Beyond the Box: New Approaches for School-Based Healthcare
I’ll be honest: When I left the high-adrenaline world of hospital labor and delivery for a job as a school nurse, I felt a little lame. I worried that I would lose my technical skills, be bored, and suffer ridicule from real nurses. I imagined long days with occasional interruptions for Band-Aids, fake stomachaches, and a lot of vision tests. I thought about teaching handwashing techniques to kindergartners or calculating BMIs for an endless parade of high schoolers—and felt underwhelmed.
I took the position because I wanted to return to the world of community health, but as I reread my job description while I waited for the ink to dry on my contract, I worried I was selling out by taking a cushy desk job and forgoing real work in the field. Fast forward a few years, and here I am at Mailman, plotting an entire career in school-based health.
My years as a school nurse were far more difficult than I expected, but they taught me to expand my definition of school-based health care, respect the potential of a young, captive audience, and recognize the power of schools in a community. Sure, I made a lot of ice packs for bumps and bruises, and infuriated numerous kids by sending them and their sham illnesses back to gym class—but I also designed and taught a course on sexual and emotional health and social awareness for middle schoolers.
I helped craft a comprehensive child protection policy and curriculum for international schools across Africa and Asia. I engaged with students, teachers, parents, and community members about self-harm, suicidal ideation, vision services, peer mediation, lice, condoms, anaphylaxis, politics, tampons, asthma, sex, drugs, obesity, pregnancy, primary care, race and health disparities, vaccinations, nutrition, gender, sexual violence, and so many other things.
My role as a nurse didn’t get me to think outside the box, it blew the box up. Through the experience, I became convinced that quality, free, public education represents one of the most valuable opportunities to create true population-level shifts towards positive health outcomes.
I quickly realized that in order to keep up with my new, school-based occupation, I needed to know more about systems, power, privilege, populations, programming and public health. I chose Mailman for its dedication to social justice, its respected Population and Family Health Department, and its proximity to the largest public school system in the United States. I figured that if I really wanted to understand school-based health care delivery, I should go big.
Being especially interested in reproductive health care, I wanted the opportunity to learn about the on-site long-acting reversible contraception (LARC) services being offered in NYC school-based health centers and the best practices for sexual health education for a huge, diverse student population. When I heard murmurings about Mayor DeBlasio’s interest in embracing and funding the Community School model as a way to improve educational and health outcomes for students, parents, and community members, I knew I needed to be in New York.
The other day, I sat in Dr. Caroline Volel’s Issues in School-Based Health course and listened to Dr. Howell Wechsler, CEO of Alliance for a Healthier Generation and a former director in the CDC, discuss the role of American schools in combating the childhood obesity epidemic. In another class session, my necklace set off the metal detectors at the George Washington Educational Campus, where I was set to tour the school-based health center with Dr. Melanie Gold, the medical director of the School Based Health Centers for the Department of Pediatrics at the CUMC and the Morgan Stanley Children’s Hospital, in order to better understand the power and pitfalls of providing reproductive health care in the public school setting. Last week, I walked the streets of Washington Heights with community organizer and Director of School Culture at Inwood Academy, Angelo Ortiz, to learn why pounding the pavement is essential to identifying the community resources needed to enhance student health.
Besides being exposed to an almost overwhelming array of school health resources and champions each week, those of us in the course are working in partnership with real schools on very real problems. There is no fluff, hypothetical or imaginary work in this class. Any literature reviews we do, surveys we create, or recommendations we make are in the service of three local schools working–sometimes desperately–to meet the needs of NYC children.
Dr. Volel currently serves twenty-five schools in Central and East Harlem as a field physician with the Department of Health and her active connections are evident in her instructional design and delivery. She wants us to wrestle with the realities– both messy and beautiful–of school health.
While we may not save the world during this seven-week course, and can only glimpse the very complex system that is the NYC Department of Education and the Office of School Health, my classmates and I will walk away with a unique insider view on a rapidly expanding field with incredible potential to affect population health in this country.
If you would like to contribute to Mailman Student Voices, please send a three to five-sentence pitch outlining your topic to mailmancomm@columbia.edu.