Last fall’s openings of the Kids’ Clinic at Aurora’s Laredo Elementary School and the Grand River Student Health Center in Parachute brought to 47 the number of such school-based health centers in Colorado – up from 40 a decade ago.

Image of child receiving eye examIn addition, at least five more schools are in the process of developing plans to open clinics, and three have already submitted grant proposals seeking funding. Over the next three years, as many as 20 new clinics may open.

At a time when budget shortfalls are forcing schools across the state to curtail services, school-based health care may be the one area that is expanding. The reason: a strategic decision made years ago to wean school-based clinics from state funding and to instead cultivate partnerships with private organizations.

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In Aurora, for example, the Kids’ Clinic at Laredo and the two-year-old clinic at Crawford Elementary are funded through grants from the Colorado Health Foundation and the Colorado Department of Public Health and Environment. They’re staffed by personnel from Rocky Mountain Youth Clinics and the Aurora Mental Health Center.

“We’re sustainable right now because we don’t use education funding,” said Melissa Field, director of policy and communications for the Colorado Association for School-Based Health Care, a non-profit group that promotes the work of school-based clinics.

“Right now, we feel it’s not a dire situation for school-based health centers.”

Statewide, nearly a third of the revenue used to fund Colorado’s school-based clinics comes from private foundations and corporate donations. Another 21 percent comes from insurance reimbursements, mostly from Medicaid and Child Health Plan Plus, since only 12 percent of the students who visit school-based health centers have private insurance.

The schools themselves must cover the cost of utilities, cleaning and maintenance but that accounts for only about 20 percent of the total costs of running a clinic. State funding accounts for even less, about 18 percent.

Some students pay a nominal fee for receiving care at school-based clinics, but many pay nothing. In fact, the state legislature this month passed a bill – H.B. 1019 – allowing school-based centers to legally waive the co-payment that they technically were required to charge students before seeking insurance reimbursement.

Funding sources for Colorado school-based health clinics

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“That was a big deal for us,” Field said. “It’s a lot to ask a 4- or 5-year-old to bring $30 to school, and we ran into a lot of issues of security. It was putting people in a bind.”

Still, health care providers continue to look for creative ways to meet their funding needs and their community’s health needs. Across the state, school-based health centers are looking at anything they can do to maximize resources, Field said.

Clinics get creative to meet students’ needs

For example, in Boulder County, the Boulder County Healthy Kids Initiative has received a grant from the Colorado Health Foundation to station eligibility technicians in the Boulder Valley and St. Vrain school districts to help screen and enroll more students and their families in Medicaid and CHP Plus health coverage.

In Pueblo, the Step-Up program takes information that schools already have – the names of children who are eligible for free or reduced-price lunches – to generate a list of students almost certainly eligible for Medicaid or CHP+ health insurance. Then they contact those families and offer to help them with the application process.

A 2009 federal grant helped expand the Pueblo model to five more sites – in Durango, Greeley, Commerce City, Montrose and El Paso County.

At present, nearly half the students who visit school-based health centers lack any insurance coverage, though many of those are eligible for the public insurance programs. A 2009 survey by the Colorado Health Institute estimated that approximately 100,000 children were eligible for Medicaid or CHP Plus but for some reason were not enrolled.

“I can only speculate why so many who are eligible aren’t enrolled,” said Liza Slavin, an eligibility and enrollment specialist working with the Durango High School School-Based Health Center.

“Most say ‘I had no idea something like this existed, I had no idea I could qualify.’ For others, there’s a stigma to accepting public benefits. If they’re being raised by their grandparents, they come from a different generation where you work hard for what you have, and if you can’t pay for it, you don’t get it. And some people just don’t know about it.”

In Montrose County, the state’s first combination school- and community-health center opened at Olathe Elementary School in December 2009. While based at the school, the clinic serves the entire community.

“That shows creativity on the part of the community,” said Jo English, school-based health center program director for the Colorado Department of Public Health and Environment.

A number of school-based clinics, particularly those sponsored by the Metro Community Provider Network, have begun working with Americorps volunteers to staff clinics.

Summit County, which is one of the few school districts to offer school-based health services at all grade levels, has been a pioneer in providing dental care services to students. Field said other clinics around the state are looking to copy that model and look at other opportunities for expanding oral health care for children.

In Prowers County, students staged a homecoming rally and made and sold souvenir towels, with the proceeds going to the student health center at Lamar High School.

“They’ve done a lot of things in Lamar to get more students involved in the health care center. They are really a model for youth engagement,” Field said.

Long history of school clinics in Colorado

Three of the earliest school-based health centers in the country were established in 1978 in Commerce City, Craig and Greeley. The program is still operating in Commerce City, which today has clinics in five schools.

In 1993, Colorado was chosen to participate in a Robert Wood Johnson Foundation-funded project called Making the Grade. The project was designed to seek the best ways for school-based health centers to become and remain financially sustainable.

Early in that project, it became clear that counting on state or federal funding would be iffy so, from that point on, the Colorado School-Based Health Center Initiative worked to identify private funding partnerships that would better insulate the school-based centers from the vagaries of public funding.

A pair of Denver studies found that teenagers who used school-based health centers were less likely to visit the emergency room and were more likely to have had wellness exams.

Since then, there has been a steady growth in school-based health centers in Colorado.

“Typically, what we look for is a school with a high percentage of students who may be on free or reduced-price lunch, because we know the same group of kids would qualify for Medicaid or CHP Plus,” Field said.

“We also look in areas where students have limited access to health services, so really rural areas. The centers are really designed for students who, because of economic situation or lack of access, might not be able to access primary or preventive care services anywhere else.”

Evidence indicates that students who attend schools with on-campus health centers do, in fact, receive better, more regular – and less costly – health care than students enrolled elsewhere. A pair of Denver studies found that teenagers who used school-based health centers were less likely to visit the emergency room and were more likely to have had wellness exams. They were 10 times more likely to have sought mental health or substance abuse help.

Primary care – including well-child and adolescent exams, care for acute illness and injury, and management of chronic conditions – remains the No. 1 reason children visit school-based health centers, statewide reports show. Primary care accounts for 51 percent of all visits. But mental health and substance abuse counseling accounts for just over one of every five visits to a center.

“In times like these, which are economically difficult, school-based health centers are a great way to save money because it’s a lot cheaper for a student to receive preventative care than to go to an emergency room later,” Field said.

“But that’s the reality that happens a lot. Having the school-based health center as an option introduces kids to the idea of going to the doctor regularly, which we hope they’ll carry on for the rest of their lives.”

Disclosure: The Colorado Health Foundation is a funder of Education News Colorado.