Medical assistant Ambar Trujillo measures Angel Zamudio, 4, at the Elizabeth… (Francine Orr, Los Angeles…)
As soon as the school day ended, the rush at the health clinic began.
Two high school seniors asked for sports physicals. A group of teenagers lined up for free condoms. A girl told a counselor she needed a pregnancy test.
The clinic, at Belmont High School near downtown Los Angeles, is part of a rapidly expanding network of school-based centers around the nation offering free or low-cost medical care to students and their families.
In California, there are 183 school health centers, up from 121 in 2004. Twelve more are expected to open by next summer, according to the California School Health Centers Assn.
The centers have become a small but important part of the nation's healthcare safety net, experts say, treating low-income patients who might otherwise not have regular medical care. Now, they add, campus clinics are serving as a model for health officials trying to reduce costs.
Academic research has shown that school-based health clinics, which typically promote prevention and provide comprehensive services, reduce emergency room visits and hospitalizations. They also improve students' school attendance, reduce Medicaid costs and promote more healthful eating, according to studies.
Recently, school-based health centers got a fiscal boost from the healthcare reform law, which allocated $200 million nationwide. California won $14 million in grants this summer to open new clinics and expand existing ones. Los Angeles County received about $4.3 million of that.
Most centers are based in low-income neighborhoods and staffed by doctors and nurse practitioners. They offer a range of healthcare services, including checkups, physicals, immunizations, mental health treatment, dental care and drug counseling. The clinics also monitor students' chronic diseases, such as asthma, and treat their illnesses so they don't miss school.
"There are so many reasons why students are not really ready to learn," said Serena Clayton, executive director of the California School Health Centers Assn. "Teachers, principals and staff members are recognizing they are not going to be successful with kids if they don't address these underlying health issues."
Clinics on school grounds are uniquely placed to find and treat those health issues. There may be a shortage of food in the house that causes stress and physical problems, or drug use that leads to frequent absences.
"You just cannot ignore the reality of the patients' lives," said Julia Lear, senior advisor for the Center for Health and Health Care in Schools at George Washington University. "You step out into the hallways and there it is."
On a recent afternoon at Belmont Health Services, Henry Quiroz, a senior at nearby Miguel Contreras Learning Complex, wanted a physical for soccer. "I need it as soon as possible," he said. "The season has already started."
Marco Perez, 18, walked into the clinic to get free condoms. On the wall were containers with brochures on anxiety, sexually transmitted diseases and alcohol.
Perez said that friends told him about the center and that he liked the privacy of it. "The parents don't have to know," he said.
Belmont Health Services opened to students in 2009 and to the community last year. Though it is operating out of a portable classroom and a mobile van, the L.A. Unified School District plans to open a new center on campus next year, with five exam rooms and space for counseling and recreation.
There are 35 clinics on L.A. Unified campuses, which opened its first more than two decades ago. The district plans to build 14 new centers, using school construction bond money.
For many youths, the centers fill a gap in care, said Dr. Kimberly Uyeda, the school district's director of medical services. "Adolescents are notorious for not receiving timely healthcare," she said.
Generally, school districts provide the facilities and community clinics or hospitals run the centers, paying for care with a mix of Medi-Cal, private insurance and government funds.
But even with the extra federal dollars, clinics still struggle to recoup their costs because many of the patients are uninsured and some of the services aren't covered. That partly explains why there aren't more centers, given that there are more than 6 million students in California.
"The challenge overall is funding," said Adolfo Lagomasino, spokesman for the Northeast Valley Health Corp., which operates four health centers in the county. "With these kind of tumultuous political times, to put it lightly, there is sort of an ongoing battle to maintain the safety net."
One of the most recent clinics to open is at Elizabeth Learning Center in Cudahy. Students can see a doctor on their own to be treated for such ailments as pink eye or a sore throat, as long as they have a consent form. That way, parents don't have to take a day off work, said clinic manager Sandy Wooten.
Elizabeth Madrigal, 18, a senior at the school, said she takes her 1-year-old daughter, Ezra, to the clinic regularly. After school one afternoon, Madrigal, still wearing her backpack, brought Ezra for her shots and a checkup.
Madrigal said the clinic is convenient. "The school is right there, so if I ever need anything, I can come over," she said.
Since opening in May, the Elizabeth Health Center, run by Northeast Community Clinics, has also reached out to parents and community members, and word is starting to spread.
On a Wednesday afternoon, Phillip Zamudio, 23, a restaurant worker who lives nearby, brought his two sons in to check on their anemia. And Rocio Cetina, 39, who attends the adjacent adult school, came in with her daughter, who had been coughing and sniffling.
"It's a one-stop shop for everybody," Wooten said.