Delivering Mental Healthcare Where Children Are: At School

Research shows that one in five youth have diagnosable mental health conditions and only 50%-80% of them receive treatment for their diagnoses. School-based clinics are one way to augment access to quality care for these individuals.

Studies of school-based health clinics find that children and adolescents with mental health diagnoses are frequent users. In fact, a recent study published by the Journal of School Health found that children who saw school-based mental health providers visited the school-based health clinic five times more frequently than students seeing only a primary care provider. This comes as no surprise to Roopa Thakur, MD, FAAP, pediatrician and Medical Director of Cleveland Clinic’s School-Based Healthcare clinics.

“Part of what we’re trying to do in our Center is get creative about how to provide medical services where the patients are, instead of expecting them to come to us all the time,” says Dr. Thakur. “For example, our in-school clinic at Lakewood High School provides both medical and mental health services because anxiety and depression were identified as primary concerns within the school district.”

In January 2018, the program opened its first in-school clinic at Lakewood High School, offering medical care five days per week and mental health services four days per week. “When we form a partnership with a new school, we have them complete a needs assessment to be sure we’ll be providing services that they actually need – and to determine if we have the right resources for them,” Dr. Thakur says. “We’re finding more and more that mental health services are needed. I wasn’t surprised by the nature of this need, but I was surprised by the magnitude.”

Mental health providers at Lakewood now include a psychologist, a psychiatrist and a patient navigator who helps coordinate mental health treatment with other organizations outside of the program. Dr. Thakur believes this is a step beyond what other school-based programs are doing and points to the popularity of these services. “Over half of the visits to the clinic are for mental health services,” she says.

A Pediatrician’s Office on Wheels

According to the National Center for Children in Poverty, 43% of Ohio’s children live in low-income households. Their families face many socioeconomic challenges, including access to medical care.

Cleveland Clinic Children’s School-Based Healthcare program for grades K-12 is working to change that. The program was established in 2014 to provide care to children where they spend much of their time: at school.

“What I love about this program is that if you can’t come to us, we will come to you,” says Dr. Thakur. “A lot of kids can’t come into the office because their parents can’t take off work or there are transportation issues.”

Now serving six area school districts, the program provides health and wellness services in a mobile unit, which Dr. Thakur says is like a pediatrician’s office on wheels. Services include complete physical examinations that may be used for sports physicals, camp, college and work authorizations; comprehensive healthcare, including diagnosis and treatment of acute and chronic illness; immunizations; health screenings for vision, hearing and scoliosis; first aid and more.

The program also provides epinephrine auto-injector prescriptions and training for school personnel to administer epinephrine to students who have life-threatening allergic reactions.

Parents must enroll their children in the program and complete a pre-visit questionnaire so providers know a child’s medical history before the first visit. Providers call the parents after the visit to review the specifics, and an after-visit summary is sent home in an envelope with the child. Parents are always welcome to attend appointments.

School-based preventive care an important tenet of population health efforts

Population health is a hot topic for medical providers. Dr. Thakur defines it as the opportunity to address the need for high-quality preventive care to improve the short- and long-term health outcomes of an entire community. “I believe that our School-Based Healthcare program is one of the most innovative ways to provide that high-quality care to patients who might not otherwise have a medical home,” she says.

A two-year grant from the Council for Economic Opportunities in Greater Cleveland has allowed the program to test for lead in preschoolers enrolled in Head Start. “Lead poisoning is a huge issue in Cleveland,” Dr. Thakur explains. “We’ve made great strides recently with legislation passed by Cleveland City Council to make Cleveland lead-safe. During the 2018-2019 academic year, more than 130 families received education and over 100 children were screened at five community Head Start events attended by our mobile unit.”

Although most students have health insurance through Medicaid, the School-Based Healthcare program has financial counselors to help enroll families who are not yet covered. Children receive services regardless of their insurance status.

Dr. Thakur also is enthusiastic about the impact of technology on the program. “Looking ahead, we’re particularly excited about the possibility of implementing telemedicine services as part of the School-Based Healthcare program. That way, if a patient needs care but is physically located somewhere other than where our mobile unit is parked, we may still be able to provide them services, including behavioral and mental health services.”