Teen clinics provide needed services

Gwinn Teen Clinic’s Nurse Practitioner Autumn Trudeau and Hematite Health Clinic’s Public Health Nurse Sarah Engstrom are showing their pride for the Gwinn Community at the “P.S. I love You” walk held in October. Right, part of an anti drug and alcohol campaign at the Hematite Health Clinic is shown. (Photos courtesy of MHCD)

By Gerald A. Messana, MPA, health officer,  Terry Frankovich, MD, medical director, Marquette County Health Department

Every parent knows the stress involved in getting a call from school because their child is ill and needs to be picked up right away and taken to a health are provider—hopefully that same day. It is often no less stressful to schedule time away from work for routine well-child exams, sports physicals, mental health counseling visits or immunizations.

Fortunately, for over 20 years, Michigan has been starting and supporting school-based clinics, also called Child and Adolescent Health Centers (CAHC). Currently, there are 102 such centers across the state and over 10,000 nationally. Why create CAHCs? Well, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the American Academy of Pediatrics (AAP) all agree that, “Healthy kids are better learners.” In fact, school-based clinics have been able to demonstrate a variety of positive outcomes, including improved school performance for children, increased student attendance and graduation rates, success in treating and preventing conditions such as obesity and asthma, reduced hospitalizations and emergency room visits and improved mental health for students utilizing the clinic services. In our state, the Michigan Department of Health and Human Services (MDHHS), in coordination with the Michigan Department of Education (MDE) has created and oversees Child and Adolescent Health Center (CAHC) grant program.

Over the past five years, the Marquette County Health Department has applied for and been awarded funding for two CAHCs; one in the Gwinn Area Community Schools district and one in the Ishpeming Public Schools district. The Gwinn Teen Clinic is located in the Gwinn High School/Middle School and has been serving the students ages 10 to 21 years of age in the district since 2012. The Hematite Health Clinic is located in the Ishpeming High School/Middle School serving the same age group, and began seeing students in 2015. Each clinic is staffed with a licensed family nurse practitioner, a licensed master’s prepared social worker, a registered nurse and a secretary. The two clinics are open throughout the school year and over the summer. Services include primary care, preventative care, comprehensive health assessments, vision and hearing screening, medication management, immunizations, treatment of acute illness, co-management of chronic illness with primary care providers, health education and mental health care.

Prevention is the cornerstone of public health and recognizing problems early on can prevent the onset of chronic diseases which contribute to a lifetime of poor health and even premature death. Providing resources and education to children regarding the importance of nutrition, exercise, the dangers of smoking and illegal drugs, are preventative measures that can reduce the risk of developing diabetes, heart disease, cancer and other chronic conditions. In addition, with a CAHC on-site, children can receive treatment for minor illnesses and injuries which might otherwise have taken them out of school for a day or more. Having a licensed clinical social worker onsite allows children to receive needed counseling and support on a regular basis, again, without multiple absences. Keeping children in school supports school success.

part of an anti drug and alcohol campaign at the Hematite Health Clinic is shown.

During the school year students schedule appointments, obtain a “pass” from the office and see the providers, usually during class periods. All required parental consents are obtained and clinic staff makes every attempt to involve parents and guardians in the care of the children through phone calls and written information sent home. The clinic accepts all insurance carriers, including Medicaid and Blue Cross Blue Shield. In addition, the registration staff in both clinics are knowledgeable and trained in assisting students and their families with the enrollment process for Medicaid. No child is turned away due to an inability to pay.

In general, the clinics resemble what is commonly known as a family practice office. However, these child health centers are not intended to replace a child’s primary care provider, but rather to be a complementary service. With that said, there are a number of children who do not have a primary health care care provider and rarely receive medical care due to a variety of barriers. For these children, CAHCs may offer their only access to health care.

CAHCs, including those in Marquette County, pride themselves on providing not only direct medical and mental health services but also in looking at the whole child—including behaviors which may impact their health and well-being. For example, every student utilizing the clinic is asked to complete a risk assessment annually. This is a grant requirement and the state recommends a survey tool called the Rapid Assessment for Adolescent Preventative Services (RAAPS). There are approximately 21 questions which focus on identifying risky behaviors in youth. Once completed, the student and the provider (nurse practitioner or social worker) review the survey together and this serves as tool in developing a care plan for the student throughout the year.

Another program requirement of the grant is the implementation of evidence-based interventions which can help improve the overall health of the school population. Data obtained from the RAAPS is used to identify common risk behaviors in the school population. Educational programs are then brought into the classrooms to educate the students on preventative measures to address those behaviors, thereby reducing health risks. Recent educational programs have included a “Life Skills” course, which teaches children how to say no to drugs and alcohol, and “Media Smart,” which addresses the risks of social media and the internet. Education is not the only program requirement.

Staff in both clinics are passionate about their work and devoted to improving the health of each student and the school as a whole. Whether a student is receiving a simple immunization or is getting stitches for a laceration, he or she receives the full time and attention of the clinic staff. The clinic is a safe and supportive environment for all students.

Child and Adolescent Health Centers are a tremendous benefit for students, families, schools and the school districts in which they are located. The school boards, school administration and faculty of the Gwinn and Ishpeming school districts recognize the value of the clinics and have been incredibly supportive of clinic staff and program services. The Marquette County Health Department would like to take this opportunity to thank the school boards and employees of Gwinn and Ishpeming school districts for their on-going and enthusiastic support.


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