Health Care and Insurance and Education & Workforce Development and Environment

School-based clinics get boost from grant: Learning Well Inc. operates in 53 Marion County schools

January 17, 2005

Indianapolis-based Anthem Foundation gave Learning Well Inc. $100,000 to open two school-based clinics in Marion County and support its efforts to address childhood obesity and asthma. But the effect will go much further than that, one board member said.

"We're finally seeing stability and potential for growth," said Betty Wilson, a member of Learning Well's executive committee and CEO of The Health Foundation of Greater Indianapolis, which has plowed millions into the program and is a driving force behind the group. "Our grant is 10 times bigger, but theirs allows for expansion. That's what we've been waiting for."

Already, Learning Well has clinics in 35 Marion County schools and outreach programs to another 18. Organizers have high hopes for an even broader reach.

"I'd like to see more growth, more clinics," Wilson said. "But in the current environment, I'm delighted with its progress."

Indeed, the going hasn't been easy at a time when tight budgets mean school-based nurses are increasingly rare. Wilson and other community leaders began talking about opening school-based clinics more than a decade ago.

The idea is simple: Healthy students are better students.

"Kids can't learn if they're not in school," said David Frick, president of Anthem Foundation, the philanthropic arm of newly merged-and renamed-insurance company WellPoint Inc. "If you keep them healthy, you keep them learning."

By 1998, those initial "Wouldn't it be nice?" conversations had progressed far enough that the Health Foundation formed and funded the School Wellness Collaborative to figure out a way to make it happen.

A little more than two years ago, it finally did.

After a series of fits and starts, organizers realized the ad-hoc group wasn't getting the job done. So they formed a standalone agency to do what the Wellness Collaborative could not: collaborate.

"There was no infrastructure, no clear expectations," said Learning Well Executive Director Donna Stephens, who took over when the organization launched in October 2002. "Everyone had to go back and do their own jobs. There was nobody to take responsibility. Nobody had the time."

Stephens did. Under her leadership, and with the help of a $5.5 million pledge from the Health Foundation, the organization has evolved. Its impressive infrastructure now includes an array of health care providers that equip and staff the clinics and dozens of schools more than happy to accommodate them.

The clinics provide health care for thousands of students each year and health education for countless others. Learning Well pays most of the bills, although the providers chip in some, too.

"This is really unprecedented in the United States," Stephens said. "Usually, a school system and a [health care] provider will work together, but not like this."

Indeed, Learning Well's partners make up a virtual who's who of local health and education: four major hospitals, several health clinics and the county health department on one side of the equation, with 10 public school corporations, local parochial schools and a handful of charters on the other.

"It's taken a long time but, by gosh, we're getting there," Stephens said. "We're really on the road now."

Which isn't to say there haven't been some potholes along the way or there aren't obstacles ahead.

Washington Township schools, for example, recently pulled out of the program. The district disagreed with Learning Well's decision to have a registered nurse or nurse practitioner in all clinics, preferring the medical assistants it had hired through an earlier grant from the Health and Hospital Corporation of Marion County.

"We were quite pleased with what we had been doing," said Steve Keith, director of student programs for Washington Township. "We didn't think that was necessary, and we didn't see any funding coming our way."

So the school system will continue to earmark more than $400,000 of its own money each year for school-based clinics. There's no denying the benefits, Keith said.

"It has really, really improved the level of service we're able to provide to students and parents," he said. "Attendance is going up ... overall academic performance is up. Certainly, the climate in the schools is better."

Although the school-clinic movement's "healthy students are better students" mantra makes sense, there's little hard data to support it. The American School Health Association's Journal of School Health reviewed a number of studies on the topic for a report in its November issue, and couldn't find a definitive connection.

"Intuitively, school health programs recognize that their work has a positive influence on academic performance," the report said. "However, the current research base provides insufficient evidence ... that can be widely generalized."

But that doesn't mean the theory isn't true. Although health care programs are not the only reason for students' success, there's no denying their impact, the Journal report said.

"It definitely makes a difference, without a doubt," observed Mickey Lentz, director of the Archdiocese of Indianapolis' Office of Catholic Education.

Attendance is up at the two center-city Catholic schools served by Learning Well clinics, she said. It's too soon to say whether test scores also will improve, but Lentz is a believer nonetheless.

"These students probably weren't getting a whole lot of health care," she said. "We're really trying hard to get clinics into two more schools next year. ... It's a really good deal for us."

Indianapolis Public Schools Superintendent Pat Pritchett likewise is sold on the program.

"I keep bugging them about needing to expand," he said. "We need to find a way to put these services in every school. There's so much need."

That's because ever-tighter budgets and ever-higher standards have taken their toll on the school nurses of days gone by. Make that days gone long by. IPS hasn't

had nurses in every school for more than

30 years, Pritchett said.

Programs like Learning Well can make a difference, he and others said.

"It just makes sense: If you want a healthy community, you've got to start with children," said Dan Hodgkins, executive director of health promotion at Community Health Network, one of the Learning Well partners. "This can really have a huge impact on the health of kids."

Greg Porter agrees. As a vice president of Health and Hospital Corporation, he knows the benefit of starting healthy habits at a young age. And as a state representative and past chairman of the House Education Committee, he sees the link to education.

"When we talk about educating children and getting them up to speed, we have to make sure they're in school," the Indianapolis Democrat said. "Learning Well helps them get back into the classroom. This is crucial, not just for [the students], but for all of us."

Still, Stephens knows her work is far from done.

Expanding the program-indeed, even maintaining it-means developing and maintaining a steady stream of revenue. The Health Foundation's $5.5 million commitment is set to run out in mid-2006, potentially leaving a big hole in the agency's $1.6 million budget.

"This year, I'm really going to concentrate on funding," Stephens said, which can be difficult given the agency's ongoing work and the short-term outlook some funders have. "The worst thing that could happen would be for someone to fund a clinic for one year, have everything go well and then they pull back funding anyway. We wouldn't have any way to keep it open."

She plans to appeal to private foundations first and solicit additional corporate support once the program is better known and understood.

"This could have a huge economic impact on the city," Stephens said, perhaps practicing her pitch. "If we keep students in school, they have a better opportunity to learn, graduate and become self-sufficient.

"It's a long-term deal, though. We've got to keep this going for a long time."
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