Check back frequently as we share school-based health care stories from around the country throughout February and beyond.
A School-Based Health Center's Thorough Staff Helps a Student with Diabetes
When a young child presents with a 2 day history of complaints of vaginal itching it is not uncommon to think that it may be due to poor hygiene or bed wetting. But not at a school-based health center located in Montgomery County, Maryland where the Nurse and the Nurse Practitioner were efficient and thorough in their assessment of this 4 yr old uninsured child that was seen at her SBHC. A urine specimen was sent to the lab, but the urine was also tested in the SBHC to see if there were ketones or glucose, which revealed large amounts. A fingerstick was done to test her blood sugar and it was high. Further history revealed weight loss of 1.5 lbs in 3 weeks, increased thirst (waking up in the middle of the night to drink) and frequent urination. A diagnosis of Diabetes was suspected. All findings were translated to mom in Spanish via the school based health center certified nursing assistant who is bilingual.
The child was sent to Children's National Medical Center for further evaluation. The NP contacted the Emergency Room to coordinate the child's arrival. Transportation via cab to the hospital was arranged immediately by the Site Coordinator. The child was admitted and her diagnosis confirmed.
The child has since returned to school and is doing well. The Nurse has helped the family obtain Medicaid for this child and the child now has a primary medical doctor overseeing her care. The family is receiving counseling from the Mental Health side of the SBHC to help them deal with this disease and the child is seen daily in the SBHC to learn about and monitor her disease. She is now feeling better and is doing very well, thanks to her school-based health center.
A Video from Katishtya School Health Clinic in San Felipe Pueblo, New Mexico
A School Based Health Center Success Story:
Jones Jaguars Girls on the Run
Embarking on year two of implementing a School Based Health Center, known as The Wellness Center at Jones Elementary School in Springdale Arkansas, the Physician’s Assistant and Licensed Clinical Social Worker looked for an educational outreach venue that would support both physical and mental health. The students at Jones are overwhelmingly the children of poverty and speak English as a second language; they lack financial, social and transportation resources to participate in organized sports or extracurricular activities. Living a few miles down the road from Bentonville Arkansas, the home of Wal-Mart, the students live in the shadow of wealth. As a complement to the Wellness Center at Jones and in efforts to improve access to physical activity and to address the childhood obesity epidemic, the personnel at Jones applied for and received a Joint Use Agreement (JUA) grant from the Arkansas Department of Education in 2010. With the $10,000 awarded in JUA funds the school district purchased supplies and materials to build a quarter mile trail on school grounds. The City of Springdale agreed to provide the manpower and equipment needed to install the trail. The JUA trail at Jones Elementary is now available for use by students, faculty and staff when school is in session and by the community at other times. The staff from the Wellness Center in recognition of the resources provided through the Wellness Center combined with the facility provided by the Joint Use Agreement trail decided to use the Girls on the Run program. The program is ideal because it addresses the physical, emotional and social needs of the child. Girls were invited to join the Girls on the Run Team and were provided with generic running shoes through the district’s social service fund. They participated in physical training for six weeks as well as bonding exercises, self esteem building activities, anti bullying curricula and art projects. The entire process was a great success. Girls expanded their physical activity parameters, explored character traits and positive pro social interaction and experienced enhanced self esteem through feelings of accomplishment and through recognition provided by classmates, parents and community members.
On the morning of the race, the Jones Jaguars Girls on the Run Team was transported via school bus the twenty or so miles to Bentonville Arkansas. Running side by side with the Physician’s Assistant, Licensed Clinical Social Worker and Administrative Assistant from the Wellness Center at Jones Elementary, the girls competed in a 5 K run. The festive atmosphere, balloons, food and thousands of cheering spectators provided for an over the top exciting experience for the team. Parents proudly watched and waved hand-made signs. The pride of accomplishment achieved through training for and completing a 5-K run is one that would not have previously been within reach for the girls from Jones.
To add icing to the cake, the Principal at Jones arranged a surprise victory run-through for the girls when they returned to school. Students from each classroom decorated signs and the entire student body stood cheering in the hallways as the girls ran a lap through the building. Their accomplishments uplifted the students, faculty and staff and provided an example and incentive for future participants. The Girls on the Run Program optimized the use of the Wellness Center and Joint Use Agreement grant funds to educate and support wellness in a proactive manner. The Wellness Center at Jones Elementary serves the school and students in ways that are above and beyond just treating the sick students and providing wellness checks, although those are important aspects of service. As a part of the school’s family of adult employees, the Wellness Center Staff have a unique view of the lives of their students. They are able to observe both social interactions and classroom dynamics and to come to informed decisions about the needs of the students and families that they serve.
Whitefoord Community Program's School-Based Health Center Serves Atlanta, Georgia
HEALS Helps a Student with Pneumonia
One cold morning in November in Alabama, the door to the clinic opened, a mom and her two children came in. Mom was concerned about her little girl, Emily. Emily had been sick for several days. She had Medicaid and was seeing a doctor in town, but Emily was not getting better and she did not have money for gas to drive into Huntsville. Janice, our nurse, offered to check Emily and give mom advice on what she should do. As soon as Janice put the oxygen monitor on Emily’s finger, she knew something was wrong. When she listened to her breathe, Janice knew Emily needed assistance. Neither of the providers who serve at Madison Cross Roads was in that day, so Janice called Annette Potter, the nurse practitioner who served at MLK, University Place and Morris Clinics. After explaining the situation, Ms. Potter agreed that Emily needed to get to the hospital as soon as possible. Janice explained the situation to Emily’s mom and then called 911. Emily was transported to Huntsville Hospital and subsequently admitted and stayed several days.
A few days later we spoke with mom and learned that Emily had double pneumonia. Mom appreciated our care so much, she has asked us to assist her in changing her Medicaid provider so she can always bring her children to the HEALS Clinic.
A School-Based Health Center Helps a Family New to Knoxville, TN
Jacob and his mother recently moved to Knoxville from Memphis, TN in order to be nearer Jacob’s sibling who attends the TN School for the Deaf in Knoxville. Jacob has hemophilia and a small cerebral aneurysm that is being followed closely for the time being. Jacob had received excellent care in Memphis, but his mother had had difficulty locating appropriate specialists and primary care in Knoxville. Jacob needed a school entry physical but had also expressed an interest in running track now that he was in middle school. No restrictions had been placed on his activity by previous specialty care so the nurse practitioner completed the physical, including the sports entry component and provided them with all the paperwork Jacob needed for school. A 504 plan was confirmed. She was also able to ensure continuity of care for his hemophilia and aneurysm by arranging specialist care for Jacob. The family left the clinic feeling much better about their decision to move to Knoxville and confident in their ability to thrive here.
Washburn School-Based Health Rap, Minneapolis, Minnesota
Having trouble viewing the video? You can also watch it here on Vimeo.
A Mobile Medical Van Helps Students Across Los Angeles
Providence Little Company of Mary’s Partners for Healthy Kids (PFHK) mobile medical van visits ten Los Angeles-area schools on a weekly basis to provide free medical care for children in need. PFHK’s impact is as diverse as the patients it sees: healing a baby’s painful rash, providing sport physicals, removing a toy soldier’s hand from a boy’s aching ear, identifying a painful limp as a serious condition requiring immediate surgery, helping a mother enroll her children in health insurance, and stabilizing a teen’s asthma attack until the paramedics arrived. The number of stories told by PFHK staff about the grateful families and children they have served is limitless. There is one story that stands out, not because it involves a child on the brink of death or the identification of a pandemic outbreak, but because of the impact that PFHK had on this teen’s physical as well as social and emotional health.
Juan* is a teenager who had very bad acne. Boys at school teased him, girls wouldn’t talk to him, and he knew his family couldn’t afford to take him to the doctor unless it was a more serious medical condition. He knew the PFHK staff was on his high school campus and for months thought about seeking treatment, but he was too embarrassed and was worried if his family could afford it. After talking to a friend who told him PFHK was free, he put his embarrassment aside and mustered up the courage to ask his mom if he could seek treatment, of which she readily agreed.
At Juan’s first appointment he walked in wearing a hooded sweatshirt with the hood pulled up and his head down to avoid eye contact - something his mom said was quite common of recent. His mom also reported that he had become quite withdrawn, stayed in his room instead of playing with the neighborhood kids, no longer brought friends over, and he opted to not try out for the Junior Varsity soccer team. She just attributed these changes to him being a teenager.
After the initial assessment, the PFHK clinician explained that acne was very normal for teens his age and with some changes in hygiene and a few medications he would notice major improvements in his condition. He was given the medication he required and told to return in 3 weeks for further evaluation. When he returned he said that he had been following the clinician’s instructions and he had noticed a small improvement. Juan continued to come for periodic follow up appointments so that his medications could be adjusted, and as he got to know the PFHK staff he began to open up more.
Nine months after his initial visit he happily reported only occasional outbreaks that responded very well to the acne spot treatment he was now using. But more importantly the PFHK staff noticed some real changes in his behavior and demeanor. He no longer wore the hooded sweatshirt; he greeted the staff with warm hellos telling them about his activities in school clubs and sharing that he was a little nervous about the upcoming football game where he would be introduced as one of the Homecoming King nominees.
While Juan wasn’t selected Homecoming King, the transformation that PFHK staff witnessed was remarkable nonetheless. With the medical care he needed to clear up his acne, Juan regained his self-confidence and returned to being an outgoing and active young man. One might scoff at the idea that the treatment of a minor medical condition such as acne would warrant the need for school based health centers. In the case of Juan, who had limited access to health care services, it was such a school based health center that made a world of difference in his life.
A Student is Trying to Open a School-Based Health Center in Her Community
My name is Angelines and I am a senior at Capital Preparatory Magnet School located in Hartford, Connecticut. As a graduation requirement we have to do a Senior Social Justice Project (SSJP), I chose to try and implement a school-based health center in my school. Capital Prep has students from different towns in Connecticut and I believe that having a school-based health center would be beneficial for students and their families. I also believe that all students should receive health care. I have met with the PTO from the school and I have their support. I just need help making this come true. I’m sharing this story for feedback and advice.
Children's Dental Services Provides Dental Care in Over 250 Locations in Minnesota
For more than ninety-three years Children’s Dental Services (CDS) has provided portable dental care out of over 250 locations across the state of Minnesota, over 90% of which are located in schools and Head Start centers. In fact, CDS is currently the primary provider of school-based dental care in Minnesota. Because of CDS’ long standing expertise and efficiency in providing quality, comprehensive portable and school-based dental care, CDS received a highly competitive grant from the Health Resource and Services Administration (HRSA), which will allow CDS to expand dental care within additional school-based health center settings.
The stories below are evidence of how CDS’ school-based dental services allowed students with emergent needs to receive care quickly and conveniently in a highly accessible environment. If CDS were not present in these children’s schools, it would have resulted in increased time lost from classroom studies, an increased risk of infection, and increased dental pain. No matter what the dental need may be, CDS school-based dental care provides an immediate solution to dental-related problems experienced in a school setting. Here are three specific examples of how school-based dental care has helped students:
A second grade girl at Dayton’s Bluff Elementary School in St. Paul, Minnesota was sucking on her shirt, which was decorated with metal sequins. A metal sequin from her shirt lodged between her top front tooth and the gum membrane. It was barely visible and she could feel it moving up. CDS had a parental consent form signed for this child, which allows her to be seen during the school day without a parent’s presence. The teacher immediately brought her to CDS’ school-based clinic where a dentist was able to quickly remove the sequin without causing the child any pain. The nurse at the school reported that if CDS had not been there to provide care, a parent would have had come to transport this child to the emergency room. This would have resulted in the child missing the remainder of the school day, and experiencing the potential trauma of an emergency room visit. Instead, the little girl happily returned to class after a fifteen minute visit to CDS’ on-site dentist.
A 5th grade boy was playing on the playground at John A. Johnson Elementary School in St. Paul, Minnesota when he fell and chipped his tooth. Half of his front tooth was missing from the fall. His mother immediately came up to the school, as the child was in excruciating pain. He was then brought to CDS’ school-based clinic, where a CDS dentist was able to repair his tooth and relieve his acute pain. The child returned class later that morning.
At Ramsey Elementary in Minneapolis, Minnesota two second graders collided during gym class. The impact was so hard it caused the front tooth of one child to fall out. Luckily, a CDS dentist was able to repair the tooth at its Ramsey at school-based clinic immediately.
A school nurse at one of CDS’ school-based locations aptly expressed her appreciation for CDS’ dental clinic within her school by saying, “We're so fortunate to have a permanent dental clinic right in our school building. We always say that we wish they could be here every day! In between their visits I start a list of kids who come to my nurse's office with dental pain. This is not your usual loose tooth visit: these are children with abscesses, severe and multiple caries, and are kids in need of immediate care. There are usually 6-12 names on the list every month. The families, even though they understand their child is in pain and in need of a dentist, are unable to get the services they need outside of our building due to their housing, transportation or other life needs so having Children's Dental here is a huge gift for the kids and their families.”
January Marked the Lavaca Wellness Center’s One Year Anniversary
Dr. Robert Sanders, D.O., nurse practitioner Jonathan Broniste, and their staff had nearly 6,000 patient visits in 2011. Despite minimal advertising, Dr. Sanders and Mr. Broniste see a long list of patients daily. January 2012, has proven to be the busiest month for the clinic all year. The staff served 153 student visits of the 578 total visits.
“The clinic has far exceeded our initial expectations. The doctors have been able to treat students, staff, and the community, meeting needs that have not been accessible in 35 years. The numbers of people that have been served out of the Clinic have been amazing for the first year,” Lavaca Public Schools Superintendent Jared Cleveland said.
The clinicians had 5,940 visits during the clinic’s first 12 months. Eighteen percent of the 2011 visits were students, 3% were school staff, and the remainder were members of the community. Teacher absences were down 20%, a fact that Superintendent Jared Cleveland attributes to having the clinic on campus. The Wellness Center averages about 500 visits per month and is the only school-based clinic in the state to boast a full-time physician.
Initially, Dr. Sanders thought the majority of patients would be from Lavaca, Arkansas; but he’s been pleasantly surprised that his former patients from as far away as Oklahoma, Mountainburg, Waldron, and Paris are willing to make drive to be seen by him. Dr. Sanders points out that Mr. Broniste has a following of his own.
“I wasn’t expecting us to be as busy as we are,” Dr. Sanders reflected. “I wasn’t expecting as many students as we are seeing and [members of] the community that we are seeing. It’s been a real benefit to Lavaca and the surrounding area.”
Mr. Broniste believes the partnership with the school lends both credibility and viability to the wellness center.
“I think the people feel more stability that the clinic is going to be here so they feel willing to use us because they don’t have to go somewhere else,” he said. “I’ve had people tell me they don’t mind coming out here because they don’t have to sit and wait for hours in the doctor’s office.”
Students and teachers are able to be seen by medical personnel during a brief break from the school day without having to miss hours or even an entire day. It’s especially helpful for parents who live in Lavaca but work in Fort Smith or farther away.
“The people are trusting us to take care of their kids. I see elementary kids sitting in here with someone from the school. After an examination of the child, I just call the parents and tell them what’s going on. There’s that trust.”
Although school-based, the Wellness Center is like any other clinic. The only difference is they cannot do x-rays. Mr. Broniste says they can do simple procedures that would be done in any other out-patient setting. We are open even if the school may be out on spring break or summer vacation.
“If we were just seeing school kids, the clinic would not still be in business, but by seeing the kids and being open to the community, I believe this will be a self-sustaining model,” Dr. Sanders said. “It’s a perfect model to get a physician into the rural communities of Arkansas.”
Dr. Sanders says his plans for the future are to continue building the practice and potentially expand the clinic itself. The school is currently remodeling another classroom for Dr. Cody Friddle’s dental clinic and an optometric clinic. These two new areas will free up some space in the clinic that Dr. Sanders already has plans for. He hopes to get be able to join the state children's vaccine program, thus providing another service for the school and the community.
Superintendent Cleveland sees the clinic as a model for both the state and the rest of the nation.
“Having a public-private partnership reduces costs and increases services for the community,” he explained. “Currently, the school is receiving $550,000 in grant funding over a period of three years to support building the infrastructure for the Wellness Center. Once the grant funding runs out, the doctors involved will pay rent/utilities to the district for the spaces occupied, creating a funding stream supporting the school.”
A School-Based Health Center Helps a Family New to Alabama
Only a few days after we opened our clinic, Heals, a mom came to see us with her son, John. She had recently moved to Alabama from Tennessee and had no insurance. John had many health problems and the nurse at Madison Cross Roads suggested she come see us. Mom spoke with our nurse, Janice, and made an appointment for John to see Dr. Cartwright. Mom then spoke with our clinic coordinator, Anne, and she began the process of assisting mom in applying for Medicaid. John began seeing Dr. Cartwright immediately, even though his Medicaid had not yet been approved. Dr. Cartwright was able to give John medication that had been donated to the clinic. John’s Medicaid was not approved for almost two months, and during that time he saw Dr. Cartwright and Ms. Ketchum, our nurse practitioner, several times.
Today John is a healthy and happy little boy. He continues to see Dr. Cartwright and Ms. Ketchum on a regular basis. His mother thanks us at each visit for the care we have given her and her son.
A Story from HEALS, Inc.
Huntsville, Alabama
A little girl had been suffering with constipation and a distended abdomen for some time. This child was not with HEALS, but had a primary care provider that had been treating her for constipation for some time.
At the end of October, The child’s teacher became concerned, and asked the HEALS staff if they could see her. The HEALS staff communicated with the mother, saw the child, and the mother changed her primary care provider to HEALS. The HEALS providers intervened, saw the child on a day to day basis, and were able to correct the constipation problem. When the constipation problem was corrected, the child still had a distended abdomen. Tests were ordered from Huntsville Hospital, and it was discovered that she had tumors in the abdomen. She was immediately transported to St. Jude’s and received the necessary care.
The happy ending to this story is that the cancer was 100% treatable, and there is every hope that this little girl will have a happy and healthy life.
Embarking on year two of implementing a School Based Health Center, known as The Wellness Center at Jones Elementary School in Springdale Arkansas, the Physician’s Assistant and Licensed Clinical Social Worker looked for an educational outreach venue that would support both physical and mental health. The students at Jones are overwhelmingly the children of poverty and speak English as a second language; they lack financial, social and transportation resources to participate in organized sports or extracurricular activities. Living a few miles down the road from Bentonville Arkansas, the home of Wal-Mart, the students live in the shadow of wealth. As a complement to the Wellness Center at Jones and in efforts to improve access to physical activity and to address the childhood obesity epidemic, the personnel at Jones applied for and received a Joint Use Agreement (JUA) grant from the Arkansas Department of Education in 2010. With the $10,000 awarded in JUA funds the school district purchased supplies and materials to build a quarter mile trail on school grounds. The City of Springdale agreed to provide the manpower and equipment needed to install the trail. The JUA trail at Jones Elementary is now available for use by students, faculty and staff when school is in session and by the community at other times. The staff from the Wellness Center in recognition of the resources provided through the Wellness Center combined with the facility provided by the Joint Use Agreement trail decided to use the Girls on the Run program. The program is ideal because it addresses the physical, emotional and social needs of the child. Girls were invited to join the Girls on the Run Team and were provided with generic running shoes through the district’s social service fund. They participated in physical training for six weeks as well as bonding exercises, self esteem building activities, anti bullying curricula and art projects. The entire process was a great success. Girls expanded their physical activity parameters, explored character traits and positive pro social interaction and experienced enhanced self esteem through feelings of accomplishment and through recognition provided by classmates, parents and community members.
One cold morning in November in Alabama, the door to the clinic opened, a mom and her two children came in. Mom was concerned about her little girl, Emily. Emily had been sick for several days. She had Medicaid and was seeing a doctor in town, but Emily was not getting better and she did not have money for gas to drive into Huntsville. Janice, our nurse, offered to check Emily and give mom advice on what she should do. As soon as Janice put the oxygen monitor on Emily’s finger, she knew something was wrong. When she listened to her breathe, Janice knew Emily needed assistance. Neither of the providers who serve at Madison Cross Roads was in that day, so Janice called Annette Potter, the nurse practitioner who served at MLK, University Place and Morris Clinics. After explaining the situation, Ms. Potter agreed that Emily needed to get to the hospital as soon as possible. Janice explained the situation to Emily’s mom and then called 911. Emily was transported to Huntsville Hospital and subsequently admitted and stayed several days.
Jacob and his mother recently moved to Knoxville from Memphis, TN in order to be nearer Jacob’s sibling who attends the TN School for the Deaf in Knoxville. Jacob has hemophilia and a small cerebral aneurysm that is being followed closely for the time being. Jacob had received excellent care in Memphis, but his mother had had difficulty locating appropriate specialists and primary care in Knoxville. Jacob needed a school entry physical but had also expressed an interest in running track now that he was in middle school. No restrictions had been placed on his activity by previous specialty care so the nurse practitioner completed the physical, including the sports entry component and provided them with all the paperwork Jacob needed for school. A 504 plan was confirmed. She was also able to ensure continuity of care for his hemophilia and aneurysm by arranging specialist care for Jacob. The family left the clinic feeling much better about their decision to move to Knoxville and confident in their ability to thrive here.
For more than ninety-three years Children’s Dental Services (CDS) has provided portable dental care out of over 250 locations across the state of Minnesota, over 90% of which are located in schools and Head Start centers. In fact, CDS is currently the primary provider of school-based dental care in Minnesota. Because of CDS’ long standing expertise and efficiency in providing quality, comprehensive portable and school-based dental care, CDS received a highly competitive grant from the Health Resource and Services Administration (HRSA), which will allow CDS to expand dental care within additional school-based health center settings.
Dr. Robert Sanders, D.O., nurse practitioner Jonathan Broniste, and their staff had nearly 6,000 patient visits in 2011. Despite minimal advertising, Dr. Sanders and Mr. Broniste see a long list of patients daily. January 2012, has proven to be the busiest month for the clinic all year. The staff served 153 student visits of the 578 total visits.
Only a few days after we opened our clinic, Heals, a mom came to see us with her son, John. She had recently moved to Alabama from Tennessee and had no insurance. John had many health problems and the nurse at Madison Cross Roads suggested she come see us. Mom spoke with our nurse, Janice, and made an appointment for John to see Dr. Cartwright. Mom then spoke with our clinic coordinator, Anne, and she began the process of assisting mom in applying for Medicaid. John began seeing Dr. Cartwright immediately, even though his Medicaid had not yet been approved. Dr. Cartwright was able to give John medication that had been donated to the clinic. John’s Medicaid was not approved for almost two months, and during that time he saw Dr. Cartwright and Ms. Ketchum, our nurse practitioner, several times. 
A little girl had been suffering with constipation and a distended abdomen for some time. This child was not with