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Foundation Sets $23 Million for School-Based Health Services

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The Robert Wood Johnson Foundation has launched a five-year, $23.2 million grant program to improve health services for school-age children who have limited access to medical care.

Beginning in January, the program, called "Making the Grade: State and Local Partnerships to Establish School-Based Health Centers,'' will award $100,000 planning grants to 12 states that are working with school districts to develop or expand school-based health services, according to Lisa Olszewski, a foundation spokeswoman.

Based on the success of these planning projects, up to 10 of the grantees will be eligible to receive four-year implementation grants averaging $1.8 million each.

During the 15-month planning period, states will review existing laws and regulations, pinpoint barriers to integrating health services in schools, and develop a specific plan to eliminate them.

The grantees will also be charged with suggesting innovative ways to train the school health workers who will be administering the bulk of the services to students. The grant money will largely be geared toward staff development, data processing, and supplies, according to Ms. Olszewki.

"Making the Grade'' builds on a decade-long foundation effort to support adolescent health-care programs in schools by supporting the coordination of services that the foundation sees as key to the success of a school health program.

"State legislators and schools will have a planning year to work out their differences,'' said Julia Graham Lear, the program's director.
"To expand the number of health programs, we think it's important to get the policy pieces in place,'' explained Polly Seitz, the foundation's senior program director.

Overcoming Obstacles

One obstacle to developing successful school-based clinics, foundation officials say, is Medicaid. Under federal law, school clinics are not automatically eligible to be Medicaid providers. The cumbersome demands of qualifying for Medicaid take "too much energy away from care providers who should be taking care of the kids,'' said Ms. Seitz.

Program organizers added that community opposition to clinics may be the most challenging hurdle. Many communities have objected to school clinics that offer reproductive services, such as condom distribution, charging that they promote sexual activity.

"There will be communities where parents say they don't need it--where there may already be a plethora of services--but this is a good way to provide incentives to reorganize what some states are doing,'' said Ms. Lear, an associate research professor at George Washington University.

A Potential Model

Despite these barriers, foundation directors hope that once these programs are established, they will become models for the national health-care-reform effort, which is likely to include a plan for a network of school-related health services.

Although the number of school-based clinics in the United States has grown from less than 50 in 1986 to 400 today, there are not nearly enough clinics, health experts say, to attend to the health needs of children who otherwise lack access to medical services. By helping states and communities identify organizational barriers, Ms. Lear said, states can create an environment where a network of clinics in schools is possible.

Education leaders already are hailing the program as a necessary step toward strengthening interagency partnerships in health and education.

"We are just delighted that this foundation is willing to work with schools to bring down these barriers and to insure that children are fully prepared to learn,'' said Michael A. Resnick, the associate executive director of the National School Boards Association.

More information on the grant program is available from Ms. Lear at (202) 466-3396.

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