AMENIA — In a region like northeast Dutchess County, where health care options are limited and changing all the time, a more centralized, “wraparound” approach, at least for the children in a family, can be a major time-, money- and academic life- saver. Such is the case with the School-Based Health Center (SBHC), the first in Dutchess County, in the Webutuck Central School District (WCSD).
Located in a hallway between Eugene Brooks Intermediate School (EBIS) and Webutuck High School, the Federally Qualified Health Center (FQHC) was initially set up in May 2022, and has been running full steam since September. It is a fully functioning facility open to all students residing in WCSD.
Officially known as part of the Nita M. Lowey Center for Health in Schools, reflecting the Westchester congresswoman’s efforts on behalf of children’s health, the Center is accepting enrollment on an ongoing basis. Currently at about 35% of the district’s total of 625 students, the staff hopes to reach 70% in the near future.
What are FQHCs?
Federally Qualified Health Centers (FQHCs) are facilities that offer health care to individuals in local communities without regard to whether or not those patients can pay for services or are insured. For some students, the school-based FQHCs replace primary care providers, while for others, their primary care providers still provide much of their care.
On March 30, Livia Santiago-Rosado, MD, FACEP, commissioner of Dutchess County’s Department of Behavioral & Community Health, paid a visit to Webutuck’s SBHC. An emergency physician for about 20 years in Queens, Manhattan, Long Island and recently at Vassar Brothers, Santiago has seen the health care system from many angles.
In the early days of her tenure as commissioner, Santiago was dismayed to note the incidence of school absenteeism in some communities, and set about seeking reasons and remedies. The burdens on parents to find providers who have appointments available, take time off work to take their children to the appointments, and other delays result in loss of academic and work time. Her research led her to Open Door Medical Center and its community and school-based models.
In New York state, it’s children-only in SBHCs
To the commissioner’s query as to whether parents and teachers partake of services, operations director Sara Hodgdon of Open Door — with centers in Westchester, Putnam, Ulster and now Dutchess counties — noted that New York state mandates that school-based centers treat only students, with some exceptions.
Several years ago during an outbreak of bird flu, SBHCs were permitted to vaccinate parents and other family members as well as teachers against that. At present, students may get all their vaccinations at school.
The commissioner, expressing that it would be even better if all family members could take advantage of such convenience, noted that the same issues of access to health care, productivity and efficiency apply also to other family members, especially in rural areas. If the parent is ill, the child may not be able to go to school, and a child’s illness may prevent a parent from going to work.
WCSD Superintendent Ray Castellani admitted that easily available health care for everyone is a good goal to aim for, but that schools are generally shut down after the extended school day, so access would be problematic. Both agreed that for purposes of whole-family access to medical care, stand-alone facilities are doubtless better.
One such facility is currently being built in North Canaan, Connecticut, conveniently sited near a supermarket and other stores. There are a few in Dutchess County.
Hodgdon elaborated on that theme, noting that many of Open Door’s current providers are pediatric nurse practitioners (NP), whereas in a whole-family facility, “a whole different model of employment” would be required.
Currently, other staff include Lindsay Neptune, a nurse practitioner and director of SBHC clinical services; Angela Sinon, NP, who is relatively new on the job; and in the school nurse’s office adjacent, Brandice Roberts and Colleen Hazelton. Other providers may be brought in as needed.
Services students receive encompass what they would receive from a primary care provider and include once-yearly wellness visits, in which individual needs are determined; rapid testing for strep, influenza, and samples for PCR COVID-19 tests; pregnancy testing, with assured confidentiality for older students; management and forestalling of asthma attacks; arranging prescriptions, if needed, to be immediately available to parents; and other services.
Occasionally it is as simple as supplying a place for a student to rest a while, then sending them back to class.
Parents need to sign a one-time consent form and enroll their children via a link on the website or at community events.
Mental health services
Another exception to the students-only rule is in mental health services available at the Webutuck location. Families may be brought in to figure out whole-family solutions to issues that present in children and teens.
On its first day of operation, Karen Fink, of Family Services of Westchester, which works in tandem with Open Door, introduced social worker Brooklyn Talarico, recently arrived from Poughkeepsie where she worked with children as well as adults and is glad to be surrounded by young people in this “satellite” mental health clinic at the Center. When adults are included in sessions, the focus in on the family as a whole.
All present agreed that “it’s a brilliant use of space” when students can have their physical and mental/social-emotional health needs met in the place where they spend most of their waking hours.
Santiago pointed to future efforts as Medicaid rules are expected to change later this year. A true Social Determinants of Health (SDOH) network would be able to identify all the aspects that affect a person’s mental and physical health, refer that person to the appropriate providers, and then assure that the services they need are provided — that last point being the new angle, so that all along the line, providers and agencies are “on the hook,” and nobody falls through the cracks.
Webutuck’s School-Based Health Center is the first SBHC in Dutchess County, in an effort to provide a more seamless approach to health care equity for all.
