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.’”

 

Not long for this world

Denver teen pregnancy prevention organization to close its doors at the end of the year

PHOTO: freestocks.org

A Denver-based nonprofit focused on teen pregnancy prevention and youth sexual health will close its doors at the end of 2017 after losing two major grants.

Andrea Miller, executive director of Colorado Youth Matter, announced the news in an email to supporters Monday afternoon.

The organization, begun in the 1980s as a volunteer-run group, provides teacher training and assistance in picking sex education curricula for 10 to 25 Colorado school district a year.

Miller said she’s hopeful other organizations will pick up where Colorado Youth Matter leaves off — possibly RMC Health, the Responsible Sex Education Institute of Planned Parenthood of the Rocky Mountains or the state-run Colorado Sexual Health Initiative.

Colorado Youth Matter’s biggest financial hit came in July when federal officials announced the end of a major teen pregnancy prevention grant mid-way through the five-year grant cycle. That funding made up three-quarters of Colorado Youth Matter’s $1 million annual budget.

“It feels like we’re getting cut off at the knees,” Miller said.

About the same time, the organization lost a family foundation grant that made up another 10 percent of its budget.

Miller, who took the helm of the organization just 10 months ago, said one of her primary goals was to diversify funding, but there wasn’t enough time.

Miller said with a variety of factors playing into the state’s teen pregnancy rates, which have been at record lows in recent years, it’s hard to say what the impact of the organization’s dissolution will be.

She said Colorado Youth Matter has worked successfully with school districts with different political leanings to find the right policies and resources to address the sexual health of their students.

“We have been masters at meeting the school districts where they are,” she said.

Wanna go outside?

Less plastic, more trees: New effort seeks to reinvent preschool playgrounds and capture kids’ imaginations

This play structure at Step By Step Child Development Center in Northglenn will go away under a plan to create a more natural and engaging outdoor play space.

Michelle Dalbotten, the energetic director of a Northglenn child care center called Step by Step, doesn’t like her playground.

Sure, it’s spacious, with a high privacy fence bordering an adjacent strip mall parking lot. It’s also got a brightly colored play structure surrounded by lots of spongy rubber mulch.

But Dalbotten and her staff have long noticed that the kids get bored there. They clump together in the small shady area or on a few popular pieces of equipment. Sometimes, they start throwing trucks off the play structure or shoving their friends down the slide.

Something about it just doesn’t work.

Recently, Dalbotten found a solution in the form of a new grant program called the ECHO initiative, which aims to reinvent more than 100 preschool and child care playgrounds across Colorado over the next few years. Think mud kitchens, looping tricycle trails, vegetable gardens, stages, shady reading nooks and dump truck construction zones.

The idea is to create outdoor spaces that capture kids’ imagination, connect them with nature and keep them active in every season. Such efforts grow out of a recognition in the education field that healthy habits start early and boost learning.

The current preschool playground at Step by Step is covered by rubber mulch.

Step by Step staff members had talked many times about their stagnant play space. But it was hard to envision anything different until they attended a design workshop with experts from ECHO, a partnership between the National Wildlife Federation, Qualistar Colorado and the Natural Learning Initiative at North Carolina State University.

“We knew we were missing the boat somewhere because (the children) weren’t super-engaged and we had a lot of behavioral issues,” Dalbotten said. “But we just couldn’t see past it, I guess.”

For child care providers, it’s a common challenge, said Sarah Konradi, ECHO program director with the regional office of the National Wildlife Federation

“This is a very new idea to a lot of folks,” she said. “It’s hard to sort out as a layperson.”

ECHO, borne out of a decade of research from the Natural Learning Initiative, will hand out $355,000 in grants over the next three years. The initiative prioritizes centers that serve children from low-income families or other vulnerable populations.

Fourteen centers — Step by Step and Wild Plum Learning Center in Longmont are the first two — will get $10,000 awards for serving as demonstration sites willing to host visits for other Colorado providers.

Leaders at Step by Step say kids and teachers often congregate in the limited shady spots.

Around 100 other centers will receive ECHO’s $5,000 seed grants and expert assistance to revamp their outdoor spaces.

Such transformations can have a big impact on children who may spend thousands of hours a year at such centers, said Nilda Cosco, director of programs at the Natural Learning Initiative.

“When we do a renovation of the outdoor learning environments as we call them — not playgrounds — we see increased physical activity … more social interactions among children … less altercations,” she said.

“The teachers have to do less because the children are so engaged. There is so much to do.”

ECHO, which stands for Early Childhood Health Outdoors, is the latest iteration of a program Cosco started a decade ago called “Preventing Obesity by Design.” That effort revamped outdoor space at about 260 child care centers in North Carolina, South Carolina and Texas.

Cosco said such makeovers can ”prevent obesity by counteracting sedentary lifestyles. Children walk more, exercise more, are conversant with healthy eating strategies.”

Dalbotten and her staff have big plans for their play areas, which sit behind a plaza that houses a bingo hall, Dollar Tree and Big D’s Liquor store. They’ll get rid of the colorful play structure and the rubber mulch in favor of a more natural look. There will be trees, shrubs, small grassy hills and a winding trail leading to a wide array of activity areas.

This porch will get new lighting, fencing and foliage to make it a more attractive outdoor space at Step by Step.

The center’s smaller toddler playground will get a similar reboot and its tiny yard for babies — mostly bare except for a couple low-hanging shade sails — will be expanded to include a shaded deck where teachers can sit or play with babies. A barren concrete porch on the side of the building will be remade into a cozy activity area decorated with bird houses, planter gardens and butterfly-attracting foliage.

At the recent design workshop Dalbotten attended, ECHO leaders displayed photos from other centers around the country that have gone through outdoor transformations. She saw one that stuck with her.

“There were kids everywhere,” she said. “It was super cool looking. I was like, ‘Oh look, we can be that. We can have kids everywhere.’”

PHOTO: Natural Learning Initiative
The play space at Johnson Pond Learning Center in Fuquay-Varina, NC, after a makeover.
PHOTO: Natural Learning Initiative
The outdoor play space at Spanish For Fun Academy in Chapel, Hill, NC, after a makeover.