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Governor Links Health and Learning

Robert Landauer

Physically sick schoolchildren probably aren't learning much. If they're both mentally ill and disruptive, they may make it near-impossible, too, for their classmates to learn much.

These and other thoughts occurred to me Thursday, when Gov. Ted Kulongoski visited Roosevelt High School's health center in Portland to announce new schemes he has adopted to gain traction for the Children's Charter that he announced earlier this year. Access to basic physical and mental health care for all Oregon children is a priority.

Boiled to their essence, the governor's new tactics increase access points for young people to health care and maximize public and private insurance payments for treatments.

One important idea is a new employer-sponsored Children's Group Plan to decrease the number of uninsured children. It does this by providing an incentive to businesses that don't offer health insurance for their employees to buy this low-cost coverage. Working families with incomes up to 185 percent of the federal poverty level also may be eligible for a subsidy to buy the Children's Group Plan through their employer.

Another tactic is to raise the current asset limit for the state's Children's Health Insurance Plan program from $5,000 to $10,000. The intent, says Kulongoski's staff, is to see that "parents do not have to impoverish themselves further in order to gain health care for their children."

The most intriguing parts of the unveilings, though, were twofold: (1) Kulongoski's assertion that "We can help guarantee our children's health by providing access to health care in schools . . ." and (2) that he went out of his way to make the statement at a school health center, symbolically emphasizing that it is vital to integrate funding with school-based access.

Sixty-five percent of students in Oregon's 44 school-based health centers in 14 counties said that without such centers they would not be receiving any health care, according to a 2001-02 customer-satisfaction survey. Clearly, school-based access to health care is important in low-income districts.

In 1999, before fiscal crises whittled state and local budgets, a mental-health professional was on the staff of about half of the school-based health centers. At that time, 17 percent of all visits to the centers in high schools were connected to emotional health; in middle schools, it was 15 percent of visits; and in elementary schools, the figure was 16 percent of visits. In the 2001-02 report 14 percent of all visits still were specifically made to mental health or alcohol/drug specialists, and 16 percent of all visits resulted in drug, alcohol and mental health diagnoses. By the fall of 2003, 55 percent of the state-funded and 42 percent of the locally supported mental-health and alcohol/drug staff at school health centers had their hours reduced or were let go for budgetary reasons.

A nurse practitioner, physician or physician's assistant and a registered nurse or a community health nurse work at the centers in most communities. They follow up leads from teachers, provide many treatments and early identification of serious problems, reinforce prevention messages and link kids to traditional sources of care that can offer more intensive treatment.

In November 1999, Oregonians were preoccupied with sentencing hearings for 17-year-old Kipland Kinkel, who had killed his parents and two Springfield high school students and wounded 25 other students. Just then, Dr. Harold Koplewicz, director of New York University's Child Study Center, wrote pertinently in the November Newsletter of the Alliance for the Mentally Ill of Lane County: Parents of children at high risk for violent, harmful behavior "are told to please take them to a community psychiatric clinic, but only 11 percent of those parents follow through. . . . When they have school-based clinics that take care of mental health problems, 90 percent follow through."

That's why I've long suspected that most schools could profit more from mental detectors than from metal detectors. Kulongoski, too, connects the dots between children's health, learning and safety and community security.

© 2004 Oregonian Publishing Co. All rights reserved. Used with permission of The Oregonian.

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