September 1, 2010
Catholic Health World

Taking a wellness message into schools

Services lay foundation for healthy communities
By JULIE MINDA

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It's the start of a new school year. Students are stocking up on school supplies. Teachers are updating lesson plans. And Catholic health care providers who serve in their local schools are preparing for a fresh batch of new patients.

For these clinicians, the work is not just focused on tending to students' cuts and bellyaches, it's geared toward preparing them for a lifetime of wellness. "I find it exhilarating to be able to invest in kids' lives by giving them the tools to become healthy adults," said Trina Gwaltney, one of two nurses hired by Mercy Foundation of Roseburg, Ore., to teach healthy behaviors in six rural school districts.

Mercy is among the many ministry providers that partner with schools to make inroads into tough-to-reach populations with substantial health care needs. Some providers create a network of primary care centers at schools; others provide clinicians to serve districts; others supply health educators; and others host mobile clinics that set up shop in underserved school districts.

Need for medical homes
Iris Malone is a family nurse practitioner at the Northside High School-Based Health Center in Lafayette, La., a clinic operated by Lafayette's Our Lady of Lourdes Regional Medical Center. She said schools are an ideal location for a health center because "kids trust the environment that they're in. They're there almost eight hours a day. It's an environment that they feel comfortable coming to, and they trust the staff that's there."

Our Lady of Lourdes established the center after an assessment revealed that many children in this low-income part of Lafayette lack access to primary care.
Kenneth Coleman directs school-based initiatives for Detroit's St. John Providence Health System. He said the system developed its network of 10 school-based clinics after an assessment revealed that many children who repeatedly use the emergency department are clustered by ZIP code. In many cases, their parents do not have transportation, and so it is difficult for them to get their children to a primary care physician. Or those on Medicaid can't get appointments quickly due to a lack of providers.

To help children overcome access problems, St. John Providence put primary care clinics in the ZIP codes identified in its analysis. Located primarily at public elementary, middle and high schools, the centers provide health education, mental health care, basic health care, and a nurse and/or a nurse practitioner for students. Students' families pay nothing out of pocket; the center bills a third-party payer when one is available.

Agnesian HealthCare in Fond du Lac, Wis., runs a school health program in a middle school in a medically underserved area. "Most of the students do not have access to a medical home, and they see me as the front line," said Patti Shippee, one of two clinicians Agnesian employs to serve the school. In addition to providing direct care, Shippee, who is a nurse, said she functions as a case manager, assessing students' needs and helping them and their parents to meet those needs, sometimes through referrals to other care providers.

Marian Sheridan, administrator of health and safety for the Fond du Lac School District, said the Agnesian program is connecting with these students at an opportune time in their lives since "middle school is a time of transition, a time of high-risk behaviors and a time of great need" for services for youth using drugs or alcohol and those with mental health needs.

St. Vincent's HealthCare in Jacksonville, Fla., serves adolescents in schools in low-income areas through its St. Vincent's Ronald McDonald Care Mobile. The van travels to 24 public and parochial high schools and middle schools, providing free primary care, immunizations and sport physicals. Mary Alice Phelan, director of community relations and community benefit at St. Vincent's, said these adolescents are in "the age group least likely to receive regular preventive care. Once the student has passed the elementary level, parents and caregivers become less concerned about the health of that child until that student requires immunizations or sports physicals."

Ripple effects
A clinic operated at Grand Island Senior High School by Saint Francis Medical Center of Grand Island, Neb., provides medical services, mental health care, substance abuse evaluations and suicide evaluations.

The clinic serves many teenagers from low-income and immigrant families. Many students come from families that are transient and have not established a medical home. The clinic's strong suit is its accessibility. "We do not turn anyone away for the inability to pay," said Donna Sanders, vice president of mission and corporate responsibility officer for Saint Francis.

In Douglas County, Ore., where Mercy Roseburg operates, there are no school nurses. Also, there is a high level of poverty, significant numbers without jobs and insurance, and illiteracy, said Pam Frank, coordinator of the Healthy Kids Outreach Program, the Mercy initiative supplying the nurse educators for programs in Roseburg schools. Many of the small communities in the region have no health care provider.

Rather than focusing on providing direct care, Mercy employs a public health model in the schools to instill the value of healthy choices and prevention in kids, so they can live strong, healthy lives. "We have a very proactive approach," said Frank, explaining that the nurses visit classrooms at 15 schools, educating on hand-washing, nutrition, heart health, dental hygiene and character development.
Gwaltney said the potential for positive impact on community health multiplies when kids pass on what they've learned at home.

Impacting lives
Students in Ouachita Parish, La., would have no ready access to mental health care and very limited access to health education and health services were it not for a school-based health center run by St. Francis Medical Center of Monroe, La. The center provides mental and behavioral health care, crisis intervention, social services and basic health care.

Stalanda Butcher, program manager of the center, said that a survey the center conducted with students and teachers several years ago indicated that the students needed help dealing with grief, anger and other strong emotions. She said that when they get help with such needs — and with their physical health — it positively impacts their performance.

"When students are in class and healthy, they are better prepared to learn and excel," Butcher said. "In addition, our students attending our behavioral health sessions are reporting less aggressive behavior and have developed strong conflict resolution skills." The school also has reported a decrease in truancy over the last three years and it attributes some of this improvement to the health center.

The relationships formed through school-based programs can give hospitals and health systems a springboard from which to help in other ways, said Coleman of Detroit's St. John Providence. For example, that system has learned about — and responded to — students' needs for books, uniforms and other costly school supplies. Coleman said, "I've been glad to be involved with a system committed to helping kids. Some of our employees even help these students with money from their own pockets. It's an example of how we are living out the values of this system daily and consistently."

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