Behind Eleanor McMain Secondary School, a single, beige modular building sits on a slab of concrete next to the basketball courts. Between classes, a few teenagers lean on the wheelchair ramp that leads to the front door, escaping the scorching sun under the roof's eaves. From the outside, it looks like just another overflow classroom parked behind a school.
But this unassuming building is more than the average school portable; it might be the future of primary health care for students across the region.
This is one of nine local school-based health centers (SBHCs) that have opened on New Orleans campuses since Hurricane Katrina. With support from the Louisiana Public Health Institute, local hospitals, the Louisiana Office of Public Health (OPH) and a host of national funding agencies, an organization called School Health Connection is positioning these clinics to deliver a full range of primary-care services to the area's public school students.
"We function essentially as a pediatric clinic on school grounds," says Dr. Ryan Pasternak, director of the adolescent medicine program at LSU's Health Sciences Center and medical director for School Health Connection.
He shows off one of the fully outfitted exam rooms in the clinic portable. It has a blood pressure monitor, an IV stand and an oxygen tank. The results from EKG tests performed with the machine in one corner of this room can be sent to a pediatric cardiologist for reading. The clinic even has its own small laboratory where staff members screen for problems like anemia and high cholesterol.
Providing health services in schools isn't entirely new. "It used to be that nurse in the front office with the Band-Aid," says Colleen Bodet, a nurse practitioner who works with Pasternak at local SBHCs through the LSU adolescent health department. She watched as school clinics started emerging in Louisiana in the early 1990s, but even those didn't have quite the comprehensive reach of the new system. "I am so excited about what we're going to be able to offer the kids," Bodet says.
"It tends to be an under-engaged population," Pasternak says. 'Adolescents aren't seen as being sick."
When he was still training, Pasternak saw how easily teenagers could slip through the cracks when he worked in one of New Orleans' five SBHCs. That was before Katrina, when each site was run independently and coordination was almost nonexistent. "Part of my intention on coming back to New Orleans was to have a more cohesive model," Pasternak says.
He was hired in 2005, six weeks before Hurricane Katrina.
All five of the Orleans Parish centers flooded. All the centers in Jefferson Parish were damaged. The system Pasternak had hoped to revitalize needed to be completely rebuilt.
Leaders from SBHCs formed a network to pool resources and re-establish care in the schools. By May 2006, the network received an $8.7 million grant from the W.K. Kellogg Foundation to develop school-based health centers in the New Orleans area. Administered by the Louisiana Public Health Institute, the funds went into rebuilding and expanding the clinics through the School Health Connection program.
So far, nine centers have opened in the Jefferson and Orleans school systems; more clinics are planned for the Recovery District schools. The immediate goal is to have 12 more if things go well. At a minimum, each SBHC is staffed with a part-time doctor, a nurse practitioner, a registered nurse, a trained behavioral health-care specialist and a data specialist. Other specialists frequently visit the SBHCs on a rotating schedule.
To enroll as patients, all students have to do is get their parents to sign consent forms. Uninsured patients are welcome, and clinic staff members are trained in the process of enrolling students in Louisiana Children's Health Insurance Program, or LaChip. Services are free, and students may remain patients for up to one year after completing high school. The clinics are open during the summer.
Patients complete a risk behavior screening that helps gauge a student's risk for problems like suicide, depression and anxiety. The high-risk kids can be referred to in-house services like individual counseling or group therapy sessions. Depending on the situation, a student might be paired with a school social worker, a clinic therapist or one of the psychiatrists who regularly visit the sites.
"The behavioral health need is critical," Pasternak says. It's a sentiment he repeats frequently. As with so much of New Orleans, local adolescents still suffer high rates of post-traumatic stress disorder, but have few resources for treatment.
"Think about it: If a young man is having behavioral issues, where is he going to get care?" Bodet asks. "Now they're getting it here."
Still, there are obstacles.
The McMain site has one entire room dedicated to dental care " with a dental chair and brand new equipment. So far, however, it sits unused. "Getting a dentist to come in and provide services has been difficult," Pasternak says. "We have tons of supplies, I just need somebody to come back in."
Because of their partnerships with schools, the SBHCs may not distribute condoms, discuss abortion or write prescriptions for contraceptives though if a student asks, they can refer them to other providers.
Sustainability is also a challenge. A site like McMain has an annual operating budget of approximately $300,000. The SBHCs are equipped to bill Medicaid for the services provided, but Medicaid and grants from the OPH only cover about half the cost. School Health Connection is pursuing other grants and working on a way to bill private insurers, but the co-pay is a sticking point for a service that is completely free to students.
Difficult as it is, the effort to provide health care in schools doesn't go unnoticed. Kristin Collins, a 2007 graduate of New Orleans Science and Math Charter High School " and current office assistant there " appreciates having access to the SBHC.
"Thanks to Hurricane Katrina, my immunization records were destroyed," Collins says. During her senior year at the high school, she learned that she couldn't enroll in college until she could prove she was up to date on her vaccinations. So she marched over to the school clinic and had it taken care of. "I basically had to get them all over again," says Collins, now a full-time student at Xavier University. "But it was so convenient," she says, adding that she could get her shots and walk right back to class. "I wish it could have been like that in elementary school."
Proponents of SBHCs point to lower rates of absenteeism as one of the benefits of having substantial health services available on campus. If a kid wakes up and feels ill, a parent can send them to school to get treated. Bodet, whose two daughters went to public high schools without clinics, points out that parents don't have to take off work to haul sick kids around when they know they have a place to go at school. And because it's so convenient, health staff can diagnose problems early, when they're more manageable.
That kind of care can mean more than just an extra day or two in class.
"Dropping out (of school) is strongly coordinated with health problems," Pasternak says. If a student has a serious or chronic problem, it can get in the way of his or her ability to focus even when they are in school. If someone close to the student has a serious illness, that also can be an obstacle. "They're not engaged in school because they're anxious about their parent or guardian's health," Pasternak says.
"It really rounds out our comprehensive student support system," says Bridget Ramsey, director of New Orleans Science and Math school. "We feed their minds as well as take care of their psychosocial needs. It's good to be working in such a progressive environment."
"That group has been able to convince three different school systems Jefferson, New Orleans, Recovery District that it's important," Bodet says.
Last spring, the SBHCs received a grant from the Robert Wood Johnson and W.K. Kellogg foundations to develop an electronic medical records system that will integrate School Health Connection into the schools even more. The electronic records travel easily with students who change schools or get referred out to other providers. The new system will mean improved continuity of care for kids in the SBHC system.
"I haven't seen a patient in a school-based health center in the past week who has a primary physician or if they do, they haven't seen them in two to three years," Pasternak says.
The electronic records will also allow School Health Connection staff to track health trends within schools and across the region. They will be able to spot improvements or see what areas need more attention. New Orleans area schools aren't the only stakeholders interested in the results. The National Assembly on School-Based Health Care which advocates for school health centers across the United States is keeping tabs on the innovations here, too.
"They're watching very closely what we do," Pasternak says, adding he already sees benefits. 'I've always asked where my patients go to school," he says of the patients he sees in his private practice. "It means so much more now. I can refer them back to their school-based health centers."
- Sammy Mack
- Dr. Ryan Pasternack and nurse Colleen Bodet at the McMain student health-care center