Responding to Trends in Pediatric Obesity, SBHC Site Starts Nutrition Program
Consistent with national trends in pediatric obesity, many students enrolled in school-based health care (SBHC) are overweight/obese. To address this problem, a SBHC site in Middletown, CT, offered a multi-disciplinary nutrition group targeting students with a body mass index (BMI) greater than 85 percent, though any student was welcome to participate. The group focused on healthy eating and increased physical activity.
Meet Izaiah, a 13 year-old eighth grade student from Middletown with a BMI of more than 95 percent. According to Karen Veith, a nurse at his school-based health center, other than his weight, he was healthy and did not regularly visit the health center. After completing six weeks of the nutrition small group sessions, he began eating right and exercising regularly. Izaiah lost 40 pounds and gained a ton of energy. When Karen asked, “How did you lose the weight?” He responded, “It was easy.” He decreased his soda intake from 5-6 sodas per day to ½ glass of soda per day, and he drank more water. He cut back on his portions and had one handful of potato chips instead of eating the whole bag. He walked everywhere and played more basketball with his friends.
Fast forward a few years. Izaiah is now a senior in high school. He’s lost a grand total of 74 pounds and is more confident, happy, and healthy. He attributes all of the changes he made to his participation in the nutrition small group sponsored by his school-based health center.
Routine Test for Student Leads to TB Diagnosis/Treatment for Entire Family
Meet Jack, an eighth grade student from Brooklyn, NY. He came to his school-based health center with a bad cough and chest pain. SBHC staff administered a routine test for tuberculosis (TB) and it came back positive. The school-based health center referred Jack for a chest x-ray, and then offered to test other members of his family free of charge.
His mother, younger sister, and younger brother were tested at the center, and all three tests were positive. His sister’s follow-up chest x-ray showed an active Tuberculosis infection. The school-based health center sent her to hospital for treatment and she has since recovered.
The reality is that many children come to school sick because they have no place else to go. One of the community benefits of school-based health care is that it can identify a health condition in a child that may impact the whole family. In addition to treating students, many school-based health centers provide care to family members, such as younger siblings and parents, and to the broader community surrounding the school.
SBHC Rallies to Perform 15 Physicals in Time for Opening Game
When the girls’ basketball coach approached the school-based health center and asked if it could do a few sports physicals, Janice Bear, SBHC nurse at Fair Haven K-8 School in New Haven, CT, told him, “Of course!” If there was a way she could help get kids playing sports who want to play sports, she would do it. The coach said he was having a hard time getting sports physicals for some of the girls and wondered if the school-based health center could help out. He thought it would probably be about 4 or 5 kids. Janice had him distribute clinic permission forms and an SBHC introductory letter to all the girls’ families who were not already signed up with the health center.
When Janice arrived in the center the next day, the seats were already occupied with not 4 or 5 kids, but 15 basketball players and two families newly arrived waiting for school entry physicals for their three children. Janice and her colleagues worked all day, skipping lunch to complete the physicals.
Later that week, after the girls’ first basketball game, the assistant principal and several of the girls came down to the center with a bouquet of flowers. “For what?,” Janice asked. “For working so hard that day so we could play,” said one of the girls as she presented Janice with flowers and two cards, one signed by all the players and one signed by the coach and administration. Janice was almost in tears, but she says it was a reminder of the good SBHC staff do as practitioners. “Indeed, this is what school-based health centers are all about!”
Finding Help When No Else Could: A Student’s Deteriorating Tooth Prevents Eating & Learning
Alex, a 19-year-old senior at Woodlawn High School in Shreveport, LA, desperately needed dental care. Vanessa Mathews, an SBHC nurse, treated Alex the best she could, but knew he needed to see a dentist. His gums were swollen and bleeding, and he couldn’t eat anything but apple sauce. Alex ate in the clinic for several days because he was embarrassed to eat in front of anyone else. He was too old to be on Medicaid and his mother couldn’t afford private dental insurance or the cost of a dental visit.
The lack of dental care in the Woodlawn High School community was a major health concern for those not covered by Medicaid or any other dental insurance. That lack of oral health coverage became a driving mission for the center. The center discovered that Shreveport was also home to The Children’s Dental Clinic, a service made up of local dentists who volunteer their time, supplies, and skills to help children in the community. The program provides dental care for any child, no matter the age, who is still in school and has limited financial means.
After completing the proper paperwork, Vanessa got Alex an appointment with a dentist within one day. It only cost him $5.00 for the preliminary visit and then $5.00 for the root canal that he needed. A few days later, Vanessa passed Alex in the hallway and he was smiling so big! “It warmed my heart and made my day,” explained Vanessa.
Although one in five school-based health centers provide onsite dental health services, the clinic at Woodlawn High did not. However, like most SBHC providers, the center helps students identify free or low-cost health care resources in the community. Community resources often in need include: dental care, reproductive health and family planning, food banks, and homeless shelters.
A Day in the Life of A SBHC Nurse Practitioner… And You Thought You Had a Productive Day!
Have you ever had one of those days when, after leaving the office, you felt accomplished and motivated to do more? A day where you jump into your car or on to your bus and think, “Wow. That was a successful day. I helped so many people. What would they do without me?”
Now, imagine you had that feeling every day. In SBHC, providers hear about these days all the time. Take for instance one day at a school-based health center in Ashland, OR. In a six-hour time frame, Judy Blickenstaff, a family nurse practitioner at Ashland High School, accomplished the following:
- Performed a fasting and two-hour blood sugar check, including finding the student food for a glucose load as dad had eaten hers.
- Made a new asthma diagnosis and prescribed an inhaler and taught its use.
- Consulted with a student about her birth control method and made a change.
- Diagnosed an ear infection and consulted with student’s mom about it.
- Counseled a student about depression, family issues, friend issues, and food issues.
- Took care of a student with back pain.
- Diagnosed possible new genital herpes and taught, counseled, and consoled the student.
- Gave several immunizations.
- Washed cinnamon out of a student’s eye. (Foods class had been wild!)
- Discovered a new allergy and wrote up an emergency plan for the school and prescribed an Epi-pen for the student.
- Talked to a dad who called about his daughter, who was depressed. Called poison control for consult, then called dad back and had him take her to the hospital for suicide attempt. Notified her primary care provider. Scheduled her for counseling here at the school.
- Called a mom to tell her about her daughter’s suicide attempt two weeks earlier.
- Talked to a mom who called to say that her daughter is threatening violence and suicide. Referred her to outside resources.
- Sent three students home with various illnesses.
- Arranged supervision for the new counseling intern.
- Scheduled to be guest speaker in the health classes and the alternative educational classes.
- Helped a foster mom arrange a psychological evaluation for her daughter.
- Gave numerous analgesics for headaches, menstrual cramps, and tightened braces.
- Scheduled Epi-pen training for four school staff.
Although Judy didn’t manage to get all the charting done, she did do what many people wish they could… have a meaningful impact on the lives of more than 40 people in one six-hour day. How many of us can say that?
SBHC Treats Severe Acne, Making a World of Difference in a Young Man’s Life
Meet Juan, a teenager who had very bad acne. Boys at school teased him, girls wouldn’t talk to him, and he knew his family couldn’t afford to take him to the doctor unless it was a more serious medical condition. He knew there was an SBHC center on his high school campus and for months thought about seeking treatment, but he was too embarrassed and worried that his family couldn’t afford it. After talking to a friend who told him services at the center were free, he put his embarrassment aside and mustered up the courage to ask his mom if he could seek treatment—which she readily encouraged.
Juan walked into his first appointment wearing a hooded sweatshirt with the hood pulled up and his head down to avoid eye contact—something his mom said was quite common as of late. His mom also reported that he had become withdrawn, staying in his room instead of playing with the neighborhood kids, no longer bringing friends over, and opting to not try out for the Junior Varsity soccer team. She’d just attributed these changes to him being a teenager.
After the initial assessment, the SBHC clinician explained that acne was very normal for teens his age and that he would notice major improvements in his condition with some changes in hygiene and a few medications. The clinician gave Juan the medicine he needed and told him to come back in three weeks for evaluation. When he returned, Juan said he had noticed a small improvement. He continued to come for periodic follow-up appointments so his medications could be adjusted, and as he got to know the staff, he began to open up more.
Nine months after his initial visit he happily reported only occasional outbreaks that responded very well to the acne spot treatment he was now using. More importantly, though, the staff noticed concrete changes in his mood and behavior. He no longer wore the hooded sweatshirt; he greeted the staff with warm hellos, telling them about his activities in school clubs and sharing that he was a little nervous about the upcoming football game where he would be introduced as one of the homecoming king nominees.
Armed with the medical attention he needed to clear up his acne, Juan regained his self-confidence and reemerged as an outgoing and active young man. One might scoff at the idea that treating a minor medical condition like acne would warrant the need for school-based health centers. In the case of Juan, though, with his otherwise limited access to health care services, it was SBHC that made a world of difference in his life.