Mon September 9, 2013
Miami School Health Clinics Are Re-Imagining The Role Of The School Nurse
It’s a Wednesday morning and the waiting room is already starting to fill up at the North Miami Beach Senior High School clinic.
“Go ahead and have a seat.”
A 16-year-old girl with an enormous red bow pinned above her ear approaches the appointment window. A beveled glass pane slides open. The woman behind the desk doesn’t ask for insurance information; she asks to see a hall pass.
The teenager with the red bow takes her place in a waiting room chair next to classmates who, between hushed exchanges of gossip, occasionally erupt in giggles.
This school clinic at North Miami Beach is part of the Dr. John T. Macdonald Foundation School Health Initiative—a network of school-based health clinics in Miami, operated by the University of Miami Miller School of Medicine. Connected to larger teaching hospitals and an array of specialists by electronic health records and telemedicine, clinics like this are re-imagining the role of the school nurse. And there’s evidence that what’s good for students’ health is good for their grades.
“More and more, there will probably be a push for more school health programs—we’re an alternative,” says Dr. Dr. Joycelyn Lawrence, medical director for the School Health Initiative clinics. “We’re able to provide linkages between a child’s health care, but also their academic well-being as well.”
According to the National Assembly on School-Based Heath Care, there are currently 242 full-service primary care clinics located in Florida schools—twice as many as there were 10 years ago.
The clinics enroll students with their parents’ consent at the beginning of the year. And then when students aren’t feeling well, they can take themselves to the doctor’s office on campus. Parents don’t have to leave work unless a child is severely ill or injured. For everything else, kids are able to return to class as soon as they’re seen.
A Model For Other Places
As a result, research shows school-based health clinics can cut absenteeism in half. In one study of high-risk students, African American boys who used school-based health clinics were three times more likely to graduate than peers who didn’t. School immunization rates at the Miami clinic sites are much higher than state and national averages.
Each of the clinics under Lawrence’s supervision has a telemedicine unit—kind of like a fancy Skype setup—that allows students at school to connect on streaming video with a specialist at the University of Miami hospital or another site. If a student needs something more than primary care—a cardiologist, mental health counseling, a nutritionist—a consult can be arranged without ever having to take the child out of school.
The School Health Initiative also employs community health workers who act as community liaisons and help enroll students in Medicaid or subsidized insurance through Florida KidCare—some of which helps cover the cost of the clinics. The rest of the funding comes from grants and partnerships with hospitals and universities.
In 2012, the School Health Initiative was granted a $4 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services to develop oral and mental health care.
“This model is great for inner cities, but it also could work for underserved communities in Nebraska, Oregon, Alaska,” says Dr. Arthur Fournier, who helped develop the School Health Initiative and recently retired as the associate dean of community health at the University of Miami Miller School of Medicine.
Fournier even borrowed some of the practices developed at the Miami school clinics and exported them to a health care partnership in Haiti.
“We’ve now set up a school health program in Haiti where we have mobile teams of nurses lead by a nurse practitioner and community health workers who go to 17 schools,” says Fournier.
Like A Family
Last winter Boothe developed a cough that gradually worsened until one day, in the middle of a class, he had trouble breathing—“gasping for the last air,” he says. His teacher sent him to the clinic and Dr. Marcia Dodo, the nurse practitioner on staff, saw Boothe was having an asthma attack.
She helped stabilized him while the clinic arranged for him to go to the emergency room. “It’s a like a family, it’s like my aunts and my moms,” says North Miami Beach senior Nicholas Boothe.
After a day stay in the hospital, Boothe came back to school and was able to get follow-up care at the campus clinic. He didn’t have to choose between going to school or going to the doctor’s office.
Boothe is doing better now. He’s on the water polo and swim team—breaststroke is his favorite. When he graduates from high school, he hopes to get a scholarship to a small college out of state.
“I like school, but I’d really like to get out,” says Boothe. “I’m glad it’s my senior year.”
Unfortunately for him, there’s no definitive cure for senioritis.
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