News & Announcements
Legislative Report
Links & Contacts

School Linked Health Services


by Camille Giglio, September, 2000

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 .


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.)


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.


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 Education.

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.


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.


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.


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 care programs:

  1. 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.
  2. 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.
  3. 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.
  4. 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 Welfare Agency.

    3. Secretary of Child Development and Education.

    4. Directors of the State Department of Health Services.

    5. State Department of Social Services.

    6. State Department of Mental Health.

    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 statements.

    2. Complete a community needs assessment.

    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 Clinton Administration

    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 Act (ESEA).

    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.


    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 policies.


    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.