School-based health center works to keep kids in class, out of emergency rooms

ByTalia Richman

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Running around the school yard during recess used to leave Eugene Pennington wheezing.

The third-grader at KIPP Harmony Academy in North Baltimore has asthma, a condition that can make it difficult for him to breathe when he plays football or baseball.

School nurse Katherine Bissett noticed how often Eugene was coming to the health clinic in the afternoons with chest pains and a racing heart. So she referred the 8-year-old to the doctor whose office is just a few feet away, and together they drew up a plan for Eugene to visit Bissett each day before recess to get a few preventative puffs of his inhaler.

The self-proclaimed “fastest kid in the grade” now can run around with his friends without suffering shortness of breath.

This type of intervention is a hallmark of The Rales Center, one of just a handful of school-based clinics inside Baltimore public schools. The clinic at KIPP is the only one in the city run by the Johns Hopkins Children’s Center and it offers comprehensive, in-house medical care to many of the 1,500 students who attend the elementary school, or the Ujima Village Academy middle school. Both schools are located in the same building and operated by KIPP, a national network of public charter schools.

At least at these schools, the days are gone when a school nurse could only offer basic care for scrapes, fevers and stomachaches.

The Rales Center essentially operates as a pediatrician’s office, albeit one located across the hall from the cafeteria in the sprawling school building. The staff provides vision exams, asthma screenings, vaccinations and other primary care services. Dozens of students come as walk-ins to see the school nurses each day, and they can be referred quickly to the pediatrician if a serious issue is identified.

The center’s goal is to keep kids in classrooms and out of emergency rooms by promoting healthy living and preventative care for chronic illnesses such as Eugene’s asthma. School health officials say it’s important that they treat students at school and help eliminate some of the barriers that hinder low-income families from accessing quality healthcare.

The center opened in 2015 with a $5 million, five-year grant from the Norman and Ruth Rales Foundation.

In its first two years of operation, the school saw a 23 percent drop in chronic absenteeism among students with asthma and a 30 percent drop among students with ADHD. As of December, the center helped students avoid 177 visits to the emergency department, Bissett said.

“We save the ER a lot of time and money and we save parents a lot of missed time at work,” she said. “Every time a parent has to pick up their sick child from school, they’re missing hours of pay and maybe endangering their future at their job.”

What the outcome data can’t convey, Bissett said, is the value of having a consistent healthcare provider in the building every day. The center employs two nurses, a pediatrician, a nurse practitioner and other office support staff.

This stands in stark contrast to many schools across the country. Roughly 35 percent of schools only employ nurses part-time, according to the National Association of School Nurses, while about a quarter don’t employ school nurses at all.

Because she meets with many children on a daily or weekly basis, Bissett said, “I know what’s going on at home. I know what’s going on in classes. I know if they’re getting in trouble. I know if they’re having problems with friends.

“That knowledge allows me to treat the whole child with a far greater level of insight than a pediatrician who sees a kid a few times a year,” she said.

The health care providers focus on stepping in before a medical problem causes a student to take time off from school. They look for patterns — if there’s a middle school girl missing almost the same three days each month, they can approach her and offer prescriptions or tips on dealing with menstrual pain.

“The things people would never think are a cause of missed school days, we’re able to solve right here,” Bissett said.

The clinic bills students’ insurance the same way a traditional doctor’s office would and it accepts all forms of insurance.

“As a school-based health center, we’re committed to seeing any child regardless of ability to pay,” said Dr. Kate Connor, the center’s medical director.

Connor said that operating out of the school has other benefits. For example, she’s able to sit in on meetings about how to create Individualized Education Programs, or IEP plans, for students with disabilities.

“A pediatrician in the community wouldn’t be able to leave their office to attend an IEP meeting with a student,” Connor said.

About 2.5 percent of the nation’s schools offer comprehensive primary-care services to some degree, according to the School-Based Health Alliance. This includes more than a dozen in Baltimore.

Connor said Hopkins and other officials are looking at ways to duplicate the program in other schools across the city, though this intensive model is much more expensive to run than a traditional nurses’ office.

An analysis of the program, published last year in the American Journal of Preventative Medicine, found that the money funneled into the Rales Heath Center translated into greater long-term savings because students missed fewer days of school and parents missed less work. It also diverts pricey trips to the emergency room.

But the analysis also estimated that if the model was duplicated citywide, it would cost an additional $45 million annually.

“It has been very effective,” said Rales Center co-founder Dr. Tina Cheng. “We recognize the cost is high, so we’ve been trying to think of what parts of the Rales model we could implement in other populations.”