Health Care

American children face increasing physical and mental health risks, such as infection with the AIDS virus, alcohol abuse, and suicide. Yet many children lack access to regular health care needed to prevent disease, disability, and unnecessary hospitalization. A small but growing number of communities have turned to an innovative approach to reach children with limited access to health services. School-based health centers afford children easier access to needed health services by bringing providers to the children, furnishing free or low-cost services, and supplying the atmosphere of trust and confidentiality adolescents need. The centers do not, however, provide all the health services required by students and cannot reach adolescents who have dropped out of school. A lack of stable financing is a major concern for the centers, with some centers reporting insufficient funds to meet all children's needs. Centers have also had difficulty recruiting and keeping appropriately trained nurse practitioners and physician assistants, who are their key primary care providers. Community debates over the appropriateness of providing reproductive health services in the centers have limited the centers' ability to meet some adolescents' health needs. Communities lack access to information on establishing new centers and solving problems at existing ones. Furthermore, research measuring the impact of the centers on health and education outcomes is sparse. Coordination of school health programs within the federal government has begun, but the Department of Health and Human Services lacks a focal point to answer outside inquiries, provide technical assistance, or develop a research agenda.

GAO found that: (1) SBHC afford children easier access to needed health services by bringing providers to the children, furnishing free or low-cost services, and supplying the atmosphere of trust and confidentiality adolescents need; (2) SBHC do not provide all health services required by students and cannot reach adolescents who have dropped out of school; (3) a lack of stable financing is a major concern for SBHC, with some centers reporting insufficient funds to meet all children's service needs; (4) SBHC often have difficulty obtaining reimbursement from public and private insurers, including Medicaid; (5) SBHC have difficulty recruiting and retaining appropriately trained nurse practitioners and physician assistants; (6) community debates over the appropriateness of providing reproductive health services in SBHC have limited the centers' ability to meet some adolescents' health needs; (7) communities lack access to information on establishing new centers and solving problems at existing SBHC; (8) research measuring the impact of SBHC on students' health and education is sparse; and (9) although efforts to coordinate school health programs within the federal government have begun, the Department of Health and Human Services does not have a focal point to answer outside inquiries, provide technical assistance, or develop a research agenda.