Children growing up in poverty are, overall, less healthy than their more advantaged peers. This is due to their greater exposure to a variety of health risks (e.g., limited primary care, poor nutrition, lack of physical activity, trauma, family instability). Poor physical and mental health in childhood negatively impacts attention, learning, and school engagement, as well as future educational achievement and attainment. Given the interdependent relationship between health and educational outcomes, promoting a healthy foundation for socioeconomically disadvantaged children is key to closing the achievement gap. To date, however, health and educational interventions have been implemented separately, limiting their overall impact.
Schools provide a natural setting in which to address children’s health and psychosocial needs. Though many school-based health clinics exist, their services are typically limited in scope, restricted to a subset of students, and not integrated with educational activities. Given the acute and complex needs of children in poverty, a new approach to school health is needed. This approach must: 1) provide comprehensive pediatric care tailored to the needs of children in poverty; 2) promote the foundations of wellbeing for all students (healthy behaviors, socio-emotional skills development, stress management) as part of the school day; and 3) promote a positive school climate. By working in partnership, health and educational stakeholders can address the shared determinants of health and educational disparities that limit opportunities for students to achieve their full potential.
In August 2015, with a gift from philanthropy, Johns Hopkins University, under contract with the Baltimore City Health Department, partnered with KIPP Baltimore school to launch the Rales Health Center (RHC). KIPP Baltimore is a Baltimore City Public charter school whose student body (n=1,500 students) is 99% African American and 88% free-lunch eligible. RHC is staffed by a pediatrician, nurse practitioner, two school nurses, a medical assistant, a school wellness coordinator, and a family advocate. A mental health team is also on site. RHC provides school health services (i.e., school nursing) to all students in the school, as well as pediatric care including acute care, chronic disease management, and preventive health services for health center enrollees. Schoolwide efforts include screening, and health campaigns for all students. In addition, RHC staff explicitly work in partnership with school leadership and staff to identify and address student psychosocial needs that impact education, e.g., promoting attendance, attending individualized education plan meetings and parent-teacher conferences, and screening students with disciplinary problems for unmet psychosocial, mental health or other medical needs.
In the fully integrated RHC model, clinicians are focused on wellness and prevention, rather than simply health care and treatment of disease. Further, RHC engages with students and families where they already spend time and makes addressing wellness a natural part of the fabric of families’ lives. The expectation that wellness is both attainable and accessible, is critical to building student, family, and community well being.