Touchy School Health Clinic Issue Is Expected to Surface Again

After a three-year hiatus, the emotion-tinged issue of school-based health clinics is again expected to come before the San Diego city schools Board of Education sometime this spring.

A proposal to consider a pilot clinic in the East San Diego area anchored by Hoover High School will be discussed Friday by a multi-agency committee of school district, city, county and community college administrators known as the “New Beginnings” project. It was formed last year to look at ways of providing better, more coordinated health and counseling services to San Diego students.

School board approval would be required for implementation and--as happened in July, 1986, when district trustees voted, 3-2, to reject a similar plan--the public debate may well center on the sensitive issue of providing family planning and birth-control information, as well as contraceptives, at a clinic.

Proponents, however, hope this time to steer the debate more toward the issue of providing basic medical care and counseling, which they say would be the clinic’s major role. The impetus for resurrecting the clinic question comes in significant measure from school administrators bothered by the lack of basic health-related services available to many urban-area students.

Prepared to Argue

But clinic supporters are prepared to argue the need for family planning information as well, and will come armed with results of a telephone survey conducted last fall for them on the issue by the San Diego County Office of Education.

In the poll, which has not been distributed publicly, two-thirds to three-fourths of 566 adults living within district boundaries and randomly surveyed favored private foundation-supported clinics where students could attend with parent permission, and where both birth control and prenatal care information would be provided.

Such a setup is along lines of three school-based health centers now operating on high-school campuses in the Los Angeles Unified School District.

On Friday, the teen pregnancy task force of the New Beginnings project will suggest to the full committee that the Hoover community be surveyed as to whether it favors a school-based health center for easier medical access for students.

In its report, the task force said its study of national and local literature, and interviews with local health officials, found a lack of knowledge among many teen-agers about human sexuality, about pregnancy and about where to get help either for prevention or care of pregnancy. The committee also said that “school nurses see a large number of students each day . . . (and) many parents recognize the school nurse as the primary provider of health care.”

The report, written by school district health director Edward Fletcher, makes no recommendations on the specific functions of a clinic, such as whether it would only provide family-planning information or would dispense contraceptives as well. Now, district personnel can provide no family-planning counseling but can only suggest that worried students seek private help. The district also has three small programs, all filled to capacity, for helping teen-agers either pregnant or already with a child to continue their schooling.

New Beginnings selected the East San Diego area served by Hoover for study because the neighborhood has wide ethnic diversity and many low to lower-middle income students who need basic medical care as well as drug, family, mental-health and employment counseling.

Students Come and Go

Hoover has one of the district’s highest mobility rates--51 out of every 100 students who begin in September are in other schools by the following June--as well as having the greatest need among local secondary schools for federal education assistance.

The project also has committees on school attendance/dropouts and data collection for the Hoover area, which will suggest Friday more structured ways for social counseling services to avoid duplication of effort and provide quicker access.

The task force recommendation dovetails with a separate study undertaken since June 1988 by a school-community committee at Hoover known as Hoover 2000. That committee focused on ways to improve social services, based on experiences of teachers and counselors, and the fact that the school nurse asked for a transfer to a smaller school last year after becoming burned out from seeing 1,000 students, month-in and month-out, for primary care.

With the help of San Diego State University, Hoover undertook a health survey of its students in October. Among major findings: three-fourths of the students had medical care three times or less in a year; one-third received care from the school nurse; one-half had families eligible for government medical assistance and one-third had families who must pay cash for care; and one-fourth reported at least occasional problems of depression, stress and emotional upset.

Although many public and nonprofit agencies provide counseling and medical care in the area, the efforts are poorly coordinated and poorly used by students, the survey found. But an overwhelming majority of students wanted more information on health matters, from basic care to drugs to sex-related issues--and more than half said they would use a school-based clinic.

At a meeting earlier this month, the Hoover committee voted to present its findings to New Beginnings and to combine efforts for a common proposal.

Nurses Are Swamped

In particular, committee members noted the heavy use that students make of the school nurse, not only at Hoover but at most schools throughout the district, and especially in lower-income areas. That led Hoover Principal Doris Alvarez to emphasize the primary care and counseling function of a clinic and to suggest that students from the elementary and middle schools around Hoover be eligible for services.

District nurses already are swamped with student demands for their time, in large part because only a few schools have full-time nurses. Nurses also note an increasing tendency to send students to school sick and put the problem of arranging transportation home or seeking a medical referral on the nurse.

And administrators point to an incident at Oceanside’s Lincoln Junior High School this month in which the entire student body of 700 students had to be tested for exposure to tuberculosis because of a sick student who remained in school because the family had no health insurance or money to visit a doctor.

The specifics of any school-based clinics--location on or next to a campus, family planning information, funding--would be up to the Board of Education. In 1986, the board voted down the concept of a foundation-funded clinic without getting to specifics regarding family planning and contraceptives.

In Los Angeles, the clinics are supported by the Robert Wood Johnson Foundation of New Jersey, which had offered support to San Diego in 1986 and which backs many of the more than 100 school-based clinics nationwide.

In Los Angeles, parental permission is needed before a student can use the clinics, and, although birth-control counseling is offered and contraceptives issued, there is no abortion counseling and there are no referrals for abortion. Figures show that 90% of the students visit the clinics for primary care, stress and weight-related matters.

But no matter what limits, San Diego anti-abortion forces are expected to oppose any health-clinic plan because they view them as stalking horses for birth-control measures that include abortions or abortion referrals.

Already twice in the past month, Joan Patton of the Coalition for Family Values has appeared before the school board to denounce existing programs aimed at providing basic family-planning and pregnancy information to students as merely precursors to abortion referrals by school administrators.

The fact that schools health director Fletcher wrote the New Beginnings report will only infuriate opponents of clinics, since they view Fletcher as a catalyst for expanding family-planning programs. Patton attacked Fletcher by name in her board appearances.

Catholic Boycott Staged

The Catholic Diocese of San Diego opposed the idea of clinics in 1986 and sponsored a one-day boycott of classes by Catholic students attending San Diego public schools to drive home its point.

But school administrators will point to the results of the poll, in which 66% of those surveyed would favor health clinics if voluntary with parental permission required. Twenty-nine percent would oppose and 5% were unsure. If the clinics were paid for by foundations rather than by public funds, support increased to 71%, with 21% opposed. Three-fourths said they would favor clinics if prenatal care were provided and 77% would favor clinics if birth-control information were provided.

“Indeed, support for the clinics increases as the sensitivity of the information provided increases,” said the report by Decision Research of San Diego, which asked the special questions for the school district as part of a general survey on educational issues done for the county Office of Education.

Although the county office released its poll results in December, the district has not publicly released the results done specifically for its administrators, circulating them among educators.

“On each of the health clinic questions, there are no differences between men and women, and only small differences across other groups,” the report said. “Parents and non-parents alike favor the clinics, with only the parents of children past high school somewhat less enthusiastic . . . the objections of higher-income groups appears to be economic, since, when it is indicated that the clinics would be paid for by private foundations, support among higher-income groups is actually higher than for low-income groups.”

SURVEY ON SCHOOL HEALTH CLINICS Persons over age 18 living in San Diego ZIP code areas served by the San Diego Unified School District were selected and interviewed between Sept. 29 and Oct. 19 by Decision Research of San Diego. Interviews were with 566 adults in households with telephones in which English or Spanish was spoken. The sample was drawn using a random digit sample, which includes all telephone exchanges found in the ZIP code area.

School No Age Preschool Male Female Children Children Children If health clinics were voluntary, with parental permission: Favor 64% 68% 65% 70% 74% Oppose 31 27 31 24 21 Don’t know 5 5 4 6 4 Clinics paid for by foundations, not public: Favor 72% 71% 75% 74% 77% Oppose 21 20 19 18 17 Don’t know 7 9 6 7 6 Prenatal care information included: Favor 73% 76% 78% 75% 89% Oppose 22 19 19 19 9 Don’t know 5 5 3 6 2 Birth control information: Favor 77% 76% 82% 76% 85% Oppose 19 19 16 18 13 Don’t know 5 4 2 5 2

Past High School Age Children If health clinics were voluntary, with parental permission: Favor 60% Oppose 34 Don’t know 6 Clinics paid for by foundations, not public: Favor 59% Oppose 28 Don’t know 13 Prenatal care information included: Favor 62% Oppose 30 Don’t know 8 Birth control information: Favor 64% Oppose 28 Don’t know 9

Source: San Diego County Office of Education