Hancock County School-Based Health Center
| Topics |
Schools
Youth
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| States served |
Tennessee
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| Description |
Hancock County is very rural, sparsely populated, and isolated. There are no major roads in the area, and the region’s mountainous ridges are connected by twisting country roads, a situation that increases the isolation experienced by many of the county’s residents. At the time of the grant award, Hancock County was designated as a health professional shortage area. The county’s 6,000 residents could receive primary medical care at 2 clinics located in the county, and a public health dentist provided dental services to the county’s children one day per week. People living in Hancock County experienced several formidable barriers to accessing the health care services available to them. More than 80 percent of the county’s children were living in poverty, 12 percent of high school students in the county reported that they had used the powerful narcotic Oxycontin, and obesity and adolescent pregnancy were common problems for area youth. In addition, many residents did not have health insurance, and those who did often could not afford the high copayments required to receive medical care. |
| Services offered |
Grant funds were used to establish a comprehensive schoolbased health center in one of the county’s high schools. In the second year of the project, the clinic was moved to a new location so that it could serve both middle school and high school students. The project also supported an additional clinic based in an elementary school; this clinic provided comprehensive, onsite primary care services to some of the State’s poorest children. Children and parents were able to use the clinics’ services at no charge, which dramatically increased their access to health care services. The services offered by the clinics included immunizations, health assessments, family planning, episodic care, chronic disease care (e.g., for asthma or diabetes), mental health treatment, substance abuse treatment, first aid, anger management sessions, and health education. The middle school and high schoolbased clinic employed a full-time mental health professional who provided individual and group counseling. A wide range of organizations participated in the project consortium: - The county public health department provided immunizations, pregnancy care, infectious disease care, and dental services.
- The local rural health care consortium accepted clinic referrals when students needed to see a physician.
- The county recreation program provided after-school mental health services and first aid and triage care during the summer months.
- Jubilee Youth Ministries offered a range of programs for troubled youth.
- The county court received referrals for alcohol and drug abuse treatment.
- The county extension agent provided nutrition and diabetes education programs.
- The local school system provided space for the clinic and covered the cost of utilities.
- The Hancock County Health Council worked to better coordinate health services and reduce duplication of services.
- Local pharmacies provided free or low-cost medications.
The Hancock County School-Based Health Center project offered several innovative education and support programs. The “Walk Across Tennessee” program was available to sixth through eighth grade students. The 6-week program encouraged students to walk during their free time and to keep track of the number of miles they walked during the 6-week period. Most of the students who participated in the program accumulated miles that equaled what it would take to walk across the State of Tennessee. Several high school students also participated in the program. Clinic staff walked with the students, which provided an opportunity for students to talk about their problems and concerns in a more relaxed atmosphere. Other innovative programs offered by the project included: - A mock rape trial, presided over by one of the county’s judges, in which students role-played the trial participants, including the defendant, the district attorney, the attorney for the defense, the victim, the jury members, and the witnesses
- A “Baby, Think it Over” program, in which students were given a doll with a computer chip that recorded feeding, changing, holding, cleaning, and attention and indicated which babies were being neglected
- A drug abuse prevention program sponsored by the National Guard
- A life skills program for 6th through 12th graders
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| Results |
Some 97 percent of students were enrolled in the primary care clinic program, and 100 percent were enrolled in the triage, first aid, health screenings, and health education programs. Children with chronic health problems, such as diabetes, obesity, and asthma, were provided case management services to coordinate their care across multiple organizations and service agencies. One of the project’s surprising findings was the high demand for mental health services. In fact, the most frequent reason that students came to the clinic was to receive mental health services. Tennessee’s health care crisis proved to be one of the project’s most challenging realities. During the course of the project, many students lost their health insurance because of increasingly stringent requirements for qualifying for TennCare, the State’s Medicaid program. Many working parents withdrew from employersponsored health insurance programs because they could not afford the premiums. In such cases, students who are eligible for insurance coverage through their parents’ employers are not eligible for TennCare coverage. |
| Replication |
The school-based health care clinic model could be useful to many rural communities. Many of these communities are skeptical of health care services provided by “outsider” organizations, but this challenge can be overcome by making the community aware of how such services can improve the health, well-being, and educational attainment of children. In addition, although this project did not encounter any resistance to providing family planning services, treating sexually transmitted infections, and serving pregnant teens, other communities should be prepared to address such opposition by educating the community about the need for such services and how these services can prevent future health and social problems. The project is seeking additional funding sources to support staff positions and clinic services. In the meantime, the project is exploring the possibility of asking local health service organizations to support staff positions so that the services provided by the program can be sustained. |
| Source |
Outreach Sourcebook, Vol.10, 2000-2003, Office of Rural Health Policy
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| Contact person |
Jennifer Schallers-Ayers, PHD, RN, Associate Professor and Clinical Director
East Tennessee State University
P.O. Box 70676
Johnson City, TN 37614
423.439.4064
schaller@etsu.edu |
| Date added |
May 15, 2009 |
| Date reviewed |
February 22, 2010 |
Summaries of success stories are provided by RAC for your convenience. Please contact the success story contact person directly for the most complete and current information.
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