Beyond the Clinic: Creating More Space for Preventive Care in Schools

Guest Post by Laura Burgos, 2017 Meade Fellow. As a Meade Fellow, a fellowship opportunity run by the Harvard Graduate School of Education and the Institute for Educational Leadership, she personally met with several education policy influencers during a weeklong visit to Washington, D.C. The Fellowship provided her with a unique opportunity to visit organizations driving policies resulting in interventions like SBHCs.

As a principal several years ago, I assumed leadership of a K-8 charter school in Louisiana with an onsite school-based health center (SBHC). At the time, I knew very little of what this type of partnership entailed and whether it was sufficient in meeting the needs of my students. During my time as a Meade Fellow, I sat down with John Schlitt, President of the School-Based Health Initiative, and attended the Coalition for Community Schools Awards, where school districts from around the country were recognized for their approach to incorporating health and related services into their school communities. According to Schlitt, there was a time when schools felt that they were not in the business of healthcare. That is no longer the case. “There is a growing recognition of the interdependence of health and education,” he explains. As an educator, I’ve long recognized the limitations of how we continue to define the purpose of not just schooling, but the concept of the school facility and the services afforded to students. Yet, a question arose during our conversation that I continue to wrestle with: Is the clinical approach enough?

Children living in historically underserved communities, both in urban and rural areas, arrive to school with medical and behavioral needs that are often left unaddressed. SBHCs are established within schools as an intervention designed to meet the needs experienced by children who are economically and socially disadvantaged. School agencies contract independent healthcare providers to respond to these needs. The model is one that, at minimum, provides students with primary health care, with many school sites offering additional services such as mental health care, dentistry, and related social services. SBHCs meet a critical need for students, and are considered to be a preventive approach to addressing the disproportionate barriers to academic success our students face; the byproduct of much larger societal issues rooted in racial inequity. The SBHC is the clinical part of what I envision could be an even greater approach to removing the obstacles to education achievement. But what if school facilities were designed to proactively foster student health and wellness in a manner that was integrated into the learning experience?

Just a few months ago, I joined other Harvard University students on a Silicon Valley Trek, visiting the world’s leading tech industry corporations to discuss their stake in U.S. education. As I toured the facilities of each corporation, including Facebook’s Menlo Park campus and Netflix, I couldn’t help but think, What if we designed the space in which we serve our students in the same manner as did companies like Google? What if we considered every possible need that a young child or adolescent had and reimagined the school building as the hub that was responsive to this? If we did, we could move beyond defining a school building through merely having instructional and recreational space. We would have emotional space.

Children in historically underserved communities also attend schools that have, for generations, been underfunded. One of the greatest barriers to embedding health and wellness services into a school community is how schools are financed. Given the reality of these constraints, what would emotional space look like? In a more equitable landscape, the most innovative minds would envision CityMD meets Planet Fitness, with a splash of WeWork for kids. But let’s start small. What if classroom walls came tumbling down and the second floor was replaced with open work space? Space does matter. It promotes collaboration and a sense of creative freedom. Yet, our schools are designed with endless spatial barriers. Just consider the number of doors students must open, close, and travel through in any given day. Main entrance doors, stairwell doors, grade level “wing” doors, office doors, the classroom door, etc. The list is endless. What if students simply had more freedom through space? This could be a starting point.

The services that a school provides to support students’ emotional well-being can certainly extend beyond clinical treatment. For adults, health and wellness means fitness clubs, massage therapy, yoga classes, and acupuncture. These are preventive care measures. But what does preventive care look like for children beyond clinical practice? Let’s start with meditation. Many of us have seen the Baltimore school that replaced their detention room with the Mindful Moment Room, reducing their suspension rate to zero. Let’s go even further. How about music therapy, nutrition coaching, and fitbit competitions? Millions have been invested in providing schools with technology access. Adding fitness watches to this list wouldn’t be impossible. What about outdoor learning spaces? I recently drove by a Boston outdoor exercise park, complete with pull up bars and incline benches. Why do we still have schools with nothing but concrete and basketball courts defining their outer landscape? Schools where recess often ends with trips to the nurse or guidance counselor. What if group therapy replaced the one-on-one crisis management that currently absorbs the limited capacity of the .5 FTE social worker? These combined efforts of reimagining space to meet student needs in a proactive manner could radically enhance how we define preventive care for students.

Defining preventive care in our schools requires a collaborative approach. Our willingness to pursue collective goals will drive the innovation in our approaches to preventive care for students. One of the greatest takeaways from my experience as a Meade Fellow was the commitment to partnership that policy and advocacy groups articulated. There is a shared understanding that transforming education requires a cross-sector, interagency approach. Many leaders will agree that a SBHC should exist in every school. The clinical approach provides a strong foundation but cannot be isolated from other embedded practices that enhance students’ physical, emotional, and mental health; opportunities that should be offered before they are most desperately needed.

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