A HISTORY OF DEVELOPMENT.
by Camille Giglio, September,
The child, created from the
tiniest of seeds, is fed, nourished an cultivated at all stages of
development through to adulthood. So, too, did the idea of delivering
health care to an entire population develop from the tiny seed of
Title X, Public Health Law, in 1970. Now it is about to reach full
adulthood, through the constant feeding and nurturing of federal and
state legislation under the supervision and tutelage of private philanthropies
with names such as Robert Wood Johnson, Henry J. Kaiser, Annie E.
Casey, Rockefeller and Pew Charitable Trusts .
1970 - TITLE X, PUBLIC
HEALTH SERVICE ACT.
In about 1970, during Richard
Nixon’s Presidency, Congress passed and Nixon signed into law, Title
X of the Public health Service Act This Act authorized government
funding of and support for Contraceptives, or Family Planning. Then
Senator George Bush was lead Republican in support of this Act.
One month after the Act passed,
Dr. Alan F. Guttmacher, then President of Planned Parenthood Federation
of America (PPFA), told supporters that in order to achieve “the perfect
contracepting society,” Planned Parenthood, in addition to offering
contraception, sterilization, abortion and genetic counseling, would
have to establish ‘contraceptive education for all youth so that at
the appropriate time in their lives contraception will be accepted
as naturally as breathing.” (School Based Sex Clinics: New Promise
or Old Problem? 1986 American Life League, Inc.)
1972 - FIRST SCHOOL LINKED
The St. Paul, Minnesota,
Maternal and Infant Child Care Project opened in 1968 offering health
care, including contraception, to adolescents. By 1972, the MIC project
opened a health clinic in a local junior-senior high school
During the next ten years
Planned Parenthood developed an efficient advertising campaign convincing
legislators and citizens that teen pregnancy was of epidemic proportions.
They further created statistics showing reductions in teen pregnancies
in areas where privately funded school based clinics existed in support
of their agenda of placing contraceptive dispensing “health clinics”
on school property with government funding, with distribution to the
students without parental knowledge or consent.
1976 - BALBOA HIGH SCHOOL,
In California, then governor,
Jerry Brown created the State Office of Family Planning and an Advisory
Board and placed them in the Dept of Health and Human Services, Medi-Cal
department. The President of that Advisory Board, Tom Payzant, had
been the Director of Sacramento’s Planned Parenthood. He eventually
left to take a position in San Diego as President of the Board of
Balboa high school, in San
Francisco, was the site of the first California school based clinic.
It was run by Ira Oakun, Director of the S.F. Family Services Agency.
SAN DIEGO, CALIFORNIA
It was in San Diego that
the idea of a district wide school based clinic experimental program
began at Hoover Elementary School. When Clinton was elected Payzant
went to Washington to take a position with Education Secretary Bill
Riley and is still there.
The reason San Diego was
chosen as an SBC site was due to the fact that Governor Pete Wilson
had been a mayor of San Diego and had many connections.
1978, EDUCATION AS THERAPY.
In 1978, Senator Samual J.
Hayakawa warned the U.S. Senate that “An educational heresy has flourished,
a heresy that rejects the idea of education as the acquisition of
knowledge and skills...the heresy of which I speak regards the fundamental
task in education as therapy.”
Through the 1980s there was
constant pressure on the federal and state legislators through the
above mentioned foundations and lobbying groups to pass ever more
generous and expanded ways to d eliver family planning and abortion
services to a somewhat resistant population.
In 1980, the Rose Bird state
Supreme Court issued a decision following a long court fight over
abortion funding. That ruling entitled: Myers vs Reproductive Rights
stated that since our state funded pregnancy care, abortion, which
they considered to be a form of pregnancy care should also be tax
funded as a Right to Privacy issue. The state Constitutionally protected
Right to Privacy was established in 1970 through a ballot initiative.
This right extended to Minors through both state and federal legislation
extending to minors the “Emancipated Minors Doctrine.”
Once that ruling became accepted
it was a short hop, using the Title X legislation to begin prescribing
and delivering contraceptives to school students.
School Based health clinics
began appearing in Orange County; Santa Ana Unified School District
and in Culver City, a municipality within Los Angeles County at the
Culver City Middle and High School. (Healthy Tomorrows: A Government
Experiment in Orange County, California. A Report produced by Parents
Who Care, Westminister, CA)
Berkeley High School, in
Berkeley, CA., has also maintained a school clinic for years. By the
late 1980s there were approximately 52 school sites. Legislation was
passed appropriating tax dollars to begin supplementing the private
funding of these school clinics.
THE NINETIES: EXPANDED
In California the idea of
placing comprehensive support services at the school site was brought
to completion through passage of Healthy Start, SB 620 (Chapter 759,
Statutes of 1991). This was a key component of Governor Wilson’s plan
for prevention and early intervention programs for children.
1990. the state Managed Risk
Medical Insurance Board (MRMIB) was formed. Its purpose was to advise
the Governor on strategies for reducing the number of uninsured persons
in the state.
MRMIB administers three health
- Access for Infants and
Mothers (AIM). A pregnant woman chooses one of 9 health plans offered
through the state. AIM is funded through tobacco tax funds.
- Healthy Families Program
(HFP) 1991. providing low cost health, dental and vision care to
children in low wage families. Family premium is $4-$9/ mo.
- The Major Risk Medical
Insurance Program which provides health insurance to those who are
unable to obtain coverage in the individual health insurance market.
1991. HEALTHY START. S.B 620 (Chap 759, 1992 statutes), State Sen.
Presley, Healthy Start Support Services for Children. This bill
was a vehicle for centralized State control of the schools health
programs. SB 620 pulled together six different state departments
under one program council.
Article 2 of SB 620 states:
In order to encourage the integration of children’s services, it
is the intent of the Legislature to promote interagency coordination
and collaboration among the state agencies responsible for the provision
of support services to children and their families.
the Legislature established
the healthy Start Support Services Council
1. State Superintendent
of Public Instruction
2. Secretary of Health and
3. Secretary of Child Development
4. Directors of the State
Department of Health Services.
5. State Department of Social
6. State Department of
The Council’s duties:
1. develop, promote and
implement the policy of SBCs.
2. review grant applications
and make recommendations on awarding grants.
3. assist the local education
agency or consortium in planning and implementing this program,
including assisting with local advocacy and problem solving, and
developing agency collaboration.
One of the presenters at
a 1991 Menlo Park based Ed Source Conference was Michael Kirst,
speaking for Gov. Wilson on the subject of school restructuring.
Mr. Kirst also works with the Robert Wood Johnson Foundation. He
proposed that the state could find upwards of $2 million to fund
the delivery of integrated health services to be delivered on school
property. Educators/teachers, he said, could not do this alone,
of course. He also urged educators to stop referring to “ school
policy” and begin using the term “children’s policy.” the plan was
to establish within the department of Health and Human services
a Secretary of Education for Children Services. That position was
eventually filled by former Democrat state legislator, Gary Hart.
1993. the Clinton administration
proposes the (Universal) Health Security Act . Though their total
health care package failed to pass Congress, the individual programs
within the bigger program did not die.
1994 THE MISSION OF HOSPITALS,
IN CALIFORNIA Senate bill 697, state Sen. Art Torres, amended Division
1 of the state Health and Safety Code (Chap. 812, Sec. 449.10) relating
to health facilities. SB 697 required hospitals to:
1. Reaffirm their mission
2. Complete a community
3. Adopt a community needs
assessment. Submit plan(s) to the State of California Office of
Statewide Heealth Planning and Development (OSHPD).
by 1995 Congress, had passed
four major pieces of education reform legislation sought by the
1) Goals 2000: Educate America.
This was originally a President George Bush idea co-opted by the
Clintons. Republicans, especially, admitted later that the bill
was so big, they never really read it.
2) School-to-Work Opportunities
Act. Schools, in partnership with business would evaluate and prepare
students for the jobs needed by industry.
3. Improving America’s Schools
Act of 1994. This reauthorized the Elementary and Secondary Education
4. 1995, Rep. Maxine Waters,
So. California former state legislator sponsored the School-Based
Clinic Health Service Act of 1995 - HR 1284.
This Act authorized awarding
of grants to eligible local community partnerships to coordinate
and deliver comprehensive education, health, and social services
to children or youth in school-based, school-linked or community-based
locations. This Act created a collaboration between educators, public
social service agencies, community non-profit agencies and businesses.
It’s purpose was to oversee deliver of government mandated social
services to students and their families through local entities.
FOLLOW THE FUNDING
Education reform became
a road to health and welfare reform. One Welfare Reform package
was the Temporary aid to Needy Families - (TANF). This merged with
California’s AFDC. In order to get the huge sums of money into the
state that the federal government was holding out to us, our laws
had to change. During the 1990s a large number of health and education
bills were passed, as well as regional planning bills. Schools were
now to become the site for delivery of all services to the entire
community. This requires new school designs and remodeling of other
schools. Wilson signed four bills, AB 1126, Sb 903, AB 217, and
AB 1572 to implement the healthy Families program. this allowed
the Healthy Families Program to subsidize private health insurance
Prop 10, the Tobacco Tax
increase funded actor Rob Reiner’s California Children and Families
First initiative. This money will pay for the integrated system
of social services for families with children prenatally to age
5. Reiner believes that all people should be responsible for all
the children because, following analysis after his divorce from
Penny Marshall, in 1979, he felt compelled to find a way to ‘change
social outcomes” for children as reported in the Orange County Register
for August 10, 1998.
Also developed around this
school/welfare reform was the Local Education Agency (LEA). This
California Department of Health Services plan allows schools to
bill for health services provided to people eligible for Medi-Cal.
An LEA may enroll as a Medi-Cal provider. Schools, now providing
health care can bill Medi-Cal for services to children. As a part
of this agreement the LEA must form a collaborative group which
will set priorities for reinvestment of funds.
This billing option was
established in 1993 by a State Partnership between the Governor,
Superintendent of Public Instruction and the Foundation Consortium
for School Linked Services. The Agreement requires the LEAs to establish
or designate an existing interagency human service group at the
county level or subcounty level (city) to make decisions about the
reinvestment of LEA Medi-Cal funds. This interagency should be comprised
of schools, major public agencies serving children and families
including health, mental health, social services, and juvenile justice,
courts, civic and business leadership, the advocacy community, parents
or guardians, and current safety net and traditional health care
providers (read Planned Parenthood). It is the responsibility of
this collaborative to identify community needs, how to best meet
those needs and to reinvest funds into schools or community organization
to address those needs.
California School Age Families
Education (CAL-SAFE) Program. This became operational in July 2000.
It increases the support services provided at school linked sites.
The words school based and school linked should not be used interchangeably.
School based merely means that a clinic exists on or about school
property and the various levels of government have little to do
with them. School linked is the key word since it clearly indicates
that the school is connected to all the government programs and
agencies for dispensing more than basic health care. This replaces
several former independent programs such as the Pregnant Minors
Program (PMP), School Age Parenting and Infant Development (SAPID),
and the Pregnant and Lactating Students (PALS) Program. and delivers
them through schools.
Please see Part 11. How
this plays out in the local community.