School-based health centers remain vital resource during pandemic

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Yale New Haven Hospital Photo

Nurse practitioner Shannon Knaggs examines a student at the Augusta Lewis Troup School's Health Center in New Haven.

During the pandemic, 13-year-old Estrella Roman (Estrella Roman) and her mother took a 30-minute walk at Rogers Park Middle School in Danbury many times, even though the school Closed for face-to-face learning. This is because the school’s on-site health center is where Estrella is located, and she emigrated from Ecuador with her family in 2019, where she received routine vaccinations, health care and headache treatment, and other medical services.

Katherine, Estrella's mother, does not speak English. She said through Estrella that she is very grateful to those who told her that Astrella can still be there even after the school is closed. The teacher who was taken care of there. She praised the school nurse for being patient and speaking Spanish, and said that if she did not serve the school medical center, she would not know where to seek care.

In the three decades of its operation, Connecticut’s school-based medical center (the state defines it as a fully licensed primary medical institution) has become a vital medical service option, especially for those who cannot access routine Medical services for children.

In 92 school health programs funded by the World Health Organization 

Of the 27 communities across the state, 80 are designated as "on-campus medical centers" and provide comprehensive health care services, including diagnosis and treatment of acute injuries or diseases; treatment of chronic diseases; physical examinations; immunizations; prescriptions and Dispensing; reproductive health; laboratory testing; crisis intervention; individual, group and family counseling; oral health; referral to specialist care; and linking to community providers. The other 12 "Expanded School Health Plans" provide limited services.

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During 2018-2019, 20,216 students saw 62,159 medical cases. The medical expenses are based on the school’s medical center, with an average of 3.1 cases per student. A total of 4,589 students received 60,697 mental/behavioral health visits, with an average of 13.2 visits per student, while 3,814 students received 9,557 dental visits, with an average of 2.5 visits per student.

Since March last year, the medical center has been working hard to continue to provide uninterrupted services due to the fluctuations between closed, open and intermediate public schools in Connecticut.

"During COVID, all school-based medical centers continue to provide medical and behavioral health care through a combination of on-site and remote medical visits," said Laurie Collins, the center's executive director. 

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Telemedicine improves the health of 16 New Haven public schools 

 Sue Peters, the head of the school-based health center and dental clinic in the area, said that mental health consultations will continue before the pandemic. She said that in a typical year, these centers will welcome close to 7,000 visits to meet the medical, behavioral and dental needs of students, accounting for about 60% of the student population.

She said that because "there are too many factors to consider," she is not yet able to calculate how many students will use these centers in 2020.

The staff of the health center said that this change is not easy. The lack of daily contact with students has a negative impact on visits and follow-up appointments. Due to the threat of the spread of COVID-19, dental care has been suspended during the pandemic, and dental care accounts for a large proportion of treatment services in many centers. However, creativity and flexibility have allowed health center staff to continue to provide students with certain important health care services, and in some cases have added new resources related to COVID-19.

Jolene Henion, a nurse practitioner, described the health center at Rogers Park Middle School, where she is usually busy at work, providing students with physical, vaccinations and emergency care. Rogers Park switched to distance learning in March. At that time, the school's health center had transitioned to telemedicine. But in June, when the center allowed part-time return to the building, the staff began to establish regular on-site driving vaccination clinics for children.

urgent need. The state did not abandon routine immunization requirements during the pandemic, and through-train clinics provide a safe option for families who enter the doctor’s office uncomfortably during the pandemic. The clinic also provides services to new families in the area. In recent months, Danbury has experienced an influx of immigrants, mainly from Central and South America, and its immunization schedule is different from that of the United States.

Henion said: "They are not eligible for health insurance, but we can at least let them enroll in the school." He pointed out that the latest vaccination certificate is a prerequisite for admission.

The staff of the health center also work hard to keep students up to date with the annual physical examination. Henion called on the family to remind them if their children are due. Since August 2020, when the center is open four days a week for health visits, many students will show signs of pandemic-related boredom. "I let the children complain about backaches. They sit there all day, not in chairs. Many people lie on the bed, bend over and sit in front of the computer." "They sit still for a long time. They all get fat. Up."

Mental health problems are also increasing dramatically.

"I see a sharp rise in anxiety and depression," said Clare Gelissen, a licensed therapist who works at the health center on the Henry Abbott Technical High School campus in Danbury. Currently, the school is operated in a mixed manner, with a daily attendance rate of face-to-face students at 25%. But although almost no one lives on campus, Gleason said she is busier than ever. She said: "We will definitely see an increase in children."

The addition of telemedicine makes it easy for Gelissen to stay busy; the impact of the pandemic makes it necessary. She said: "These children are so isolated from the main source of social interaction."

During the pandemic, the state's health center also assumed a new role. Collins said many people have participated in the COVID-19 test. Since December, Rogers Park Middle School has been provided with COVID-19 testing clinics by health center staff several times a week. Any member of the school community who has symptoms can attend the clinic for free. However, although this and other methods make health centers still important during the pandemic, they are not without shortcomings.

Peters of New Haven points out that usually their center's follow-up care is close to 100%. She said that now, “this is an effort to get students in.” She said that despite the current security agreement, appointments are separated, and few people stay in the building at the same time.

Henion agreed. "We are accustomed to the opportunity to contact children. Usually, I can track them at any time." She said. She is particularly concerned that uninsured students have no contact with primary care providers in the community.

"They are the people I worry about," Henion said. "I really want the children to come back."

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