A tour of the school-based health center on Beaverton High’s campus. Like the clinic at Century High School, Beaverton’s school-based health center is operated by Virginia Garcia Memorial Health Center. (OS-)
In Oregon, you can make your own primary care medical decisions at age 15, without parental consent or notification.
Yet in school districts across the state, teens are likely to need a note from Mom just to get an aspirin from the school nurse.
These two very different views of healthcare are now clashing in Hillsboro, where the nonprofit Virginia Garcia Memorial Health Center wants to offer birth control services on the Century High School campus.
The Hillsboro School Board is in the uncomfortable position of figuring out what role it has – if any – in teens’ options around safe sex.
Century’s school-based health center opened in 2013 to provide primary care and mental health services for interested students or nearby residents 20 years old or younger. The school district received a federal grant to construct the building; Virginia Garcia staffs and manages the clinic. No one is denied services if they can’t pay.
Most visits are for mental health counseling; vaccines; well-child checks; ear, nose or throat issues; and sports physicals.
The district benefits because on-campus clinics cut down on absenteeism, and healthy students are better learners.
Students – particularly those who don’t have or have limited insurance coverage – benefit from convenient access to healthcare.
Parents benefit because they don’t have to miss work to take a child to a doctor’s appointment.
Win, win, win, right?
Oregon has 76 school-based health centers in 24 counties across the state. Virginia Garcia operates six, including five in Washington County.
When the Century clinic opened three years ago, the school district had an informal understanding with Virginia Garcia – no offering birth control. But Virginia Garcia spokesperson Olivia MacKenzie said the policy isn’t written anywhere in the clinic agreement between the district and the nonprofit, which puts physicians in a bind when students ask about contraceptives.
Olivia said Virginia Garcia would like to offer those services, but only if “it’s a priority to the district and families, as well.”
The clinic does offer reproductive health services, which includes things like pap smears, screening for sexually transmitted diseases and pregnancy tests, but not “family planning services” – aka, birth control.
So, a patient at the school-based health center can find out after sex if she’s gotten pregnant, but she can’t get contraceptives to prevent it in the first place.
Within Hillsboro’s two zip codes, the Oregon Health Authority reports there were 238 teen pregnancies between 2012 and 2014. Century High even has an on-campus daycare program for students who have had a child; it’s not that far from the clinic where they can’t get preventative reproductive services.
Century’s health center does provide referrals to other clinics that can provide contraceptive prescriptions, but it’s not always easy for teens to travel for help off-campus. Last year, Washington County closed its health department clinics and contracted out for care services. The clinic in Hillsboro is now only open two days a week, and without the teen program that specifically addressed contraceptive questions.
That’s part of why Virginia Garcia is now asking to be able to prescribe birth control.
Earlier this month, the Hillsboro School Board spent an hour listening to public comment about whether birth control prescriptions should be offered at the Century clinic. Eleven residents testified in favor of offering services; six testified against. At least one woman questioned why the district was involved in student healthcare at all.
That’s something school board member Erik Seligman questions, too.
“I feel bad that there’s a problem with community access to health care in Hillsboro, but the schools aren’t chartered to address that,” he said. “The intermingling with school and health care, that’s what really concerns me … but it’s a community concern, not a school concern.”
Whether a school district should help students get access to primary healthcare is an entirely different question than whether a school district should determine what kinds of primary healthcare students have access to.
Let’s start with the first question: Is is appropriate for schools to have clinics at all?
Yes. It definitely is.
No one is in a better position to help students access healthcare than the school district where they spend most of their time. That’s why this model works so well, especially for the most vulnerable populations. About a quarter of the Century clinic’s patients come from families at or below the federal poverty line; 66-percent are covered by either Medicaid or the Oregon Health Plan.
In a state survey last year, nearly half of school-based health center patients said they either wouldn’t have another place to go, or weren’t sure where they could go, for medical services outside the school clinic.
In many ways, the district is already in the healthcare business. It addresses nutrition by choosing school lunches. It address mental health with bullying and suicide outreach programs. If it’s going to provide a daycare for students with children, it shouldn’t stand in the way of services to prevent teen pregnancy in the first place.
Which brings us to the second question, about contraceptives. School boards shouldn’t be a roadblock to teens’ access to preventative care.
The district can best serve the clinic and its patients by simply being a landlord. Birth control – not abortion, mind you – is considered a function of a primary care facility. How, what, and why it is prescribed should not be influenced by a school board.
In an ideal world, you know who would be making decisions about teens’ bodies? Teens. With the guidance of a physician, and the support of a parent.
Sadly, that doesn’t always happen. Not all students have easy access to medical care. Not all students have good relationships with their parents, or have parents who know how to help them.
Those are the students who need full primary care services from the school-based health center most of all. And the last thing they need is a lecture from the school board about what kind of health care services they should be receiving.
— Samantha Swindler
@editorswindler / 503-294-4031