It’s been common for a child who needs a flu shot or who is feeling unwell to miss class because he needs to be seen by a medical provider.
But several school districts and health care providers in Southwest Missouri want to change that by putting basic health services directly in the schools.
“We’re thinking it’s an opportunity to get health care more immediately to our students,” said Carl Junction Superintendent Phil Cook, whose district is one of at least three in the region currently pursuing or considering a school-based health center.
School-based health centers began cropping up during the 1970s in elementary schools for those who could not afford or access primary care. There are now more than 1,900 health centers and programs connected with schools nationwide, according to a 2010-11 report from the School-Based Health Alliance. They exist in all types of schools — urban and rural, public and charter — and serve all ages of students with many types of health care services, according to the report.
There are only a handful of school-based health centers in Missouri, but if work continues this summer as planned, there will be two new health centers in Carl Junction and Webb City schools by the fall, while Joplin is considering a proposal.
Local efforts
Carl Junction is working with Freeman Health System to provide on- and off-campus health services to students and staff. According to their agreement, a nurse practitioner at a Freeman clinic on Main Street, just a few blocks from the schools, would be available for health care needs and would collaborate with the school nurses via video. Students could also be transported by the school to the clinic if needed.
Stacey Whitney, nurse for Carl Junction schools, said available health services would be similar to those offered by a family practice office, such as physicals, treatment of minor illness or evaluations. Parental consent would be required for all services, she said.
Cook, the superintendent, said the district would be responsible for providing the space for an onsite wellness center, which will be converted from an old weight room at the high school, as well as the staff to drive students to the Main Street clinic.
He said the process by which students seek medical help at school will largely remain the same, with them first seeing the school nurse and notifying their parents. But the addition of the nurse practitioner could provide the necessary medical care that some students might not get otherwise, he said.
“It’s one of those deals that’s a no-brainer,” he said. “If we can do this to help kids and help families at no expense to the district, then why wouldn’t we?”
Whitney said a school-based clinic could improve school attendance and increase the availability of health care in a community where health providers generally aren’t located. It also could prevent parents from taking up to a full day off from work to take their children to Joplin for medical visits, she said.
Freeman will partner with Ozark Center and ACCESS Family Care to also provide behavioral health services and dental services, said Richard Schooler, the health system’s executive vice president and chief operating officer. He said the partnership with the district is expected to “greatly” improve health care accessibility in Carl Junction.
“Sometimes when you don’t have good access, there’s a tendency to delay going to the provider, and it results in poorer care, so we think by providing better access it’s going to improve medical care,” he said. “When you can improve medical care and dental care and behavioral health care for students, that’s a win for everybody.”
Webb City plans to partner with Mercy. While details are still being worked out, the district is trying to create a health center that is based at the high school and could serve all students and staff within the district, Superintendent Tony Rossetti said.
The district would face a “nominal” upfront cost to renovate a space in the high school to create a clinic with a waiting room and two exam rooms, Rossetti said. Services would be provided by Mercy with parental consent, he said.
Rossetti cited a desire to improve student attendance and overall student health as a key factor in pursuing the health center.
“We know that kids struggle to get health care for a variety of reasons, and we want our kids to be successful,” he said. “If some of their basic needs aren’t being met, that makes learning that much more difficult.”
Tracy Godfrey, president of Mercy Clinic for the Joplin, Carthage and Kansas divisions, said the school-based health care model is not designed to replace families’ pediatricians or primary care physicians. Instead, it would offer care when and where it was sought by those who need it, she said.
“It really is all about putting care out in the community where it is needed,” she said.
The concept of school-based health centers has also attracted the attention of a Missouri lawmaker. Legislation from Rep. Jay Barnes, R-Jefferson City, which passed out of a House committee during the recently ended legislative session but did not make it to the House floor, would have encouraged the construction of school-based health care clinics in high-poverty districts.
Barnes’ office said school-based health centers provide several benefits to schools and communities, such as decreasing visits to emergency rooms and increasing access to primary care and immunizations.
“(They) knock down many of the barriers that children from high-risk families often battle, including lack of private health insurance, transportation to appointments, parental absence from work, lack of awareness and other stressors that keep children away from health professionals,” Emily Walker, Barnes’ legislative assistant, wrote in a February memo.
Joplin has been working toward a school-based health center for more than two years. Although the Board of Education has not yet decided whether it wants to proceed, the proposal currently under consideration would involve Freeman Health System, ACCESS Family Care, Ozark Center and Preferred Family Healthcare Inc. to provide a range of health services to students from a clinic in the new high school.
Board members last week, wanting to review the scope of the project and needing more time to consider it, tabled the proposal, but it could resurface for further discussion at this month’s meeting.
The proposal, as submitted by the medical collaborators, would provide services such as evaluation and treatment of injury and illness, physical examinations, immunizations, reproductive health services excluding abortion services, nutrition counseling, and a variety of behavioral health services.
Mark Barlass, executive director of student services for the district, said during the board meeting that the district would be financially responsible for providing the space, but would not compensate the health providers for any services rendered, or provide any staff.
Barlass said an area in the high school that was previously intended to be a classroom for occupational and physical therapy would be turned into the clinic if the proposal is approved. Under the proposed design, the clinic would include three exam rooms, a reception area and a restroom.
On a question from the board last week about which students would be served by the clinic, Barlass said only high school students would be eligible to enroll in the program initially, although it could be expanded in the future if the need arose and transportation availability allowed.
Barlass also said consent from a parent or guardian would be obtained before any care was provided, and all health information would be protected by federal health privacy laws.
He said the idea of a mobile health clinic that could rotate among schools was discarded because of high costs associated with maintaining it.