School-Based Clinics Create New Relationship in Academics, Healthcare

Thanks to the Dr. John T. Macdonald Foundation School Health Initiative, the roles of school health professionals across the country might undergo drastic changes in the near future. The initiative – which is a network of health clinics based in schools around Florida operated by University of Miami M. Miller School of Medicine – seeks to bring a student's healthcare together with their academics to the benefit of both.

Currently nearly 250 such clinics operate around Florida, a 100% increase over a decade ago. In the beginning of each new academic year – and with their parents' consent – students are enrolled in the clinics which then serve almost all of their primary care needs. The arrangement doesn't just benefit students. who now can have almost all their physical ailments seen to as soon as possible, but also their parents. When there's a doctor on campus, parents don't have to leave work to get their children medical care during the day. Direct parental intervention is required only in cases of severe illness or injury.

School-based clinics don't just improve health outcomes – they also provide substantial educational benefits.

As a result, research shows school-based health clinics can cut absenteeism in half. In one study of high-risk students, African American boys who used school-based health clinics were three times more likely to graduate than peers who didn't. School immunization rates at the Miami clinic sites are much higher than state and national averages.

Each of the clinics under Lawrence's supervision has a telemedicine unit—kind of like a fancy Skype setup—that allows students at school to connect on streaming video with a specialist at the University of Miami hospital or another site. If a student needs something more than primary care—a cardiologist, mental health counseling, a nutritionist—a consult can be arranged without ever having to take the child out of school.

The School Health Initiative also employs community health workers who act as community liaisons and help enroll students in Medicaid or subsidized insurance through Florida KidCare—some of which helps cover the cost of the clinics. The rest of the funding comes from grants and partnerships with hospitals and universities.

According to Sammy Mack of NPR's State Impact blog, in addition to the primary care offered by the clinics, the program is now looking to offer mental and dental health services thanks to a $4 million Health Care Innovation Award from the Centers or Medicare and Medicaid Services. According to one of initiative's founders, Dr. Arthur Fournier, the next step would be to expand outside of Florida to provide services in inner-city schools as well as in areas that are underserved by doctors and other medical facilities.

Fournier even borrowed some of the practices developed at the Miami school clinics and exported them to a health care partnership in Haiti. "We've now set up a school health program in Haiti where we have mobile teams of nurses lead by a nurse practitioner and community health workers who go to 17 schools," says Fournier.

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