School-based clinics, nurses bridge care gaps for kids, communities after Helene
By Jennifer Fernandez
When the remnants of Hurricane Helene tore through western North Carolina, nurses based in schools and medical personnel from school-based health centers jumped in to help.
One counselor and a colleague visited a family in a home that had been washed downriver, where they listened to a child’s terrifying story about swimming through her bedroom, said Charley Thompson, communications manager with Blue Ridge Health. The Hendersonville-based system supports more than three dozen school-based health centers in western North Carolina.
The counselor spent one-on-one time with each child in the family to help them process what had happened, she said.
“We were all in such shock,” Thompson said of the storm’s aftermath. “Here we were dealing with all of these issues that we hadn’t really dealt with before.”
While schools were closed — some for several weeks — school nurses found ways to connect with students by working in shelters and distribution centers. School-based health centers set up pop-up clinics in the community and went looking for families that needed medical and mental health care.
Behavioral health issues are a concern more than two months later, as students struggle with displacement and, in some cases, losing a friend or family member. (As of Dec. 4, the death toll from Helene in North Carolina stands at 103.) Health professionals are also keeping an eye out for patients’ physical reactions to the flooding — an increase in respiratory illnesses, asthma getting worse or exposure to mold.
“I think we will see more down the road when they start to move back in, or work starts to be done on their houses,” said Shannon Auten, student services director for Henderson County Public Schools. Less-than-ideal temporary living situations might also lead to health issues, she said.
“Helene has definitely taken a toll on everybody,” Auten said.
Health care in schools
School nurses and school-based health centers serve students’ health needs, although not in the same way.
School nurses ensure that students are meeting vaccination requirements. They also manage medication schedules and help with everyday care, such as headaches; sometimes they provide emergency care, such as triage and first aid for broken bones. A lot of their focus is on prevention and chronic conditions, said Kim Berry, school nurse supervisor for Henderson County Public Schools.
School-based health centers offer laboratory services, medical diagnosis and treatment, and prescriptions.
In many cases, both programs also serve as the medical home to students — especially for underserved youth.
“So many of these kids don’t have other options, and we may be their only health care,” Berry said.
The close connection students have with their school nurses was evident in the wake of Helene. Berry remembers volunteering with another school nurse at a shelter a couple of days after the storm and seeing a middle school student.
“He immediately recognized her,” she said. “He immediately felt comfortable in this awful environment — a middle school boy being stuck in a shelter.
“I mean, can you imagine how awful that would be?”
Between 35 percent and 50 percent of the students who use Top Dog Clinic at Ashe Middle School get their primary care there, said clinic nurse practitioner Terrie Clark. Top Dog is run by AppHealthCare, a regional health department that serves Alleghany, Ashe and Watauga counties.
Easy access to care is key, and having health care available in the place where children spend the majority of their day can help close care gaps, research shows.
Transportation is a barrier for 15 percent to 20 percent of students at AppHealthCare’s school-based health centers, according to their parents, said Director of Operations Jessica Muldowney. So, the clinic set up where they go to school improves their access to care.
Access improves education too
School-based health centers improve health literacy and outcomes for school staff, students and the wider community, research shows. They also help improve educational results, including reduced absenteeism, decreased disciplinary actions and improved graduation rates, according to a 2016 review of 46 studies on school-based health centers.
Having nurses on site full-time also makes a difference, according to the National Association of School Nurses. North Carolina recommends one nurse per school, but the reality is most schools share a nurse, with an average ratio of one nurse for every 833 students, according to the 2023 Healthy Schools report.
The number of students being released from school early due to injury or illness is cut in half in schools that have a full-time nurse compared with those that don’t, the group said. For Henderson County schools, which have a nurse in every school, about nine in 10 students who see the school nurse return to class, Berry said.
“We have found the more children can stay in school … the more likely they are to be successful in the long run,” Thompson said.
Community health
School-based health centers have been around for more than 30 years. In North Carolina, more than 90 centers serve over 30,000 students, according to the North Carolina School Based Health Alliance.
Today, many of the nation’s school-based health centers provide expanded comprehensive care, such as behavioral health, vision, health education and dental care, along with primary care.
The majority of school-based health centers have physical space within a school. Some centers use telehealth only, some have a mobile unit, and some are situated off campus but near the school they serve, according to the School-Based Health Alliance’s 2022 census.
Many, like Blue Ridge Health’s centers, also serve the surrounding community. After Helene, Asheville struggled with water issues, but Thompson said the school-based health centers provided water and clothing and other things students and families needed. That aid was available to anyone in the community, not just students who use the health center, she said.
“It is such an incredible resource for our community and does help overall to keep our community healthy,” she said.
And the community seems to recognize the importance of school-based health. Ashe County gives AppHealthCare $40,000 every year to offset any co-pays families might have.
“So any student who comes to see us … they will never get a bill for any services that are done at the school-based health center,” said Kelly Welsh, AppHealthCare’s deputy health director and chief operating officer.
And in the wake of Helene, after Atkinson Elementary School sustained damage, the local Boys & Girls Club opened their facility during school hours so the learning — and the health care — could carry on. Each teacher had their own room, and the school nurse worked out of a mobile cart.
Expanding reach
The number of school-based health centers in North Carolina is growing.
Blue Ridge Health added two centers last year and is in the process of opening two more. Many of the centers are collaborations: At Erwin Middle School, Blue Ridge partnered with the school system and the United Way of Asheville and Buncombe County, Thompson said.
“This is an ongoing process that we’re very involved in and very proud to be a part of,” she said.
Henderson schools have one nurse stationed at each school, plus several school-based health centers, with the latest opening this school year.
AppHealthCare has been working on a new health center for Sparta Elementary in Alleghany County; it is expected to open in January. In February, officials hope to receive a mobile health bus to use throughout the three-county district, including at schools, Welsh said. The retrofitted RV has two exam rooms.
Ashe County Schools is building a new middle school, which will be next to the high school. The Top Dog Clinic will move there, allowing high school students access to its services.
Welsh said the Sparta site is a K-8 school with the high school nearby, allowing students there access to the clinic as well.
“That’ll be exciting for us to open up in that clinic,” she said.
Local providers predict that the extra help more school-based centers can provide will be needed.
Auten said a lot of students are dealing with anxiety — from being displaced and from watching their parents struggle.
Thompson also sees students struggling with mental health issues after Helene, so they’re working to expand behavioral health services and offering telehealth sessions.
Auten said it’s hard to know what to expect.
“Nothing like this has ever happened in western North Carolina,” she said.
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