Feature                                                  Pages 31-35


Delivering Health Care Inside

the Schoolhouse    

The Kenosha, Wis., district partners with a community health organization to operate site-based clinics in three schools for students and families


During the nine years I worked as a principal of an elementary school, many students came to school with serious health care needs. They required attention for lingering medical or dental problems, but their families didn’t have health care insurance or a family physician to turn to.

As other staff members have done, I would give money to parents to enable them to take their child to a local clinic to have an illness or infection diagnosed and perhaps to obtain the necessary antibiotics. Often the school social worker would transport parents and children to a publicly funded clinic or to the nurse of the day located at a local grocery store for those who required a vaccination or antibiotic but didn’t have a private provider. The staff wanted to ensure the students received the help they needed.

This story is much more common than many in our community tend to realize. Those who have adequate health care take the coverage for granted.

Access to preventative health and dental care for students is something every principal wants for students. 

Susan Valeri Brass School
Brass Community School is home to one of the school- based health centers in the Kenosha, Wis., Unified School District.

A Modest Start

Those of us working as educators in the Kenosha, Wis., Unified School District could easily see how the unmet health needs of our students often interfered with their ability to learn.

A common problem educators see is the student with the constant sinus infection that never goes away because it remains untreated. One success story we can report from the past year relates to the school-baesd clinics keeping students in school who chronically complain about not feeling well and asking to go home. The nurse practitioner in the clinic has collaborated with school staff and parents to have those children checked out on-site, allowing them to remain in class when there is no medical need to send them home. We have then supported these students with counseling to find out what the underlying issue might be.

We set a goal to get students and families preventative health and dental care. We started by collaborating formally with the Kenosha Community Health Center, a nonprofit organization that provides comprehensive health care to underserved citizens. The partnership began on a simple level by co-managing a single program, Seal-A-Smile, in three elementary schools in 2009. This oral health program, sponsored by the Wisconsin Department of Health Services, has grown to include 17 elementary schools in Kenosha, serving students in 2nd, 3rd and 5th grades as of last fall. Based on the success of Seal-A-Smile, we began to address other health concerns that were interfering with the ability of students to learn fully. The discussion of school-based health centers started in May 2011 with Kenosha’s superintendent, Michele Hancock, a member of AASA’s Coordinated School Health School Administrator Training Cadre, funded by the Centers for Disease Control and Prevention. Hancock is a strong advocate of meeting the health needs of students to make them better learners. She and other leaders of the school district and the community health center sought ways to deliver health care to families without health insurance or access to medical providers.

An advisory committee targeted three schools with student populations having a high need for health care. (The percentage of students qualifying for free and reduced-price lunch was a key consideration.) The schools were asked to commit to this initiative as pilots. Once we created and sustained a successful model, we intended to expand the services to other schools in Kenosha.

To learn from other educators, we sent four individuals, two from the district and two from the health center, to a national conference on school-based health care in June 2011, an event run annually by the National Assembly on School-Based Health Care. Conference sessions focused on the startup of health centers within schools, an extremely valuable resource in our development.


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Needy Selections
To launch this initiative, we chose three elementary schools — Curtis Strange Elementary, Brass Community School and Chavez Learning Station — to more easily define the health care options available to students and their families. The goal was to get the health care centers up and running successfully at the elementary level before addressing the more challenging issues of adolescents at the secondary schools.

The community health center committed to providing a nurse practitioner to serve at the three sites with a physician to oversee the delivery of medical services.

We identified an appropriate space to be used for the health clinics in each school. The rooms were chosen with regard to size, access to water, access to an outside door (for entrance to the clinic when the school would not be open), Internet access, phone hookup and location in the building. The school district’s facilities department took responsibility for the painting, carpentry work and setup of the clinics, while the community health center picked up the cost for all materials and equipment.

We had hoped to open the health centers in January 2012, but ultimately decided it best to wait until the start of the 2012-13 school year. During the intervening six months, the school district forged an agreement with the community health center.

The additional time also enabled us to plan for strategic marketing and create operating procedures, which included developing permission slips, information sheets, a letter to parents explaining the available services and a list of frequently asked questions for parents, guardians, students and staff. This information was mailed to homes along with student enrollment packets.

The marketing plan for the fledgling health centers culminated with a distinctive postcard that was sent home in students’ backpacks from the three schools at the end of the 2011-12 school year to be posted as a reminder of the new medical services available. We made presentations to school staff to explain the role of the school-based clinics.

In April 2012, the nurse practitioner spent a week at one of the schools to observe the workings of the office, the health information person, the school nurse and the principal. The nurse practitioner gathered information on how she and the community health center’s medical services could support the students and their families. These insights also helped us plan where the nurse practitioner would be assigned and when, as we scheduled her to work 12 hours a week at each location.

 Susan Valeri
 Susan Valeri2
Sue Valeri (left), director of special education and student support in Kenosha, Wis., joins a nurse practitioner in one of the district's three school-based health clinics and a classroom visit.

Basic Services
Much of our attention has focused on the specific services to be offered at the health centers. In fact, these discussions continue to take place at almost every meeting. We initially limited the services to ensure we weren’t taking on too much and intend to expand services over time.

We started by offering these services, which are promoted in our materials to the schools’ families:

Preventative care: Well child health checks, immunizations, Seal-A-Smile dental sealant program, sports physicals and health education with child and parent.

Acute health care: Diagnosis and treatment, referrals as needed, follow-up visits as needed, and health education with child and parent.

Chronic health care: Monitoring and treatment of medical needs based on condition and health education with child and parent.

The kickoff for the school-based health centers began with staff from the Kenosha Community Health Center attending open houses at all three schools, where they registered families and answered questions. The three principals encouraged families to tour the health centers and become familiar with the offerings. We used other incentives to encourage student and parent visits, including book giveaways for children, raffles for prizes donated by local businesses and health product giveaways.

During the first seven months of the 2012-13 year, patient visits to the three school clinics ranged from 103 to 126. At one of the elementary schools, acute visits (for addressing earaches, sore throats, common colds and the like) represented about two-thirds of the encounters. At a second school, health checkups accounted for two-thirds of the activity, and there were three visits for tests of lead in students’ bloodstreams. The third school administered 14 immunizations, mostly during the winter months.

Expansion Plans
As we approached the end of 2012-13, our plans for the new school year include opening a center at one more elementary school and possibly one middle school and growing the programs at the current schools. We are also exploring the addition of mental health care services for students. The health centers currently do not have access to a psychiatrist or a physician who specializes in mental health. We will continue that conversation, as we clearly see the need for expanding into this area.

The first year of operation of the school-based clinics represented an exciting opportunity for the Kenosha Community Health Center and Kenosha Unified School District. Our goal is to help students and families and ensure health care needs do not interfere with student learning. Ultimately, we hope to build the capacity to offer preventative, acute and chronic health care services to all of our district’s 22,600 students who might need them.

Susan Valeri is director of special education and student support in the Kenosha Unified School District in Kenosha, Wis. E-mail: svaleri@kusd.edu


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