When Tianna Jernigan's ear began to ache earlier this school year, she walked downstairs to the school clinic at the KIPP Ujima Village Academy, where a doctor diagnosed an infection and prescribed medicine to treat it.
It was a relief to Tiffany Brown, 38, who did not have to take time from work to ferry her 13-year-old daughter to the doctor but was still able to get her medical care.
A trip to the doctor's office on school grounds was made possible for the first time this academic year for children at the KIPP Ujima Village Academy and its sister school, KIPP Harmony Academy, under a new model for a school health clinic that offers more extensive medical services than the typical nurse's office.
Like most schools, the KIPP academies, located in the same building on Greenspring Avenue in Northwest Baltimore, used to offer only basic care by nurses. They could put a bandage on a scrape or take the temperature of a student who felt ill.
Now a doctor and nurse practitioner on staff can diagnose illnesses, prescribe medicine and offer other primary care services. The school also provides vision exams, dental services and behavioral health care.
The hope is that by offering medical options in the school setting, students will have fewer absences caused by illnesses and in turn do better in school and have a brighter future. The KIPP clinic is run by the Johns Hopkins Children's Program with help from a $5 million, five-year grant from the nonprofit Norman and Ruth Rales Foundation.
"This clinic is so much more than a nurse's office of the past," said Ronald J. Daniels, president of the Johns Hopkins University, at an open house for the clinic Friday. "It's much more than a place to go for a Band-Aid or aspirin."
A handful of schools around the country have adopted the model in some form, even as many schools are cutting nurses for budget reasons. About 2.5 percent of the country's schools, or 2,300, offer comprehensive primary-care services to some degree, according to the School-Based Health Alliance. More than a dozen do in Baltimore.
Health problems can severely affect a child's ability to do well in school, research shows, and those who live in low-income areas are affected disproportionately. Nationwide, nearly 50 percent of children who live in poverty suffer from a chronic health condition such as diabetes or from a behavioral or learning problem, according to Hopkins.
"We know we have to close the health disparities gap to improve a kid's education and give them a better chance at a future," said Joshua B. Rales, president and trustee of the Norman and Ruth Rales Foundation. "We think this health center is one way to do it."
The foundation and Hopkins will evaluate the program for five years, and hope to expand the model to other schools if it makes a difference in health outcomes, Rales said.
Across the country, offering extensive medical care in schools has helped reduce emergency room and hospitals visits while curbing school absences and improving academic performance. Similar clinics have made health options more accessible for historically hard-to-reach populations, particularly in poor communities. Two studies found that adolescents were 10 to 21 times more likely to go to a school clinic for mental health services than a community health center.
"We know if we are really going to address the problem we need to go to where the children are," said Dr. Tina L. Cheng, director of the division of general pediatrics and adolescent medicine at Hopkins and co-director of the new center.
The KIPP schools were chosen for the new clinic because they are open to innovation and serve a population Hopkins and the Rales foundation want to target. Nearly 85 percent of the schools' 1,500 students qualify for free or reduced-price lunches.
Kate Mehr, executive director of KIPP Baltimore, said many of the students suffer from chronic conditions such as asthma that flare up and cause them to miss school.
Staff at the KIPP clinic will help students manage these chronic conditions. Many students take daily doses of medication at the clinic, and when they are having trouble breathing, they come to see the doctor rather than having parents take them to an urgent care center, emergency room or doctor's office.
On Thursday, students walked in for various illnesses. Seven-year-old Morgan Thompson, a second-grader, held her stomach because she said it hurt. A nurse practitioner took her temperature, gave her water and planned to monitor her for a while. Z'Niya Payne, an 11-year-old in the fifth grade, said her chest hurt. She was given allergy medicine and told to rest. The nurse practitioner then listened to her breathing, which sounded clearer.
As part of the clinic, Hopkins will offer health education and wellness programs.
Dr. Leana Wen, Baltimore's health commissioner, is a proponent of comprehensive health centers at all city schools, but said cost poses a huge hurdle. The funding the KIPP schools are getting by far surpasses that of any other school health clinic in Baltimore, she said. In addition to the Rales funding, the clinic also bills students' insurance — whether private or Medicaid — for visits.
"We would love to get that funding and support for all of our schools," Wen said.
The School-Based Health Alliance estimated it could cost $250,000 just to cover the basic staff for a comprehensive clinic.
"It is not an inexpensive model, and then you want to be able to generate enough visits as well to sustain it," said John Schlitt, president of the School-Based Health Alliance. "It is hard for every school to have one."
Brown is thankful for the new clinic at KIPP. When her daughter became ill before, it became a burden because she had to find someone to fill her shift at the hospital where she works.
"It was so nice," Brown said. "They saw her at school, gave her a prescription and I could stay at work."