School health clinics making a difference in Waikato communities

Annually, thousands of youth in communities across the Waikato region struggle to access health care services, restricted by barriers such as cost, lack of transport and fear of talking to a health care professional.

Thankfully, as they begin to walk through the doors of their high schools, wharekura, alternative education facilities and teen parent units this month, there's a team of 11 registered nurses and 19 general practitioners (GPs) ready and waiting to fight this access impasse.

These health professionals, based at 29 education facilities across the Waikato region from Te Kauwhata to Taumaranui and including the Coromandel, belong to Pinnacle Midlands Health Network's school-based health service. It's a free service that tends to fly under the public radar but that last year alone tallied more than 10,400 visits from students who need it most.

"We're funded to cover nurse-led clinics in decile one to three high schools, wharekura, alternative education facilities and teen parent units. In most cases, nurse-led services also have access to a GP," Pinnacle MHN youth health lead Melissa Davidson said.

"We also have GP-led clinics in decile four to seven schools for up to two hours per week. Most clinics allow students to drop in whenever they're available. Appointments can also be arranged prior, which is important when parents or caregivers want to accompany a student to see the nurse or GP."

Since 2002, when the service began operating, nurses and GPs have served a diverse range of primary care health needs. And there's no question about the service being well used across the region.

"Last year 1,936 students across the region visited a nurse for sexual health reasons, 310 students for mental health reasons and 438 for injuries. We had 6,598 additional nurse visits for things such as general medical, abuse or neglect. There were 2,747 GP visits, an increase of almost 1,500 visits when compared to five years ago," Melissa said.

Every year nine student in schools where a nurse is present is also eligible for a Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression, Sexuality and Safety (HEEADSS) assessment. This assessment includes weight, height, vision and hearing screening and referral to further services if needed. "The purpose of doing this screening early is so that physical and psychosocial issues are picked up and dealt with early, and therefore less likely to affect students later on," Pinnacle MHN school clinics GP Bronwyn Campbell said.

Bronwyn emphasises that parents and caregivers are strongly encouraged to visit clinics with their youth. "Ultimately we want families to be involved in the students' appointments because students live in families. Sometimes parents or caregivers come in, other times the older sibling brings the younger one. There are, of course, times where a student doesn't want to involve others, in which case we always respect confidentiality so long as it's safe to do so," she said.

Success stories across the service are rife, with Taumarunui High School nurse Rebecca Downey and GP Dr Anna Teata reporting zero unplanned pregnancies in three years thanks to proactive provision of sexual education and contraception options. Similarly, Ngaruawahia High School nurse Sarita MacDonald and GP Dr Karen Benattar say the local community pharmacist is dispensing less emergency contraceptive pills thanks to young women being able to access to contraception early.

According to Dr Teata, asthma and eczema are particularly prevalent in the school community and would be poorly controlled without input from her and Rebecca. "Families aren't necessarily in a position to engage with local health services in which case these health issues are left untreated. We provide such things as funded inhalers and eczema cream for students to walk away with."

Paeroa College nurse Jennie Carey has saved anxious and suicidal students' lives by building relationships with them and referring them for counselling. "Mental health issues are very real for students. We're in the privileged position to talk with them and make sure they are referred to the right place in the health system to get the help they need," she said.

"Ultimately we're pleased to be at a point where, for the most part, there doesn't seem to be a stigma about seeing the nurse because students visit for such a variety of reasons including sore throats, acne and general ailments," Melissa said.

"At the crux of it, our aim is to reduce poor health outcomes for youth and families who traditionally face access barriers by making make ourselves readily available in their day to day education setting at no cost. Our hope is that youth will have a great experience when they visit us and therefore stay engaged in the health system once they leave secondary school," she said.

School principals around the region are praising the service for the significant difference it's making for young people.

"At Ngaruawahia High we have a school nurse available for our students three days a week and a GP for two hours on a Tuesday. They go above and beyond to ensure students have access to health advice and services. The support our students receive is second to none and we are extremely fortunate," Ngaruawahia High School deputy principal Claire O'Fee said.

Recognition amongst lower decile schools in the region is only increasing, with two additional schools currently in negotiation to come on board in 2018. This is accompanied by the challenge of suitable resourcing.

"Because creating a positive experience for students is an essential part of the service, we aim to employ those who are specifically skilled at working with young people and families. Finding the right people for the job is something we take seriously and isn't always easy. However, we are proud to have built a strong team of school-based health experts over time," Melissa said.

Minimum training requirements for employees include HEEADSS, smoking cessation, resuscitation level 4 and certificates in child protection and family planning. "All our nurses and GPs also have regular professional development sessions with Pinnacle MHN," she said.

"The school-based health services team considers it a privilege to be at the forefront of primary health in education facilities across the Waikato region. We hope to continue making a difference in young people's health for many years to come."