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.’”

 

Kids eat free

Colorado could expand lunch subsidy to high school students

PHOTO: Helen H. Richardson/The Denver Post
Bernadette Cole serves food to students at Prairie View High School in Brighton.

When Colorado expanded a school lunch subsidy to middle school students, the number of sixth- through eighth-graders eating lunch at school went up in districts across the state.

Twenty-sixth percent more middle school students ate lunch at school in the Greeley-Evans district, where a majority of students live in poverty, but even in the more affluent Littleton district in Denver’s south suburbs, 11 percent more middle school students ate lunch.

For school nutritionists and children’s advocates, these kinds of results make the case for extending this same lunch subsidy to high school students.

“We know the co-pay is a barrier because of the large uptick in participation when it goes away,” said Erin Miller, vice president of health initiatives for the Colorado Children’s Campaign.

The “co-pay” is the 40 cents per meal that families who qualify for reduced-price lunch — but who make too much money to qualify for free lunch — are responsible for. The federal government picks up most of the cost for these lunches, and since 2008, Colorado has covered the 40 cents for the youngest students, rendering those lunches free to their families. This program has gradually expanded, reaching middle school students in legislation passed last year.

A bill that passed out of the House Education Committee Thursday would cover the 40-cent cost difference for high school students, a longtime goal of advocates.

“The state of Colorado has been trying to ensure that kids in poverty have access to food for a decade,” said Danielle Bock, nutrition services director for the Greeley-Evans district and a public policy and legislative consultant with the Colorado School Nutrition Association. “This is the final step.”

Miller said hunger affects children in school not just academically but also emotionally, with hunger even associated with higher suicide rates. Advocates have pushed to expand the state subsidy because participation in school lunch goes down as children get older, even as their caloric needs go up.

Currently, households that earn less than 130 percent of the federal poverty level, or $32,630 for a family of four, qualify for free lunch through the federal program. Families who earn between 130 and 185 percent of the federal poverty limit, or up to $46,435 for a family of four, qualify for a reduced-price lunch. It’s children from that second category families who will benefit if this bill becomes law.

Bock said the vast majority of school food service agencies in Colorado have unpaid lunch debt that, under federal law, they can’t just write off. School districts either pick up the costs out of their general fund or try to collect from parents, which sometimes leads to the controversial practice of “lunch shaming,” in which schools serve less nutritious and appealing alternative lunches to students whose parents owe money.

Lawmakers started out wanting to ban lunch-shaming, but school nutritionists convinced them it would be better to have the state cover some of the extra lunch cost for families who are struggling to make ends meet.

When Denver ended the practice of serving “alternative” meals to families who hadn’t paid for lunch, the amount of lunch debt skyrocketed, with a large portion of it coming from families who had not signed up for subsidized lunches and might have the means to pay.

According to a fiscal analysis, Colorado plans to spend $2.2 million on lunch subsidies this school year. Expanding the program to high school students would cost an additional $464,000 next year, with that money going into school food service budgets.

pass the microphone

This Memphis senior was kicked out of three high schools. Here’s how he got on track to graduate.

PHOTO: Gillian Wenhold, The Social Exchange
Despite what John Chatman calls a “really tough childhood” where he was often left on his own, he’s on track to graduate from alternative school G.W. Carver College and Career Academy this year.

In front of more than 100 people, John Chatman recalled the bullying he endured as a child for having a stutter.

Chatman was one of seven educators and students who took the mic at Chalkbeat’s February story storytelling night. The stories centered around school discipline practices, a topic we recently covered in this special report.

“Growing up in the area I grew up in, it’s hard to deal with that,” said the 18-year-old. “You’re an outcast. … It made me hate school, because I never could enjoy it. I may answer a question and stutter, [and other students would] get to laughing and cracking jokes.”

Kids stopped making fun of him in middle school when Chatman became a star middle school football player in Memphis — but the prestige that came with playing football disappeared when he was injured on the field.

“I took my injuries and replaced them with the streets,” Chatman said. “Throughout my ninth-grade year, I was starting to lose myself. … By 11th grade, I didn’t know who I even was.”

During that period, Chatman said he was kicked out of three high schools and eventually wound up at G.W. Carver College and Career Academy, an alternative school for expelled students, housed in former Carver High School.

“This school changed my life forever, Chatman said.

To hear more about how Chatman’s life changed, watch the video (or read the excerpt) below.

The storytelling night was hosted by Chalkbeat Tennessee, Spillit, and The Knowledge Tree. The video was filmed by Gillian Wenhold for The Social Exchange, a pay-as-you-can public relations and content creation firm for nonprofits, and businesses owned by women and people of color.

My 11th-grade year was the time I decided I had to change. The change was when I finally got kicked out of school. Well, I’d been kicked out of school but this was the kick-out-of-school that kicked me in my back real hard and said you only have one strike left. If you mess this up, this is it. It’s over with. You’re not going to see the light of day. Due to that, I ended up going to Northeast, and it still didn’t get better. In fact, I’m going to tell y’all the transitions of my schools. It started at ninth grade at Central, couldn’t come back to Central and I had to go to East , got kicked out of East and went to Northeast. Got kicked out of Northeast and now I’m back at Carver.

I’ll tell y’all, this school changed my life forever. I wouldn’t be here right now if it wasn’t for that school. It happened like this. There was a guy named Roger. We used to run together during the same time period. …

[During a presentation of past Carver graduates], an image of Roger popped up clear on the screen. It wasn’t up for nothing bad, he was on the road to making a six-figure [salary]. I was like, ‘This was the same person I used to shoot dice with?’… Now he’s living a life and I’m stuck here. I’m still doing the same stuff I’ve been doing and not getting no different result, and that’s called insanity… I took it, and I told myself if he can do it, I know I can.

Spillit, storytelling
PHOTO: Xzavier Bonds
Chatman speaks to a packed room during Chalkbeat’s storytelling event.