Board explores school-based health services

According to Nicolescu’s presentation, in 2020, the Columbia Gorge Education Service District (ESD) conducted a community health assessment with the purpose of gauging any unmet health needs of students in Wasco County, gathering data from both youth and guardians through surveys, listening sessions, focus groups and interviews. The top unmet needs were identified by both youth and guardians as mental health care — with 30% of eighth graders and 25% of 11th graders in The Dalles reporting experiencing symptoms of depression the previous school year — preventative and primary care — illnesses, injuries and wellness care — and addressing health barriers experienced by Hispanic/Latinx and Native American/American Indian youth.

According to the presentation, there were also populations of Wasco County who desired medical care but did not receive for specific reasons, with the data indicating 47% of participants who identified as uninsured did not receive medical care in the previous year, and 19% of households insured by Medicaid reporting the same.

“In general, school-based health services are an accessible way for youth to get medical care and mental health care. They provide comprehensive services, and they provide it in a … cost effective way,” said Nicolescu, stating that the main services provided by school based health services include sports physicals, well child checks, immunizations, visits for acute illness and injuries and mental health services including counseling for issues such as depression and anxiety.

According to Nicolescu, there are currently 78 School Based Health Centers (SBHCs) in 25 of the 36 Oregon counties, with 40 of them being located in rural communities — including neighboring Hood River County School District. “Currently, school based health centers are typically certified in the State of Oregon. That’s how they remain sustainable. So they receive funding through the state of Oregon, through local public health authorities, and then also through medical partners in the community,” she said.

A key goal of a SBHC, said Nicolescu, is to improve access and reduce barriers for school aged youth to receive healthcare in the event of situations such as not currently having or unable to assess a primary care provider, seeing students at no-cost if they are uninsured due to its status as a federally qualified health facility, and reduce barriers such as transportation or absenteeism, as the centers are located on campuses and students would have to rely less on parents or guardians to drive them to appointments and sacrifice less classroom time by leaving school.

“This doesn’t make kids and families choose between getting health care and deciding whether or not to miss class,” said Nicolescu.

Citing data from a recent status report given by the SBHC State Program Office, Nicolescu said that, during the 2020-21 school year more than 17,000 students were reported to have received care from a SBHC in a total of 56,000 visits, which averaged to approximately three visits by each student during the school year. She noted that the 2020-21 school year actually saw a decrease in visits due to that the year being hybrid learning due to COVID 19.

“Prior to the pandemic, we were seeing a pretty significant increase in how many visits SBHC’s were getting until 2020, in which we really saw a significant decrease. So of those 56,000 visits, 40% were for primary care 51% were for behavioral health, and a lot of those were via telehealth during that school year," Nicolescu said.

“When you’re introducing something new like this into a community, there can be some hesitancy and some questions about whether or not it’s bringing real value to the community, and I think something to think about is that we know that when SBHCs are introduced into communities … it’s not only associated with improved health outcomes, but also with improved educational outcomes, things like reduced absenteeism and GPAs go up,” said Nicolescu, who noted that SBHC are not designed to replace primary care providers, but to be a resource for the community and the school districts. “When students have access to reliable and accurate medical information, they can make health decisions for themselves that align with their own values and align with their family’s values, instead of learning about things on social media, etc. …”

Nicolescu noted the current efforts to expand school-based health services in NWCSD and address needs identified in the 2020 community health assessment include assisting student’s in accessing well visits and sports physicals, as well as encouraging the utilization of the virtual behavioral health program provided through One community health and the HRCSD SBHC.

“There’s telehealth portals and each of the schools in the district in which students can enroll in this program and access behavioral health services virtually with one of our behavioral health consultants at One Community Health,” she said.

Nicolescu asked that the school board continue to hold events for the One Community Health mobile unit to visit NWCSD to perform well child visits and sports physicals for students, “I would like to eventually start increasing our visits to The Dallas High School to really get an understanding of what the needs are to really understand what the demand is for these visits. And doing that with the mobile unit is a really easy way to bring services to the kids and get a sense of how much demand there is what they need, what sorts of services they’re requesting.”

Nicolescu noted that the eventual goal would be to eventually have a brick-and-mortar SBHC in The Dalles that all NWCSD students can access.