School-Based Health Centers

What exactly is a School-based Health Center (SBHC) and why do they exist?

Well, a SBHC is essentially a medical clinic that operates on school property, either inside of the school or next to it, and is generally promoted to students through the school. These clinics provide a range of primary health care services to children by healthcare professionals. They are often advertised as a “convenient” option for parents so that parents don’t have to miss work to take their own child to the doctor. Just let the school handle it for you! 

But Why? Doesn’t the school already have a nurse? 

Yes! Schools do already have nurses, however the argument is that school nursing services are limited. School nurses can only provide first aid, or other services as directed by the parent. SBHCs can offer a wide range of services, and with a simple consent form buried in the stack of enrollment forms each year, they can do so without parental intervention or knowledge. 

SBHCs were first developed as the focus of “school health” expanded beyond just education. The Robert Wood Johnson Foundation helped pave the way for the development of this model, and still today funds the Center for Health and Health Care in Schools. 

Schools had already been an interest of public health officials. In fact, as the first vaccines became available, schools became a tool to get them into children. In 1858, the public school system was even used to conduct a pharmaceutical safety study for the first polio vaccine. At that time, 100,000 children in public schools were given doses of polio vaccine, or placebo, and then monitored through the schools. 

Ever since, people have largely overlooked the appropriateness of such things as immunizations and health screenings in school. Anyone remember the scoliosis tests we were given when we were in school? 

Platforming off of this, Pediatric and Nursing professionals pioneered school based health services, under the guise that too many children had medical needs going unattended, and that healthier children made better learners. From there, the reasoning expanded into equitable access for those who were uninsured. 

So the first SBHCs were opened in the 1980s. By 1985, there were only 31 SBHCs in the Country. By the 1990s, thanks to continued efforts from lobbying organizations there were 1,000. But it was the acknowledgements from the Obama Administration, and the inclusion of SBHCs in their healthcare reform efforts that really changed the landscape. Thanks to ample funding included in The Affordable Care Act, the number of SBHCs more than doubled throughout the 2010s. By 2020 there were 2,500, and that number is set to skyrocket again as the Biden Administration has renewed the Obama era interest in SBHCs. The Biden Admin has not only renewed interest, but has prioritized SBHCs as a key opportunity to access children during the day, with no parental intervention. 

In 2022, the Safer Communities Act was passed and signed into law. Within this legislation, there was an emphasis on mental health services which provided for Medicare to support States in creating mental health programs in schools. It also required CMS to provide guidance to States in order to provide mental health services explicitly in school. It also reauthorized the Pediatric Mental Health Care grant for five years. Overall, it granted $1 Billion dollars to expand School-Based Mental Health Services.

In 2023,  each State qualifies for up to $50 million in grants for the express purpose of opening new SBHCs in public school, with again, an emphasis on “racial and lower socioeconomic communities”.

Why are they dangerous?

The marketing materials for SBHCs make these clinics sound great. Convenient, affordable, equitable. This is how they are sold to lawmakers, school districts and even to parents. But you don’t have to look very deep to see that they are admittedly intended to be the “medical home” for your child, including primary health care services, reproductive healthcare, counseling, dental and mental healthcare. Meaning they are intended to replace all of the providers a child would typically see outside of school. Essentially eliminating a whole chunk of parenting responsibility. 

To really address the danger of SBHCs, we have to really step back and look at the big picture. 

The Model

It’s been no secret that the Government has been taking an increasing interest in our children. We hear more and more rhetoric coming from politicians about “the children!”, we are tracking more policies than ever that affect minors, homeschooling, education, consent, and parental rights are being debated on a national stage. 

There is even a push of propaganda to paint “parental rights” advocates as extreme right-wing activists. Even though, given our Nation’s history, it is the minorities and lower income populations that should probably be the most concerned about this. After all, it isn’t the children of the elite that are being targeted. It’s ours. 

For the last 4 Presidencies, revising the educational model has seemingly become standard. 

Bush had No Child Left Behind, Obama had Every Student Succeeds, followed by the Common Core Initiative, and now Biden has The Whole Child Model.

SBHCs are the key step in achieving The Whole Child Model. SBHCs are the major step in bringing outside services inside the school. They are intended to increase “school connectedness”. Essentially leading students to believe the schools genuinely care about them and can be trusted without question. With the level of involvement in the school SBHCs have, and the direct access to children, advocates have often boasted about the ability to drive social behaviors, increase total immunization compliance, and shape the child’s development. In other words, their goal is to raise your children.

Services Generally Offered

SBHCs offer a broad range of services intended to replace a child’s family doctor. Examples of SBHC services are:

  • Routine pediatric care, including immunizations, sick visits, & well-child visits. Health screening, eg. 
  • Early Periodic Screening & Diagnostic Testing (EPSDT). 
  • Mental and behavioral health services, including assessment, counseling, & prescription medication.
  • Reproductive counseling & birth control prescription and management.
  • Pregnancy related care.
  • Sexually transmitted disease care, including HIV/AIDS screening & management.
  • Substance abuse interventions (drugs and alcohol).
  • Social Emotional Learning (SEL) support.
  • Dental services (exam, x-ray, cleaning, and sealant when indicated).
  • Vision care (exam and corrective products when indicated).

Essentially, the State through the school becomes the parent, and the parent. Which raises a lot of questions and concerns, especially considering the struggle Education continues to experience. 

Main concerns

SBHCs are largely unregulated.

As this model has been rapidly developed and implemented, the regulation is being pulled from a combination of places. Crossing medical regulation and educational regulation,but falling under neither. When something does happen at one of these clinics, there is no clear ownership of responsibility, and no clear path of complaint or recourse. 

SBHC services are broad in scope, and often exclude the parent.

At best we have seen open ended “medical consent” forms tucked into a thick enrollment packet. After speaking with countless parents, we found that most of them sign the form thinking it is the emergency medical form for the general school nurse. Most parents don’t even realize their child’s school has a fully functioning medical clinic. But in the eyes of the law, no one cares if you realized what you were signing. Once those forms are signed, the clinic can treat your child. 

To further complicate things, we have seen multiple States now passing minor medical consent laws, or exceptions to laws. This allows minors to give consent to medical treatments. So, in these States, or in States with these exceptions, your child could be undergoing medical treatments during their time at school, and you would never know. 

SBHCs generally focus on immunization, reproductive health, sexual health, and mental health services.

Meaning that regardless of a family’s religion, culture, or ideology, your child could be vaccinated, given birth control, including invasive birth control options such as implants and IUDs, and even medicated without the parent ever even knowing.

Children will suffer in the name of convenience.

There has always been a point to parents parenting their children. As the parent, no one knows that child like the parent. No one knows that child’s medical history, familial history, and needs like a parent. 

When there is an emergency outside of the school, or when a child becomes symptomatic, it is not a school administrator taking that child to the Hospital. It is the parent. If the parent does not know what medications the child is being administered, or what the child has been treated for, the parent is unable to relay that information in emergency situations. The very life of the child can hang in the balance in these situations. 

Education is already suffering.

We already have numerous issues with education. Our teachers are already underpaid for the work expected of them, and now we want to pile on more responsibilities? Our students are already struggling, there is so much emphasis placed on testing and not enough on actual learning and ability. 

Should we really be packing the school with more organizations, more bureaucrats, and more services with less oversight?

SBHCs provide inappropriate access to children while parents are away. 

Education was one aspect of childhood that we had managed to standardize, and we had only just begun to realize how harmful even that could be. Because children are not standard. Each child is unique, each with their own personalities, desires, inspirations, and needs. When it comes to meeting the needs of a child, it is personal. Even in regard to mental and medical care. It’s important to find the right counselors, therapists, and even Doctors. Professionals that the child feels comfortable with and responds to. In addition to this, each family has its own unique factors that go into the vast array of decisions parents make.

A Muslim family, or a Jewish family will participate in activities and services, and even seek medical care in accordance with the tenants of their faith. Religion can affect the decisions of a family in a way that those of other religions, or no religion, may not understand. Worse, if given access to children of these families, some may not even respect the religious or cultural aspects. Would you want someone with entirely different religious or cultural values dictating such intimate things for your child? No!

Children are typically safest with their parents.

SBHCs are intended to replace the family doctor.

Advocates, and Federal Administrators have admitted that a primary goal of SBHCs is to make the public school the center of care. To develop a location where “all needs” of a child will be met, including education, mental, medical, and social health.

There is no set standard for who employs the providers.

Because there is very little oversight or regulation, there is also no standard method for opening or operating a SBHC. There are already thousands of SBHCs across the US, and there are multiple models being used.

Some clinics are being run by Hospital Networks, contracting rental space within the school. Others are being run by private Pediatrics practices, in partnership with the school. Some are receiving Federal and/or State funding. Others are technically privately operated businesses.

Due to the lack of standardized model of operation, it can become very convoluted and unclear who is involved or what incentives may exist. Not to mention the accountability and liability issues that will become problematic.

If the State, through the school, controls what your child is taught, what your child believes, their medical care, and their counseling, what does that make the parent?

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