Saving Multnomah County's School-Based Health Clinics

By Liz Smith Currie of Portland, Oregon. Liz is the policy director at the Oregon School-Based Health Care Network - an organization that seeks to advance access to school-based health care for Oregon's children.

Imagine if your kid has a sore throat. She wakes up in the morning crying, "Mom! I can't swallow well," the way only a sick kid can say it. A couple of problems pop into your mind. You used all your leave when she had the chicken pox – oh, and you used all your meager savings as well to pay for her hospital visits. If you call in for the day on this sore throat, you won't get paid, maybe even fired. You take a gamble that she doesn't have strep throat, give her baby aspirin, and put her on the bus. "At least," you say to yourself, "there's a health center at school."

Since 1987, Multnomah County's school-based health centers have provided health care to children who wouldn't otherwise have access to complete care. This pioneering program has received accolades and is a model for the 1,700 school based health centers across the country that provide for society's most vulnerable. It's a source of pride for the schools where these clinics are housed and a beacon of hope for families who otherwise have no options. That's why when Multnomah County's middle and elementary school health centers were left out of Chair Ted Wheeler's proposed budget, protests began. Parents, teachers, nurses, business people and students testified or wrote the commission against the cuts. Governor Ted Kulongoski and eight state legislators even took the unusual step of writing the Chair to ask him to reconsider.

There are various reasons why kids don't see a personal physician: lack of insurance or transportation, a parent unable to leave work, kids may be unable to communicate the condition or issue with their parent, and the list goes on. Whatever the reason, nothing negates the fact that they deserve regular preventative care or treatment for chronic or acute medical conditions. School-based health centers overcome many of these barriers because they are like having a doctor's office in your kid's school. They bill the kids with insurance and they provide services on a sliding scale to those who can't afford health care in a traditional setting. School-based health centers see children who have rarely, if ever, seen a doctor, children who've never been immunized, and children who've ignored their own continuing health issues because they knew their parents could not afford treatment. Nurse practitioners have caught life-threatening conditions like cancers, diabetes, and heart conditions.

School-based health centers serve all Multnomah County students that need it through 12 centers across the county. In the 2005-2006 school year, county school health centers treated 6,500 children in 20,653 visits. Of those visits, 52 percent of clients were a racial or ethnic background other than White, and 63 percent of clients had no insurance. Students from any background are encouraged to use the centers and some offer summer hours. Summer hours are vital to ensure that student athletes can receive sports physicals, teens have a place to go to address their ever-changing issues, and children with no insurance can still get the regular care they need.

Commissioner Jeff Cogen championed the school based health centers during his 2006 campaign and pushed to save them – all the school centers, the summer hours and the East County Teen Clinic – during this first budget session of his term. Jeff's reasoning was simple: if and when the Oregon Legislature passes the Oregon Health Kids Program, Multnomah County will have increased reimbursements to pay for the services they provide.

The Oregon School-Based Health Care Network is committed to working with the commission and the health department to find other solutions to help support these critically needed services. Our clinics will remain for one more year. It's up to our representatives or and the voters to make sure they are allowed to stay open for many more years. I appreciate Jeff and the other commissioners' first step. Please encourage your state representative to vote for Healthy Kids and take the next one.