On Jan. 31, Cleveland City Council members advanced legislation authorizing the use of $3.75 million of American Rescue Plan Act (ARPA) funding to build three school-based healthcare clinics, provide medical supplies and telehealth equipment to existing facilities in schools, and launch a campaign to make community members aware of the new clinics and services.
These clinics would provide in-school healthcare services from MetroHealth, Cleveland Clinic and other providers in addition to services offered by school nurses and psychologists. The investments in telehealth equipment would give students in all schools access to physical and mental health professionals without having to leave their school building.
But the school-based clinics would not just be for students, Cleveland Metropolitan School District (CMSD) CEO Eric Gordon told council members.
“The goal is to create a family care system,” he said. “All CMSD students, families, and employees will have access to healthcare through the Integrated Health Initiative.”
The initiative, which requested the ARPA funding for the new clinics, is a partnership started in 2020 by CMSD, Say Yes Cleveland, and local health providers. The initiative’s goal is to provide on-site physical and mental health services in schools and increase family access to healthcare.
The Cleveland Foundation and the Gund Foundation were founding supporters of the initiative, and if the legislation passes, the ARPA funds for the project will go through the Cleveland Foundation.
The initiative’s task force, made up of representatives from partner organizations, also helped create an Integrated Health Department at CMSD, which will eventually manage the in-school clinics and the partnerships with external health providers.
A “hub-and-spokes” model for providing healthcare to Clevelanders
Gordon told council members that the locations of the new clinics haven’t been decided, but the strategy is to ensure there is a brick-and-mortar healthcare facility accessible to every school community.
Key factors in those decisions will include input from Say Yes specialists on which neighborhoods have a high demand for support services, the volume of students and families in each school’s geographical boundaries, and data from MetroHealth on Cleveland’s healthcare deserts.
During the meeting, representatives from the Cleveland and Gund foundations showed a map with the location of each CMSD school and healthcare facility. The map will help the initiative’s task force identify where the new clinics should go.
Gordon said it’s not practical to have a physical clinic in every school.
“It makes more sense to use a hub-and-spoke model where we use this kind of a map to figure out where healthcare hubs are, where a medical team is on site, and then have telehealth options at all school locations where there are not hubs,” he said.
A “hub” could be a school-based clinic or a facility operated by one of the Integrated Health Initiative partners. The “spokes” are the schools without a clinic, which would be outfitted with telehealth equipment connecting students to professionals, with the option to go to a nearby hub for in-person care if needed.
Gordon said the three additional school-based clinics will help complete a “sufficient hub-and-spokes model” in the city, particularly with the telehealth options. The state did not allow those in schools prior to the pandemic, he said.
What healthcare is available in schools right now?
Since returning to in-person learning in 2021, CMSD has assigned a full-time nurse to every school building, according to Gordon. The district has two nurse managers who oversee school-based care. Each building has at least one registered nurse (RN) or licensed practical nurse (LPN).
Every LPN reports to an RN either in their building or a nearby building. Since CMSD formed its Integrated Health Department, it has hired two nurse managers and an executive director who oversee school-based care.
CMSD also staffs school psychologists in every building.
Gordon said each school has a student support team consisting of a nurse, a psychologist and a Say Yes family support specialist. The Cuyahoga County ADAMHS Board also provides behavioral specialists from private mental health providers such as Applewood and Beech Brook.
According to CMSD spokesperson Roseann Canfora, the district currently partners with 16 health providers to support scholars through mobile clinics that visit the schools, telehealth, and on-site care. MetroHealth operates one school-based health clinic and will open two additional brick-and-mortar clinics in CMSD schools this year, funded by a state grant.
Who pays for this?
While the $3.7 million in ARPA funds the initiative requested would pay for the three-year improvement plan laid out in the legislation, including the three new school-based clinics, the actual healthcare costs from professionals outside the school are covered by insurance, Gordon said.
He added that a majority of Cleveland students and their families do not have insurance, so the costs are covered by Medicaid.
Gordon said this is economically sustainable for the district but also for the health professionals outside the school because preventative care provided in school-based clinics costs much less than emergency room service, which is often the only medical care many families access.
Everything else, including pay for the RNs, LPNs, and school psychologists hired by CMSD, is budgeted for in CMSD’s annual budget.
Gordon said he has forecasted all of these costs in the district’s five-year plan, which is financially solid.