Visit to the Bronx provides insight into school-based health programs

By Pia Christensen
Association of Health Care Journalists

Journalists learned about the scope and structure of some of New York's school-based health centers during a field trip to two Bronx schools on Oct. 17, preceding the 2008 Urban Health Journalism Workshop.

The field trip, arranged by AHCJ and Montefiore Medical Center, started with a bus ride that featured Margaret E. Rogers, F.N.P., the Montefiore School Health Program's training and education coordinator. During the ride, Rogers explained the history of such programs, who they serve, how they are structured and funded in New York and answered questions about what kinds of services are provided. She explained the link between health and school attendance, as well as the toll a sick child can take on a parent's employability.

The first stop was a lively visit to P.S. 28 Mountain Hope, a public elementary school in the Bronx, where attendees met Annie Moss, a community health organizer who talked about the school's partnership with a community-supported agriculture program as a way of getting fresh fruits and vegetables into homes in the community. That day was a harvest festival which emphasized to students the relationship between the fruits and vegetables on their plates to the produce they receive through the program.

Meg Charlop, director of community health for Montefiore's School Health Program, explained some of the challenges of trying to encourage physical activity and good nutrition in children who attend schools without gyms or physical education teachers. She said that gyms were transformed into classrooms as a result of the "No Child Left Behind" act.

The journalists then split into groups to visit classrooms and observe the "Moving Smart" program, a set of exercises the children do in the classroom as an effort to increase their physical activity. The pre-kindergarten children in one class, led by teacher Alexis Sichler, demonstrated stretching, jumping jacks, marching and then a cool down with breathing exercises all set to a narrated CD that took children on a journey around the world by telling them they were going to the Great Wall of China, Mount Kilimanjaro, the New York City Marathon and other places. Before long, the journalists were joining in the exercises.

Senior school aide Robyn Anderson is responsible for overseeing the children at lunchtime as well as before and after school. She encourages as much physical activity as possible, including play on the jungle gym and karate. She said that if the temperature is above 32 degrees, the children go outside. In inclement weather, they play board games or watch movies – though Anderson said she is not a fan of television. The school has a small track where the children can run, but it goes through the area where they play baseball so the two activities can't happen at the same time. Anderson said the children enjoy the exercise and often come to her before school begins to ask if they can exercise.

A visit to the school's clinic followed, where , including physicals, immunizations, mental health counseling and referrals to other services that are available year round. Providing the services at the school allow for an immediate diagnosis, letting the nurse practitioner write a prescription and sometimes even administer the medication right away. The clinic finds that compliance and follow ups are much more successful than in traditional clinic settings.

Healthy children can affect an entire community, Campos said. "If kids exercise on a regular basis, they go home [and] they don't have time for mischief. They do their homework, they get to go to bed early. [If] they get to go to bed early, they get to come into school on time. If they come into school on time they have a better education. The next thing you know, you have a whole community full of children that are highly educated, going to college, higher self esteem, less crime, more earning. That itself transforms a whole community."

Nurse practitioner Jaqueline Kelderhouse, F.N.P., said  many immigrant families' first introduction to health care in this country is through the school clinic when they register their children and the children need immunizations. "Parents, once they really know about the clinic, are extremely thrilled to use the clinic." Kelderhouse discussed the circumstances of many of the immigrant children they see. She said that oftentimes the children have been separated from their parents for many years and the parents feel guilt over that. "We're really doing family outreach because the families come in and they need lots of things."

After a quick ride to DeWitt Clinton High School, the journalists were sent to the principal's office where they met Geraldine Ambrosio. She is principal of the second largest high school in New York, with about 4,400 students. With so many children, the school is broken up into seven "small learning communities" that each have a dedicated assistant principal, teachers and support staff in an effort to keep students from falling through the cracks.

Ambrosio discussed some of the challenges the school and students face. The school has a program that allows students who are parents to bring the babies to school, increasing the likelihood that teen parents will finish high school. There are 18 babies in the program now. In addition to caring for the babies, the school arranges  activities such as that day's trip to the zoo for the teen parents and their babies to help teach the young parents how to take their children on outings. The school also helps the teen parents look for colleges that have day-care programs.

Ambrosio thinks it encourages other students to be more responsible. "Other kids can see that it isn't so fun to have a baby" because they can see what the teen parents are dealing with. She said the school-based health center helps attendance because they can care for students' medical, dental and emotional needs. The Montefiore program and the school are working together on a pregnancy prevention campaign.

Clinton DeWitt's program includes a dentist who works in a clinic on campus. Debra Sperling, D.M.D., does cleanings, fillings, preventive care and applies fluoride sealants to prevent future damage. She has worked out a partnership with the school's English department that allows her to see students for exams and treatment programs. She said the most common problem she sees is decay and that dental care is the last thing a family in need takes care of.

Christina Lima, a social worker at DeWitt Clinton, said that she is seeing more stressed kids lately. She said that often they are immigrants adjusting to being in a new place and a new school. Others are feeling financial stress at home – even before the latest financial crisis. Lima said she has seen an increase in online bullying, using social networking Web sites. Lima and Amy Rowe, F.N.P., said that care in the clinic has prevented many students from going to emergency rooms and is thus cost effective. They said that they are also a resource where students can ask about things they don't feel comfortable asking their parents. The clinic provides counseling, prevention, reproductive health exams and some care for sports injuries.

Lima described the clinic as "a fixture in the school" and a place where students come for solace.