By RICHARD ROTHSTEIN

HULA VISTA, Calif.

FOUR years ago Dennis Doyle, an assistant superintendent of schools in this town on the Mexican border, reviewed attendance and test score data at the elementary schools. Not unexpectedly, schools with low scores also had poor attendance. Dr. Doyle figured that achievement would rise if he could keep the children, many from low-income and non-English-speaking families, in class.

Advertisement

Meanwhile, Britt Berrett, chief executive of Sharp Chula Vista Medical Center, worried about a related problem: his hospital's uncollected bills for children without regular health care, who used emergency rooms for nonurgent treatment.

At a meeting of the local Human Services Council, Dr. Doyle and Mr. Berrett discussed their troubles and devised a solution: a mobile clinic sponsored by the school district, the city, Sharp Chula Vista and another local hospital. The clinic, with a nurse, a nurse practitioner and a nurse assistant, began rotating among five schools with high absenteeism, treating problems that would otherwise have kept pupils at home, like asthma.

Now attendance has improved, and scores have risen.

That success also stems from the clinic's ties to other services. After a pupil has been treated at the clinic, volunteers introduce the child's mother to a family center on school grounds. There, mothers are recruited for English-language classes, and a paraprofessional tries to enroll their children in a health plan. Some, whose family income is too high for Medicaid but too low to afford private coverage, may be eligible for the federally subsidized Children's Health Insurance Program, enacted by Congress in 1997. Children who are not citizens may get coverage from a patchwork of less-well-known public and private programs.

Aida Meza, a paraprofessional at the family center adjoining the Vista Square Elementary School, says follow-up contacts are often needed because many mothers hesitate to enroll their children in the federal insurance program: although children born in the United States are eligible as citizens, their parents may be in the country illegally and fearful of government agencies.

Because the plan requires parents to enroll personally, Ms. Meza must call them back to the center at each step of the application process, translating for them on a speaker phone to health department officials. The plan requires small monthly premiums and periodic re-enrollment; Ms. Meza helps those daunted by the paperwork to comply.

Then she must take care that the coverage is actually used. Many immigrants are unfamiliar with the concept of preventive care and seek treatment for children only after an illness becomes serious. So Ms. Meza calls parents often, to ensure that their children get regular checkups and treatment for minor illnesses before they progress.

Largely because of Ms. Meza's efforts, three-quarters of Vista Square pupils now have health insurance. Most of the rest get free care at the mobile clinic.

The family center also provides training for mothers who work as community liaisons throughout Chula Vista. The mothers conduct classes for neighbors on issues like the importance of prenatal care, watching for diabetes and identifying women in depression.

A mobile clinic at the school site creates more work, not less, for Vista Square's regular nurse. Medications must now be dispensed. Children with asthma now have inhalers to be administered. With children enrolled in health plans, they now have regular doctors with whom the school nurse can consult when she observes new symptoms.

The clinic, the family center and the school nurse all share a common purpose: to keep children healthy enough to attend school, and alert enough to do well. Asthma, for example, does not harm performance just by keeping pupils out of class. If they are awake at night wheezing, they are too tired to pay attention even if they do make it to school the next day.

These services cost an average of about $300 a pupil per year, paid by the two participating hospitals, San Diego County, the City of Chula Vista, Medicaid, private foundations and the school district. Dr. Doyle insists, and data seem to confirm, that this spending has contributed to gains in test scores and other measures of student learning.

In a report for the National Bureau of Economic Research, Janet Currie of the University of California at Los Angeles and Mark Stabile of the University of Toronto, both economists, estimated that among children whose mothers are not high school graduates, each incidence of serious disease or injury raises the chance of being in the bottom fifth of the test score distribution by 7 percent.

That is a bigger impact than most analysts have previously identified. But in Chula Vista, Dr. Doyle seems to have come to a similar conclusion, and acted upon it.