Rural School-Based Health Centers Increasing in Central Valley

LIVINGSTON — Salina Mendoza grew up in a tiny unincorporated community called Oro Loma on the west side of the Central Valley. Her parents were farm workers and resources were scarce, especially when it came to medical care. It wasn’t just that the doctor was a 30-minute drive away in Firebaugh; going there meant losing a day’s work.   

“For me, it was growing up in a place where access was always an issue,” Mendoza said. “My dad had the only vehicle so that meant if we ever had to go to the doctor, he couldn’t go to work that day.”

And if he didn’t go to work, he wouldn’t get paid. “You grow up and you really don’t go to the doctor,” said Mendoza, who is now the Central Valley program manager for the California School-Based Health Alliance

Merced County’s First On-Site School Clinic

It’s a situation Ralph Calderon sees every day. He’s the principal of Livingston High School in this Central Valley town of 14,000 in Merced County. He said more than 90% of his students come from low-income families, typically from homes where both parents work, yet the median family income is below $40,000. Employment is usually in the fields, the packing houses or at the Foster Farms chicken processing plant.

“You either go to work and get paid, or you don’t earn that money,” he said. “Yes, our parents absolutely love their kids and want to take care of them. But if it’s a choice of food and clothing and a roof over their heads, the health problem is always going to come in fourth.”

It’s one reason that Livingston High School will soon be the first site in Merced County to have a school-based health center with its own primary care physician and behavioral health clinician.

“We have a lot of mental health issues, stressors from poverty,” said Calderon. “There are an inordinate amount of students with anxiety disorders that sometimes turn into full-blown panic attacks. These are the things we want to try to get addressed.”

In fact, Livingston High School makes three times the number of ambulance calls as the other high schools in the Merced Union High School District, and it’s the smallest school, with about 1,100 students.

Stakeholders Say Students’ Mental Health is a Concern

The idea for the center evolved last year when the district was working on its Local Control Accountability Plan. Part of the process is to engage a stakeholder group of parents, students, teachers, administrators and staff to determine the needs of the district.

“The largest area of concern was mental health and the overall wellness of students in our district,” said Tammie Calzadillas, assistant superintendent of educational services.

A local clinic that had an active relationship with the high school proposed a partnership. Livingston Community Health, a federally qualified health center, suggested a school-based community health clinic.

Calzadillas said she became convinced this was the direction the district should take after looking at several studies. “Overall attendance rates improve, the health of the family improves,” she said.

According to the California School-Based Health Alliance in Oakland, there are 231 school-based health centers in California. The schools usually provide in-kind contributions. The centers get reimbursed through private health plans, the Child Health and Disability Prevention Program, Family PACT and Medi-Cal, California’s Medicaid program.

Livingston High School will provide the facility, phone lines and parking spaces. Livingston Community Health will provide the services. “This is really about the overall health and wellness of students and taking the services to where the students and parents are,” said Leslie McGowan, chief executive officer of Livingston Community Health.

The on-site center is expected to be open part-time by late summer and running full-time within a few months if approval is granted by the Office of Statewide Health Planning and Development. 

“What this will do is provide another point of access to care,” McGowan said. “The needs of our community are definitely ones we feel equipped to address. We’re a 45-year-old organization here.”

ACA Leads to More Rural School-Based Clinics

The majority of school-based health centers are in urban areas; Los Angeles has 73, San Francisco has 17, and Fresno has 11. But more clinics are opening up in rural areas, said Mendoza, in part because of the Affordable Care Act.

“They have grown significantly in the Valley and that is definitely because of the ACA’s Health Resources and Services Administration grants,” Mendoza said. Just this year, several school-based clinics opened in rural valley towns including Atwater, Raisin City and Earlimart.

Mendoza helps schools like these by providing start-up tech assistance. She also works with planning committees to navigate the process, and she started a coalition so administrators and staff can network and share knowledge, training and resources. She said a lot of these clinics start because schools are an axis of information for parents and are often troubleshooting health problems anyway. “This is a great way for schools to support academic success,” Mendoza said. “You help troubleshoot on campus and all of a sudden students can get back to work.”

But there are protocols. For instance, students at Livingston High School won’t be able to go to the center whenever they want. Students will still go through the school nurse if they aren’t feeling well and parents will be involved with appointments. “We want to make sure that when there’s a physics exam, we don’t have 27 students with stomachaches on the same day!” said Calzadillas.

Once the Livingston High site is up and running, the district plans to put a school-based health center on the East Campus Educational Center in Merced. Eventually all six high schools in the district could have clinics.

“I’m a true believer in the education of the whole child,” said Calzadillas. “What people tend to say is, ‘You’re a public educator. Your job is to educate.’ What I say to that is, ‘If not us, then who? Who is going to take care of these kids?'”

It’s certainly an attitude Mendoza would have appreciated growing up on the west side of the valley where access to medical care was difficult and a school-based health center would have been ideal for her family. “I would have loved to have had the opportunity to go to a doctor,” she said.

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