An essential part of providing effective healthcare is meeting patients where they are. Cincinnati Children’s does that literally and figuratively at its school-based health centers, located at Rockdale Academy, South Avondale School and Hughes STEM High School.

With minimal staff—one nurse practitioner and one receptionist/scheduler or medical assistant at each center—the SBHCs offer regular checkups, sick visits, immunizations, management of chronic illness, sports or work physicals, and prescriptions to 1,600 students, plus an additional 3,000 children, ages 0-19, in the community. In-person and telehealth visits are available, and they’re open during the summer, spring and winter break.

The first SBHC launched at Rockdale approximately 22 years ago, followed by South Avondale 2 years later. Some people questioned the need for the centers with Cincinnati Children’s Pediatric Primary Care Center located just two blocks away. But the data showed that 50 percent of the schools’ students who listed Cincinnati Children’s as their primary care provider hadn’t been in for a well-child check for 3 years.

“Getting families to come to the health center was a slow sell at first,” says Lisa Crosby, DNP, APRN, CNP, clinical director for all three sites. “But with the schools’ backing, they gradually warmed up to us. Now, the students themselves are our strongest ambassadors. They urge their new classmates to ‘make sure your mom signs that [consent] packet, because if you go to the health center, they’ll take care of you.’”

The centers even get calls from moms in labor and delivery, wanting to make appointments for their newborns.

“It’s especially gratifying when we see the children of former patients,” Crosby says. “They tell their kids, ‘This is where I used to come for my checkups.’”

Many of the staff, including Crosby, have worked at the SBHCs since the beginning. Having such a small, tenured team virtually ensures that patients and families will see a familiar face when they come to the center, which has been paramount in building trust. “No one likes to feel like they’re getting shifted around. We’ve developed the cultural competency to make our families feel nurtured and loved,” she says.

Accessibility is a key component of the care the SBHCs provide. When kids are scheduled for an appointment, they can usually be back in class in less than an hour, whereas if they went elsewhere for care, they would probably miss the rest of the school day. If a student needs follow-up, they can be called down to the center without disrupting mom or dad’s work schedule.

Crosby recalls one mom who had three kids in need of COVID testing, which would typically have taken 1-3 days to arrange in the scheduling system. “The mother drove down from Mason, and our nurse practitioner went outside and swabbed the kids so she wouldn’t have to miss another day of work,” she explains. “Because we are such a small team, we can be more accommodating.”

Some patient visits occur during the school day without a parent or guardian present.

“When we call the parent to give a visit summary, we sometimes find that the phone number we have is incorrect or they don’t answer because they are not permitted to receive phone calls at work,” says Crosby. “We don’t get to have the dialogue we would have if they were part of the visit. However, we always send, at minimum, a written summary of the visit to keep parents informed and part of their child’s care. On the flip side, we often get to have deep, connected conversations with our patients that don’t happen in other settings due to the parent’s or caregiver’s presence.”

Crosby and her small but mighty team often have to be more innovative to meet patient needs. The integration of behavioral health into primary care started with the SBHCs. They connect patients and families with social workers, dental services, nutritionists, asthma care coordinators, Legal Aid and other community resources.

“The support we get from the school principals and the nurses is so important to our work,” says Crosby.

Mona Mansour, MD, is the medical director of the SBHCs. She loves the depth of relationship and the strong connection staff are able to have with families. “Being in the school building means you’re closer to their lived experience and social context. It feels safer, more accessible. There’s a lot of joy.”