School Based Health Clinics Serve as Front Line of Community Health Efforts.
BHHS Legacy Foundation Funded School Based Health Clinics Serve as Front Line of Community Health Efforts.
Fiama, aged 13, sits patiently with her mother in the small waiting area of a school based health clinic (SBHC) on the West Side of Phoenix. She is relaxed. This is not her first time here. In fact, Fiama has been coming to this clinic regularly, since she first came in to be treated for acute asthma more than three years ago. She is waiting to see her Family Nurse Practitioner, Susan Vovakes, who has overseen her treatment throughout her time coming to the clinic.
Fiama is in for a checkup and for possible treatment of allergies. The very fact that she comes in for a checkup at all is a success story in itself, as wellness visits are a vital component in maintaining children’s health
As Vovakes recalls, Fiama was not in good shape when she first saw her. “Fiama was a little girl with an extreme case of asthma, short of breath and coughing,” Vovakes says. “She was in the red zone, I almost sent her to the ER.”
The fact that Vovakes ultimately was able to treat her at the clinic, rather than simply referring her to an emergency room, has been essential to Fiama’s well-being. Initially, Vovakes prescribed a steroid inhaler just as the emergency room would have. The difference was in the follow up.
Fiama’s mother is Latino and speaks virtually no English. Vovakes, who speaks Spanish, was able to work with Fiama and her family over time to establish a pattern of proper care that has led to Fiama’s marked improvement. This consistent, on-going attention has improved Fiama to the point that she doesn’t need the steroid inhaler any more.
“My asthma was really bad,” Fiama recalls, “and my grades were low because I missed school.” Today, her favorite subject is math and she’s getting an A. “I miss less now,” she explains.
This never would have happened if she had sent Fiama away to the emergency room, where she would have been treated for her immediate symptoms and released, simply to repeat the cycle again and again.
Broad community benefits.
Fiama’s case illustrates many of the benefits the SBHCs provide, including increased preventative care, reduced school absence and improved classroom performance.
Over 80% of the children seen by SBHCs have returned to class, allowing them to focus on learning and academics.
SBHCs also help to reduce emergency room usage. Over 90% of program participants have indicated through client satisfaction surveys that without services provided by the clinics, they would have obtained services at a local Emergency Department. This further burdens already stretched emergency services, as well as limiting patients on the on-going care they are able to receive.
The clinics are also a first line of defense against emerging health challenges, such as the recent measles outbreak. Child obesity is another major challenge, according to Vovakes, who estimates that 20- 25% of the children she sees are already obese. “You can see they will be diabetic in three to five years if they aren’t already,” she says. Families don’t always understand the danger of obesity, but for those who are willing, Vovakes can refer them to a program to support the proper lifestyles changes kids need to make to avert obesity.
The BHHS Legacy Foundation helps fund school based health clinics (SBHCs) in low-income areas in Phoenix, operating in partnership with organizations including Abrazo Health Care, Arizona Department of Health Services, Alhambra, Osborn and Washington School Districts and in conjunction with St. Vincent de Paul Dental Clinic and the Chris Town YMCA. The clinics offer primary medical care and dental services to children who are uninsured and underserved. In many cases, this is the only health care a child and their family will have.
BHHS Legacy Foundation was formed in 2001, following the sale of Baptist Hospitals and Health Systems Inc. to a for-profit corporation, to ensure the net proceeds from this transaction would benefit Arizonans, especially those living in the areas previously served by those facilities-- the Greater Phoenix and Bullhead/Laughlin Tri-State area. The Foundation focuses on supporting efforts that enhance and improve the quality of life and health of children, families and senior citizens who are primarily low income and underserved. Its School-Based Health Clinics Program has supported over 8,000 children’s clinic visits since its inception in 2000. “We found that children in these economically underserved areas were not receiving appropriate access to healthcare until it was a serious emergency,” says Gerald Wissink, Chief Executive Officer of Legacy. “We felt that providing preventative care was vital to these families.”
This is borne out by Vovakes’ experiences on a daily basis. “Just by educating families on basic healthcare can really improve their lives,” says Vovakes. “Some children come in and they are skinny, anemic. You get them dental care and suddenly they can eat and their problem goes away.”
Clinic staff members work closely with school nurses and school social workers, as well as parents to provide proper health care services and education. Services include physical exams as well as child-care, the diagnosis and treatment of major and minor illnesses and
health education, including nutrition, exercise and the dangers of drugs, alcohol, and tobacco.
“It’s a true win-win situation,” observes James Washington, Director of School Based Clinics for Abrazo Health Care. “Schools are mandated to reach performance measurements,” he says, “and our program keeps kids in school. Children that are healthier are better learners. In today’s tough economic climate, these services are all the more needed.”
Unfortunately, schools do not have the resources to fund the clinics themselves. This is where the BHHS Legacy Foundation has stepped in. “We’re pleased that we’re able to help children maintain a level of healthcare that enhances their ability to learn, and to grow up to have bright and healthy futures,” says Wissink.
Convenience is critical.
The clinics are organized by school district, so that any family with a student attending a school in that district is eligible. A key to these clinics’ success is their convenience. “These families have so many other obstacles they have to overcome,” says Vovakes. So cutting down the geographic distance between them and basic healthcare is essential. Once they arrive, the clinics provide a one-stop shop, with diagnoses, treatment and prescriptions all dispensed on site.
Understandably, services at this clinic are in high demand. “We’ve been booked solid,” says Sylvia Melendez, Community Liaison. This means six physical examinations a day plus appointments left open for children coming in sick. If she can’t schedule a child here, she will work them in at another clinic and drive them there.
According to Sylvia Ortega, Eligibility Coordinator, parents go to great lengths to keep their kids eligible for the clinic. “Some parents, even if they move out of the area leave their kids in the same school so they can be eligible. We see lots of families who are not eligible for Access of KidCare,” she says.
For many families, their only other option is the yerberias, traditional herb shops. In fact, some families rely on the yerberias and only come to the clinic as a last resort.
“I see kids who have never had medical care,” says Vovakes. They come in for fractures, asthma and allergies, among other childhood ailments. She recently had four kids come in with fractures in one day, which explains the selection of crutches arrayed against a wall in her examination room. “Some come only after a couple weeks when it’s more difficult to set the bone as the healing process has already started.”
In addition to treating children on site, the clinic also serves as a referral source for other resources in the community. “Mothers know we are here for them,” Ortega notes, “so they open up to us about other needs they might have.”
Ortega sends children needing eye checkups and glasses to Costco, with whom the clinics have arranged a partnership. In addition, Ortega can refer families who are hungry to St. Mary’s Food Bank, and for those needing clothing to St Vincent De Paul’s.
The clinic has also been successful in arranging for specialized care when needed. One little girl was born with a badly deformed hand. The clinic was able to help arrange for her to receive reconstructive surgery at a local hospital. Other children in need of extensive treatment have been helped as well.
“We are very passionate about helping kids live better,” says Wissink. “They are already challenged in so many ways, it’s vital that we get them the basic healthcare they need. That’s why we at the Foundation are committed to funding these clinics for the long term, as part of our mission to support systemic improvement in the health of our community.”