Analysis Human Rights

How School-Based Health Centers Have Become a Lifeline for East Bay Immigrants

Julie Morse

Through a medical-legal partnership in Oakland, attorneys help students and their parents who need assistance reversing deportation orders, applying for visas, and tackling other citizenship hurdles.

Edgar wasn’t afraid when a man appeared by his mother’s car window where he was sitting and strangled his neck with a chain. His younger brother started screaming, and the man took off. Their mother, Guadalupe, who was ordering them lunch from a Mexican restaurant nearby, heard her son’s cries, and came running back to the car and called the police.

This is what Guadalupe told me when I came to interview her at the offices of the East Bay Community Law Center (EBCLC), a teaching clinic based out of University of California Berkeley School of Law that offers free services to low-income residents. Eventually, the police used the restaurant parking lot’s cameras to identify the suspect. He was soon found, and he quickly admitted to the assault. “I was happy that my son didn’t have to testify,” she said.

However, as a result of the attack, which happened back in May, Edgar started having back pain and went to see the doctor at Hawthorne Elementary School-Based Health Center.

Under the Affordable Care Act (ACA), undocumented immigrants like Guadalupe and Edgar are prohibited from receiving health insurance through Medicaid and the Children’s Health Insurance Program. Additionally, their families don’t qualify for tax credits to help pay for private health insurance, and they are precluded from buying coverage on the ACA’s marketplaces. Fortunately, in California’s East Bay, school-based health centers (SBHC) provide free clinical health services to anyone under 24 years old, regardless of their citizenship status.

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There are around 2,315 SBHCs across the country, and many were established in the 1980s, including the centers in California. Today there are 246 SBHCs in the state, and up until recently, their purpose was to provide accessible clinical and mental health care services and dental care for students. However, since the uptick in undocumented minors migrating in the 2010s, that mission has shifted.

The Oakland Unified School District (OUSD) realized that the medical needs of these incoming kids are deeply intertwined with their precarious immigration statuses. In response, La Clínica de la Raza, a nonprofit community health system, and EBCLC implemented a medical-legal partnership, an initiative that introduces attorneys to students and their parents who need assistance reversing deportation orders, applying for visas, and tackling other citizenship hurdles.

Like many students, Edgar has a long-standing relationship with his SBHC. He had his first appointment at Hawthorne in 2004 when he was 6 years old, just after he and Guadalupe moved from Zacatecas, Mexico, to Oakland. Although he’s 19 now and attends a high school with its own SBHC, whenever he has a health concern, he turns to Hawthorne.

At the Hawthorne clinic, the doctor asked Edgar and Guadalupe if they had ever applied for a visa. Neither had any idea of how to go about seeking permanent residency. The doctor told them she would put them in touch with a lawyer. Two days later, Guadalupe received a phone call from Mindy Phillips, an Equal Justice Works Fellow at EBCLC. They scheduled an appointment at Hawthorne and began Edgar’s Deferred Action for Childhood Arrivals (DACA) application.

“The SBHCs have built a rapport and relationships with students and families that serve as a foundation of trust,” said Phillips. “It’s considered an accessible and safe place where students trust the teachers, medical providers, and behavioral health clinicians. When those medical providers suggest students speak with a lawyer to address legal issues, it significantly reduces the fear and anxiety related to disclosing information to a lawyer, especially about your legal status.”

In fact, according to an OUSD survey, 98 percent of students feel more comfortable talking to a SBHC clinician than to other doctors or nurses. “Teenagers at the SBHCs are more open to sharing. We give them that agency,” said Dr. Raul Gutierrez, who runs the SBHC at Fremont High School in East Oakland, a school that specializes in matriculating newly immigrated students. “When I see 16- and 17-year-olds in an SBHC on their own terms in an environment that’s theirs, then I’m seeing a young adult who is taking responsibility for their own health.”

Although SBHCs are designed to give students autonomy in their health-care choices, their well-being is also dependent on family stability. The medical-legal partnership had been in the works since 2010, but wasn’t officially implemented until 2014, when the OUSD started to observe more and more students from Mexico, Honduras, Guatemala, and El Salvador matriculate into East Bay public schools. Between 2011 and 2014, the number of youth apprehended at the border jumped from 15,949 to 68,551. Out of the 53,518 children who were released to sponsors in 2014, 5,831 went to live in California, the third most popular destination after New York and Texas.

Kids who don’t have legal representation face much higher rates of deportation than those who do. Their livelihood is especially endangered by Immigration and Customs Enforcement (ICE) initiatives like Operation Border Guardian, which has relentlessly targeted people who arrived in the United States as unaccompanied minors. “When I asked them if they had an attorney, a lot of them said no,” said Gutierrez. “That just got us asking more questions. We started to ask the schools, ‘Do these kids have a lawyer? Do you know where they’re going?’”

These concerns prompted some schools to start hosting immigration clinics. Phillips currently runs three or four hour-long clinics at four different schools, twice a month. In the last two years, she’s received around 600 referrals for her services helping families secure visas and residency.

Guadalupe has also referred Phillips to her friends. “I imagine myself in the place of the mothers of children who hadn’t been able to apply for visas. It makes me sad for everything that’s happened,” she said.

The attack in the restaurant parking lot also qualified Guadalupe and her husband to apply for U visas, which are designated for victims of certain crimes and their immediate family members. They’re also filing an application for Edgar, as his DACA designation will expire in 2019, and U visas can take 2-3 years to be fully processed.

“Kids like mine had the illusion of continuing with their DACA, and now those who weren’t able to renew theirs are defeated,” Guadalupe said. President Donald Trump‘s executive orders have contaminated school environments with racial tensions and provoked fear and anxiety among immigrant students. “I think students pick up a lot of rhetoric from the news, maybe from their families about how they’re supposed to feel and react to immigrants,” said Gutierrez. “In the culture of the school, especially one with so many immigrant students, sometimes [the students] call each other names or isolate each other in subgroups. That causes a lot of stress for these students. They don’t want to come back to school.”

The GOP’s unhinged approach to health-care reform also threatens the future of SBHCs. According to Bonnie Trinclisti, the director of Clinical Services at Native American Health Center, another nonprofit that administers SBHCs in the East Bay, many SBHCs are financially dependent on Medi-Cal, California’s state-based Medicaid program. “No one who comes to a SBHC will be turned away for lack of ability to pay, so if we can’t bill [Medi-Cal] then the third-party revenue is going to be severely pressed,” she said. “I think we’re going to have to be really creative.” Although grants also support SBHCs, severe federal changes to Medicaid could force them to minimize their services.

“A lot of the times I’m referring a patient to a lawyer through the medical-legal partnership, while immigration might be the most important thing on their mind, the lawyer is able to sit down with them and talk about other things that might be affecting their lives, like housing or access to public benefits,” said Gutierrez.

In one case, Philips was introduced to a student whose father had been detained by ICE for 13 months. Although Phillips worked to get him released, while stuck in a detention center, his family fell behind on bills, and eventually they received an eviction notice. A housing attorney at the EBCLC quickly acted to represent the family in the eviction case and they were able to stay living in their home.

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