Implementation Description

Invest Collegiate Imagine (IC Imagine) is a school focused on increasing their educationally disadvantaged (ED) student population and implementing strategies that will ensure their academic growth. The school’s leadership team recognized that in order to effectively serve ED students, they would need to intentionally focus on not just the student, but the entire family and broader school community, which has resulted in the implementation of a number of family support services. The first strategy to be fully implemented was a school-based health center. Underserved students often have limited access to medical care and it has been shown that health issues play a significant role in student motivation and student achievement (Stuart Wells et.al., 2016). School-based healthcare eliminates many of the barriers to care such as cost, transportation, and trust (Potter, 2019). With a school-based model in place, families no longer need to take as much time off from work and students can spend more time in the classroom learning (Buckley, 2010). Recognizing the benefit of a school-based healthcare model and that Blue Ridge Health, a community-based provider, was interested in establishing school-based health centers and had reached out to learn more, the school’s leadership team moved to implement the model. Through a Memorandum of Agreement (MOA), Blue Ridge Health Center opened in the school building in the fall of 2019. 

Blue Ridge Health runs the school-based health center in a way similar to a doctor’s office, offering accessible and primary care to students, families and staff every day. The center provides a full-time nurse, a Physician’s Assistant (PA) three days a week and mental health provider three days a week. Families are able to make primary care well appointments and can receive immunizations at this location. When a child is not feeling well during the school day, they are able to go to the center and receive an exam. If a prescription is required, a parent is contacted and they can fill the prescription prior to picking their child up from school. If the situation requires less treatment, the student may be able to return to the classroom missing little instructional time. The addition of a school-based mental health provider has had significant implications on the school’s culture and dynamics and provides students with the timely support they need when they are in a moment of crisis.  

With minimal cost to the school, a simple MOA established between the school and the healthcare provider formalized this mutually beneficial partnership. The school did provide furniture and a space for the center which is located right inside the front door of the building so it is convenient and accessible for families. Like any doctor’s office, insurance or Medicaid is billed for the visit. Schools have become an essential community hub, especially for the ED population. On-site health care is just one simple way to support families within the school community.

Results

The health center is well utilized by the school community. Initially a PA was there only two days a week, but the demand was great enough that a PA is now there three days a week. Student absenteeism decreased from 7% average daily absences in the 2018-19 school year to 4% during the 2019-20 school year. 56% of students and 55% of staff have selected the on-campus health center as their primary care provider. In addition, relationships at the school have improved. Sickness is no longer a divisive issue because parents are less stressed about missing work and students do not miss as much instructional time.

Challenges

There were few challenges associated with the implementation of the school-based health center, but it was important to establish parameters of use and to ensure that all staff understood these procedures and practices.

Future Modifications

Per the school’s leadership team, ideally, more families will decide to select this location as their primary care provider and it will be staffed with a PA five days a week. In order to grow interest, the school will continue to strategically market the availability of this student and family support service.

Critical Components

Getting Started

  • The first step requires researching local healthcare providers, establishing a partnership, and executing a formal MOA. Next, school’s must consider how best to incorporate a healthcare center into their facility selecting a location that is easily accessible to all.

  • Once the MOA and a location are finalized, it is important to develop procedures for use of the health center ensuring that students who are feeling unwell are able to receive treatment at the center when a nurse or PA is available.

Ongoing Supports

IC Imagine has seen use of the health center increase over time, so it will be important to ensure that it is staffed with adequate medical personnel as more families chose this location as their primary care provider.

Equity Connections

  • Students facing educational disadvantages are less likely to have access to high quality healthcare facilities and more likely to see a correlation between their health and academic achievement (Rothstein, 2011). An effort to offer on-site healthcare ensures that students, regardless of any potential disadvantage, have access to the healthcare they need. 

  • Guardians of educationally disadvantaged students, especially those living in poverty, are less likely to have access to paid sick time when compared to more affluent households (Ben-Ishai, 2015), thus limiting their ability to take time off work when their child is sick. As a result, students living in poverty are more likely to attend school while still sick (Rothstein, 2011), which may increase the public health concerns related to viral transmission within the school community. The presence of an on-site healthcare facility allows 1) students, regardless of any disadvantage, to quickly get the medical attention they need; 2) medical practitioners to evaluate a student’s condition to determine if they need to be picked up by a guardian, thus potentially limiting unnecessary time out of work; and 3) school leaders to focus on students’ academic achievement with the understanding that healthcare needs are being met. 

Research

1.     Basch CE. Healthier students are better learners: a missing link in school reforms to close the achievement gap. J Sch Health. 2011;81(10):593-598. Retrieved from doi:10.1111/j.1746-1561.2011.00632.x

2.     Ben-Ishai, Liz (February 13, 2015) CLASP. The Serious Consequences of Lack of Paid Leave. Retrieved from https://www.clasp.org/sites/default/files/public/resources-and-publications/publication-1/2015-02-12-FMLA-Wages-Lost-Jobs-at-Risk.pdf

3.     Love, H., Schlitt, J., Soleimanpour, S., Panchal, N. Behr, C. (May 2019) Health Affairs. Twenty Years Of School-Based Health Care Growth And Expansion Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05472

4.     Rothstein, Richard (March 1, 2011) Economic Policy Institute. A Look at the health-related causes of low student achievement. Retrieved from https://www.epi.org/publication/a_look_at_the_health-related_causes_of_low_student_achievement/

5.     School-Based Health Alliance (n.d.) About School-Based Healthcare. School-based health care: where health and education intersect. Retrieved from https://www.sbh4all.org/school-health-care/aboutsbhcs/

6.     Strolin-Goltzman J, Sisselman A, Melekis K, Auerbach C. Understanding the relationship between school-based health center use, school connection, and academic performance. Health Soc Work. 2014;39(2):83–91.

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