The Problem: Healthy children make better students and lead more productive lives. But many children and adolescents—especially those in low-income and medically underserved areas—lack access to quality, affordable and preventive health care and show up to school with the physical and emotional burdens of untreated illness or injury.
Background: As the school nurse at the most economically disadvantaged school in the state of Oregon for more than a dozen years, Maxine Proskurowski, R.N., M.S.—an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program—saw firsthand how health affects student performance.
Often, students she encountered at the now-closed Whitaker School in Eugene, Ore., struggled in school because they suffered from poor health. A good number of students—many the sons and daughters of immigrants and refugees—had not gotten a single vaccination in their lives, leaving them vulnerable to everything from rare diseases like the measles to everyday viruses like the flu. Some had never undergone a routine physical examination from a professional health care provider, and still others had never been treated for chronic conditions such as asthma, depression or diabetes, or for preventable problems like tooth decay.
“I saw it all,” she recalls. “It was like being in a third-world country.”
As the school’s nurse and social worker, Proskurowski had only limited resources to treat the vast range of health problems afflicting the school’s student body. But the students at Whitaker often had nowhere to go besides Proskurowski’s office.
Many were reluctant to visit community health centers because, as adolescents, they feared confiding in strangers about sensitive issues such as drug, alcohol and tobacco use, sexual identity and reproductive health. And those who did have health insurance or the means to see a private health care provider may not have had the time or ability to wait for an appointment with a physician.
“Teens contemplating suicide,” Proskurowski notes, “need immediate attention.”
The lack of available, affordable care left far too many Whitaker students in the emergency room, where they didn’t get the kind of comprehensive long-term care they needed to get and stay healthy and to thrive in school and society, Proskurowski says.
The Solution: As a young professional in 1987, Proskurowski got wind of a burgeoning movement to make health care more accessible to students through “school-based health care centers,” which essentially bring a doctor’s office to school grounds. At the time, there were only two such centers in the state of Oregon—one in Portland and one in Eugene—and Proskurowski saw a tremendous need for more.
So she joined a loose network of grassroots activists and embarked on a campaign to build more school-based centers. These centers can range from a small office staffed by a part-time nurse practitioner to complexes with interdisciplinary staffs that provide comprehensive primary, acute and preventive care for physical and mental health conditions.
She talked to her colleagues and superiors at Whitaker about the need for school-based health centers, asked for donations at Rotary Club meetings and promoted the cause at local churches. She made her first foray into politics during informational visits to the state Capitol and a few years later joined a nonprofit organization called the Oregon School-Based Health Care Network.
Her work yielded tangible results. In 1991, the Oregon state Legislature became one of the first in the nation to earmark money for school-based health care centers and provided funding to help establish dozens of centers across the state.
But Proskurowski hit a roadblock in 2003, when the state legislature zeroed out funding for school-based health care centers, forcing several to close. Still, Proskurowski—who had since moved into a new position as the program manager for health services at the Eugene School District—wasn’t daunted. That year, she applied for the Robert Wood Johnson Foundation Executive Nurse Fellows program, hoping the fellowship would help her focus on restoring funding for school-based health centers. She was able to use the expertise gained during the fellowship to secure major contributions from other philanthropies, including the W.K. Kellogg Foundation.
State legislators eventually reinstated funding for the centers, and have since continued to fund them—even in the face of severe revenue shortfalls caused by the recession. There are now 44 school-based health centers in the state and more are in the works. The movement is growing on a national level as well.
The centers have provided students of all backgrounds with a wide range of services and have saved the state countless dollars in unnecessary health care expenses, Proskurowski says. And the long-term benefits are incalculable, she says. “Children are the stewards of our future. If we don’t have healthy children then we don’t have a healthy nation.”
RWJF Perspective: The Robert Wood Johnson Foundation has been and continues to be a strong supporter of school-based health care centers because they are an ideal place to provide access to health care for children, particularly the uninsured. School-based health centers help limit absenteeism and improve academic performance, enabling children and adolescents to lead happy, healthy and productive lives.
The Foundation has provided grants to build school-based centers around the country and has helped existing facilities expand services into areas such as mental health and dental care. It also provides funding for the Center for Health and Health Care in Schools, a nonpartisan resource center at the George Washington University in Washington, D.C.
Learn more about the Executive Nurse Fellows program here.