Her child's asthma used to dictate Tonya Randolph's schedule. When Nikea, now in middle school, was younger, Randolph or her husband would be called away from work every few weeks to bring their daughter to the doctor for an emergency nebulizer treatment. The parents lost work hours and Nikea missed class.
But in rural, economically depressed Wayne County, N.C., the Randolphs might be considered lucky. Their jobs include insurance and permit absenses.
Wayne County ranks ninth out of 100 state counties in numbers of uninsured children. Like in many areas, parents tend to neglect routine medical care as children age; older kids don't discuss their health, so the perceived need is decreased. Lengthy appointment waiting periods and less than understanding employers compounded the situation, making it diffi cult for parents to obtain medical care. Consequently, adolescent healthcare fell through the cracks. "Our district had a lot of [middle school aged] kids who had not seen a doctor since they entered kindergarten. Their immunizations weren't up-to-date, and preventative needs like nutrition, health education and mental health services were unmet," says Phyllis Hill, a nurse and clinical director of the Wayne Initiative for School Health.
WISH has helped the district become the picture of adolescent wellness. The effort consists of four middle school-based health centers staffed by full-time registered nurses and rotating nurse practitioners, dieticians, health educators, clinical social workers and mental health service providers.
Established in 1997 as a collaborative project among Wayne County Public Schools and community agencies, WISH provides basic health care and addresses mental health issues. Pregnancy prevention is also a goal, with health educators touting abstinence (as required by state law) and available to answer kids' questions in private.
WISH is working. The district has experienced a 75 percent decrease in teen pregnancies, a 4 percent increase in attendance, improved test scores and fewer adolescent emergency room visits. For the Randolph family, it means school-based healthcare staff monitor Nikea's asthma management plan. When her condition fl ares up, she gets a nebulizer treatment at school and returns to class without missing a beat. "She's not falling behind. WISH keeps her on the right path," sums Randolph.
Partnering for Health
Multiple partners share time, funds and expertise to improve kids' health through the Wayne County's WISH initiative. Besides the district, partners include:
The Wayne County Health Department and Department of Social Services
A local hospital, as well as pediatric and mental health service providers
Communities in Schools, a local education foundation.
Partners contribute in all sorts of ways. Communities in Schools, for instance, handles Teen Court for youth charged with misdemeanors like marijuana possession, which ties in with WISH drug and alcohol education programs.
Jumpstart To Wellness
In the 1990s, Wayne County administrators set their sights on a national $492,000 Robert Wood Johnson Foundation health care grant to fund their vision of meeting children's health needs. Preparations for the supergrant included ensuring community collaboration, explains Allison Pridgen, director of student support services. With $8,000 in planning funds from an endowment, key players met twice monthly for a year and hammered out details. "Everyone saw the need for school-based health services. We had to know what each entity would ante up," she adds.
The district remodeled several class- rooms in its fi rst two WISH schools to create mini doctor's offi ces. The county supplied dieticians, health educators and other staff. All total, in-kind contributions from community partners added up to $800,000, and WISH was able to secure its Wood Johnson Foundation grant to open the fi rst two school-based centers at middle schools with at-risk student bodies.
Have all the efforts to include healthcare as part of a school district been worth it? Superintendent Steve Taylor certainly thinks so. "Healthier children are better prepared to learn," he says. "We're taking care of kids' physical and mental health needs to help them perform better."
WISH serves nearly 2,000 kids annually, charging only for services that require a physician or nurse practitioner. If the family is unable to pay, WISH covers the charges. Do the math: It isn't cheap. "We're good at pinching pennies," says Allison Pridgen, the district's director of student support services. And students have organized penny march fundraisers. "The kids are as aware of what WISH means as adults," says Shirley Simms, vice chair of the WISH board of directors. Pridgen devotes several hours a month to identifying grants. A recent $10,000 Kellogg Foundation grant funded an obesity prevention project, and similar grants have funded pregnancy prevention efforts. "These projects aren't [the initiative's] only focus, but we can incorporate them into other programs," notes Pridgen. A case in point is Snack and Learn, a program funded by local business partners. Students select topics like peer pressure or tobacco use, and speakers discuss the issue in-depth over a healthy snack. Pregnancy prevention education programs bolster Baby Think It Over, which pairs students with a computerized doll to give them a taste for parenting realities.
WISH for the Future
WISH has delivered real results and garnered the National Civic Star Award for 2005 from the American Association of School Administrators and Sodexho School Services. What's next? The district initially targeted middle-school aged kids, as those years are prime years for preventing bad habits. Last fall, a high school center opened to help support at-risk teens; this fall, the district will open a second one. The newest centers are scaled down versions of the middle school operations and designed to meet basic needs. A staff nurse can refer students to additional service providers as necessary. In all likelihood, the high school centers are a fi tting sequel to the initial middle school success story.