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This article is dedicated to attempt to describe how and why community college health services are alike and how they are different. In an attempt to get an overall picture of the services provides throughout the 108 (2003-04) campuses, the Health Service Administration of California Community Colleges (HSACCC) undertook the task creating a survey and then getting data not only from our 85 member colleges but all 109 colleges. This was no small undertaking for our organization.
Surveying Our Members
In 2003 - 04, the HSACC (Health Services Association, Community Colleges) initiated the momentous task of surveying all Student Health Center programs within the California Community Colleges. In creating the survey we utilized the TITLE V regulations regarding the use of fees collected by districts to pay for health services. In section 54702, it listed those services which may be paid for by the funds. It lists three classes of services: Clinical Care services; Mental Health services, Support services and Special Services (see Figure 1 below).
Figure 1.
Clinical Care
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| Assessment, Intervention and Referral |
| First Aid, Basic Emergency |
| Health Appraisal |
| Communicable Disease Control |
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Support Services
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| Maintain Health Records |
| Laboratory |
| X-ray |
| Pharmacy Service |
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Mental Health
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| Crisis Intervention |
| Short-term psychological counseling/assessment |
| Alcohol/drug; eating disorders; stress management; suicide prevention, sexual harassment/assault |
| Recovery |
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Special Services
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| Health education promotion |
| Teaching/Research |
| Student Insurance |
| Environmental Health |
In creating the survey questions, we took that list of services and created a questionnaire which identified the 14 separate services identified in section 54702. In additional we asked for some data on which schools had health centers and how service was provided. We found that 78 Colleges had a health centers on the campus; 13 colleges contracted their service out to a community provider and 5 colleges did not report. Therefore for the service questions we had 96 schools reporting on most questions (click here for Figure 2). Based on those data, there are an additional 13 campuses which do not have health services/centers.
In addition we collected data from the Chancellor's office website on students served, revenue and Board of Governors Waivers (of health fees) granted. For that data we obtained information on105 colleges.
In order to determine clinical and mental health services, we asked for the types of health practitioners who were available at the Health Center. We found that 57 health centers had Medical Doctors or Nurse practitioners to provide primary care on site; 54 sites had mental health counselors and 65 sites had the services of one or more Registered nurses (click here for Figure 3). It should be noted that at 7 additional sites, the RN provided mental health services. Health Education was provided on 74 campuses.
Next we looked at emergency response activities and crisis management and found that 59 schools provided campus emergency response and 69 provided crisis response for their campuses. 68 health centers provided communicable disease control. In addition up to 69 health centers serve as a campus resource for crisis, disaster and safety issues (click here for Figure 4).
One of the other services which may be provided is student accident insurance (excludes athletic insurance): 45 health centers paid for accident insurance from health fees and 46 health centers did not pay for accident insurance. This becomes a significant issue when we begin to look at the diminishing revenue (health fees) available for provision of health services.
70% of Health Centers provide 10 or more Services
Finally, we looked at the aggregate number of services provided by our community college health centers and found that thirty-six health centers provided at least 13 services, thirty two health centers provided at least 10 services(click here for Figure 5). The picture that evolves is that 70% of health centers provide at least 10 of the services outlined in 54702 of TITLE V.
Sometimes we hear complaints about the disparity of health services provided to community college students. Actually, our survey found that 70% of our colleges are providing the majority of services which are identified as services we may provide by regulation.
What about the other 30% of Health Centers?
Why are the other 30% of health centers unable to provide more services? It is really about funding. Some schools have too few students to afford more than first aid capabilities, other schools have too many students who are waived from paying the health fee. In either case it comes down to funding.
What is the Funding Crisis?
Health centers are funded by a $13 student paid health fee. However certain students have been exempted/waivered by statute from paying the fee. The critical issue in the funding crisis in health services relates to the growth in health fee waivers. Fee waivers have grown from 400,000 students statewide in 1994-95 to 650,000 students statewide in 2003-04 (the latest available figures from the Chancellor's website; click here for Figure 6). That represents $17 million statewide in lost health fee revenue.
We then looked at the number of schools affected by the Health Fee Waivers or low enrollment numbers. We found that 49 schools have lost 20-39% of their health fees due to fee waivers making it necessary to decrease service. There are 13 schools that have lost >40% of their fees due to waivers. Those schools who have experienced >40% losses have experienced drastic cuts in staff and hours of service (click here for Figure 7).
How Can Health Center Funding Be Stabilized?
In a separate article in this journal issue, author Kate Hartzell details the efforts of HSACCC to stabilize funding over the last 10+ years. In 2004-2005, the organization has undertaken two initiatives. An unsuccessful effort (again this year) to have a backfill of waived health fees put in to the budget of the Community Colleges. Although the "backfill" received broad support statewide and was part of the augmentation budget approved by the Community College Board of Governors, it was not funded in the Governor's January 2005 budget proposal for Community Colleges.
The second initiative was to get legislation introduced that would amend section 76355 of the Education Code to eliminate the mandatory waiver of health fees for the 650,000 + low and moderate income students. Assemblyman John Laird (D-27th Assembly District) introduced AB982 in February 2005 with the concurrence of the California Community College System office. It is an effort to find a reasonable low cost way of stabilizing the funding for health services since state budget options in this California state funding crisis are not available.
HSACCC and the Chief Student Service Officers (CSSO) have been working with organizations throughout the community college system to gain support for the legislation. By the time this article is published, you will know whether this effort has been successful.
Acknowledgements:
The author would like to praise the efforts of Mary Mirch, past HSACCC President (Glendale College) for her immense efforts in creating, disseminating and collating the data for the Health Center Survey. In addition, to thank Becky Perelli, HSACCC President-elect (West Valley College) and her staff for collecting and collating additional college data. Finally, I would like to thank Mary Gill, HSACCC consultant, for her wisdom and efforts in assisting HSACCC in our continuing efforts to stabilize funding to improve health service to California Community College students.
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