September 1999
WASHINGTON, D.C. - School-based health centers (SBHC) are in-school environments where residents can provide health education and services to students, decreasing absenteeism and allowing for well-child care and emergency health visits.
The centers afford students independent, immediate access to care and cut down on missed class time due to illness and injuries. "Some kids care about their school work and do not want to miss class, so they walk down and take care of things themselves. I think this creates a sense of empowerment," said Kathleen O. DeAntonis, MD, pediatric resident, Mercy Hospital of Pittsburgh.
Students enjoy the immediate reassurance about health issues that are worrying them, including anything from a cut acquired during shop class, to dealing with swelling from a bee sting or sexual health issues. For example, if a student's pregnancy test results are negative, the student stops worrying, said DeAntonis.
"Then we can move on to talking about how it came to be that the student was worried about that in the first place," she said.
Individual and one-on-one health education within the context of the visit and the classroom are especially important, said DeAntonis. "We are health providers, and we are there for the students in a way that enables us to help them. We have a lot of health information, medical knowledge and directives, and not being able to share this would be frustrating."
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---Kathleen O. DeAntonis, MD,teaches classes focusing on issues
such as the female reproductive system, pregnancy and sexually transmitted diseases.
PHOTO COURTESY OF KATHLEEN O. DEANTONIS, MD
Residents provide physicals, immunizations and general well child care. "I have identified a
certain number of students likely to be behind in immunizations, even some teenagers you would
expect to be up-to-date with immunizations, blood work and screenings are behind," said
DeAntonis.
A lot of injuries, illnesses, students who should be home in bed, and students who want to go home but truly aren't sick enough to be excused come through the clinic, said DeAntonis. Approximately 40% to 50% of work performed in the clinic are physicals (including preparticipation physicals) and well child care.
Another 35% is divided among injuries including cuts, scratches from fights and pokes in the eye, and kids with illnesses like strep throat and pneumonia who should not even be in school, she said.
The rest of the visits are made up of gynecological services including sexually transmitted diseases (STD) treatments, pregnancy tests, pregnancy follow-ups, and care for pregnant students having contractions. Also, residents act as liaisons to the student's obstetrician because "many times the teenagers aren't knowledgeable about how to get in touch with their own doctors or persistent enough to wade through the system," DeAntonis said.
---School-based health enters allow for immediate care of students
and prevents visits to off-site physicians for minor injuries.
PHOTO COURTESY OF KATHLEEN O. DEANTONIS, MD
The services are provided in a timely manner and decrease illness and injury duration. "I hate
to see a kid limping on a swollen ankle for a week or with a rash that could have been cleared up
earlier," said DeAntonis. "I am really happy to be there for the students and to be able
to help them."
School officials also enjoy the immediate care, said DeAntonis. "Attendance is a huge issue with them, and the numbers clearly show that we help them with that."
Aside from immediate treatment and decreasing absenteeism, the center also provides health experiences for students who for one period a day every semester work in the SBHC learning about eye and ear screenings and how to read blood pressures.
Parents also play a role in the care. "I try and phone them after every visit," said DeAntonis. "I think many parents are of the mind set that once a child is past their shots and is not little anymore, they are grown up and do not need well child care."
Although parents are grateful when their child's sore throat or cellulitis is treated, they often do not want to discuss sleep habits, eating and after school activities, she said.
Another drawback, she said, is that the Residency Review Committee considers a continuity experience of just one age group to be not useful. It is really only feasible if an additional continuity experience is provided with a wide variety of ages, she said.
Initially, the flow and management is hard to learn, and it is difficult for an intern to get settled in and work productively at the same time. "You do not have nurses pushing things along for you and putting papers in your face and getting things done, so it is a little hard to learn that."
The continuity clinic where DeAntonis practices is affiliated with Mercy Children's Medical Center (MCMC). MCMC, which is part of Mercy Hospital of Pittsburgh, has provided structured school health experiences for Mercy's residents for the past eight years, said Pamela A. Heald, MSN, RNC-PNP, nurse practitioner at MCMC.
An intern is first exposed to school-based health early in their internship during a school health community medicine month, and exposure remains consistent throughout their three-year residency.
This is an entire month of school health experiences for the residents. The curriculum includes courses, preparticipation, athletic physicals, multidisciplinary meetings, operations meetings, assisting school nurses, and participation in development of HIV and sexuality policies and curricula, said Heald.
She also said that after some exposure, residents may choose a SBHC as their continuity site. Residents, in general, are underexposed to adolescent medicine, added DeAntonis. "I've seen that there is so much more to adolescent medical care. As a resident who has had a SBHC as my continuity site for three years, I cannot speak enough about how useful and wonderful it has been."
For more information:
- Bradford BJ, DeAntonis K, Bishop AW, et al. Training health care professionals in school-based health centers. Session C4. Presented at the National Assembly on School-Based Health Care meeting. June 24-27. Washington, D.C.
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