Centers bringing health care to students

For years, doctors insisted she lose the weight. But Elena Plata-Daling could never find the motivation to do it.

Then last spring, a health center opened up in her SeaTac high school. And all of a sudden, a nutritionist was down the hall, not bus rides away. She stepped on a scale recently to find 20 pounds gone.

"Getting started — that's the hardest part," said Plata-Daling, 15, who visits Tyee Campus Health Center monthly for support. "But once you're going, you're going."

School-based health centers are fast emerging as a force in adolescent care, providing primary care and mental-health counseling to a population that often avoids doctors, for reasons of cost, convenience or fear. In a public-health survey six years ago, 75 percent of Seattle students who visited the centers said they would not have gotten care otherwise.

"It's an age when they're starting to become independent, and mom is less likely to cart them off to the pediatrician," said Linda St. Clair, manager of school-based health centers for Public Health — Seattle & King County. "It's a key time."

The number of school-based health centers nationwide has jumped from about 200 to around 1,700 since 1990. Seattle tapped into the trend early, starting a center at Rainier Beach High School in 1988, and working with Public Health to set up centers in every high school and four middle schools. The centers, funded mostly by the Families and Education levy, treat 5,000 students a year for everything from obesity to asthma to depression.

As part of a push to improve adolescent health, state officials announced this spring they had federal money available to start three new centers. Currently, there are only two outside of Seattle — one at a small alternative school in Kingston, the other at the Tyee Educational Complex, a collection of several small high schools in SeaTac. The centers often open in underserved areas like SeaTac, a community that has shifted in recent decades from a mostly white and middle-class population to one that is more working-class and immigrant.

The SeaTac/Tukwila area has the highest rate of uninsured people in the county, at 22 percent, according to the most recent Public Health statistics. The area also has among the highest rates of teen pregnancy, diabetes and asthma hospitalizations.

But until last spring, there were no medical clinics in SeaTac. And for people without cars, bus service is so scant that it can take two transfers to get to a community clinic. What a hassle, said Plata-Daling. She would rather not go.

"We're kids," she said. "We'd rather just suck it up and tough it out."

Beyond the school nurse

The school nurse remains a critical component of any school, providing acute care, among other things. But school-based health centers go beyond that to address chronic conditions like obesity, a serious problem in South Seattle and South King County. The area has the highest rate in the region.

In its first year, the Tyee health center, which is run by the private, nonprofit Community Health Centers of King County, has seen about 600 students, mostly for sports physicals, immunizations and reproductive health, which includes birth control and screening for sexually transmitted diseases.

The reproductive-health aspect occasionally raises concerns. But clinic staff members point out that they are required, by state law, to offer those services when asked, and to keep it confidential. Same goes for mental-health and substance-abuse counseling.

It was, in fact, the offer of birth control that pulled Plata-Daling in. She wanted it but wouldn't ask her pediatrician. She cased out the school clinic, found it friendly and made an appointment.

Once she was there, she addressed another critical health need: losing weight.

This kind of thing happens all the time, said Alyssa Spingola, nurse practitioner at Tyee. A student makes an appointment for flu symptoms, then starts to talk about a more serious problem affecting performance at school.

Catherine Carbone-Rogers, a spokeswoman for the Highline School District, said the health center at Tyee makes good academic sense.

"If we can reduce the absenteeism, then that's going to help the kids get better grades," she said.

Critical conversations

Doctors are so overloaded with patients these days, they rarely have the time to sit down and talk with a patient about life. But school-based health centers consider that conversation critical. If you don't ask, said Laura Stuart, nurse practitioner at Rainier Beach, kids often won't open up.

So building rapport is a part of the health-center routine. Rainier Beach staff members often stand in the hallway, talking to kids. A weekly brown-bag lunch tackles topics such as domestic violence and cancer. After 19 years, the center has become a haven for some students, who post their art, even prom pictures, all over the walls. Stuart begins every visit with a few casual questions — How are you doing? What classes are you taking? — to set the tone. That's how she was able to spot depression in one of her patients, a girl devastated by her grandmother's death and falling behind in school.

Stuart referred the girl to Malikah Duncan, the mental-health counselor, and within minutes of their first session, the student was letting the grief loose.

About a third of school-based visits in Seattle relate to mental health. As funding for community mental-health services gets scaled back, public-health officials say the centers fill a critical need.

"These kids aren't pulling out phone books and researching where they can find a therapist," Duncan said.

At Rainier Beach, where 65 percent of students qualify for free or reduced-price lunch, Duncan often counsels kids through bereavement issues. Some are mourning parents lost to drugs, or death. Others are simply struggling with growing up alone, their parents working three jobs.

The girl whose grandmother died had parents. But her mother was HIV-positive. So was her stepfather. Duncan connected them all with a support group. Then she referred the student back to Stuart's office for antidepressants.

The girl's mood has stabilized now. She's showing up in class. She's reaching out to her teachers. This week, she's doing something that seemed impossible a few months ago: She's getting ready to graduate.

Cara Solomon: 206-464-2024 or csolomon@seattletimes.com