Bossier needs rethink of school clinic policy

What appears to be the signature initiative of Bossier Parish’s new school superintendent threatens to bring controversy if not implemented correctly and for the right reason.

Last week, the Bossier Parish School Board unanimously awarded the job to assistant superintendent for administration and personnel Jason Rowland. Oddly, he was the only applicant in contrast to the last several occasions when the district hired a superintendent, perhaps because the district over this span only promoted from within and this discouraged outside candidates and in-home potential candidates who considered Rowland’s ascension as inevitable.

In the months leading up to his promotion Rowland worked on establishing school-based health clinics, both permanent and rotating, on the belief that this would discourage absenteeism. Indeed, since the onset of the Wuhan coronavirus pandemic and lingering beyond that, nationally truancy (defined as a student missing at least 10 percent of class days) has doubled to about one in five.

In Bossier, where the state defines “chronic absenteeism” as 15 or more days absent, counting students once at the state level, once per school system, and once per site, the district’s rate last academic year was 21 percent. Unfortunately, these statistics weren’t kept prior to the pandemic, and the initial foray in AY 2019-20 wasn’t done at the district level. Still, then most of the district’s non-high schools than had rates below 10 percent and no high school had a rate as high as last year’s average across all of the district’s schools.

He reiterated that policy upon securing the job, which apparently won’t come to fruition until perhaps the next academic year. Bossier will join a growing number of districts in Louisiana operating these (Caddo Parish has had these for many years, operating four this year). Their purpose is to provide basic primary health care resources to students, which may also include mental health, immunizations, and counseling. Typically, a district provides space and often durable equipment and then contracts operation to a local or state/regional/national health care provider.

Growth in the number of these has spurted higher in the past couple of years, not only because some districts used federal pandemic money fueled by record debt growth to get these started but also when Democrats controlled all of the federal government as the pandemic waned they pushed through legislation granting more dollars in particular for this purpose. Along with that expansion, however, has come questions about whether their presence usurps parental authority to direct their children’s health care.

While SBHCs need consent forms to service children, some employ broad language that authorizes wide-ranging interventions of which unmindful parents may object. For example, some push the Human Papillomavirus Vaccine that prevents sexually-transmitted pre- and cancerous diseases, but which some parents fear encourages sexual activity and causes adverse effects that have landed the only U.S.-approved maker of the immunization in court. And, of course, coronavirus vaccinations remain a sore point for many.

Also, allowing SBHCs to offer much beyond the traditional school nurse model without limited consent and with consent interminably rather than on a case-by-case basis opens the avenue for medical counseling without parental involvement, much less knowledge of it that could escalate to interventions to which parents object. For example, if mental and behavioral health counseling is allowed, this could be abused to sway children who complain about depression to believe this is a product of gender dysphoria.

Finally, it’s not at all certain that going much past, and spending all the money necessary to go beyond that point, the traditional school nurse model will solve for the absenteeism problem in a significant way Rowland claims the expanded model will address satisfactorily. The causes of absenteeism are complex, and Bossier schools may not even fit the typical pattern. For example, typically black, Hispanic, and low-income students accumulate unexcused absences at a significantly faster rate than others, but in Bossier racial differences in rates are negligible, except that Asian students have a much lower rate of absenteeism.

Plans have been to have the two permanent clinics at Bossier High and Rusheon Middle. The former has the highest rate although the latter has a couple of other higher, and were chosen because they were located in a “medical” desert. Four other schools by the same criteria, which doesn’t include some schools with higher rates, were chosen for frequent visits by a mobile clinic. Still, relatively speaking, it seems commitment of serious grant dollars plus ongoing commitments annually to operate would be a costly intervention given the value it would bring and alternative uses.

In a way, schools themselves on the issue of health can be blamed for the rise in absenteeism. For a couple of years until recently, schools were telling students to stay home if they had the least symptom of ill-health. Building expensive infrastructure is much less cost effective than expanding school nursing capabilities and using incentives to get students who might have a minor ailment to school and using those facilities (especially when the incentives to stay home increasingly become more attractive, principally through technology that makes self-entertainment far more possible and rewarding in the short run).

Rowland’s policy needs a serious vetting before proceeding further if Bossier taxpayers want assurance that this won’t be an expensive solution that hardly moves the needle. High quality data need to demonstrate a major reason why students at a few select schools don’t show up is because they don’t have access to health care resources that otherwise would put them in the classroom. Analysis needs to show the extent of the problem cannot be addressed satisfactorily by the school nurse model. And if these data and analyses support the clinic concept, then rules must be put in place that ensure maximal opportunity for parents to be informed and participate in decisions made about their children’s care every step of the way.

Bossier parents and taxpayers need to have assurance that this idea is driven by a good likelihood of a solid payoff and not by tides of political fashion and resources, which has yet to happen.