Amanda Wilde (Host): Welcome to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. I'm Amanda Wilde, your host, with pediatric nurse practitioner Colleen McEvoy, who is here to fill us in on school-based health centers, what they are, how they work, and the ways they're expanding access to care for local students and families. Colleen, thank you so much for being here.

Colleen McEvoy, RN: Well, thank you for having me. It's a topic I care about a lot. So, I'm glad to be able to talk about it.

Host: You are passionate about the care you provide. And I know you have a special interest in teens and families. What got you interested in adolescent medicine?

Colleen McEvoy, RN: Well, when I initially wanted to study to be a nurse practitioner, I thought of going into women's health. And then, I worked in a pediatric clinic, and I really loved pediatrics. And adolescence is a time where you can, I hope, affect good change for youth and help them learn how to access healthcare and help them, you know, succeed as they become adults.

Host: So, pediatric clinic was your gateway to this interest. For families who may not be familiar with them, what is a school-based health clinic or center?

Colleen McEvoy, RN: A school-based health center is a clinic or health facility located on or near a school campus that is usually run by an outside health agency like a hospital or a clinic. And they operate in coordination with a school district to provide healthcare for students. For example, California has about 250 school-based health centers, and that number has been growing because it allows students to be seen where they are every day and get good healthcare.

Host: Well, what types of services do students receive through a school-based health center?

Colleen McEvoy, RN: it varies. Some school-based health centers, for example, are located at elementary schools, some are middle, and some are high schools. There is also usually some on college campuses. And I primarily have worked in high school-based clinics. There, we provide a full range of services related to reproductive health services, birth control, STD testing.

But also, the majority of what I usually do is other services. Mental health being huge right now, huge issue for adolescents and youth. So, I do a lot of mental health visits and refer to behavioral health. We do sports physicals, general illnesses. Like if a child has a sore throat, I can test for strep throat. Injuries, I can diagnose or refer to get an X-ray for a child, things like that.

Host: That's very comprehensive. How do students connect with these school-based health centers?

Colleen McEvoy, RN: Well, in order to see students for routine medical services, we need consent from their parents. But it's great because students can learn how to access healthcare on their own, and they can come in. You know, schools traditionally had a school nurse. Most schools cannot afford to have a full-time school nurse anymore. But by having a nurse practitioner or a physician there part-time, if a student needs something and we have consent from the parent, we can treat the child. So, students will go to the health office or someone at school and say, "I want services," and reach out on their own sometimes. Or sometimes parents can call and say they want their child seen.

Host: You mentioned parental consent being key to using the center. How do parents stay informed and involved when their student receives care at a school center?

Colleen McEvoy, RN: Well, in order to treat a student for primary care services, we need consent from the parents, either written or verbal. So, if a student, for example, comes in and they have a stomach ache and they want to be seen for that, if I don't have written consent that we try to collect at the beginning of the school year, I call the parent and I say, "Is it okay if I see them for that?" And then, I do see them and usually call the parent afterwards to follow up with the treatment plan and diagnosis or whatever the next steps are.

There are services that students can consent to on their own. In the state of California, students consent to services for reproductive health without needing parent consent. This can be upsetting to parents and scary, but the nice thing about having the clinic at the school is I can also provide a lot of health education. So, a lot of times, adolescents and teenagers are coming in, like wanting to know more about birth control, for example. For other reasons, for acne or to regulate their periods, because they're very active in sports, and they can do that ideally with parent knowledge. But if they need the services, they can consent on their own for that.

Host: And then armed with more information, they can make better decisions.

Colleen McEvoy, RN: That is the goal, yes. So oftentimes also, I go to classrooms and do education on birth control methods and sexually transmitted infections to help keep the kids knowledgeable. I mean, the school provides some usually reproductive healthcare, like one year in school, but we feel it's much better for them to get that education every year. So, that helps prevent a lot of teen pregnancy, which is challenging for everyone.

Host: Yeah. there are many ways you're touching on regarding how these centers really help students stay healthy and ready to learn.

Colleen McEvoy, RN: Yes, that is the goal, to help them be ready to learn. And there's a lot of evidence that it does help kids stay in school, be healthy, and be more available to learn.

Host: How do school-based health centers support families?

Colleen McEvoy, RN: Well, even in a small town like where I live, parents usually there are two parents working. They don't have time to take off and take their child to the doctor or for a sports physical, or if they're struggling in school and there's concern they have attention deficit disorder, it's hard to get time off work and take your child in, even if you don't have far to travel.

So, it really helps families get the child seen, and then parents don't need to take the time off work. We can coordinate over the phone or through other methods, you know, for a follow-up plan. So, parents tend to really like it once they understand more what's going on. When we started here, there was concern about reproductive health, like I say, being offered on campus without parent consent. But the primary thing we're doing is offering other services.

Host: Is that what you would like families to most understand about the long-term value of these centers?

Colleen McEvoy, RN: I think so, definitely. Like, even if it's scary to think that your child can come in and get reproductive health services without your consent, and I understand that from a parent perspective, that must be scary. Really, we're always advocating for safe reproductive health and safe sex and consensual things and trying to educate and keep kids safe.

Most of what we're doing really is other things like education about birth control. And, you know, the biggest thing that I've seen since we started this school-based health center is the increased need for mental health services. I'm not a therapist myself. But I can treat with medication and refer and offer some support for mental health challenges. There's been such a huge spike in depression and anxiety in youth in general in the last 10 years that we've really done a lot for that.

Host: Well, as you said, there's evidence to support the effectiveness of these centers. just logistically speaking, do school-based health centers work with a student's primary care provider if they are not providing primary care services themselves to that student.

Colleen McEvoy, RN: Yes, definitely. In a small town where I live, we overlap with a lot of patients as their primary care provider. But in larger cities, and I worked in a school-based health center in the Bay Area before moving here, there is coordination of care with the primary care provider. That's the goal.

The goal is not to replace the primary care provider because, for example, school-based health centers aren't usually open all the time during summer vacation, or they don't have someone on call on weekends and holidays. So, we would reach out to the parent initially. And if they wanted, we could then reach out to the primary care provider with access with information about their healthcare, whatever happened at the school, and whatever we recommend. Like if, you know, sometimes you'll see a kid who can come in with a headache, and you have the concerning features for which they need further evaluation. And of course, then we would reach out to the primary care provider or have the parents reach out to the primary care provider for follow-up.

Host: When you look back on your community, what are some key moments you see that made you realize the effectiveness of having a school-based health center there?

Colleen McEvoy, RN: Well, for example, sometimes what happens is, you know, a youth, I've seen youth who their parents were too busy or not able to get them into healthcare and they'd be like, "You know what? I haven't had a physical exam in years. I want to come in and get that." And so they come into the school clinic and then that helps loop them into care which they weren't getting in the first place because for whatever the reason, if their parents are overwhelmed or they're not native English speakers or whatever was going on, it was hard for them. The child wasn't getting care and they see that there's someone at the high school and they're like, "I want to get tested to make sure I'm not an EVEC because my periods are heavy," or whatever health concern is going on. And it really does teach kids to access care on their own which they need to do as adults and bring some children back into care that were not getting any care.

Host: Colleen, when you look back five or 10 years from now, what would success look like for these centers?

Colleen McEvoy, RN: Well, now I practice in a rural area, and we have a school-based health center at the high school in this town, and we offer some services, but we don't offer all the services I would like to offer. For example, some school-based health centers, which I didn't mention earlier, they have eye doctors and dentists at the school-based health center. In this rural area, for example, it's very hard for children to get to an eye doctor. We have very limited services. And that's a basic need. You know, kids need glasses so they can see at school, and we try all sorts of things. But kids on health insurance through the state of California Medi-Cal often can't get glasses without driving an hour and a half each way. And that's nutty.

You know, it'd be really nice to see that. It'd also be nice to have school-based health centers. We're at the high school, but maybe have something at the elementary or middle school or other communities in towns, you know, south or north of here where they don't have them and youth are struggling a little bit more.

Host: Well, Colleen, this has been a really comprehensive look at how school-based clinics effectively support kids and families, and a good look sort of into the future by looking backwards five or 10 years from now. Thank you so much for raising awareness about these school-based clinics.

Colleen McEvoy, RN: Well, thank you for talking to me and providing information to people about this because I think it's a really good model of care for youth.

Host: Again, thank you, Colleen. And for more information about school-based health centers, go to nih.org/schoolclinics. If you enjoyed this podcast, please share it on your social channels and check out the entire Mountain Medicine podcast library for topics of interest to you. Thanks for listening to Mountain Medicine, the official podcast of Northern Inyo Healthcare District.