Jan. 21, 2016 -- Healthy children usually arrive at school ready to learn. Lack of quality health care impacts student achievement. A child with an untreated ear infection, sore throat, or undiagnosed chronic ailment has a much harder time sitting still and focusing on a lesson. No amount of discipline or talk intervention will help: the child needs to see a doctor.
But what if that child has no doctor, or instead has serious obstacles to get an appointment to be seen?
The Cleveland Clinic School Based Health Center Mobile Unit, located at Boulevard and Oxford elementary schools, is filling that gap. On alternating Mondays, Nurse Practitioner Cathy Quinn-Welsh arrives with two support staff to provide medical care for students. Every Monday from 8 a.m. - 4:30 pm, there is medical care accessible for Cleveland Heights-University Heights students.
Only in its second year, Cleveland Clinic School Based Health Center Mobile Unit began by serving Lakewood last year, with great success. Cleveland Heights-University Heights Director of Student Services Jeff Johnston detailed the program at the June 2015 Board of Education meeting, explaining that it is designed to keep children in school, enhance performance, and improve student attendance. When school resumed in the fall, CH-UH joined Maple Heights and Euclid as new participating districts. The initial district launch was at Boulevard, with Oxford services added in December.
Collaborative chronic care
School nurses represent the main school-based health care most students receive, which is a challenge, since no building except Heights High has a full-time nurse. Nurses travel between two or three district buildings every week to dispense medications, assess acute symptoms and make referrals, but they cannot make medical diagnoses or write prescriptions.
“While the nurse may suspect a student has strep based on symptoms and a brief exam, no testing or diagnosis are possible at school. Instead, the nurse must refer them to their doctor for a strep test and antibiotics,” explained District Head Nurse Linda Rudy. “Fortunately, the Mobile Unit can handle the all that: labs, diagnosis and prescription.”
With enrollment and parental permission, Cleveland Clinic School Based Health Center Mobile Unit provides physicals for sports, camp or work; acute and chronic illness diagnosis and care; health education; referral services; health screenings; first aid; immunizations and mental health consultation and referrals. For some students, this may be the only medical care they have access to, but the Mobile Unit also provides supplemental care for children with a regular doctor and insurance.
Among the most common chronic health challenges in Cleveland Heights-University Heights are asthma, food allergies, and seizures. Asthma keeps children awake at night, leading them to be drowsy and inattentive, more irritable and with more behavioral problems. They might grow more likely to refrain from exercise and end up less physically fit. Asthma has become the biggest cause of chronic school absence, with sufferers from low-income families more likely to miss school than those from middle-class families.
Children with undiagnosed or untreated asthma can get nearly everything they need in one stop. In fact, prescriptions for inhalers has been a huge part of the Mobile Unit’s operations so far. After a diagnosis the school nurse can help students manage their condition. “For chronic illnesses such as diabetes and asthma, nurses follow doctor’s orders for managing related medical issues at school. Nurses also confer with doctors, nurse practitioners and primary care professionals on an ongoing basis to help students with certain medical issues manage them in school.” said Rudy.
How it works
Even if the child is not a Boulevard or Oxford student, any student can enroll and be seen at the Mobile Unit location most convenient to them. All building nurses can help parents enroll in the Cleveland Clinic School Based Health Center Mobile Unit program, making a child eligible for all of the services offered. If a family has Cleveland Clinic provider, the student retains their physician, and records from any services at the mobile unit will enter the Clinic database for reciprocal access.
With the exception of enrollment paperwork, everything can be handled over the phone. Appointments are made by school nurses, removing yet another obstacle. For families with insurance, it is billed like a regular doctor visit, lab or whatever service is needed. If a child is uninsured, a Cleveland Clinic financial counselor works with families to make payment arrangements. Depending on each family’s situation, reduced rates are available.
On the day of the appointment, the student is escorted to the Clinic Mobile unit, a bright, cheerful bus adapted with two exam rooms and a small restroom, just a short walk from the school’s front door. Parents are encouraged to attend the first appointment if possible, but it is not required.
Thirty-nine students are currently enrolled in the program. Students beyond Boulevard and Oxford are beginning to sign up, and Quinn-Welsh isn’t worried about the slow start. “We will grow and grow here in the Heights. There is a social worker and nurse in every school identifying children in need, which is so important. We see far more students than some of the districts where in-building student support services are weaker.”
In-building support is essential to the program’s success, but it’s even more important for district families. Enrollment, insurance and financial aid paperwork can prove a large enough obstacle to prevent those families in the greatest need from getting the medical care essential to a child’s well-being. That’s why Boulevard Nurse Peggy Sivokoff and Social Worker Karen Allen make special arrangements whenever needed, even sometimes bringing paperwork to a student’s home. This made a difference for the mom who worked multiple jobs, balancing a schedule too challenging for health care appointments. Boulevard staff helped her get the paperwork in order, and appointments were made for all four children to be seen on the same day.
Strategically located to service students in the entire district, the Cleveland Clinic School Based Health Center Mobile Unit is available to all Cleveland Heights-University Heights students. Boulevard is convenient for central students; Oxford serves the far north. The goal is to expand coverage to the high school soon, making health care accessibility easier for the high school students onsite as well as for families in the far eastern part of the district.
Catherine Quinn-Welsh, Nurse Practitioner
Loreen Rudd, Coordinator at Cleveland Clinic
District Head Nurse Linda Rudy (firstname.lastname@example.org)
Peggy Sivakoff, BLVD, GEAR, CAN Nurse