Health Clinic Helps School Turn Around

As the school day began, school nurse E.J. Antinozzi’s office was buzzing.

Two friends, Yeniel Cedeno and Ja’ven Smiley, came in to take their medications as soon as their bus arrived

Then another little second grader entered, complaining of dry lips and itchiness all over. He got words of comfort, some Vaseline on his lips, and cooling lotion rubbed on his belly and legs as the nurse asked, ​“Did you wash your face this morning?”

An older girl came in next complaining of fever and sore throat. A scanning thermometer registered 99 degrees, which is pretty normal. Yet the sore throat made school nurse E.J. Antinozzi send her across a short hall to the Advanced Practice Registered Nurse Lisa MacMaster.

MacMaster examined the girl for strep throat, or as many of the kids in this heavily Latino school call it, ​“infectione de galgante.”

Luckily the test was negative. The nurse gave the girl some ibuprofin, wrote a note to the girl’s mom, and the child was sent back to class.

That was an average half hour in the life of the school-based health clinic (SBHC) at the Hill Central Music Academy on Dewitt Street.

Hill Central opened its full-fledged clinic two years ago, fully staffed and well equipped with daily medications for nearly 100 kids, four cots for kids to rest on, an examining room, a private office for social worker Blake to counsel kids singly or in groups, and much else. In that time it has proved one of the ingredients in the dramatic decline in absenteeism at the school.

It is one of of 18 such school-based health clinics throughout the New Haven Public Schools staffed both by school nurses — who work for the city’s health department — and augmented by nurses and social workers from outside agencies whom the Board of Ed contracts to staff the clinics.

In Hill Central’s case, the school nurse, Antinozzi is there four days a week, up from two days in previous years. MacMaster and the social worker Phillipa Blake are both employees of the Cornell Scott-Hill Health Center, on nearby Columbus Avenue; they spend most of their time at the clinic keeping the K‑8 school’s 483 kids healthy.

In addition to Cornell Scott, the New Haven Public Schools subcontracts with four other community partners to staff the SBHCs — Fair Haven Community Health Center, Yale-New Haven Hospital, the Clifford Beers Clinic, and, of course, the city’s health department. All have a nurse practitioner, a social worker, and an office manager. Eight of the 18 clinics also provide dental services. The state Department of Public Health provides grant money to fund 11 of the 18, with the remaining seven established and sustained by the partners through contributed services and some billing, reported Susan Peters, the city’s director of school-based clinics.

“If you’re not feeling well — mind, body, and spirit — you’re not ready to learn,” said MacMaster.

You’re also not ready to learn if you’re not in school.

Antinozzi, who has been a public health nurse in the schools for 11 years, estimated that Hill Central clinic receives about 2,500 annual visits from the kids — many, of course, repeat customers from among the 483 kids in the K‑8 school.

Many visits involve minor fevers and small aches. ​“We’re big on mosquito bites,” she said. The kids often go back to class after a short sojourn on one of the clinic’s chairs or four comfortable cots.

However, Antinozzi also has on hand 65 individualized inhalers to treat kids with asthma, about 20 epi-pens for individual students who have allergies ranging from peanuts to seafood to milk, and other medications of the kind that Yeneiel and Ja’ven took with their little Dixie cups of water.

Almost 90 percent of the kids and their families are also signed up at the nearby Cornell Scott-Hill Health Center. So, in an abundance of caution, any issue presenting itself as slightly more than routine — such as a fever of 99 combined with a sore throat, such as one little girl complained about during my visit — Antinozzi refers to MacMaster.

That represents about 1,200 kids a year whom MacMaster sees for treating those seriously bad throats, if they emerge, and other matters bearing on kids’ well being; giving physicals; dealing with allergies, diabetes, weight management; immunizations; and so forth. She has a small lab in the facility where she can test immediately for strep, for example.

She in effect runs a branch of the Cornell Scott-Hill Health Center within the school. As an APRN, an advanced practice registered nurse, she can in addition, for example, prescribe antibiotics when necessary and have them delivered to the school.

That seamless service makes the life of parents of ailing kids, especially stressed out working parents, a lot easier, and a less stressful parent makes for a more healthy home life.

Hill Central’s nurses said that often when a parent comes to pick up children, they are resting in one of the comfortable cots in the clinic, needed antibiotics in hand, and all the information has been relayed already to the child’s primary physician at the health center.

“We can see them more frequently than their doctors and provide more frequent follow-up,” MacMaster said.

The arrangement provides a kind of continuity of care that also results in building relationships with families, she added.

When children have emotional or psychological problems, that falls to the clinic’s social worker, Phillipa Blake. She helps kids referred to her to manage social skills, getting along with peers, and reducing disruptive behaviors. There are also kids whose ADHD medicines she helps manage, and she conducts therapeutic sessions with kids singly, in groups, and helps parents get over a sense of stigma if she has to identify a child as having some mental health problems to be dealt with.

Occasionally there are more serious issues, such as depression and other behaviors that emerge when, most frequently, kids are experiencing the divorce of their parents or the death of a relative, like a grandparent, she added.

Very very occasionally — perhaps once a year, Antinozzi estimated — a child really loses it, kicks, screams, and throws things even while being dealt with in the SBHC offices; in such instances the clinic staff calls in 911.

“It’s about the total child,” said Blake. ​“If they’re off, it’s going to show in their work.

Blake has prepared a form that all the school’s teachers have, and it is that form, filled out by the teacher, that results in a referral to Blake in the clinic. Usually the teachers are in touch with the child’s parents first.

Although MacMaster speaks some Spanish, if translation services are required, they are provided by the clinic’s third employee, office manager Leshla Nieves. Also a Cornell Scott-Hill Health staffer, she’s the one who told me how to say strep throat in Spanish.

The two other most frequent phrases she translates from the staff to kids and especially from and to their parents: ​“sana” for scabies; and ​“piojos” for lice.

Just as I was writing this down, another little patient entered, and I heard Antinozzi say, ​“Good morning, my handsome friend. Not feeling so good?”

With recent state cuts, the main grant funding the majority of the system’s SBHCs have been cut by 30 percent over the past two years, Peters added. She said all the partner agencies are determined to continue, billing where services can be billed to insurance companies but providing what’s needed regardless of reimbursement.

On the plus side, a recent oral health grant of $30,000 from the state is permitting the hiring of an additional hygienist to provide dental services to two more schools.

Click on or download the above audio file to listen to a discussion with Will Clark and Sue Peters about the city’s 18 school-based clinic, on WNHH’s ​“Dateline New Haven” program.

This episode of ​“Dateline” was made possible in part thanks to support from Yale-New Haven Hospital.