First Person

Private money shields school health clinics

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.

stethoscope illustrating school based health careIn 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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Local schools tap private funds

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.

“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.

First Person

‘I didn’t feel like I had anyone to ask for support’: Why it matters to have teachers who look like me

PHOTO: Alan Petersime

For 10 years — the first decade I was in school — all my teachers were white women.

As a Mexican-American kid, I didn’t get the chance to have a man of color as a teacher until high school. Going into my senior year, I like how diverse my teachers are now, but I wish I’d had the same experience when I was younger.

When I think about why it matters to have a teacher I can relate to, I think back to fifth grade. A classmate said to me, “Mexicans are illegal—they cross the border every day! How about you, did you cross the border?” This bothered me. So, after class, I asked the teacher for help. But all she said was, “That’s OK, he was just playing.” From there, I had nowhere to go. She was at the top of the food chain.

In 1990, before they met, my mother and father came over the border from Mexico. My mom’s parents weren’t making enough profit from their cattle ranch, so they had little choice but to immigrate. My mom came with them to the United States and worked at a restaurant so she could send money back home. My father followed his older brother here because he wanted to start a new life. Little did he know he would one day cross paths with my mother and eventually start a family.

But my classmate was “just playing” when he insulted all of this. I wish my teacher had done something else.

If I’d been the teacher, I would’ve taken a different approach and worked to understand why we were acting and responding the way we were. Maybe the other student and I could’ve found common ground. But, unfortunately, we never had a chance to try.

Up until ninth grade, I had zero male teachers of color. I didn’t feel like I had anyone to ask for support when things like the fifth-grade incident happened. Many of us students felt that way — and that’s why I want to be a teacher, a fifth-grade teacher in particular. I want to make my culture an asset in the classroom and be a teacher students feel comfortable confiding in, no matter their background.

A teacher’s perspective: Cut from the same cloth: Why it matters that black male teachers like me aren’t alone in our schools

In middle school, I started seeing more male educators, but they were all white. Then, when it came time for me to start high school, I ended up going to school in a different neighborhood — an hour commute away—and things finally changed for me. Since starting high school, I’ve had six male teachers of color, and it’s made a huge difference.

My high school makes a big deal out of the whole “building relationships” thing. To my teachers and everyone else at the school, relationships are just as important as academics. At first, it was hard to get used to, but eventually it started making sense to me. I’m in an all-male mentorship group led by two African-American men who openly share about their struggles growing up in New York, and give us advice in any area of life — including what it means to appreciate our cultures. This is one of the things I like most about my school.

It’s hard to explain the way it feels to have a teacher who looks like you; they’re like older brothers who become a huge part of our lives, even if it’s just for four years. They make it easier to connect and socialize and help me feel more like I belong. To me, learning from someone who reflects who you are is one of the best things a student can experience.

Near the end of the school year, my mentorship group did an activity where we took turns getting asked questions by other students and staff. One of the mentors asked me, “What’s it like being Mexican American and how has your background influenced your goals?” No one had ever asked me that before, and it took a long time for me to process the question.

After a few moments, I spoke a bit about my family’s story and shared some of the stereotypes I had encountered and how they affect me today. Everyone was so supportive, and the mentors encouraged me to continue breaking stereotypes and defining myself rather than letting others define me.

It was nerve-wracking at first, telling my story in that group, but after three years of high school, we’d developed that level of trust. It was the first time I’d shared my story with that many people at once, but it felt intimate and very different from the time in fifth grade when that kid tried to tell my story for me.

Finally having teachers that look like me has made a huge difference. They don’t just mentor me and help me with my academics, they also make my goal of becoming a teacher seem more realistic.

Having men of color I can look up to and model myself after is a big part of why I have no doubt I’ll make it to college — and eventually be able to give other kids the type of help my mentors have given me. I know where I’m needed, and that’s where I’m headed.

Jose Romero is a senior at EPIC High School North in Queens, New York. This piece originally appeared on the blog of TNTP, a national nonprofit and advocacy group that trains new teachers.

First Person

A Queens teacher on Charlottesville: ‘It can’t just be teachers of color’ offering lessons on race

PHOTO: Bob Mical/Creative Commons

In a few short weeks, school will resume in New York and I’m already thinking about how we are going to address racism within the four walls of my classroom. I’m thinking about what texts, historical and current, we can read and films and documentaries we can watch to support dialogue, questioning, and solutions for combatting that ugly, pervasive thread in the fabric of our country’s patchwork quilt called racism.

Last year we read “Narrative of the Life of Frederick Douglass,” a former slave turned abolitionist, and juxtaposed its reading with a viewing of Ava DuVernay’s documentary “13th,” which discusses modern-day slavery in the guise of mass incarceration. Students asked questions of the documentary as they watched it and discussed those queries within their groups and with the class at large afterwards.

We do our children and ourselves a disservice when we don’t have these difficult conversations as a part of our collective curriculums. However, many teachers from various walks of life are neither well-versed nor fully comfortable discussing race on any level with their students. Not talking about racism won’t make it go away. If anything, not talking about racism in the classroom further perpetuates racist ideologies that are, at their root, born out of ignorance. Education’s goal is to dispel ignorance and replace it with truth.

With that being said, just how many teachers feel equipped to facilitate lessons that touch heavily upon race in the classroom? Not nearly enough.

According to Teaching Tolerance, “The dialogue about race should start in the classroom — the teacher-prep classroom, that is. Preservice teachers should be exploring multiculturalism and discussing ways to honor diversity in their future classrooms.”

But often, Hilton Kelly, a professor of education at Davidson College in North Carolina told the site, the coursework isn’t giving future teachers the training they need to talk about race. “Even when future teachers take courses on diversity and multiculturalism,” Kelly said, “those courses don’t take the critical approach to race that future teachers truly need.”

“Food, folklore and festivals are not the same as an analysis of race in America,” Kelly argued.

But an analysis of race in America is exactly what needs to happen. Furthermore, it can’t just be teachers of color solely facilitating such lessons in their classrooms.

I don’t want to write about the events going on in Virginia. I don’t want to think about it. I’m so tired of the hatred and I long for peace, but I can’t very well in good conscience remain silent. That would be akin to protesting with those hate-mongers in Virginia last weekend. I can’t just write about back-to-school shopping, lesson planning, and business-as-usual while my brothers and sisters in Virginia are being murdered in cold blood by white supremacist American Nazis.

Are the children of Virginia safe? Are our children anywhere safe? What can I do to make a difference within the hearts and minds of the children whom I teach? If education is our best vehicle for bringing about change — which it is— how am I going to infuse the lessons I teach with critical thinking and analysis about racism in the United States for the seventh-graders entrusted in my care? How are other educators planning to address these events with their students at every grade-level?

I pose these questions to all who are reading. Whether you are a teacher, a student, a parent, an administrator, or a community member, I plead with you to work together to create answers that work toward healthy conversations and hands-on action in the fight against racism.

Vivett Dukes is a teacher at Queens Collegiate: A College Board School. A version of this post first appeared on New York School Talk