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Student clinic considered for Scappoose schools

Scappoose to become only school district in Columbia County with no SBHC

SPOTLIGHT PHOTO: MARK MILLER - Lisa Maloney (background left), a school board member for the Scappoose School District, questions Nicole Lawrence (foreground) from the Public Health Foundation of Columbia County after a presentation on the possibility of opening a school-based health center in Scappoose on Monday, April 27.The Public Health Foundation of Columbia County is recommending the Scappoose School District move toward opening a school-based health center, the foundation’s SBHC coordinator told members of the school board Monday, April 27.

Nicole Lawrence said the foundation would act as the medical sponsor for a clinic on a Scappoose public school campus, assuming responsibility for providing care, as well as prospective medical liability. The clinic would serve Scappoose students — as well as students from the neighboring St. Helens School District — and their siblings, as proposed. However, the approval of the school board is needed for the health center to move forward, she said.

“After looking at all of the data, the healthcare need here and how the other school districts in the county have addressed the need, the School-Based Health Center Planning Committee also would like to implement a school-based health center here in Scappoose,” Lawrence told the board.

Skepticism from school board

School-based health centers have become increasingly common in Oregon school districts. St. Helens has had a clinic, the Sacagawea Health Center, operating on the campus of Lewis & Clark Elementary School since 2000. Several Sacagawea representatives were present for Monday’s board work session in Scappoose.

The grand opening of a school-based health center in Clatskanie is scheduled for Wednesday, May 20. That will leave the Scappoose School District as the only school district in Columbia County without an on-campus clinic, as Lawrence noted.

About 10 percent of Sacagawea’s student contacts last year were Scappoose students, according to Lawrence. She and Brenda Peer, school nurse for the Scappoose School District, said there is a clear need for a Scappoose SBHC, where students could receive medical care without leaving campus.

“If you take anything away from this presentation, I hope that you would see that there really is a healthcare need here in Scappoose,” Lawrence said.

The presentation was received cautiously by the board members at the work session.

Lisa Maloney, an outspoken skeptic of school-based health centers, read a lengthy list of questions she had about the proposed clinic, including how much control the school district would have over its operations and what evidence the planning committee has found to indicate that many district families have “barriers” to healthcare access.

“I just haven’t seen, and I don’t see the need, for Scappoose — where there’s a need in our community,” Maloney said. “And if we can already send students to all these other places which are very close — the county health, the other school-based health center in St. Helens — then we can go ahead and send them there. They can get transportation.”

Board Chairman Will Kessi said he is concerned about potential costs to the district associated with opening a school-based health center. He wants to be certain that Scappoose’s need for a SBHC outweighs the cost and liability of having one.

“I’m not ready to say ‘oh yeah,’ you know, I’m not ready to carte blanche say ‘do it,’” Kessi said. “I’d only say don’t stop researching it, but I don’t think I’m in a position ... to give you the go-ahead to start talking about building.”

Mitch Neilson, the school district’s business manager, said he has gamed out scenarios in which the district can minimize costs and liability, such as by repurposing a portable building to serve as the clinic.

Lawrence said the clinic would be set up to bill health insurance but would not turn away patients for inability to pay, just as Sacagawea operates.

Reproductive services questioned

Some opponents of SBHCs, including the group Parents’ Rights in Education, have criticized the clinics for providing access to sexual education and reproductive healthcare.

Maloney challenged Lawrence directly on the subject.

“If a 9-year-old girl goes in and wants birth control, she can certainly get it. She can certainly get it at a school-based health center,” Maloney said pointedly. “Nine-, 10-, 14-[year-olds].”

Under Oregon law, healthcare providers must give equal and confidential access to reproductive care regardless of the patient’s age.

However, Sherrie Ford, director of the Public Health Foundation of Columbia County, noted that SBHCs can choose not to provide particular services to their patients.

Lawrence said Sacagawea encourages parental involvement in healthcare decisions at the clinic and noted that written consent is required for children under 15 to be seen for general medical care.

As presented to the school board on Monday, the Scappoose SBHC would provide health screenings and write most prescriptions, as well as primary, preventative, and mental healthcare services and limited dental and reproductive care. Condoms would be available by appointment only on a situational basis, and contraceptive prescription requests would be handled by referral.

While Kessi and other school board members said they were not ready to grant approval Monday, they asked Lawrence and her co-presenters to address their questions and come back for a future board work session.

“We need to take our time and really talk about it,” Kessi said.

Kessi also suggested he and his fellow board members visit Sacagawea in the meantime.

The SBHC planning process is being funded by a $40,000 grant from Kaiser Permanente Northwest. The grant was awarded to the Public Health Foundation of Columbia County last summer, and the school board gave initial approval in August for the foundation to begin studying the potential for a Scappoose school-based clinic.