No replacement likely for school-based clinic until at least 2009
LINDEN HILLS — Southwest High School’s school-based clinic closed at the end of last school year and was not expected to reopen until next fall at the earliest, raising concerns about student health care.
Students who would have visited the clinic for everything from the routine physical required for school athletics to immunizations to mental health counseling will have to seek those services off-campus this school year.
That may mean students seeking health care will spend more time out of class this year. Others, officials feared, might not receive adequate treatment or counseling for health issues.
Teenage Medical Services (TAMS), the adolescent outpatient health service of Children’s Hospitals and Clinics of Minnesota, operated the independent school-based clinic. It was shuttered quickly and quietly at the end of last school year, Southwest Principal Bill Smith said.
“I was notified one day [and] the next day it closed,” Smith said.
“It was quite a shock, and it was done so rapidly there really wasn’t a recovery time,” he added later. “I think we’re going to have a lot of questions from our students.”
Children’s Hospitals cited ongoing “financial challenges” in a written statement explaining the decision to close the Southwest clinic.
“We have had to make difficult choices to limit the scope of some services we provide, particularly those that are neither hospital-based nor adequately reimbursed by insurers,” the statement read.
In 2007, at least 250 students used the Southwest TAMS clinic for 650 visits, Donna Amidon of the Minneapolis Department of Health and Family Support said. In any given year, about half the students seeking care at a school-based clinic will be uninsured or underinsured, Amidon said.
Her count did not include mental health-related visits or students who received health education at the clinic on any of a number of topics, including reproductive health, chemical use and nutrition. She estimated the actual rate of student use to be “a lot higher.”
This year, Southwest will be the only one of the city’s seven traditional high schools without a school-based clinic. Southwest students will not be able to access clinic services at other high schools.
Southwest will still have a school nurse, but the nurse cannot make a health diagnosis, prescribe medication, administer immunizations or perform a number of other tasks that formerly handled by the
Seeking a replacement
As Southwest administrators prepared for the new school year in August, they were also scrambling to inform students and families of the change.
Smith said a letter listing nearby adolescent health care providers would be included in a new school year welcome packet for families. The school also was beginning the search for another community partner to provide school-based health care, he added.
“It’s not going to happen at the start of the school year,” Smith cautioned, adding that it might not be until fall 2009 or later that a school-based clinic reopened in Southwest.
The former clinic space was converted to school offices over the summer, he said.
The Minneapolis Department of Health and Family Support administers most of Minneapolis’ school-based clinics. Southwest and North High School — where the clinic is operated by NorthPoint Health and Wellness Center — were the only exceptions.
The school district does not fund the clinics and does not benefit financially from their operation, but does provide them with rent-free space in high schools, Mary Heiman, the Minneapolis Public Schools (MPS) nursing services manager, said.
When they can, the clinics bill students’ family’s health insurance providers for any care provided.
Still, uninsured and underinsured students make up a significant portion of the students seeking services. Clinics provide those students care for which they may not be reimbursed.
“The bottom line is there is never a fee charged to the student or the family,” Amidon said.
She said it would be a challenge to find a new partner for Southwest or the resources to expand the city administer clinic program to the school. The city-administered clinics operate on a budget of about $2 million per year, funded through a combination of federal and local grant dollars and some city dollars.
Heiman, who serves as the MPS liaison to the school-based clinic providers, said the loss of TAMS at Southwest happened so quickly the district had little opportunity to begin the search for a new health-care partner.
The loss of free, confidential, in-school care could impact a number of students in ways both small and large. It will also impact the school nurse, now the sole school-based resource for Southwest’s nearly 1,700 students.
Amidon said the closure could mean students spend more time away from school and extracurricular activities like sports, theater and school clubs. Students who participate in those activities are less likely to engage in high-risk behavior, she noted.
Amidon said student mental health care was “one of the biggest areas of concern” in schools. And her department will monitor Southwest for a rise in teen pregnancy rates, one potential consequence of the loss of the reproductive health care offered in the clinic.
“That’s one of the things we’ll watch closely this year,” she said.
Amidon also expressed concern for students who lack adequate health insurance. Instead of receiving free care, they may have to pay sliding-scale fee at an off-campus clinic. They also will have to find transportation.
Even those small barriers could cause a student to delay or forego care, she said.
“It’s something we’re all for sure concerned about,” she said.