Breaking down barriers to healthcare for outcomes ever better

Nurse practitioners at the University of Rochester School of Nursing provide free health services to students at school-based health centers in the City of Rochester, breaking down barriers to quality care and helping students stay focused, healthy, and ready to learn.

Many students in the Rochester City School District, one of the poorest school districts in the nation, face significant barriers getting an education from inconsistent support at home to actual homelessness. But, with a full-service clinic that provides free comprehensive physical and mental health services on-site at their school, getting access to quality health care is significantly less challenging than it might be otherwise.

Staffed and supported by nurse practitioners from the University of Rochester School of Nursing, the School-Based Health Centers not only help students manage chronic conditions such as diabetes and asthma, but diagnose and treat acute illness and injuries, offer physical and mental health assessments and mental health therapy, provide birth control services, and have on-site laboratories and medication dispensaries. University physicians are also available for collaboration and consultation.

With more comprehensive services than offered by the school nurse, the clinics function as a satellite primary care office. With parent or guardian permission to enroll in the program, students can visit the clinic at any time for any service. The clinic treats students regardless of their ability to pay or health insurance status, and no out-of-pocket expenses are incurred, while allowing students to stay in school.

“Some students do have primary care they access, but it means parents have to miss work,” says Kim Urbach ’98N (MS), director of the school-based health center program. “It’s not just a benefit for the child. It’s a benefit for the parent and financial stability of the family.”

And that may help students meet their academic goals. Health disparities mirror gaps in educational achievement. But research on school-based health centers shows that they can not only improve health outcomes by reducing emergency visits and hospitalizations, but they may also lead to better attendance and academic outcomes.

Among the most frequently cited reasons for visits to the health center are mental health or behavioral issues. The clinics’ psychiatric nurse practitioners can dispense medication, but also are educated in individual and family psychotherapy, which is critical in supporting a population of students who may be experiencing trauma from a recent violent event or the chronic stresses associated with living in poverty.

“The mental health services are incredibly important. The population has experienced a lot of trauma both personally and secondhand,” says Urbach, noting that the clinic uses questionnaires in its physical exams to help uncover signs of potential behavioral concerns. “The physical health services act as a ‘back door’ into the mental health services.”

There are more than 2,300 school-based health clinics across the United States. The School of Nursing gets reimbursed for care to students covered under some insurance plans, but because the clinic is a state-funded entity, all surplus revenue is poured right back into it in the form of supplies, equipment upgrades, or the hiring of new staff.

Kathy Rideout ’95W (EdD) was dean of the School of Nursing when the program was developed. “This is a service to keep our kids healthy. The healthier our kids are, the healthier they’ll be as adults. If we are able to maintain not just their physical health, but their mental health, we’re creating the next generation that is going to enter adulthood more physically and mentally healthy, which makes them more productive citizens. They need to have the proper health care so that they can think better, learn more, and really be able to succeed in that kind of environment.”