Six-year-old Julie Hughes woke up with a sore neck. Her mom felt guilty sending her off to school, but it was her second day at a new job and she had to get to work. In class later that morning, Julie’s Grade 1 teacher noticed that she was in too much pain to sit through class. So she sent her down the hallway to see the doctor.
Julie attends St. Mary’s Community School in downtown Saskatoon, which has a pediatrician’s office tucked among the classrooms, and where teachers, like family doctors, give referrals.
Saskatoon’s Catholic school board has three of at least a dozen school-based clinics in inner-city neighbourhoods across the country that proponents say are making big strides in public health with little public funding. They are designed to help low-income families who may have trouble navigating the health-care system, with scheduling, transport, language and intimidation acting as barriers.
Early findings from school clinics show myriad conditions being diagnosed – from common ailments that had gone untreated, like ear infections or sight problems, to more serious conditions such as autism, fetal alcohol syndrome and asthma. Developmental disorders and behavioural problems that can fly under the radar for years are also often found – in one Toronto school, 19 per cent of kids have received such a diagnosis. And the benefits stretch beyond access: The clinics keep families out of backlogged emergency rooms and offer a chance for early diagnoses before health problems become chronic.
In the past five years, five clinics have opened in Vancouver and one in Montreal. On Wednesday, a third school-based clinic in Toronto will open, at Brookview Middle School in the Jane and Finch neighbourhood. The area has the fifth-highest rate of diabetes among Toronto’s 140 neighbourhoods, according to a 2007 report by the Institute for Clinical Evaluative Sciences.
With cash-strapped provinces straining to cover health-care costs, advocates say this kind of out-of-the-box thinking provides a shot of relief. The clinics are typically set up in vacant space, an unused classroom or the old nurse’s office, so cost is minimal. But many say the patchwork of funding that keeps these clinics open –most coming from charitable foundations, fundraisers and private donations – isn’t sustainable. Operators are collecting data on the impact of the school clinics to make the case for support from provincial health ministries.
“We can’t build medical access points for children on philanthropic donations,” said Catherine Parsonage, the executive director of the Toronto Foundation for Student Success, which oversees the city’s school clinics. “In order to expand this model, we need some support from our provincial government.”
The clinics were born from the model of social pediatrics, which preaches that the whole community has a role in children’s health. Convenience makes them popular with parents, and teachers are happy to be involved, especially if it makes for healthier and more attentive students.
“We were handcuffed before from helping with so many kinds of things,” said Tricia Carter, a teacher at E.D. Feehan Catholic High School in Saskatoon, where the old photocopy room became a clinic in January. “You have no idea how excited we are to have such immediate access to health care.”
A unique partnership in Saskatoon has allowed school clinics to take root. Motivated by a scathing report that found deplorable health among the city’s low-income residents, the Saskatoon Tribal Council teamed up with the Catholic school board and the University of Saskatchewan to launch the province’s first clinic at St. Mary’s Community School in 2007. It’s also open to the local community, and is so popular that waits for non-urgent appointments have climbed from two days to four weeks.
In the first 3½ years, Maryam Mehtar, a pediatrician and professor at the University of Saskatchewan who has teamed up with Greater Saskatoon Catholic Schools, saw more than 900 patients at the clinics. Hundreds more have visited an optometrist and psychologist who also come to the schools.
Dr. Mehtar said that often students are referred because they’re inattentive in class. It’s her job to determine if they’re anxious because they’ve been shuffled between foster homes, depressed, or have an undiagnosed illness or condition. “Ninety per cent of what I see are mental health, behavioural and developmental issues,” she said.
Julie’s mother, Elizabeth Mandel, 25, had planned to take her child to their family doctor on the other side of town after school on Thursday. It was her second day as a receptionist at a hair salon, a job the single mother of two badly needs. The school called to tell her they’d taken Julie to the pediatrician. After screening for meningitis, Dr. Mehtar concluded that the girl’s pain was muscular.
“It was such a relief, a weight off my shoulders,” Ms. Mandel said.
In another recent case, staff at E.D. Feehan referred a Grade 9 student who had been acting out and was being considered for suspension to Dr. Mehtar. She discovered that the boy was in considerable pain from an undiagnosed ear infection.
The model has been so successful that Greater Saskatoon Catholic Schools is building a new school across the street from St. Mary’s with a clinic. It will open this fall, and is believed to be the first of its kind.
While the social pediatrics model is gaining momentum, it’s still in its infancy in Canada. Gary Beaudin, a consultant for the Greater Saskatoon Catholic School Division, said that without much hard data on the benefits, it hasn’t been an easy sell to provincial health authorities or even some health-care practitioners.
“Not everyone wants to work with the low-income community and not everyone gets what we’re doing,” Mr. Beaudin said. “It’s outside the box.”
It took Gilles Julien, Canada’s “father of social pediatrics,” nearly 30 years of offering services before he received any public funds. He opened two social pediatrics centres (not in schools) that were initially funded by donations. Public and media attention to his work eventually won him an annual $1-million commitment from the Quebec government, but he said other operators will need to produce data to make the case for funding.
Ontario’s Ministry of Education gave $25,000 to the Toronto District School Board last year to complete a preliminary evaluation of its pediatric health program.
Multiple studies from the past five years on school clinics in the United States suggest access to care for disadvantaged groups improved. Research teams led by Brock University’s Terrance Wade, the Canada Research Chair in youth and wellness, have also noted that attendance rates for children with medical conditions improved when they had access to a school clinic.
The Champlain School clinic in Montreal, which receives no public funding, is open five days a week and has an annual operating budget of $120,000 – from fundraisers and private donations – which pays for supplies and salaries for therapists, a director and a receptionist. The local health centre pays for a social worker and the pediatrician on staff bills the province.
Samuel Harper, the clinic’s pediatrician, says parents find the setting far less intimidating than an emergency room or walk-in clinic, making follow-up visits more frequent.
“Part of it is the smallness of it. We know everybody that comes. When you go to the [community clinic] it’s more and more institutionalized where you show up at the gate and take a little number and then wait behind the yellow line.”
In Toronto, Ms. Parsonage’s organization has come up with a different model at one of its clinics: Salaried nurse practitioners deliver care so the provincial Health Ministry doesn’t have to pay a physician. For now, all three Toronto clinics are funded by donations to the Toronto Foundation for Student Success.
Because the clinics are in schools, there are no rent or utility bills. Aside from about $8,000 to $20,000 to set up the room, it would cost only $15,000 a year to keep a clinic open one day a week, she said.
“There isn’t a hospital, private clinic or walk-in clinic that can do that,” Ms. Parsonage said.