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The Denver Private School District

The Denver Public School District can no longer afford to provide its current level of health and social services to students and is looking to outside agencies for help. But the possibility that DPS might contract out nursing, psychology and social services has some employees worried about losing their jobs and others concerned about the quality of care that students will receive.

The district has appointed three task forces to examine each of the service areas. But some task force members fear their recommendations will be ignored, and others despair that some of the organizations represented--most notably the Denver Health and Hospital Authority--stand to gain from partnerships with the district.

"Even though I'm a health-care provider on the nursing task force, I have very little input, and that's what's alarming," says Deanna Hanna, a school nurse at both Morey Middle and Cory Elementary schools, as well as the nurse representative for the Denver Classroom Teachers Association.

While Hanna recognizes that DPS probably needs to change its policies to meet the growing demand for the services, she is concerned about the way services will be managed if they're contracted out. "When you're employed by the district, as we are, all children are served. As an employee of the district, I am part of the educational team, and I am accountable to the school principal. But if I were in a contract service, I'd be beholden to whoever is running it. I'd have to serve a lot more schools, and I wouldn't be able to serve all kids," she says.

Richard Rosenow, a social worker at Horace Mann Middle School and the union representative for social workers, says, "If they're talking about getting people from other agencies to help us do our job so we can do less clerical work, we'd welcome that with open arms. But that's not the message were getting. We're getting the message that they're trying to phase us out entirely so they don't have to pay our salaries and benefits."

DPS currently employs 51 psychologists, 60 social workers and 51 nurses at an annual cost of $6.9 million--a small fraction of the district's $392 million budget.

Rosenow, who has been a DPS social worker for 26 years, says social workers from outside agencies would simply fill the role of caseworkers by coming into a school, working with a student and then leaving. "We do much, much more. We provide daily, ongoing support services for kids and their families. Often, kids will come in to see us a few times a day. You're not going to have a caseworker waiting to provide services to them," he says.

DPS officials gave the social work task force a mission statement that indicates the district already knows what it wants, adds Phil Hernandez, the Denver Department of Health and Human Services manager and a task force member. "We're supposed to deliver the rationale for reducing the budget, I guess."

The mission statement reads, in part, "The district cannot maintain the comprehensiveness [sic] level of health and welfare services that it has taken on...A collaborative effort with various care providers needs to be initiated. By partnering with city departments and community-based agencies there can be a higher level of impact on services to children and families. This partnership can be more cost effective, and perhaps, considerably reduce the district's budget for this kind of expenditure."

Despite the ominous tone of the statement, school officials say employees' fears are unfounded and that DPS is simply trying to provide better medical and mental health care to students--without eliminating jobs.

"Last spring, when the school board went through the budget cycle, we faced a significant budget deficit of about $15 million," says Denver Board of Education member Elaine Gantz Berman, who sits on the nursing and psychology task forces. "At the time, there were proposed cuts for social workers. The board asked the district staff to work with the appropriate agencies in the community to look at a number of different services--social workers, psychologists and nurses--and to see what needs kids have for those services, what services they are currently providing, and what the most efficient ways there are of meeting those needs." She adds that it's far too early to know if privatization will even be considered.

The task forces are supposed to deliver their recommendations to the school board later this month or in early May--just in time for the coming school year's budget deliberations. Hanna says one of the main proponents of contracting out services is nursing task force co-chairman Paul Melinkovich, who also represents one of the probable bidders, the Denver Health and Hospital Authority, a nonprofit public health agency for low-income residents.

"Now that schools have Medicaid reimbursement, kids have dollar signs on them," Hanna says, referring to a bill passed by the state legislature in 1997 allowing school districts to track students who are eligible for Medicaid coverage and receive matching funds from the federal government. DPS will collect an additional $500,000 this year as a result.

"The Denver Health and Hospital Authority has lost a lot of Medicaid patients because patients have more choices than they used to and can go to other agencies for care," notes Hanna, who has been a school nurse in DPS for 31 years. "There is a captive audience of Medicaid patients in the schools, and Denver Health wants to increase their client list."

Melinkovich, the associate director of community health services and director of school-based health centers for the Denver Health and Hospital Authority, insists the organization is not driven by an opportunity to boost its bottom line. "What we've said repeatedly is that we want to be involved so we can provide the best services we can to kids," he says. But Melinkovich also says that additional Medicaid revenues "will help whoever is providing health services in the district."

"I think what I'd like to see happen is that there be a real critical look at what partnerships could be formed between the district and Denver Health to provide a higher level of care," Melinkovich says. "What's preventing that from happening is the fear of privatization and loss of jobs. There's never been any discussion about cutting DPS nurses and hiring nurses from Denver Health. Our plan would be to continue with the nurses already in the district."

The Denver Health and Hospital Authority has been working with the district for a long time to provide more care to school-aged kids, Melinkovich says. Denver Health performs immunizations at some schools and for the past decade has been operating clinics, known as school-based health centers, in twelve of the district's largest schools, enabling DPS students to be treated without having to leave school. According to Melinkovich, there are now 1,100 school-based health centers around the country--a 50 percent increase from 1996.

School officials say they aren't sure if they could save money by contracting out services. DPS has already contracted out nursing services at Pioneer Charter School and in pilot programs this year at North High and Valdez Elementary. The district spends no less on the Denver Health nurses at its two pilot schools than it does on DPS nurses.

Judith Igoe, director of the office of school health at the University of Colorado Health Sciences Center, says there are some isolated examples of school districts contracting out health services nationwide but that it is almost impossible to know exactly how many there are, because school districts tend to privatize services--including food, busing and maintenance--for a couple of years and then provide them again in-house. "This is not a widespread practice," she says.

The benefits of contracting out health services are still unknown, says Igoe, who is on the nursing task force. But, she adds, "no matter who is delivering the service, there are still insufficient resources put into this kind of health care. My caution is to move slowly in this area."

Children's Hospital is the only other health-care provider in Colorado that has provided public and private school districts with nursing and therapy services. And it's been doing it for fifteen years. Children's Hospital currently has contracts with eight small school districts: Adams 50 in Westminster, Bennett, Byers, Englewood, Deertrail, Littleton, Sheridan and Strasburg.

Chris Perreault, clinical manager of the school health program at Children's Hopsital, says DPS hasn't approached the hospital about contracting out services. And the hospital won't approach the district, because it provides services only upon request. "Our program is not meant to compete with school nursing but to be available as a resource. We're very supportive of school nursing," Perreault says, adding that the school districts with whom Children's Hospital has contracts requested their service only after school nurses had retired or when they had gaps in nursing services.

Perreault says people are often wary of the word "contract" and fear that contract employees won't be part of a school team. But Children's Hospital sets up nursing programs that are tailored for the individual school. It's not, Perreault says, a "rent-a-nurse" scenario.

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