School-based health clinics are relatively new to Missouri, but they have been common for years in many other states, beginning in Massachusetts in 1967.

The bay state, which has a "been-there, done-that" reputation when it comes to health reform, has built a system that offers students a range of primary-care and behavioral-health services inside schools. Students don’t have to miss school to see a doctor or make expensive after-school visits to emergency rooms for conditions such as untreated asthma.

Officials gathered at Roosevelt High School in St. Louis this morning to mark the opening of one of the few comprehensive school-based health clinics in Missouri. Staffed by an advanced practice nurse and a medical assistant, the clinic serves students, children of students and members of Roosevelt’s staff.

The idea for the school-based clinic grew out of discussions between the city schools and Mercy in West County, helped along by a grant from Boeing Co. After Mercy launched a health literacy program about two years ago, a new idea emerged. A group associated with Roosevelt began to talk to the hospital about the possibility of a clinic inside the school.

After making a commitment to open and operate the clinic with its own money and federal-state Medicaid funds, Mercy got a welcome surprise from Boeing. The company stepped in with a $1 million grant, half of which is being used to run the clinic for four years, while the other half is going to an existing Mercy health clinic.

Boeing offered a “significant investment” because it wants “to make a positive impact in the communities where our employees live and work,” says George Roman, the company’s vice president for state and local government operations. He thinks Boeing’s contribution will help “dramatically improve the overall education experience at the school.”

This approach to health services shows how far Dr. Philip J. Porter’s idea of school-based health services has come in 45 years. Then the head of pediatrics at a city hospital in Cambridge, Mass., Porter is said to have sent a nurse practitioner to a city elementary school to provide care to the students. The concept caught on.  By 1987, the Robert Wood Johnson Foundation had underwritten a project to open school-based clinics in 24 high schools in 14 cities

Since then, roughly 2,000 school-based clinics have been set up nationwide. Some are more comprehensive than others. One operates inside St. Louis’ International Welcome School, which serves refugees and immigrants. Another is run by People’s Health Clinics to serve Vashon High School; still another one is in Springfield; and at least one is in Kansas City.

What makes Roosevelt’s clinic unique is that it has full-time health providers on site each school day while other local clinics open their doors as little as one day a week. Mercy is committed to increasing the clinic staff at Roosevelt in the event of an increase in the demand for health services, says Bob Bergamini of Mercy’s Center for Innovative Care.

The clinic’s family nurse practitioner, Kathy Woods, was busy this week screening students and clearing them for participation in sports. One of her big challenges is serving a school where 21 languages are spoken. Like all nurse practitioners, she is required under Missouri law to partner with a physician who must review her medical work. Dr. Sarah Cole, a Mercy clinic physician, is overseeing the project at Roosevelt.

Mercy has learned that what works elsewhere might not be ideal for an inner-city school, Bergamini says.

“Let me be blunt: If I’m out in the Rockwood District and I wanted to set up an after-school program, it’s a pretty easy thing to do.”

But not at Roosevelt. One administrator explained that an after-school program might pose a problem because it means students who stay after school would “get on a late bus that goes into some neighborhoods that they don’t want to go into.”

End of discussion.

He was asked if the clinic might branch into addressing the ballooning diabetes among teens as well as programs to address obesity.

“At the end of four years, I’m sure we’ll be providing good primary care and some other services as well,” he says. He has learned from others around the nation, he says, that “we should not go into this with some pre-formed notion of what the community needs. I emphasize that to all our co-workers, to the school and the students. We need them to tell us what they need (beyond primary-care services), and we’ll figure out how best to respond.”

When asked why Mercy didn’t open a neighborhood health clinic, Bergamini said a clinic situated outside the school probably would mean students would miss some class time even if the clinic is only a few blocks away.

Although some school-based clinics elsewhere have touched off controversy by offering family planning services, Bergamini says this one would not. Mercy is a Catholic health system and its services are in keeping with the policies of the Catholic Church.

“If a student comes in and says ‘I want birth control,’ we will have to refer them to a different provider. We are not going to close the door on anyone. We won’t just say, ‘go find somebody else’ ” Such students will “get a referral to an appropriate specialist, just like any other referral.”

How will Mercy define success?

One big goal, he says, is to provide primary care in a way that helps students avoid missing school due to health problems involving themselves or their children, if they are parents.

“We’ll have to see how well it (the clinic) is received and how well it’s utilized. We’ll be able to track how many of the students have a diagnosis of asthma, for example, and have an asthma action plan. If  it’s a good service and if we are meeting needs, then I’ll expect that Mercy’s commitment will continue.”