School-based health centers could improve Philly kids’ educational outcomes

Over 2,500 school-based health centers (SBHC) are situated in primary schools across the country. Of those clinics, which provide mental, sexual, dietary and other vital health services directly to students on campus, only 20 are based in Pennsylvania.

Education Plus Health, a South Kensington-based nonprofit that serves as the Pennsylvania affiliate of the national School-Based Health Alliance, has had growing success with the model in the seven years since its founding and currently serves 7,326 students through its centers, based in public, private and charter schools.

All 236 students served at the organization’s 21st Century Program in North Philly’s Building 21 High School, for example, have demonstrated increased grades in reading and mathematics.

A lot of that success has to do with properly treating kids with asthma.

“Asthma is the leading cause of absenteeism,” said Education Plus Health Executive Director Julie Cousler Emig. “School-based health centers have a strong demonstrated impact on cutting absenteeism rates. More seat time should lead to better educational outcomes.”

"More seat time should lead to better educational outcomes."

Philadelphia has infamously high infant mortality rates, child mortality rates, teen birth rates and absenteeism. Cousler Emig suspects SBHCs are a missing piece of the child health puzzle in Philadelphia and Pennsylvania.

Pennsylvania, she said, used to have more SBHCs, but the number has dropped due to dwindling support.

“Finances are a challenge,” said Cousler Emig. “Most school-based health centers across the state are funded by the state or city [government].”

And although local leadership is starting to pay attention, support for SBHCs in Philadelphia and Pennsylvania is moving slowly. A lot of that lethargy, she said, has to do with leadership changes.

Insurance can pose another problem. In predominately low-income-populated schools, such as Title I schools, most students are on Medicaid plans. And while Cousler Emig said most Medicaid plans, such as Keystone First, understand the importance of SBHCs and work with them to provide support, Medicaid reimbursement rates are generally low and students insurance coverage often lapses.

In many states across the country — such as New York, which supports the 255 SBHCs operating in schools across that state — state governments provide dedicated funding streams for SBHCs that account for these challenges.

Private insurers are also a little behind the ball. Nurse practitioners at SBHCs in Pennsylvania, for example, can’t be primary care providers.

“Fifty percent of our services are written off as charity care,” said Cousler Emig. That’s for students who are either uninsured or are out-of-network.

Education Plus Health is looking to expand into more public schools in the coming year, and Cousler Emig is hopeful that the city’s Community Schools initiative will take more steps to bring SBHCs to more public schools across the city.

“They should be at all schools in Philadelphia,” said Cousler Emig. “It’s something we’ll have to stay [working] at for a long time.”