Congresswoman Jan Schakowsky, Ninth District, IL
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A new class of clinic
 

January 7th , 2003

By Ames Boykin

Daily Herald

Patients at a new health center opening soon in suburban Chicago will need no insurance to see the doctor.

They'll also escape the hassle of dodging red lights to make it on time to the doctor's office only to be asked to browse through magazines for an hour.

Instead, getting in to see the doctor will merely require a hall pass.

Maine East High School in Park Ridge will join the growing class of schools that have health centers when it opens its clinic in late January. The project is a partnership between the school and Advocate Lutheran General Hospital, located just down the street from the school.

An underused storage space in the lower level of the school, after months of construction, is becoming a clinic, with examining rooms and a staff equipped to go beyond the work of a school nurse in treating students and helping them stop bad habits that could land them in serious trouble later in life.

With parental permission, Maine East students can get an examination, immunizations, pregnancy tests, prescriptions for commonly used medicines and mental health counseling.

There already are about 20 school-based health centers in Chicago and its suburbs. Maine East's will be the first in the Northwest suburbs.

School-based health centers are still uncommon, yet their numbers have grown since the first ones opened in the 1970s. Only about 5 percent - or 1,500 - of U.S. schools have one. Illinois is in the top 10 with about 40.

Critics who ask why educators are interested in health care can expect the same answer.

"In order for kids to do well, they have to be well," said Maine East Principal David Barker.

That's the link for educators. Healthy students make better learners and, for them, it's that simple.

"A student who is feeling ill can go to the health center and go back to class, and not miss a day of school," said Judy Redick, Illinois Department of Human Services' administrator for school health program.

Though there are limited federal, state and local resources to start and operate such clinics, more communities over the past three decades have recognized the need to offer students health care down the hall.

Filling a void

American schools have long emphasized the importance of good health.

At the turn of the century, pediatricians were stationed at U.S. schools. Today, it is the school nurse who is in charge of encouraging good health.

But it wasn't until the early 1970s that schools began opening health centers. The first ones, in Denver, Dallas and St. Paul, Minn., were founded after schools recognized a need for community clinics, said John Schlitt, executive director of National Assembly on School-Based Health Care.

Educators realized at that time that students might not take the next step once they left the school nurse's office.

Without health insurance, a child's prognosis for accessing adequate health care looked grim.

"It was (a feeling of) 'We have nowhere to send these kids to,'æ" Schlitt said.

Illinois schools joined the trend in the 1980s and five school-based health centers operated until more state funding became available in 1996.

Illinois distributes about $4 million a year toward the 33 centers and others are in the planning stages, such as Maine East's was last year, according to the Illinois Department of Human Services. Nearly $2 million of the available money stems from Illinois' settlement of its class-action lawsuit against tobacco companies, the state agency's Redick said.

Maine East will get nearly $500,000 from the state over the next three years, including $200,000 in the first year.

A full-time nurse practitioner, part-time medical director and medical office assistant will staff the school's health center.

Students who visit Maine East's health clinic - scheduled to open Jan. 21 - can get a school physical, immunizations, treatment for mental health, pregnancy tests and nutrition counseling.

In addition, they can enter a program to stop smoking.

Mental health counseling is the most common reason students visit school-based health clinics, statistics show.

School-based health centers in Illinois were involved in preventing 32 suicides this year, according to the Illinois Department of Human Services.

Offering counseling and treatment at schools is among the most valuable services school centers offer because the services are convenient, safe and anonymous, supporters say.

"No one knows why you're there, and you can get any services," Schlitt said. "They could be there for a cough, a sports physical or mental health counseling. So, there's no stigma."

What Maine East students won't be able to get at the clinic is the reason people most often attack school-based health centers: contraceptives.

"It's more rare that they do offer (contraceptives)," Schlitt said. "It's a battle that communities aren't willing to take on. In reality, even when you do offer those services, it's a miniscule reason that kids come in for."

Students will not be able to get contraceptives at the Maine East center when it opens, but school officials have not ruled out the possibility the clinic might decide to change that policy in the future with the consent of the school board and the community.

Why Maine East?

A walk through Maine East is like lifting the lid on America's melting pot.

Some 50 languages can be heard in the halls. Seventy percent of its 2,100 students are minorities.

The barriers blocking Maine East's minority students from health care are equally as diverse, ranging from language to cultural differences.

Unfortunately, that reflects the trend in Illinois and across the United States, said U.S. Rep. Jan Schakowsky.

Schakowsky, an Evanston Democrat whose new district will include the high school, believes the demographics of Maine East make it a prime location for a clinic.

Maine East's clinic will serve all students, but it hopes to cater to its large immigrant population and other students without health insurance.

In Illinois, statistics show 10 percent of children are not covered by health insurance. Twenty-six percent of Hispanic children, 16 percent of black, 14 percent of Asian-American and 22 percent of low-income children have no coverage.

A U.S. surgeon general's report found 78 percent of black and 86 percent of Hispanic children don't get access to mental health services, compared to 69 percent of whites.

Navigating the American health-care system can be difficult when someone doesn't speak English. Even if a family does have insurance, working parents cannot take off work to take their children to a doctor, or teens might be asked to take care of siblings after school while parents are at work.

Those without insurance tend to flock to the most expensive place they can go.

"Right now with the culture - when they're sick they go to the emergency room," said Karen Moore, director for Advocate Medical Group. "The emergency room shouldn't be used for strep throat."

Trips to the emergency room can escalate to hundreds of dollars because patients are new so doctors have to perform expensive tests to get to the root of their problems, Moore said.

A school-based health center fills a void another setting could not, experts agree.

"It's an ideal setting," Schakowsky said. "You don't need to make sure they get to their appointment. There's no good excuse when the clinic is right there."

The clinic's goal also will be to focus on preventative measures students can take to improve their health.

Adolescents typically aren't the picture of perfect health.

"They don't eat right. They smoke. They ride on bikes without helmets," said Redick, of the Illinois Department of Human Services. "So, you're trying to teach them good health habits."

Visiting the nurse

Maine East school nurse Jan Leist rarely has a slow day.

In the last two years, Leist has logged 18,000 student visits. She estimates between 75 and 100 students visit her every day.

Students visit her office seeking treatment for everything from small scratches to asthma attacks.

But Leist will be among the first to say she can only help them to a point.

In crisis situations, she must call paramedics to transfer students to Lutheran General, just a few blocks away from the Park Ridge school.

She can't dispense medications or really treat anyone beyond giving ice to someone with a twisted ankle, so she refers them to doctors.

"But oftentimes they don't go," Leist said.

As the school began planning to open the health clinic, it surveyed students to identify need. The survey of 1,240 Maine East students found that 17 percent don't see a doctor, 13 percent use the school nurse for health care, 10 percent use emergency rooms and 5 percent use immediate care facilities.

When the school-based health center opens at Maine East, Leist expects to see just as many students. But she will be more confident the students will see a doctor because the clinic will be right down the hall.

"It's going to help me in the way I'll have a place to refer the students," Leist said. "And I know they'll have good care."

It's not unusual for a teen to be sent home because they have failed to get all their immunizations in order, Leist said.

Until the health center opens, Leist must send a letter to the parents to notify them their child must be immunized before they start school. Sometimes she has to send two letters.

Now, Leist will be able to explain to parents that students can get their immunizations at school.

The clinic at Maine East also is expected to relieve the burden for parents. Cook County offers complimentary immunizations for students, but the closest locations to the Des Plaines and Park Ridge students are located in Wheeling and Rolling Meadows, Principal David Barker said.

A model

In planning to open its own clinic, Maine East looked east.

Evanston Township High School, which opened a clinic in February 1996, has served as a model for the Maine East center.

Of Evanston's 3,100 students, 1,800 have permission from their parents to use the clinic and half of those students use the center, said Kathy Swartwout, the center's nurse practitioner.

Students visit the health center for everything from a sore throat to acne to a pap smear. They also can vent their problems and concerns in the office of a mental health counselor.

The true success of the Evanston high school's clinic can be measured in the students it has helped.

One female basketball player who came to the clinic for a routine sports physical found out she had a serious heart problem that could have killed her.

"She was feeling fine and we picked up (an aortic aneurysm) on exam," Swartwout said. "Who knows?"

The teen could have ended up in the headlines as another young athlete killed on the court because of an unknown condition, Swartwout said.

Evanston also has significantly cut the number of freshmen who miss class because they never had the required physical. As many as 60 students would miss the first day of school before the clinic opened.

Because students can get a physical at the school clinic, that is not a problem anymore.

Other things as simple as giving a teen clear skin can greatly improve their mental health.

"We've gotten their skin to clear up and their whole outlook has changed," Swartwout said.

Like Maine East, the clinic at Evanston Township High School gets the bulk of its funding from the state. Evanston also gets strong support from a local hospital, Evanston Northwestern Healthcare.

One of the biggest surprises since the center opened has been looking at who's using it. Just as Maine East hopes to serve students who have no insurance, Evanston also started out seeking to fill that need.

What the clinic is finding, however, is that all students are wandering into the center, Swartwout said.

More than half of the students, 52 percent, who use the Evanston clinic have private insurance.

A clinic in every school?

School-based clinics have seen their numbers mushroom over the past few years.

About 10 years ago there were 200 nationwide. Today, there are 1,500.

Maine East will be the first new school-based health center to open in Illinois in 2003. Others are expected to open in Aurora and Champaign.

Why aren't there more school-based health centers?

They are expensive, said Karen Berg, who heads the Illinois Coalition for School Based-Linked Health Centers in Chicago.

Maine East plans to spend $200,000 in its first year to staff it part-time. Staffing one with full-time employees would at least double the cost.

Thanks to the tobacco settlement Illinois reached, nearly $2 million became available to fund the centers, but grant money seems to dry up quickly.

"It's the battle we face right now," Berg said.

Even supporters who want to net more federal and state money to open more health centers at schools acknowledge they have no plans to see one at every school.

Berg calls that goal "unrealistic."

Redick, of the Illinois Department of Human Services, said health officials are targeting specific schools - those with a student body like Maine East's.

Besides, supporters say having a student-based health clinic will save money for both patients and the health-care industry.

Preaching prevention is an investment with a great return rate, officials said. It can save lives and money.

They favor the example of a man who has to undergo two or three heart procedures for something he could have avoided if he had changed his lifestyle years earlier.

Instead, he has to miss work and is stuck with thousands of dollars in medical bills.

"If you eliminate one heart attack, you're saving money," said George Lesmes, vice president for Advocate Medical Group.

Clinic: Maine East using tobacco settlement to fund first year.
 

 

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