On July 14, the U.S. Department of Health and Human Services announced that 11 community health centers and other nonprofits in Massachusetts will receive grants to make capital improvements to school-based health centers (SBHCs). The grants are provided through the Affordable Care Act. The Lynn Community Health Center (LCHC) is one of the grantees, receiving $499,866 for its six SBHCs.

Housed in Lynn Classical High School, Lynn English High School, Lynn Vocational Technical Institute, Breed Middle School, Marshall Middle School, and Ingalls Elementary School, the SBHCs provide comprehensive health care to students onsite during the school day. LCHC will add new exam rooms and/or behavioral health rooms at three of the SBHCs, renovate existing space at five of the SBHCs, and provide equipment for all six SBHCs. The goals of the project are: to improve access to health services; to improve effectiveness, efficiency, and quality of care; and to improve privacy for care delivery.

"Students and their families rely on our school-based health centers," said Lori Abrams Berry, LCHC Executive Director. "Our staff are there to help students with health and mental health problems, improving their ability to do well in school. Capital improvements to these facilities will expand our capacity to serve more students. They will also become more inviting, welcoming spaces, encouraging more students and parents to utilize these important and needed services."

LCHC began providing health care services in the Lynn Public Schools in 1987 and opened its first SBHC in 1991 in collaboration with the Lynn Public Schools. Primary care nurse practitioners, behavioral health providers, and case managers provide a coordinated system of primary preventive health care. The SBHCs bring critically needed access to health care for children and adolescents right where they are every school day.

One of LCHC's most significant accomplishments is the development of a collaborative, evidence-based, integrated service delivery model that recognizes behavioral health as an essential component of primary health care. This model of care has been successfully implemented at all six SBHCs. The integration of behavioral health services with primary care is a model that has won recognition for the health center by the Bureau of Primary Health Care as part of its Models That Work Campaign. The integrated horizontal model of care, with multi-disciplinary teams, de-stigmatizes the prejudices associated with accessing mental health care or substance abuse services.

The six SBHCs serve a large proportion of children on Medicaid (76%), low income (80.5%), minority (75.5%), and who speak a language other than English as their first language (53.4%).

Besides physicals and vaccinations, the ten most common diagnoses at the SBHCs include depression, attention deficit with hyperactivity disorder, acute pharyngitis, adjustment disorder with anxiety/depression, episodic mood disorder, asthma, and high risk sexual behavior.

The SBHCs provide comprehensive primary medical care, behavioral health services, case management, lab testing, immunizations, reproductive health services, nutrition counseling, psychosocial assessments, health education, dental services, eye services, and HIV testing and counseling. The SBHCs address student's underlying health and mental health problems, improving their ability to reach academic success. The SBHCs also provide students with positive connections with adults, a valuable resiliency factor.

"SBHCs provide the right care in the right place at the right time for children and adolescents" said Nancy Carpenter, Executive Director of the Massachusetts Association for School-Based Health Care. "SBHCs also help make care more affordable for parent(s) and care-takers, many of whom work in low wage jobs and do not enjoy the luxury of flex-time, tele-commuting, generous vacation or sick time, personal time or other conveniences that let them easily leave their place of employment during working hours to attend to the unexpected health needs of a child, or even to attend a scheduled medical visit."

Collaboration between the Lynn Public Schools, school employees, and SBHC staff is critical. SBHC staff participate in school committees and provide health education in the classrooms. Teachers and guidance counselors provide referrals. SBHC clinicians work with teachers to help them manage students with behavioral or health problems in the classroom. The schools and SBHCs work together to vaccinate a high rate of students for the flu, as well as educate staff and students on how to prevent transmission. After the earthquake in Haiti last year, the SBHC staff worked with guidance counselors in the schools to identify students of Haitian descent and offered them services, including behavioral health care.

"These new investments will help school-based health centers establish new sites or upgrade their current facilities to keep our children healthy," said Secretary Sebelius. "These new or improved sites will help ensure effective, efficient, and high-quality care."

"We know that if kids aren't healthy then kids can't learn," said Secretary of Education Arne Duncan. "These grants will make it a lot easier for working moms and dads to help get their children the health care they need and deserve. This unprecedented investment in school-based health care will bring communities closer together and help children succeed in the classroom."

Donna Coe

There is a boat on the wall, submerged in an acrylic ocean, a seagull painted near the top. Classical music plays softly and through the gentle lighting one can see a Zen relaxation garden on the desk. While this might sound like a scene from the beaches of St. Lucia, it's actually the office of Donna Coe, Director of Lynn's School Based Health Centers (SBHC). It is this room that has offered solace to many students at Lynn Vocational Technical High School, who according to the receptionist, "Come in crying, and come out laughing." 

Dr. Mark Alexakos

Donna always knew she wanted to work with youth, especially women, whom she saw as the stepping stone to a healthier future. Says Donna: "Women tend to be the ones who make healthcare decisions for themselves and their families. As adolescents, they are just starting to make their own health care choices so catching them here is key to the type of long-term decisions they will make for themselves and the families they will eventually raise. So to me, this seemed like the group to target."

When she tried to open an adolescent clinic at Lynn Community Health Center, she found that the youth were not comfortable there. "They saw it as the place their parents and grandparents went for care and they were wary about confidentiality," Donna explains. Some later work in high schools helped her realize that school, where kids are most comfortable, was where she should be. "It's their environment and having the teen health center there makes them feel empowered," explains Donna. So she initiated and led Lynn's SBHC movement, basing herself at Lynn Vocational Technical High School where she has been for the last 20 years. 

Lynn Vocational Technical High School is set up like most SBHCs: a health center located right on school premises. Pending parental approval, primary care and behavioral health services are available to all students. As primary care provider, Donna conducts an initial screening for each first-time student patient. After the initial visit, students return to Donna for physicals, immunizations, sick visits, and reproductive health issues. On Tuesdays, she also provides prenatal visits after school at the parent community health center for pregnant students so they won't have to miss any class. 

From the public health perspective, SBHCs enable providers to reach a whole population, identify problems early and offer preventative care. The onsite convenience enables kids to access care when they need it and without parents having to leave work to bring them to a doctor's office. One of Mark's favorite aspects about SBHCs is the way in which they engender community connections. Parent nights, working with teachers, and bringing parents, teachers, and healthcare providers together to enhance the health of their youth contribute to building a strong sense of community. "ER visits have also decreased," points out Donna. Students who before would have been sent to the ER for something like an asthma attack can now be seen at the SBHC, greatly reducing costs to the health care system and their caretakers.

SBHCs also work to reduce school dropout rates, an issue of high importance since one in five students in the Commonwealth does not graduate.  

Donna and Mark stress the importance of integrating medical and behavioral health services, making referrals to each other whenever necessary. Naturally, they get to know the students well, many of whom they see repeatedly throughout the years. 

"I meet some kids early on and see them through multiple grades," says Mark in reference to his work at Ingalls Elementary School's SBHC. "Children who have early trauma- nightmares, for example, may get more intensive treatment at first and then they may improve, but we're still here for them over the next few years just in case. If they need us, they always have us as a place they can go."

"When I see the successes of some of the kids-- especially those who really struggled-- it's really incredible," echoes Donna. "Some come back a year later and say, 'Because you were here for me, it made the difference,' and it makes me realize that even if they have just one supportive person in their life, that person can be the key to their success. Knowing that we are part of that is huge. It just keeps you going. They almost become kind of like your own kids because you do really get to know them well." 

The SBHCs- both the staff and students- are abuzz with excitement for the recently awarded grant funding. Many of the students have invested interest in "their" SBHC, serving as advocates and publicly attesting to the positive effect it has had on their lives. "To see them excited about their own health- that's what it's all about," exclaims Donna. "Part of the goal is that when they graduate, they will be able to advocate for their own health care." With this new funding, Lynn Vocational Technical High School will finally be able to replace some of their broken equipment and expand for additional office space. More space and functional equipment will make success stories like these possible for future generations. 

The June 1 storm caused significant damage to Caring Health Center in Springfield, including the destruction of 25 employee cars by flying debris.  A preliminary estimate of the damage, which includes facility costs not reimbursable through insurance as well as the storm-related transportation and housing needs of the center's employees and patients, has been set at more than $275,000.  Proceeds of the fund will also be used to help employees and patients of other western and central Massachusetts health centers affected by the storm.

 To make a gift to the fund, please click on the Network for Good link above. 

NACHC Community Health Institute & Expo

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September 23

League 20th Annual Golf Tournament

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