Seattle Teen Health Centers Called Out for Gender Affirming Care

 Readers, you may not know but through the generosity of the Seattle taxpayers (and King County taxpayers), every single high school has a teen health center. There are also six middle school centers and and seven of them at elementary schools. This is a VERY good thing because:

  • it makes it possible for students to have access to healthcare they might not otherwise receive
  • it makes it possible for students at access birth control 
  • it makes it possible for students to get sports physicals right at school (saves time for both student and parents)
  • it makes it possible for students to keep up-to-date on vaccinations
Gender issues and gender affirming care are big national stories that are certainly rile some people up. Recently, SPS came into the national view because someone told a news source (I'm still trying to figure out where this was first reported) about two SPS teen health centers that offer gender affirming care. From KOMO tv: (bold mine)

The Nova Wellness Center and the Meany Health Center are available to middle and high school students in Seattle Public Schools (SPS). Both centers offer "gender reaffirming care" to students, according to documents obtained by parental rights advocacy group Parents Defending Education (PDE).

The two centers are operated by Seattle-based nonprofit Country Doctor Community Health Centers (CDCHC). CDCHC provides several services to "transgender, non-binary and gender diverse patients," according to its website.

Some of CDCHC's services include hormone therapy, gender transition medications and referrals for gender transition surgeries. The nonprofit states on its website that it does not currently provide puberty blockers, and it says hormone therapy for "younger patients" requires "speciality referrals."

A spokesperson for SPS told CITC that "community healthcare agencies independently operate School-Based Health Centers in spaces provided by Seattle Public Schools" and the district does not "supervise or participate in the provision of health care services in these clinics."

It is not immediately clear if SPS notifies parents if their child is seeking "gender reaffirming care" at either the Nova Wellness Center or the Meany Health Center. In separate documents obtained by PDE, SPS states that staff "should not disclose a student's transgender or gender X status" unless legally required to do so, and the school district says staff should "avoid using gender pronouns" if "it is unclear whether the student asserts the same gender identity at home.

There are eight different service providers for schools that offer health services. It appears that the reason that Nova High and Meany Middle School offer these services is likely because they use the same healthcare service, Country Doctor Community Health. They are the only two to use that provider. 

In a random check of teen health centers, I actually found a couple of things more disturbing to me than the fact that a couple of the health centers offer gender affirming care.

The number one problem to me comes from parents fully understanding what signing the form means. These registration forms are all over the place in how/what they explain and I think a harried parent or someone who doesn't read English well might not realize what it means.

I'll put up several examples of the phrasing used but the upshot is - if I'm reading correctly - is that the parent/guardian will NOT be notified every time their student accesses a service. A parent is signing and giving permission for the student to access any and all services at the teen health center (with a few exceptions). 

The form at Cleveland High just says this:

  • To use these services, you must enroll your son/daughter in the health center by completing and signing our registration forms and returning them to the Teen Health Center. 

From some forms:

STUDENTS must sign for themselves if old enough to consent and would like access to the following services:

Any age - birth control, pregnancy and abortion services

13+ y/o - counseling and psychiatric medication services

14+ y/o - sexually transmitted infection (STI) testing and treatment

CAREGIVERS must sign if the student is not old enough to consent or always for the following services:

Physical and/or dental exams, medicines and shots, and all other health issues not mentioned about

Another form explains:

Usually parents sign for children who are minors (under the age of 18). There is an exception when a minor seeks services for the following:

- family planning
- sexually transmitted disease testing/treatment
- outpatient mental health treatment 
- alcohol and drug abuse treatment

Under state law, minors may consent to their own treatment for these services. When this happens, they will be asked to sign this form for themselves. 

This line appears on all forms:

School-based health centers located in Seattle Public Schools must have a signed consent from a parent or legal guardian before providing services to youth, except in situations where federal and/or state laws allow youth to access such treatment without parent/guardian consent

What I think might be useful is to actually tell parents what those federal and/or state laws say. Because again, parents may not realize all that they are consenting to for their student. I think transparency on this issue might be a good thing.

The district takes a very hands off approach to this issue but currently, the district doesn't seem concerned with transparency especially when it comes to parents. 

The Seattle World School - which serves immigrant youth - partners with a healthcare provider called International Community Health Services who DO explain those laws.

FOR YOUR INFORMATION

Under Washington State law, youth may independently access reproductive health care at any age without parent/guardian consent (RCW 3.02.100(1 and 2)). They may independently receive drug and alcohol services and mental health counseling from age thirteen (RCW 70.96A.095, RCW 70.96A.0097, RCW 71.34.530, and RCW 71.34.500) and care for STDs from age fourteen (RCW 70.24.110) without parent/guardian consent. The School-Based Health Center encourages each youth to involve their parents or guardians in healthcare decisions whenever possible.

If necessary, the SBHC will inform youth of options of and assist youth in accessing outside care. The SBHC will assist the youth in discussing these situations with parents/guardians.

Youth’s consent is legally required for release of information about the following kinds of diagnoses and treatment: pregnancy, sexually transmitted diseases (including HIV/AIDS testing), and alcohol and drug or mental health counseling.

When consent is provided for care, all information is kept confidential, except in the following circumstances:

The client gives permission through a signed release of information
If they indicates a risk of imminent harm to self and others.
They have a life threatening health problem and are under the age of 18 years.
There is a reason to suspect abuse or neglect.
Certain communicable diseases must be reported to public health authorities.

I think SPS could create a generic form that clearly states what it means for a parent or student to consent to care at a school-based health center.  Maybe there is one in the first day packets? Has anyone ever seen that?

Other issues:

1) There are different health care groups that run the teen health centers. What I find disturbing is that - for some of them - a parent has to sign in with their name and email just to look at the form. (I believe that forms are available in hard copy at every school but what parent has time for that?)  

So right there, the health care entity is gathering up data for no good reason. Parents should be able to read any and all forms without doing that.

2) . The form I noted in reason #1 above, from NeighborCare Health, asks very specific questions about gender, sexual identity and pronouns. Not all forms ask these questions.

3) The NeighborCare Health form also says the consent carries over "from year to year" and if parents want to withdraw consent, they have to send a withdrawal from care letter. 

Again, I think this is a great service to have in so many buildings but I also think in matters of healthcare, it would be nice if the district made clear what consent means. 

Comments

Anonymous said…
It's not SPS's place to provided Health care and certainly not behind the parents back. Melissa you are wrong on this one.

--Just educate
Anonymous said…
These services are not all free. It's unclear to me (a parent) what is free and what isn't. Diagnosis and advice for a basic sports injury like a sprained wrist seems to be free. Mental health counseling, seems to be not free. Maybe the first consult is free? How about ADHD meds? I don't know.

-Prices Available?
Anonymous said…
@Teen Health, I don't disagree with your points, except that we actually can fund jazz and music programs as it turns out, at least at WMS. Where there is a will there's a way and clearly we now know there was a will and a way for jazz and music at WMS. Now if only other needs (like teen health centers) could figure out how to make deep pockets want to give. Since whether or not deep pockets are interested in the need + having families at the needing school who know the right deep pockets to connect to in order to fund that school's needs = what is funded these days.

SPS funding secrets
Anonymous said…
Judging by how poorly SPS runs it's business and also how poorly many students are doing academically the last thing I would want is SPS involved in ANY THING MEDICAL. BTW placing a birth control device inside a child's arm before they even have their period is monstrous. Do you think there are no possible side effects when screwing with a child's period or hormones. Metal health screening or probing psyc test oh man what could go wrong with a teen angry at their parents over not being allowed to go to a kegger. Oh and all this without the parents knowledge.

SPS should rewind and fix the basics before crossing the line into a parents responsibility Oh and this is not a right winger saying this. Oh and we are fully aware of the consent trick you pull on parents. Geez I can hardly write this I'm shaking so much

Raging Mad
Just Educate, did you read what I wrote? Some kids have little access to healthcare. Getting a physical at school sure helps busy parents.

And,as Teen Health said (and I wrote), there is healthcare that any child over 13 can legally access without a parent's permission. If you don't like that, you can certainly tell your state reps. But logically, it seems better for a kid to access birth control and not get pregnant (or get someone else pregnant).
Folks, I have received several comments that I would print except for
1) Get Real, you did not explain wha procedure that these side effects you list would come from. Try again.

2) Nice Try, I cannot print your comment without verification from the district. I'll try on Monday.

3) SPS HOSTS the teen health centers. They do NOT administrate them and all the services are set up and delivered by healthcare CBOs.

As I have pointed out, the middle schools administer a mental health screener that is NOT validated, is invasive and, in some cases, leave parents out of the loop. I sure wish people would get more awareness of that issue.
Anonymous said…
I can attest that the health clinics are separate organizations-to the point that they do not have a school phone number. If I (a school employee) want to call the health center that is in the building, I need to dial the entire number (not just an extension like for school programs). Furthermore, they have separate staffing and payroll. They are housed in the school, but they are not a part of SPS, and never have been. At age 13, young people are allowed to make their own health care decisions-once my kids were that age, I didn’t even go in the exam room with them anymore. Don’t like it, take it up with the state reps, as Melissa suggested. I think it’s great to have a health center in the schools; it helps students and their families. Every parent I talked to was thrilled to learn that their student could get their physical at school, saving parents lots of time. I’ve also recommended that students use the health centers for mental health counseling-this is very helpful as getting appts now are months long waits. -FormerTeacher
Anonymous said…
Is this for real?

The statement - which comes as the Seattle Public School District also implemented a policy that states a student’s gender identity may be kept secret from parents - suggests that similar practices may be in place Country Doctor's sister center at nearby Meany Middle.

Oh no
Unknown said…
Thanks for covering this, and as a current high school teacher in the district with teenage children, I have very mixed feelings about these clinics. They reduce all kinds of barriers to access, but that also allows young people to seek medical care without parental input, which is problematic. I do feel like a lot of the moves towards wraparound services have had unintended consequences around marginalizing parents and increasing the role of the government school in the life of a child.

I think we all need to be very careful with these and go slowly and do it right so that way we don't get the kind of parental backlash that we see in other parts of the country.

When I've been somewhat critical of these clinics, I've been told that they are an unqualified good, and they may be, but if they are, this needs to be handled well so that we can be a model for other communities. Otherwise we're going to have the parents defending education crowd and the rest of those types causing problems and slowing progress.

Tightening up a few paperwork and communication protocols is a small improvement that could go a long way.

Go Slow and Do It Right
Anonymous said…
Just WOW and why am I paying for this via my taxes. SPS is doomed! Maybe that's what all these fringe groups want. SPS is a nut house.

Raging Mad

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