The doctor is in

Big year for school-based health in Colorado

Physician's Assistant Elizabeth Madrid chats with Jade-Marie Burgess and her son Eli at the school-based clinic at Florence Crittenton High School.

Jade-Marie Burgess lifted her two-year old son Eli onto the beige exam table. He was having tummy trouble so she’d gotten a walk-in appointment at the new clinic.

For 18-year-old Burgess, a senior at Denver’s Florence Crittenton High School, the appointment was a cinch. With the clinic just down the hall from her second-hour class and across the courtyard from Eli’s child care room, travel time was about two minutes.

Last year, it was a very different story. When her son was sick, she’d travel with him on two city buses to the clinic at Alameda International High School in Lakewood. The average time away from school was four to five hours.

It was “ridiculously long,” she said.

The clinic—still so new there are no pictures or decorations on its pale green walls—is a major milestone for the school, which enrolls 145 pregnant and parenting teenagers, as well as 109 of their young children.

School leaders believe it will help reduce absences due to illness as well as those associated with long commutes like the ones Burgess experienced.

The clinic, officially called the Alethea D. Morgan, M.D. Health Center, is also part of the reason that school-based health centers are having a red-letter year in Colorado.

Florence Crittenton High School
This new building on the campus of Florence Crittenton High School in Denver’s Valverde neighborhood replaced two cinderblock warehouses and a gravel parking lot.

It’s among five new ones that have opened across the state this fall. That’s an unusually high number for Colorado, which has a total of 61 school-based clinics. The other four new centers are at schools in Aurora, Carbondale, Cortez and Leadville.

The clinic at Florence Crittenton is also the first school-based health center in the state to offer routine obstetric services—everything but ultrasounds and delivery.

Given the population served by the school, it was “a no-brainer to add that component,” said Suzanne Banning, President and CEO of Florence Crittenton Services.

A big lift

Advocates of school clinics in Denver and elsewhere readily admit that establishing such facilities isn’t easy. It takes years of planning and the costs are formidable.

At Florence Crittenton, the clinic is part of a new $8.8 million school building. About two-thirds of that money came from a Denver Public Schools bond issue and one-third from fundraising by Florence Crittenton Services.

Operating costs will run about $200,000 a year, to be covered initially by grant funding and dollars from Denver Health, which operates the clinic.

Currently, the state has a $5.3 million budget line that provides planning, start-up and operations grants for school-based health centers.

“That is enough right now, but as the number of school based health centers grows and that pot is divided among more locations, that won’t be enough,” said Deborah Costin, executive director of the Colorado Association for School-Based Health Care.

Kids in the early childhood education program at Denver's Florence Crittenton High School play on a new playground that was part of a construction project that added a new health clinic, gym and classroom space.
Kids in the early childhood education program at Denver’s Florence Crittenton High School play on a new playground that was part of a construction project that added a new health clinic, gym and classroom space.

Still, there’s evidence that school-based clinics improve health access for kids, particularly those who face the greatest barriers in getting care.

Such barriers are often higher for Florence Crittenton students, who have to manage health care decisions for themselves and their children. Without the same-day appointment Burgess got for her sick toddler at the school clinic, it could have easily turned into emergency room visit, said Banning.

Getting students to make and keep health appointments at off-campus clinics has often been struggle at Florence Crittenton.

“We’ve always seen the challenge the girls had in navigating the health care system,” she said. “We’ve always seen that we set the appointment, but unless we gave them money and a taxicab to get down there, which we often did, they wouldn’t go.”

“Now, they’ve got nirvana,” Banning said as she led a tour of the new brick building that houses the clinic, high school classroom space and a gymnasium.

More clinics on the way

Two more school-based clinics are slated to open in Colorado next year — one on the Boulder Valley district’s Arapahoe Campus and one at a yet-to-be-determined location in the Adams 12 district. The clinics will be the first school-based health centers for both districts.

For many districts, the addition of school-based health centers represents the growing awareness about the link between health and achievement.

The idea is that students with health problems—whether asthma, tooth decay, depression or something else—miss out on learning.

“I think educators are becoming more cognizant of that,” said Costin, even as they work to raise test scores.

“Many of them are saying, ‘Well wait a minute, health is such a big part of this. Even though we’re in the education business, we need to be in the health business too, to move the needle on these measures.’”

 

Funding fight

Colorado poised to slash funding for controversial student health survey

Two years after a controversial student health survey sparked protracted debate at the State Board of Education, questions about the survey’s value have moved to the state legislature — and could mean a loss of $745,000 in state funding for the biennial data collection effort.

Funding for the Healthy Kids Colorado Survey, which comes primarily from the state’s Marijuana Tax Cash Funds, was not included in the proposed state budget earlier this spring and may not return despite requests by the state health department to restore the money.

The health survey is given to a sample of Colorado middle school and high school students in scores of districts every other year. It asks about topics ranging from nutrition to risky behavior, and proponents say it’s crucial for tracking trends and crafting interventions when trouble spots arise.

In addition to $745,000 in state dollars, the survey is funded with $89,000 in federal money. State health department officials said determining whether the survey could continue in a slimmed-down form if state money is stripped away depends on the federal budget.

“The Healthy Kids Colorado Survey is the only comprehensive survey on the health and well-being of Colorado youth,” Dr. Larry Wolk, executive director and chief medical officer of the Colorado Department of Public Health and Environment, said in a statement. “Without funding, we won’t be able to provide the kind of credible health information schools, community groups and local public health agencies need to improve the health of the young people they serve.”

The state Senate is expected this week to debate the state’s budget. The House will debate the budget after the Senate completes its review.

The health survey became the focus of a debate by the State Board of Education and dueling opinions from the state attorney general’s office in 2015 after some parents raised concerns about the explicit nature of questions on sexual behavior, drugs and suicide.

In addition, critics argued that parents should have to give advance written permission — called active consent — in order for their children to take the survey. Over the survey’s 26-year history, most districts have chosen passive consent, which means students are asked to take the survey unless parents sign a form opting them out.

Ultimately, neither the state board nor State Attorney General Cynthia Coffman mandated substantive changes to the survey or consent rules. State officials emphasized throughout the controversy that the survey is anonymous and voluntary. After the state board uproar over the survey, most districts continued to participate.

On Monday, Rep. Bob Rankin, a Carbondale Republican who helped write the state’s budget, said of the survey, “I think enough of us felt that it was just intrusive. I just don’t think it collects good data.”

Not all on the budget committee agreed.

“I support the survey,” said Rep. Millie Hamner, a Frisco Democrat. “Our school districts rely on that information for other grant programs. It is possible in the budget process we’re able to restore that.”

Chalkbeat Colorado’s deputy bureau chief Nic Garcia contributed to this report. 

red zone

Traffic pollution: an invisible health risk for dozens of Denver schools

PHOTO: Google Maps - Street View
Interstate 70 is clearly visible from the playground outside Swansea Elementary School in Denver.

Just a few hundred feet from the front doors of Highline Academy Charter School’s southeast Denver campus is Interstate 25, where more than 200,000 vehicles rush by each day.

At Swansea Elementary School in north Denver, kids frolic near the busy Interstate 70 overpass that abuts the playground. Three miles west, at a charter school called STRIVE Prep – Sunnyside, the same highway looms just past a chain link fence next to the school.

The three schools are among 29 in Denver Public Schools — 10 of them charters — that sit near high-traffic roads and the invisible air pollution those routes generate daily. Experts say such pollution can stunt lung development, aggravate asthma and contribute to heart disease, but there’s little public awareness about the problem and mitigation efforts are sparse.

A new online mapping tool, part of a joint investigative project by two nonprofit news organizations, the Center for Public Integrity and Reveal, puts the issue in stark relief. Residents across Colorado and the nation can easily check which schools fall into red zones where traffic volume, and the accompanying air pollution, is worst, and orange zones where traffic volume is lower, but still potentially problematic for kids and staff who may spend long hours at their schools.

PHOTO: Center for Public Integrity and Reveal
This screen shot of the mapping tool shows Highline Academy’s proximity to Interstate 25 with a blue pin.

The Center for Public Integrity provided Chalkbeat with raw data for schools with Denver addresses. While most were DPS schools, a couple dozen were schools in neighboring districts, including Cherry Creek, Aurora, Westminster, Mapleton, Sheridan and Jefferson County.

Eleven DPS schools — educating more than 8,000 students — fell into the red zone, which means they sit within 500 feet of roads carrying more than 30,000 vehicles a day on average. Those include charters such as Highline and Strive Prep – Sunnyside, and traditional public schools such as Swansea and Steele elementaries and George Washington, Lincoln and East high schools.

Another 18 district schools, plus one in the Cherry Creek district and one in the Adams 12 district, fall into the orange zone, which includes schools that are within 500 feet of roads carrying more than 10,000 vehicles and more than 500 trucks daily. The 18 DPS schools include two additional STRIVE – Prep locations, two schools inside the downtown administration building and the district’s magnet school for students designated as highly gifted: Polaris at Ebert Elementary.

DPS officials say air pollution resulting from schools’ proximity to busy roadways hasn’t been discussed previously and that mitigation measures — such as high-grade air filters — aren’t in place at most affected schools.

“We haven’t had this conversation before,” said district spokeswoman Alex Renteria.

Sometimes schools end up near busy roadways because that’s where districts can buy cheap land. But population growth, development trends and major transportation projects can also dramatically change the fabric of a school neighborhood. Swansea Elementary, for example, was built in 1957, before I-70 sliced through north Denver in the 1960s.

The problem of traffic-related air pollution near schools is not exclusive to big cities like Denver. It can be found in suburban and rural areas around the state and the rest of the country. Many school districts across Colorado — from Montrose to Steamboat Springs to Greeley — have at least one school within 500 feet of high-traffic routes.

Charters harder hit

The investigation by the Center for Public Integrity and Reveal, which looked at trends nationwide, found that charter schools are more likely than traditional public schools to be located close to busy roads.
That’s true in Denver, where 22 percent of the district’s charter schools were located near a busy road during the 2014-15 school year, compared to 13 percent of other district schools. Nationwide, about 9 percent of schools are near busy roads, according to the analysis.

Officials at the most impacted Denver charter schools had little to say about the issue of traffic pollution.

Christine Ferris, executive director of Highline Academy, wrote in an email: “We can’t really do much about our location and although it would be obvious to anyone who visits us, having the information highlighted on Chalkbeat isn’t my favorite idea.”

She canceled a subsequent interview with Chalkbeat.

Chyrise Harris, senior director of communications and marketing for the STRIVE Prep charter group, said via email, “STRIVE Prep operates all of its schools in district facilities and works collaboratively with the district to ensure that all students, regardless of where they live, have access to a safe, high quality school near them.”

Jessica Johnson, general counsel and director of policy for the Colorado League of Charter Schools, said in growing cities like Denver there’s limited inventory when it comes to school sites. Charter schools may end up along high-traffic routes because that’s where the chartering district has vacant space and also because such roads provide needed proximity to bus or train stops.

Of the 10 Denver charter schools near busy roads, seven are in district-owned buildings. The three that aren’t are Highline, Cesar Chavez Academy and Justice High School.

While Johnson said being close to busy roads is a fact of life for urban charter schools, she noted the impact of traffic-related air pollution is an important health and wellness issue — one that hasn’t been on the charter community’s radar.

“This isn’t an issue that we’ve seen a lot of research into locally or a lot of conversation on,” she said.

Mitigation measures

Vehicle exhaust contains a variety of harmful components, including small particles, carbon monoxide and carcinogenic compounds. While outdoor areas like school playgrounds and sports fields pose an obvious risk, the air inside buildings can suffer, too, because particles, vapors and gases often seep inside.
High-grade air filters — those rated MERV 16 — can make a big difference. According to the Center for Public Integrity and Reveal investigation, MERV 16 filters installed in California schools caught about 90 percent of fine and ultrafine particles, which are key contributors to traffic-related health problems.

Denver schools use lower-grade filters, those rated either MERV 8 or MERV 10, according to district officials.

Air-conditioning can also help somewhat, allowing schools to keep some pollution at bay by shutting doors and windows in hot weather. Of the 29 DPS schools most impacted by roadway pollution, only four don’t have at least partial air-conditioning. Those are Valverde and Steele elementaries, Polaris at Ebert Elementary and STRIVE Prep – Sunnyside. While a handful of the 29 schools will get additional air-conditioning with funds from Denver’s recent voter-approved bond, those four are not on the list.

Swansea Elementary, the second most impacted Denver school after the southeast Highline Academy location, will be getting short-term and likely longer-term relief from traffic pollution.

Renteria said as part of a project underway now, the school is getting a new heating, ventilation and air-conditioning system that will include MERV 16 filters. It will also get new doors and windows.

Additionally, a planned highway widening project will convert the current overpass next to Swansea to a covered below-grade route. Research from the Environmental Protection Agency suggests vehicle emissions are lower near below-grade roads with steep walls. The same is true for routes with certain kinds of sound barriers or roadside vegetation.

The city will monitor air quality on Swansea’s grounds during and after construction.

Here is the list of schools classified as “red” or “orange:”

Red Zone Schools

SCHOOL DISTRICT CHARTER STATUS
Highline Academy (southeast) Denver charter
Swansea Elementary School Denver
STRIVE PREP – Sunnyside Denver charter
Compassion Road Academy Denver
Steele Elementary School Denver
George Washington High School Denver
Respect Academy at Lincoln Denver
Abraham Lincoln High School Denver
College View Elementary School Denver
Valverde Elementary School Denver
East High School Denver

These “red zone” schools are within 500 feet of roads carrying more than 30,000 vehicles a day on average.

Orange Zone Schools

SCHOOL DISTRICT CHARTER STATUS
STRIVE Prep – Federal Denver charter
Columbian Elementary School Denver
Denver Center for International Studies Denver
Colfax Elementary School Denver
Cheltenham Elementary School Denver
The Odyssey School Denver charter
Contemporary Learning Academy Denver
STRIVE Prep – Ruby Hill Denver charter
Cesar Chavez Academy Denver charter
Girls Athletic Leadership School Denver charter
Bruce Randolph School Denver
Downtown Denver Expeditionary School Denver charter
Emily Griffith Technical College Denver
Dora Moore ECE-8 School Denver
Justice High School Denver charter
Polaris at Ebert Elementary School Denver
Bromwell Elementary School Denver
Rocky Mountain School of Expeditionary Learning Denver charter
Challenge School Cherry Creek
North Star Elementary School Adams 12

These “orange zone” schools are within 500 feet of roads carrying more than 10,000 vehicles a day and more than 500 trucks on average.