For many Philadelphians like Mitata Gbondo who have young children, going to the dentist can be inconvenient, costly, and even scary.
So when a dental clinic opened at William D. Kelley Elementary School, which her son attends, Gbondo jumped at the chance to get a free teeth cleaning for herself and her son. She walked up to the third floor of the school at noon on a Thursday, and entered a fully functioning dental office with candy-colored walls and a picture of a smiling toothpaste mascot.
“This experience has been awesome,” Gbondo said.
School-based health clinics, like the dental office at William D. Kelley, are expanding rapidly across the country. Experts say students — especially those who live in low-income communities — who’ve had access to free and comprehensive checkups, screenings, and even behavioral therapy, do better academically and emotionally.
According to data from Education Plus Health, a nonprofit advocacy group that lobbies for more school-based health centers in Philadelphia, in 2022-23, three out of five students who attended a school with a center improved their attendance from the previous school year.
But these clinics are often underfunded, understaffed, and usually can’t operate without the financial support of a hospital, community health partner, or university.
Some 23 states have passed legislation to try to stabilize funding for school-based health centers by dedicating state dollars to the centers in their budgets every year. But Pennsylvania is not one of them.
“We don’t have a robust system of school-based health centers at all,” said Kendra McDow, the School District of Philadelphia’s medical officer.
The district is trying to change that. McDow said it is looking for health care partners to help start new school-based health centers in one or two district schools over the next three years. After that, they want the number to grow, McDow said.
There are more than a dozen school-based health centers in Philadelphia and 30 in total across the state, according to Julie Cousler, executive director of the Pennsylvania School-Based Health Alliance and Education Plus Health advocacy groups. The majority of them are at private or charter schools. As with school-based health centers nationwide, the ones in Philadelphia schools are funded by a mix of federal aid, insurance reimbursements, philanthropic donations, and some one-time state grant money.
Only three Philadelphia district schools (Building 21, John B. Stetson Middle School, and Vaux Big Picture High School) have comprehensive school-based health centers with nurse practitioners. Edward Gideon Elementary School has a planned clinic that hasn’t opened yet, and Kelley has the dental clinic.
Meanwhile, New York state has 252 centers in schools (146 of those are in New York City), according to the state health department, and Delaware — the first state to mandate centers in every public high school — has more than 50. Newark, New Jersey just opened its first school-based health center in 2023. But recent funding cuts in New York and Delaware have put those centers in jeopardy.
Cousler and McDow said the centers are vital for Philadelphia students in particular because living in cities near several highways, industrial facilities, and other sources of pollution can trigger or exacerbate chronic health problems like asthma. Those chronic health issues can cause students to be frequently absent from school or make it difficult for them to concentrate in class, McDow said.
According to data from the Centers for Disease Control and Prevention, 21% of children in Philadelphia have asthma — more than double the national rate.
“We have high rates of asthma, high rates of uncontrolled asthma, high rates of hospital visits because of asthma,” Cousler said. “We have high rates of mental health distress among kids and high rates of kids not getting the services they need. So we just have to start going to where the kids are.”
McDow said if Philadelphia officials want to make school-based health centers “really work for our city, we have to have funding.” And she said that would mean state-level legislation.
School-based health centers would not get a dedicated funding stream from the state in Gov. Josh Shapiro’s newest budget proposal.
“Right now, there really isn’t any support for school-based health centers and that’s why it’s hard to sustain them,” Cousler said.
‘A hub of what families would need’
In the early 1990s, under former governor Robert P. Casey, Pennsylvania received a series of grants from the Robert Wood Johnson Foundation to launch a network of school-based health centers in high-need areas, according to Cliff Deardorff, who was the first public health program administrator for the grant for the Pennsylvania Department of Health. Between 1987 and 2001, the foundation spent $40 million nationwide on school-based health centers.
Deardorff said there was a lot of momentum around the new initiative.
“It was exciting. This was a new idea for Pennsylvania,” Deardorff said. “We were starting something that we hoped would make a difference.”
But when the grant funding ran out, nearly all of those centers closed. Today, Deardorff said, only one of those original school-based health centers exists.
Deardorff said building community trust around any kind of health center is crucial to keep patients coming back, staff employed, and insurance reimbursements flowing.
“To give somebody a chance to start something like this up, and then, poof, it goes away” was painful, Deardorff said.
But he said he’s hopeful state lawmakers, prompted by advocates like Cousler, might avoid the financial mistakes of the past.
Crystal Edwards, William D. Kelley Elementary’s principal, said it’s been an “honor” to have the dental clinic in her building. She said she’s seen firsthand the good it has done for her students, their families, and even her staff members who can all use the clinic’s services regardless of their insurance status.
“We try to be a hub of what families would need to make sure that their children are not just physically safe, and educationally safe, but psychologically safe and emotionally safe, and I’m just proud to be able to give that to the community,” Edwards said.
