Expanding School-Based Health Clinics: A bad ideaby Karen Holgate(Received July 10,1999) It wasn't that long ago that opponents fought against establishing health clinics on school campuses. These opponents argued that once clinics were established, clinic supporters would not be content with offering limited services to the poor. They argued that like all government entities clinics would seek to expand services and encourage greater dependence on the services offered. Those early opponents were right. Many states, and now some members of Congress, believe school-based health clinics should offer not only "comprehensive" primary health care, but also include a full range of mental health services. In California, AB 1363 (Davis, D-SD), is making its way through the legislature. This bill seeks to drastically alter and expand the scope of services offered by school health centers. The original version of this bill "required" school boards to provide "school-based health centers as traditional and safety net providers." The amended version altered this mandate by saying: "This bill would `authorize' the board to include school-based health centers as traditional and safety net providers that `meet certain requirements.'" (Reality: schools that now have centers will be greatly expanding services; those that don't have clinics will be implementing them. If some school boards try to hold-out, you can be sure they will be pressured into implementing these full-service clinics.)
AB 1363 will include comprehensive primary medical and mental health,
including:
Davis' bill continues by saying that these clinics must be "easily accessible" and must be open during classroom hours as well as limited before and after school hours. It says that local providers will decide their own "parental consent policy." As a parent, does that give you a warm and fuzzy feeling that you will have control over your child's health? Do you feel confident that your school will protect your rights? Do you believe your child's school should be allowed to determine the extent of your participation in, and "parental consent" of, your own child's basic health needs? AB 1363 mandates that clinics "shall" be "user-friendly" (for students), "private," and "confidential" and should involve parents as is "age appropriate" for the student AND only with the student's consent. (Do you still feel in control?) AB 1363 continues by saying that the clinics are to "encourage" students to use them. It makes it clear that the clinics will recognize the rights of the child (not the parents). Children will be able to participate in the "decisionmaking" process for their own health care (not parents). The bill repeatedly reiterates the students' need for privacy; it then states that students "shall be" provided with a written statement about the hours and services offered by the clinic. (not parents). Of course the bill mandates that extensive data will be collected on each child. This "consistent and complete" data is to include, but not be limited to:
This is not just a California phenomenon. In Indiana, Dr. Karen Effrem, MD, says that school-based clinics allow mental health screening, tracking, and referrals without parental knowledge or consent. She says that parents and/or the parents' insurance is often billed for these services-again without parental permission or even review of records. Dr. Effrem points out that the guidelines for diagnosing mental health are extremely broad and vague. This mounting absurdity is not just occurring within individual states; Congress has entered into the debate. Some members now believe that using school-based health centers to treat "depression" in children will help reduce the chances of another Littleton disaster.[1] Before engaging in feel good "knee-jerk" reactions to the Littleton tragedy; or before authorizing massive expansion of school-based mental health services, issues of privacy, confidentiality, parental rights, funding, and the proper role of government (and public schools) in the lives of citizens must be addressed. Psychological evaluations are already being conducted on children in classrooms across America-often without parental notification or permission. Teachers often administer surveys that ask children whether their parents treat "other children" in the family better than they treat them, whether their parents are headed for a divorce, about their personal use of alcohol, drugs or other substances, about their thoughts, feelings and attitudes, about how they feel about mom and dad, etc. Most of these surveys are given without parent notification or permission. Sometimes teachers (not trained psychologists) are asked to evaluate students. A survey given to third grade teachers in Ohio [2] asks teachers to subjectively measure and record students' behaviors. Some of these questions ask the teacher to judge whether the student 1) "appropriately questions rules that may be fair, 2) appropriately tells you when he or she thinks you have treated him or her unfairly, 3) gets along with people who are different, 4) fidgets or moves excessively, disturbs ongoing activities, 5) has low self-esteem, 6) appears lonely, 7) gives compliments to peers." Notice the subjective nature of the questions. Who determines what is "appropriate"? What does it mean to "fidget or move excessively"? (We're talking 3rd graders!) If your child doesn't give enough compliments to his/her peers, does that mean your child is not normal? In this particular survey teachers are actually instructed that if they don't observe one of the behaviors listed they are to "estimate" what they think the child would do. Can you imagine the scope of subjective evaluations of your child's "mental health" if school-based health clinics decide they can and should start screening every child for potential "mental health" problems? The opportunity for wide-scale abuse is staggering. Parents are already complaining about the abuse of current school practices. For example:
In addition to the concerns over parental rights, concerns over the growing cost to maintain these clinics should be considered. For instance, while AB 1363 is gaining legislative support, [4] SB 468, [5] will change current California law and allow mental health parity insurance coverage. For parents of school-age children, this means that SB 468 will allow their insurance to be used to pay for mental health services administered by the school-based health clinics. All too often these services will be administered, and payment made, without parental knowledge, consent or involvement. But the cost doesn't stop there. Another bill, AB 920, was also introduced this year. Designed to provide $35,000,000 in "seed" money to kick-off the implementation of these centers, the bill didn't make it out of committee this year. However, a call to the author's office verified that the bill will resurface in January, 2000. The cost to the taxpayer doesn't stop at "seed money". Pennsylvania State Representative Sam Rohrer has strong words about the cost of this movement to install comprehensive health care into our school system. Rep. Rohrer says: "What is involved in the `Medicalization of the Schools'? At issue is Medicaid. Once the government sponsored health insurance program for the poor, Medicaid has now moved mainstream into our schools. It is paying salaries, funding multiple programs that boldly intrude into the sanctity of the home, and is the cause of escalating federal and state budgets. If this weren't objectionable enough, the Medicaid component is but one spoke on the wheel of the larger societal restructuring movement that clearly orchestrates a number of large federal entitlement programs to produce what the Clinton administration calls a `safety net'." [6] Rep. Rohrer is right. The burden of supporting the "medicalization" of schools will fall on the taxpayer. Health care doesn't come cheap. And at a time when many families and older Americans can't afford decent health care, the government now wants to use highly questionable tactics to create a massive bureaucracy that will violate the sanctity of the family and drain America's workers of personal income. Taxpayers will be paying higher taxes and increased insurance premiums to cover the costs of a government run, and staffed, comprehensive, full-service health care system in schools. Rather than enact legislation that would lower taxes and insurance premiums, thus making it easier for America's families, and seniors, to afford medical care, the government's answer is to force Americans into paying increased taxes and premiums thus forcing more and more of them to rely on the government to provide these services. This is nothing more than Hillary Clinton's original-and failed-health plan now being implemented in schools across the country. It is the fulfillment of the "village school" concept. What is a "village school?" In 1996, Pomona, California established "Education Village at Plaza Azteca." This new "village school" includes "a seamless flow of services from preschool to university," [7] health services for students and their families, and a full range of services that includes social and family support systems. "Village schools" allow the centralization of government services. They have a captive audience. At the opening ceremony of Pomona's "village," Superintendent Patrick Leier said that he expected the new facility to cost $10 million. He said the district had budgeted $5 million and anticipated an additional $4 to $5 million from the state in matching funds. This, of course, is just the beginning. Initial costs pale in relation to ongoing operational expenses. Expanding school-based health clinic services to include mental health and "comprehensive primary health care" for students is nothing more than a blatant attempt to wrest control away from parents and place the decisionmaking for their child's health in the hands of the state run health center. Clinic employees will decide what services are needed; whether a child is "depressed" and whether a child needs a pelvic examination, medication, etc. And remember, the parent is NOT considered a necessity in this process. There are already ample procedures and agencies in place to aid children and parents-whether the problem be mental or physical. Expanding school-based health centers and their services are totally unnecessary. The cost is prohibitive and the potential for abuse far outweighs any imagined benefits. Increasing government intrusion into the private lives of families is something that should be taken very seriously. ### Note: To find out what you can do to fight AB 1363 and SB 468, contact Karen Holgate at Parents National Network. This article can be found at: http://paul-revere.org
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1. See May, '99 article on Conflict Resolution and death education in
Littleton.
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