School health clinics continue to grow in Missouri
Posted September 1
NORMANDY, Mo. — Something as simple as a health physical is not readily available to Ezekiel McIntyre, who's a freshman at Normandy High School.
His mother, Oneesha Everett, has tried three times to apply for Medicaid, but she still has no health insurance because she said she didn't hear back from the Department of Social Services.
"It's such a hassle to get insurance," said Everett, a working mother of four. "It's crazy, crazy, crazy."
Everett recently took Ezekiel to a small health clinic that recently opened in one of Normandy High's buildings. He got a free physical in less than an hour. Now, he can try out for football, one thing he was looking forward to at his new school.
"It's awesome that they put it in here, period," Everett said of the clinic.
Last month, Normandy High joined a growing number of public schools around the St. Louis region that are opening on-campus health clinics.
Services at these clinics include not just immunizations and checkups, but also chronic disease management care for conditions such as asthma and diabetes; counseling for behavioral, emotional and mental health issues such as anger, bullying and depression; dental cleanings; and reproductive health services including contraception, pregnancy tests and screenings for sexually transmitted infections.
Many clinics are open to area residents in addition to students and staff. Many, if not most, are free to those who lack insurance.
Research has shown that poor health is a barrier to student learning, is associated with lower grades and is a common reason why students miss school or drop out. School-based health clinics such as Normandy's are one of a number of ways educators are seeking to address not just their students' educational needs, but needs of the whole self, such as health and emotional well-being.
"The more health you have, the more ability you to have to learn," said Jason Purnell, a Washington University associate professor and director of For the Sake of All.
Normandy's clinic is the first major project to result from the For the Sake of All report, which detailed Purnell's research findings on health disparities facing African-Americans in the region.
The need for a health clinic is particularly acute in the impoverished Normandy district, where youth — a majority of whom are African-American — are twice as likely to visit the emergency room and three times as likely to be uninsured as the average St. Louis County youth, the For the Sake of All team found. A high number of emergency room visits often indicates that patients are not receiving adequate preventive care.
A school index compiled by the Missouri Wonk consulting firm found that Normandy High has more need for a health clinic than any high school in the region after Vashon, in St. Louis.
Ninety-seven percent of Normandy's students qualify for free or reduced-price lunches, a measure of poverty, and 97 percent are African-American. More than a fourth of Normandy High students lacked their required immunizations in 2016. From August to November that year, students visited the school nurse 2,205 times for a variety of health issues.
Even if a family has some form of health insurance, several barriers to health care still exist for low-income families. Parents without insurance might not know about their Medicaid eligibility or how to apply for it. Getting to a doctor's office that is a long drive away and waiting for an appointment often means missing school or work. North St. Louis County, in particular, is a "notorious" desert of preventive health care options, Purnell said.
Having a health clinic at Normandy that's open during and after school eliminates that transportation barrier and can make it easier for students to see a doctor without missing class or pulling their parents from work.
Normandy's clinic is the product of collaboration among several groups, including Purnell and For the Sake of All; the Normandy district; BJC Healthcare, which provided the clinic equipment; and the youth-centered nonprofit Wyman. The clinic is a satellite of Affinia Healthcare, which also funds the clinic by fetching a higher Medicaid reimbursement rate, because Affinia is a federally qualified community health center.
The partners are now working on getting more students to know about the clinic and use it. To do that, the clinic's staff must gain the students' trust.
"If the students don't feel they can trust the staff, they won't use the clinic," Purnell said. "It's not just transactional, but they're entrusting that clinical staff with either physical or emotional issues that are quite personal."
Missouri has been slower than other states in opening school-based health clinics.
In the 2013-14 school year, the national nonprofit School-Based Health Alliance counted 2,315 clinics nationwide, but only four were in Missouri, compared with 61 in Illinois and 322 in Florida. Some states provide grants specifically for school-based health clinics, but Missouri isn't one of them.
Missouri schools and health care providers have gradually added more. Clinics opened at the city's Roosevelt High School in 2012, Jennings High School in 2015 and Jennings' Fairview Elementary this year. The Institute for Family Medicine runs clinics that are open at least weekly at Nahed Chapman New American Academy in St. Louis and Special School District's Northview Technical High School. Northwest Middle School has a clinic that also provides dental services.
The Hancock Place School District opened one of the region's first school-based health clinics with the institute in 2002, according to Superintendent Kevin Carl. The clinic, which is housed in the district's administration building, is free to students as well as anyone who lives in the 63125 ZIP code.
Now, the For the Sake of All team is working on starting health clinics at two more high schools in two other north St. Louis County districts.
"Students who are in school and not having their physical needs met and are not healthy and well are not in a position to learn," Carl said.