School Health Clinics Expand to Include Dental and Counseling Services
Fueled by a $4 million federal Health Care Innovation Award, the Miller School has added mental health services and expanded dental services to the primary care programs of the School Health Initiative. The program, in operation for a decade, has served 11,000 Miami-Dade County public school students in nine schools and is positioned to be a national model.
Originally funded by the Dr. John T. Macdonald Foundation, the School Health Initiative established a primary care program staffed by Miller School doctors in four elementaries, two middle schools and three high schools in North Miami, North Miami Beach and Overtown. Joycelyn Lawrence, M.D., assistant professor of family medicine and community health, has led the team of nurses and nurses’ aides who have been providing primary care, lab visits, vaccines and social work services.
“In addition to those services, we wanted to deliver care in a more holistic approach,” Lawrence said. “We wanted a more comprehensive model to further address the needs of our students and their families.” Kim Greene, Executive Director of the Dr. John T. Macdonald Foundation, echoed that goal, saying they “wanted to create something that will be a national model: successful, cost effective and one that can be duplicated around the nation.”
The three-year award, one of only 107 given out nationwide by the Centers for Medicare and Medicaid Services’ new Center for Innovation, provides the funding for this pioneering program to expand its services and partnerships. The Dr. John T. Macdonald Foundation School Health Initiative at UM was the only proposal funded in Florida and the only school-based program in the nation to receive a grant.
Arthur Fournier, M.D., professor of family medicine and community health and associate dean for community health affairs, said it made sense for Medicaid to support the program. He pointed out that the initiative delivers care to children in school, a setting they attend daily, and by establishing the program in a school feeder pattern, allows providers to follow students over the years.
This innovation grant provides funding to expand dental care and add mental health counseling and community health workers to the available services. Oral care services were one of the most glaring needs for students. With funding from the Health Foundation of South Florida, Nova Southeastern University’s College of Dental Medicine has established a dental suite in a converted portable at John F. Kennedy Middle School, where 6th grade students are provided preventive dental care such as dental sealants and fluoride varnish. Having portable equipment, said Robert A. Uchin, D.D.S., Dean and Professor of Nova’s College of Dental Medicine, allows the college to bring dental care to children in underserved communities.
The University of Florida College of Dentistry, which operates a dental clinic in Hialeah, will be delivering preventive and restorative dental care for students at all nine schools in the program. Rodrigo Souza, D.D.S., Assistant Program Director at the Hialeah Dental Center from the University of Florida College of Dentistry, pointed out the strong need for dental care since children with poor oral health are more likely to do poorly in school.
With the goal of offering more robust mental health services, the Miller School has partnered with Larkin Community Hospital, a teaching hospital with the largest osteopathic residency program in the U.S. encompassing more than 30 specialties, as well as a psychiatric residency program and nursing school accredited by the Accreditation Council for Graduate Medical Education. Larkin’s psychiatry residents and fellows in adolescent psychiatry are rotating through the different school sites. Counselors will not only be on site, but will use the telehealth system already in place to see students.
By providing much-needed counseling to students, demonstrating the viability of telemedicine as a delivery system and training doctors to establish this model elsewhere, Robert Fernandez, D.O., Vice President of Education Affairs at Larkin, said the program “is a perfect trifecta.”
The award also funds the hiring of community health workers, lay people who can bridge the often cavernous cultural gap between healthcare providers and patients. Being familiar with the diverse student population, community health workers are able to provide culturally appropriate care, home visits and guidance with navigating complex systems such as Medicaid enrollment.
The School Health Initiative is a potential model program for the nation, primarily due to its adaptability, portability, and financial feasibility in reaching the underserved. As a cost-effective method of delivering primary care, Fournier believes it can demonstrate how Medicaid and HMOs can better pay for the healthcare of school-aged children.
Greene is hopeful that other groups around the nation will replicate the program. She thanked the leadership of the Macdonald Foundation’s Board for supporting this “extremely important partnership that has grown in scope and vision.”
“None of these things would be possible without the community partnerships we have,” said Lawrence, who also acknowledged the school principals.
“Success has a thousand mothers and fathers,” said Fournier. “Failure is an orphan.”