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On the ropes

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By Todd Cohen

GREENSBORO, N.C. — A seven-year-old pilot program to deliver health services to at-risk teens in Guilford County schools soon will lose funding from two health-system foundations that have spearheaded it.

“The foundation plans to bring the Guilford School Health Alliance to a close at the end of this school year,” says Robert Newton, president of the Moses Cone-Wesley Long Community Health Foundation in Greensboro.

To continue operating, he says, the program needs long-term funding from Guilford County, which has not indicated whether it will provide that funding.

Delores Fogg, chief student services officer for Guilford County Schools, says the school system is reviewing the program.

“We don’t have any further information to share at this time,” she says.

Based on a study by Moses Cone Health System, its foundation in 1998 teamed with the Endowment Fund at High Point Regional Health System to pilot school-based health services at four high schools in Greensboro and High Point, and four middle schools feeding them students.

The program initially was funded with $1.5 million over three years, with the two funders splitting the cost.

They since have extended their investment, and the school system for two years has contributed $325,000 a year.

The program places a full-time nurse and a full-time licensed clinical social worker in each school to address students’ physical and mental-health needs.

Unlike school nurses, who typically work for the county health department and provide preventive public-health services like immunizations and screening, alliance nurses provide direct care, Newton says.

While it never was clear whether the pilot was intended to be the first step in development of long-term school health services, or simply to test their value, Newton says, the pilot program initially enjoyed support and momentum.

“At the time we started this,” he says, “there was a much different attitude and a much more positive outlook for public funding of school-based health services.”

But the downturn in the economy and the related stress on the county budget have eroded support for the program, which now serves three high schools and three middle schools.

The funders plan in April to recommend that Guilford County Schools house the program and collaborate with the county health department to provide needed resources, Newton says.

“The foundation believes school-based services are worthwhile,” he says. “But the foundation believes that a strong commitment by the school system is necessary for success.”

Dr. Robert Doolittle, a physician with Urgent Medical and Family Care in Greensboro who serves as medical director for the alliance, says it was created to address the needs of teens likely to drop out of school without the health and mental-health services the program provides.

“We try to target kids who have few resources, no ready access to health care, no insurance,” he says.

The program, for example, identifies problems such as depression, substance abuse, sexual activity and parental abuse and neglect, typically catching those problems at stages when the cost of addressing them is lower and the impact is greater, he says.

At one high school, Doolittle says, one in four students identified as sexually active has a sexually transmitted infection, compared to one in eight to 10 nationally.

And most Guilford students identified as infected do not yet have symptoms or know they are infected, Doolittle says.

Leah Devlin, state health director, says North Carolina has “long ignored the health component that enables children to be successful in school.”

Last year, she says, state lawmakers approved spending $6.5 million to add 145 nurses to schools based on factors such as high needs, academic performance and the ratio of school nurses to students.

As a result, the average ratio of school nurses to students in the state will total one to 1,568, down from one to 1,918, but still more than twice the national goal of one to 750.

The budget recommended this year by Gov. Mike Easley calls for spending $25 million over the next two fiscal years to establish 100 school-based teams, consisting of a school nurse and social worker, to serve at-risk children and their families, and better connect public schools with health, mental health and social services.

Easley also wants to fund 65 additional school nurses.

“This proposal is focused on low-wealth, high-need schools,” Devlin says. “This funding is not to supplant existing resources.”

In the 1990s, when she was health director for Wake County, three local hospitals invested $1 million over three years in a program to place nurses in targeted schools to serve at-risk children and their families.

The county eventually agreed to pick up the cost of the program, she says.

Meredith Eanes, vice president of development at High Point Regional Health System, says the alliance funders “didn’t envision we were going to be the funder for all time” for what was intended to be only a pilot.

“The dream was that it could attract other funding,” she says. “I’m still hopeful the county would see that as their mission.”

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