancing health satisfaction rates and lowering asthma hospitalizations, school-based health centers additionally decrease absenteeism by allowing medical treatment at school rather than in the emergency department, save parents time and money lost from leaving jobs early to attend to their children’s medical needs, introduce students to their rights regarding medical confidentiality so as to augment comfort in a health care setting, and spawn holistic relationships with both students and families.

The Rales Health Center both literally and metaphorically transforms the sterility of the medical environment into one of support and trust.

This environment of support and trust derives not only from the integration of health and education, but also from the integration of school-based health centers and primary care. School-based health centers seek not to replace, but rather to extend, the supports of primary care.  Through working in tandem with students’ primary care physicians, Rales Health Center physicians can monitor chronic conditions such as diabetes and asthma at school while communicating with the primary care physician about long-term treatment plans. Such school-based health center/primary care integration serves not only to provide maximally effective care, but also seeks to imbue a further level of trust in parents—their child may be cared for at school without jeopardizing the support of their primary care physician.

Where this integration’s impact is unprecedented is in its holistic success.  One school nurse at the Rales Health Center told The Baltimore Sun, “I know what’s going on at home.  I know what’s going on in classes. I know if they’re getting in trouble. I know if they’re having problems with friends.”  In addition to these personal insights regarding students, the Rales Health Center case manager also knows the parents; the case manager consistently works with parents to fulfill their needs that range from applying for health insurance, finding reliable and inexpensive child day camps, and locating financial assistance resources that can assist with paying medical bills.  

The Rales Health Center staff provides a holistic understanding of students and families.  When coupled with the additional resources and connections provided by primary care physicians, the power of the school-based health center is undeniable.  Given this power, future conversations should encompass an equal emphasis on all facets—not just health—of school-based health centers’ multi-faceted approach in addition to utilizing policy initiatives to incentivize the replication of this approach in other public and charter schools.

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