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School-based Health Centers offer innovative approach to educational barriers





Tyeisha Pernell, a senior hoping to enroll at the University of Cincinnati after she graduates from West High, sits patiently in a blue plastic chair with metal legs. She fidgets with the pink-cased phone in her lap. 

After filling several syringes with immunizations to get the 18-year-old ready for college, the school nurse motions to Pernell to lift her red capped, short sleeve above her shoulder. The nurse swipes an alcohol swab across her arm and flinches as the needle plunges into her caramel-colored skin. She breathes a sigh of relief as the needle slides out and is quickly replaced by a Band-Aid. 

The nurse disposes of the used syringe in the red, hazardous waste container on the counter. Pernell, now smiling, snatches a few of the nurse’s donuts, cookies and candy. She grabs her dripping red umbrella and heads back to class. As she slips out of the door, two more students make their way into the room, ready for flu shots and vaccinations.

Nurse Barb Demasi, 55, puts students like Pernell at ease in West High’s school-based health center. The center opened at the beginning of the 2012-2013 school year and is the newest of 10 CPS health centers around town. 

Demasi, who has been a registered nurse for 22 years, knows her role extends beyond offering shots and Band-Aids. She’s there to offer the kind of consistent care that has been lacking in many of the students’ lives. She tests for sexually transmitted diseases and counsels students about drugs and pregnancy prevention. Most of all, she arms them with the information they need to protect their bodies, and their futures.

Providing basics and beyond
Demasi believes that the key to curing ailments is not always in a medicine bottle or syringe. Instead, she wants to teach students how to care for their own bodies and show them that someone cares about them and their well-being. She wants to make a simple, yet critical, human connection.

For some students, her support may be their only reassurance that they matter in this world, Demasi says. That’s one reason why she believes she was meant for the job.

“We don’t always choose the area of service, but we know where we are supposed to be," Demasi says. "I know this is it [for me]. I have to do this. I will not be happy unless I’m here. This is where I need to be.” 

Demasi has spent her career working with children in the public health sector. She keeps a letter from a former elementary student taped on the wall next to her desk:

“Dear Nurse Barb-
Thank you for being ter for me you mack my hart smile
from Bolo”

“This is what public health is all about,” Demasi says, “meeting the needs of children. It’s why I do what I do.”

Bridging a dangerous knowledge gap
The role of the nurse in the high school health center is to teach students how to take care of their own bodies from the inside out. Demasi gives them pointers on nutrition, STDs, growth, development and sex. She says the students know shockingly little about their own health. 

“Kids are not learning what I learned,” she says. But she doesn’t blame their socio-economic background for the critical, and dangerous, information gap. “It’s not poverty, it’s society.”

Providing students with preventative knowledge, the kind of information that can keep them well, she says, is important for the rest of their lives. 

“[They] don’t see the future, only day-to-day for them,” Demasi explains. “That can be very, very sad and very depressing if you let it be.” 

That’s one reason why she, in addition to giving students the tools to understand their own bodies, she makes it her responsibility to make them feel valued and special. 

Building human connections
“[There area] a lot of great young people, so much potential,” Demasi says. “They need encouragement. They need to believe in themselves.”

Alongside the encouragement and the medical treatments, she says the best medicine is listening to students, spending time with them, making eye contact with them and focusing on them and what they’re saying. A simple hand on their shoulder, a pat on the back or her daily dose of hugs, which she doles out in abundance, can make a difference. 

“A hug is a really simple thing, a way to let them know that they’re important,” the mother of three says. A tear runs down her face as she recalls the moment she realized that for many of these students, her hug may be the first hug they’ve ever experienced. “It doesn’t matter how young or old you are—it’s such a powerful gift to give or receive.”

Now, she says, students hug her back. “The service here is so much more than medical.”

Finding critical support
Demasi shares duties at the school-based health center at West High—which encompasses two schools, Western Hills University High School and Gilbert A. Dater High School for a total of about 2,000 students—with nurse practitioner Denise Gill-Roflow, CNP, MSN. They see on average about 12 students per day.
 
In many ways, the exam room is a typical school nurse territory. The counter is lined with jars that are filled with cotton swabs and wooden tongue depressors. Tiny bottles of vaccines are lined up next to Demasi’s pink and gray stethoscope. The Serenity Prayer is push-pinned to the wall. 

For some of the underserved and underinsured students who walk through the door, though, the services are anything but typical. The two nurses act as the young adults’ primary healthcare providers, says Gill-Roflow. 

It’s a concept that has everything to do with effective education, and it’s a model that’s been at CPS since the 1980s, when the Cincinnati Health Department started placing nurses in schools. 

Because educators and health professionals alike recognized that health issues undermine academic success, the first school-based health centers in Cincinnati were opened in 1999. The first centers were a partnership between Cincinnati Children’s Hospital Medical Center and Neighborhood Health Care at Rockdale, South Avondale, Burton and Taft schools—all elementaries. The Health Foundation of Greater Cincinnati provided start-up funding, says CPS Medical Consultant Dr. Marilyn Crumpton. She also serves as medical director for the Division of School and Adolescent Health at the Cincinnati Health Department. 

Funding from the Health Foundation helped launch new centers at Oyler, Hughes, Woodward, Bond Hill and Winton Hills Academy in 2009. Withrow High School followed in 2010, the same year that the city lost funding for the program. 

The Health Foundation stepped up to provide uninterrupted health services for thousands of children dependent on the centers for care.

Understanding the lasting impact
Why are these primary health care services so important to these students? Consider the facts: In 2011, the percentage of children below the poverty line in CPS was 70 percent; in addition, 32 percent of the 25,000 homeless in Cincinnati are children, according to the Cincinnati Health Department. Poor health and homelessness act as huge barriers to academic achievement.

“School-based health centers have been proven to improve the health and the academic performance of students,” says Crumpton. “Healthy students learn better because they miss less class and feel better when their health problems are taken care of. Students with a toothache or an asthma attack or an ear infection can’t concentrate.”

School-based health centers offer immunizations, fill prescriptions, help with asthma control and treat bacterial infections, as well as manage each student’s healthcare, including sports physicals and annual health assessments. 

In schools with school-based health centers, nearly all students are up-to-date with vaccines and attendance—and graduation rates have increased. 

Community partners heavily invest in the centers, including $4.8 million from the Health Foundation and the newest investment from The Deaconess Association Foundation for $375,000 over the next two years to support the Deaconess Health Check at West High.

“Healthy children are one of the best investments our community can make,” Crumpton says.

There are 10 more school-based health centers in development for CPS; and Deaconess is considering further funding for more schools, says the hospital’s executive director, Patrick Ward.

For now, nurses like Gill-Roflow and Demasi focus on individual students and hope their school will soon be included in the rising percentages of healthier students with high school diplomas.

Jessica Noll, a regular contributor for Soapbox, is an award-winning and Emmy-nominated freelance multimedia journalist, full-time PR guru, photographer and social media aficionado. Armed with her master’s degree from Columbia College Chicago, she has contributed to several news outlets nationwide, including Fox News, Nancy Grace, MSNBC, People and Story Magazine. She is currently the Community/Media Relations Director for 4 Paws for Ability.
 
Photography by Scott Beseler
Barb Demasi portrait
Flu shots
Barb Demasi preparing flu shots
Denise Gill-Roflow, CNP, MSN

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