Faces of the Safety Net: Community Health Services School-Based Health Centers Adams County School District 14

by Jessica Waclawski

The bells of Adams City Middle School ring and the halls fill with young teenagers carrying backpacks and books, eager for their lunch break. Nina McNeill turns to lock the door behind her.

“It’s typical that I get a lot of visitors during the lunch hour,” said McNeill who is the nurse practitioner at the school’s clinic. A narrow hall leads the way to a former darkroom that McNeill has transformed into her office and exam room.

“The beauty of school-based health centers (SBHCs) is that they keep kids in school,” said McNeill while sitting down at a desk that is lost against a wall filled with detailed posters about nutrition and tobacco use.

Primarily seeing walk-ins, McNeill consults kids each day for sport physicals, sore throats or weight checks. As she warned, the lunch period brought many persistent knocks at her door. McNeill stated that students are commonly looking to just stop in to say hi and chat.

“School -based health centers act as a resource for the students. These kids have a lot of concerns and having a clinic on the campus makes it easier to ask questions and to get answers,” commented McNeill. “It allows them to act independently while being responsible and teaches them early about how to understand their family’s medical history. This all works together toward preventing health problems in the future.”

Through recent data-collecting efforts, McNeill has realized that 30-40 percent of the middle school students are without health insurance. Trying to align students with a health insurance program is a part of the partnership that the middle school has with Community Health Services (CHS) which acts as a home base for the surrounding SBHCs in the community.

“The relationship Community Health Services has with the middle school is essential. Without it I wouldn’t be here,” said McNeill.

As the administrative hub for all the SBHCs in Adams County, CHS is responsible for the recruitment of providers for all of the clinics. It is also in charge of managing funding opportunities through its own staff. On top of all of this, CHS is a clinic for the community and acts as the SBHC for the Adams City High School which is across the street. The school district owns the land that the CHS building is on which allows it to be considered a part of the high school’s campus. 

“Instead of taking a day off to see a doctor, kids can come here during their free hour,” said Betty Pepin, CHS executive director. “We’re where the kids are. If they aren’t in school, they aren’t learning.”

CHS is the oldest SBHC program in Colorado, beginning in 1978 with a grant from the Robert Wood Johnson Foundation. Through its many years, CHS has learned the importance of helping families navigate insurance options available for their children.

“Getting these kids insured is the best service we can provide,” said Pepin. “If they don’t already have access, we make it happen.”

Across from Pepin’s office sits Maria Zubia who is the community outreach and resource coordinator.  Zubia assists families as they work through the confusion of health insurance application forms. She explains that the complicated process of applying for health insurance often deters families from applying because it is too difficult and felt to be not worth the time.

“Along with the large number of uninsured, I’d like to see numbers that reflect how many of the uninsured have tried to get a card and failed,” reflected Zubia, whose desk is piled high with cases she is trying to work through. 

To the local community, CHS is known as “la clínica chica,” the little clinic, or as Zubia calls it, the one-stop shop.

Cries from an anxious child can be heard from behind an exam room door.  A mother’s voice attempts to console her child in-between the tears while a bilingual nurse discusses in Spanish how to apply for insurance and educates the mother about the antibiotic medication her child needs. The door abruptly opens and the nurse dashes across the hall into a small office. From a freezer she grabs a pink Popsicle and disappears into the exam room where the cries quickly subside.

“We want to be family friendly and we believe in scheduling enough time for our appointments so that we can take full advantage of each visit,” commented Pepin as she discussed the importance of educating families on health care and healthy living.

Deb Crennen has been a nurse practitioner at the clinic for over 10 years and is passionate about the community she serves. “I am able to provide necessary and basic education by just spending more time with families. It’s not a difficult job to do. Giving appropriate time to our patients is a high priority for the clinic.”

CHS goes beyond offering primary care to providing car seat inspections to ensure that children seen in the clinic are also riding safely as passengers. If a replacement seat is needed, they are available at a discounted price of $25 and are properly installed by a certified technician.

“We are looking at the total picture of health,” said Pepin as she walked toward a back office. In the corner is a floor-to-ceiling bookshelf that is stacked full of an assortment of books. Every child who receives a well-child check up walks away with an age-appropriate book from the shelf.

“Literacy goes hand in hand with health, especially concerning the growth and development process,” explained Pepin while glancing over the nursery rhymes and Chicken Soup for the Teenage Soul. The collection of books is either donated or bought by the clinic’s own nurses. Families can also take a goody bag filled with items like tooth brushes, underwear, socks or diapers.

From elementary school through high school, CHS provides opportunities for children to receive basic health care services while learning. The Colorado Student Assessment Program (CSAP) places greater pressure on a student‘s performance, and missing class due to poor health can hinder a child’s ability to do well on the assessment. 

“It takes a lot of time and effort to provide health care to these kids,” said McNeill who also offers after-school programs such as cooking classes to teach students how to prepare quick and healthy meals. “Teachers already have too much on their plates, especially with CSAP. Family, friends and school are all key players in shaping adolescents’ well-being. School-based health centers have the ability to work with each of these.”

McNeill will soon be able to move out of her crammed exam room into an expanded space that is specifically designed to be an effective SBHC in the middle school. Through a grant made possible from The Colorado Health Foundation, Kearney Middle School will also be expanding into a modular building on campus that will accommodate an SBHC where a nurse practitioner, full-time mental health counselor and part time psychiatrist will work to provide integrated care.

“Through all these changes, we’ll still be here,” assured Pepin who will be stepping out of her position as director in the fall of 2008. “As long as there are kids needing care we’ll be providing it.”

CHI Contact:

Jessica Waclawski
Research Assistant
303.831.4200 X222