A steady stream of students come through the office door, toss backpacks aside and begin telling Delhi school nurse Holly Simmons about something that feels wrong.
"They have questions they'd never ask a doctor," said Simmons, a Delhi Educational Support Staff Association member.
"She understands us," Mindy Schmitz, a senior, piped in.
"We trust her," said ninth-grader Kaetlyn Harageones.
Simmons' office in the K-12 Delhi Academy is papered with cautionary posters about bulimia, anorexia and smoking, and ones advocating healthy foods and eating habits.
Simmons sees about 70 students a day for all sorts of illnesses, injuries, or state-mandated screenings.
Just then a student sticks her head in the door.
"179" she says to Simmons.
It's not code. She's reporting her daily blood sugar level to help Simmons monitor her diabetes.
But if severe illness strikes — a fever, strep throat or gym class injury — Simmons sends the student to the health clinic down the hallway. It's part of a growing statewide trend to provide complete in-school health care for students.
And in districts like Delhi in Delaware County, where the Extraordinary Needs Index, a measure of student need and poverty, is a high 78.8, school-based health clinics (SBHC) are godsends for families who lack access to quality primary medical care. Here, there is also a dental clinic on site, where staff later this year will be able to fill cavities and perform cleanings.
The effects of poverty on children can be devastating — asthma, poor oral health, nutritional deficiencies, exposure to toxins, illnesses and injuries from unsafe living conditions and play areas. Poor and low-income families are more likely to have children with special health needs and fewer resources to address physical, social and emotional conditions. The problem, according to the American Pediatric Association, is even more acute among the children of African-Americans, Latinos and immigrants.
"School nurses are uniquely positioned to promote prevention and wellness, and provide access to care for our children to stay healthy, safe and ready to learn," said NYSUT Vice President Kathleen Donahue, who oversees health care for the union.
NYSUT's school nurses, counselors, social workers and occupational and physical therapists work with health professionals at 238 school-based health centers across the state. The number of clinics is expected to rise as funds become available through Affordable Care Act grants. Most school-based clinics are operated by hospitals and funded through Medicaid, health insurance and grants from the New York State Department of Health. Some SBHCs are also supported by federal grants and regional and local foundations.
NYSUT continues to advocate for both school nurses and school-based health clinics to help families thrive.
The tandem treatment by school nurse and clinic staff means students miss fewer days of school for doctor appointments, and receive same-day treatment. For parents, many of whom do not have transportation or money for medical bills, the centers provide them the assurance of health care for their children and ready accessibility.
State policy requires that students with insurance do not make co-payments, and no student can be turned away for inability to pay. All they need to do is enroll in the clinic.
With three patient rooms at Delhi Academy, and a small lab at her disposal, nurse practitioner Mary Schmitt can check urine or take a throat swab. She can administer immunizations and authorize a student's return to a physical activity. If she suspects a broken bone, she can call in a prescription for an X-ray at the nearby hospital.
"We are geographically challenged," said Schmitt, who treats about 130 students a month. The rural town has 5,000 residents, many who live on back roads and sprawling farms. "People sometimes have to drive an hour to see a doctor."
Ann O'Hara, an elementary school nurse and member of the Syracuse Teachers Association, functions as a triage nurse. Her school serves 800 students in a city where 53 percent of children live in poverty. "A lot of kids do not have good access to health care," O'Hara said. "Their parents may have two jobs, with no paid days off. Time off (to go to a doctor) is a day without pay."
In the first few weeks of September, she handled daily student health problems and two emergency calls — one for a possible appendectomy and the other for a serious food-allergy reaction. She examined and charted belt marks on a young boy sent to her by a concerned teacher, then called the school social worker.
Nine drawers in her office are filled with asthma inhalers. Sixty-five students have potential for anaphylactic shock.
"My scope of practice is far, far more serious than people think," she said. O'Hara, a member of the NYSUT Health Care Professionals Council, works closely with the professionals at the school's health clinic.
"We're definitely a team," said Nancy Bailey, a nurse practitioner at the Syracuse clinic.
Carol Folkl, a school nurse and member of the Orange County BOCES TA, says having the additional support of a school-based health clinic is immeasurable.
Folkl administers 14 tube feedings a day. She also handles catheterizations, oxygen tubes and nebulizer treatments for elementary students — a large percentage of whom have multiple disabilities.
"We see 50 students per day — easily," she said.
When students have a serious health concern, or need a physical or immunization, she sends them to the clinic. The Middletown Community Health Center, established at the Orange-Ulster BOCES 12 years ago, provides support for about 2,000 high school students in career and technical programs, and special education students. The center also has locations in nearby communities, so students can receive care after school and on weekends.
"We work very closely with the school nurses," said nurse Debra Martin, coordinator of the clinic's outpatient services.
SBHCs have also found a home in higher education settings.
David Lawrence, a member of the Faculty Association at Monroe Community College and the NYSUT Health Care Professionals Council, directs a dental hygiene clinic as part of the dental studies program. Supervised dental hygiene students provide preventative care for up to 7,000 students, faculty and the public each year at the Viswanathan Clinic. Services are free for senior citizens, veterans and Medicaid recipients, and others pay up to $15 on a sliding scale.
Monroe CC student dental assistants also help operate a school-based dental center in School 17 that serves 730 students from some of the poorest neighborhoods in Rochester, said Krista Rodriguez, FA member and program coordinator. Patients are treated and educated about oral care.
"It's a whole new access to health care," said Lawrence.