Oakland schools add more clinics offering medical treatment, therapy right on campus

Sitting around the conference table at Frick Middle School’s newly-opened health center this week, a group of seventh-grade girls finished up lunch and discussed the trials and tribulations of Oakland adolescence.

“People think at our age that we should try new things, and some people try the wrong things,” said a 12-year-old, adjusting her glasses.

“You can come here for guidance if someone is trying to pressure you to do something you don’t want to do,” said a classmate in a blue sweatshirt. “Say something was wrong with your body.  Or you were too nervous to go to your parents, so you wanted to come here.  They’ll tell you, ‘It’s normal, because you’re going through changes as you’re getting older.’”

A tall student at the head of the table nodded.  “A lot of kids here have problems in their families,” she said. “So you can come here and get a pregnancy test, or get tested for something,”

The girls were just a few of the Frick adolescents who walked into the newly-renovated facility on Tuesday, strode right up to the front reception desk, and requested everything from Band-Aids to doctor’s appointments. The multi-room site is situated in the rear of Frick’s sprawling campus, next to the school’s basketball courts and overlooking the yard where students eat lunch and participate in physical education classes. Beyond the desk, where visitors are greeted by José Hernández, Frick’s academic case manager and health advocate, are two fully-equipped examination rooms, a laboratory for blood and urine tests, a medical chart room, nurse’s office, two mental health offices, a meeting room and a conference room.

“We have a lot of kids that come through for first aid, mental health, making appointments,” said mental health clinician Kara Schmitt, leaning against the reception desk outside her office. “We also go out during the lunch hour and do some health-geared workshops with the kids,” said Schmitt, who works as health care coordinator for the East Bay Agency for Children, the organization providing services at Frick.

Frick’s center, which has been open to students since mid-October, is the newest addition to the Oakland Unified School District’s nine school-based health centers, all providing medical, mental health and health education services for students and their families—at no cost, and in a place that is already part of their daily lives.

“Children spend most of their waking hours at school,” said OUSD spokesperson Troy Flint. “In order to achieve at high levels, you have to create an environment in which high levels of learning are possible. Unfortunately, that’s not possible at every school, and certainly not in every neighborhood. To compensate for the deficiency in surrounding neighborhoods and the lack of health care, mental health care and lack of resources, we provide it in a school setting.”

Oakland’s first school-based health center opened in 1989 at Fremont High School as part of a growing national movement toward providing on-site medical services at schools. Over the next two decades, centers opened at Hawthorne Elementary, Oakland Tech, Roosevelt Middle School, McClymonds High School, Castlemont High School and Oakland High. According to Mara Larsen-Fleming, the OUSD school-based health center program manager, there had been a long-standing community demand for such facilities, and the original centers were met with an overwhelmingly positive response.

Fifteen sites—the expansion is funded through grants from sources including Kaiser Permanente and Atlantic Philanthropies— are expected to be operational by the end of the 2011-12 school year. Besides Frick, which serves sixth through eighth grades, schools with new on-site centers opening this fall include Skyline High School and Elmhurst, West Oakland and Havenscourt middle schools.

“It fits so perfectly with our commitment to improving the health of the community we serve,” said Jean Nudelman, director of Kaiser’s Northern California community benefit programs. “One of our focus areas is on access to care and coverage in low-income populations. Also, it’s our headquarters city, Oakland. There’s a need in Oakland to respond in this way, both to kids and families.”

Kaiser’s funding for Frick is being distributed through the East Bay Community Foundation; and services at the health center are provided by both the Native American Health Center, a non-profit clinic that serves patients regardless of tribal or ethnic identity, and the East Bay Agency for Children, which already had two mental health therapists working at Frick.  One of them was Kara Schmitt.  “We’ve developed relationships here, and been collaborating with teachers and staff for years,” she said.

Schmitt and her Frick colleagues work with students every school day. A school nurse holds hours at the center Wednesdays through Fridays. A Native American Health Center nurse practitioner sees patients for medical appointments on Fridays.

All the OUSD sites provide mostly mental health services and basic primary care—physicals, first aid, prescriptions, immunizations, STD screenings, pregnancy tests, and ongoing care for conditions like asthma and diabetes.  Frick, like the other schools, asks parents to submit a signed consent form for students to use the health center, which serves students in grades six through eight. The forms grant permission to providers to perform outine clinical duties, like dispensing Ibuprofen or Tylenol or treating minor ailments like injuries or rashes.  Additional parental consent forms must be submitted for students to receive mental health services. “Sensitive services”– which include STD screening, birth control counseling and pregnancy testing — can be provided to students over the age of 12 without additional parental consent beyond the general authorization form.

In addition to making a variety of health services easily accessible, hosting the health center on campus benefits students in other ways, Larsen-Fleming said. “Some of our students are grieving because they’ve lost a family member in a violent way,” she said. “We need to have programs on-site that support and mitigate those issues for them so they can learn.”

Though parents must sign additional counseling consent forms, everything shared in therapy remains confidential. Clinicians are however, obligated to report if they feel the student is in danger— and Larsen-Fleming said the on-site clinicians encourage as much parent-child interaction as possible, and welcome families to participate in the services.   Most of the health centers stock a supply of snacks and juices to hand out to students who come in complaining of hunger. The centers have also built relationships with community food banks, and can connect students and families to those agencies if necessary.

“It benefits the climate of the school in general because it’s open to parents, too,” Hernández said. “A lot of times, it’s hard to get a hold of parents because either the phone’s cut off or they’re just working. So if they start coming in here for the kids’ appointments and for their own appointments, there’s more time and more things to talk to them about.”

The students themselves are usually the best sources of information, Hernández said. “Every week we asked the kids a different question,” he said, pointing to sheets of marker-scrawled butcher paper adorning the clinic walls. ‘What does being healthy mean?’ ‘How do you see your community?” ‘Why do people join gangs and how do you think you can stop it?’ ‘What stresses you out and how do you cope?’”

Students’ handwritten responses to questions like “What is something positive you would like to see in your community?” decorate the walls of Frick’s health center and help inform staff of their needs.

An assortment of multicolored, handwritten words and phrases scribbled directly on the posters represent the students’ responses to the question, “What is something positive you would like to see in your community?” The responses included “No killing? No robbery,” “Feed the hungry,” and “No violence. No gangs.”

Hernández and Schmitt believe the availability of on-site services will take the pressure off of parents who are unable to accompany their kids to appointments while providing students easy access to care at no cost. According to Schmitt, many students do not have primary care physicians or permanent medical homes, so on-site services are an alternative to the emergency rooms many of them frequent for general healthcare. On-site appointments are also generally scheduled during lunch or before and after school to minimize the amount of class time missed.

Plans are still in place to continue the school-based health center expansion in Oakland, despite this week’s announcement of several school closures.

Larsen-Fleming said the proliferation of these school-based health centers will help address the needs of students, families and the larger community. “I grew up in Oakland and I like to say it’s a city that has many, many blessings and also many challenges,” she said. “Many of our children and families have huge challenges. By providing health services on-site, we’re trying to meet those needs.”

The sweatshirt-sporting seventh-grader eating lunch around the conference table Tuesday agreed. “The health center actually has done a lot because now people can come in here and not be stressed out and ask questions without being nervous,” she said. “It’s actually a great place to come because it’s not only for the school. It’s for the community.”