Health clinic a boost for students, neighborhood

Margo Gaskins has treated a little bit of everything in the year she’s been seeing patients at a health clinic adjacent to Ingram-Pye Elementary School.

There have been the usual sniffles, coughs and stomach bugs, but there have also been broken bones, pneumonia and vaccinations.

“Sometimes it’s the mommy love instead of even nursing,” said Gaskins, who is a certified pediatric nurse practitioner. “You also have kids that come over with a stomach ache and you get down to the bottom of it, and they got to school late and the truth is they missed breakfast. I keep snacks in here for them.”

The clinic is the first of its kind in Bibb County, and it opened September 2105 in a small brick building on the Ingram-Pye campus. During that time, the absentee rate at the school has improved, and services have expanded to include care for adults.

Danielle Howard, who is principal of Ingram-Pye, said, “Our parents were able to have their children seen at the clinic versus keeping them out for a full day to go to the doctor, wait for the appointment, get back home — and then they have to make a choice: Do I send them to school for two hours or do I just keep them home for the rest of the day? And usually what they would do is keep them home for the rest of the day.”

She said last year’s attendance was at 96 percent — up from the high 80s and low 90s in previous years.

The clinic is staffed by a nurse practitioner, who essentially functions as a doctor. Unlike a school nurse, the practitioner can do an assessment and prescribe medication.

“Most of the school nurses or some of those labeled school nurse are essentially med techs,” said Gaskins, who was leaving the clinic Dec. 31. “They’ve gone to school to learn how to verify medication and pass out medication that’s already previously prescribed. And a lot of their credentials just consist of CPR. They can’t do an assessment.”

In most schools, the nurse also only visits a couple of times a week.

“So usually the teacher was left to her own devices and her own judgment, and most of the time the teachers don’t want their students to leave unless it’s a fever or they’re vomiting,” Howard said. “But for the most part they would just have their students struggle through the day. But now we can really have a concrete step on how to address them.”

The school gets consent for students to be seen at the clinic, and parents or guardians are called before and after a visit.

“Most of the time they say yes, and then they can have an appointment that day, which right there cuts down an early dismissal, which could possibly be recorded as an absence depending on what time,” Howard said.

While most of the patients are Ingram-Pye students, the clinic is open to anyone in the community.

None of Annie McClinton’s three custodial grandchildren are at the school, but she takes them to the clinic. McClinton, who lives off Napier Avenue, first used the Ingram-Pye clinic when her grandson, Shamar, needed shots.

“I’ve been taking them there ever since,” she said. “I think it’s a great idea. It’s more convenient, and it’s a good place there by the school.”

Focus on uninsured, underinsured

The center is an arm of First Choice Primary Care, a nonprofit that has operated a clinic on Walnut Street for nine years. First Choice also has clinic care at Daybreak, the Macon-Bibb County Health Department and in Warner Robins. All the clinics focus on serving the uninsured and underinsured.

The group was working with partners such as Mercer University and the United Way and was looking at grants for school-based health centers, said Katherine McLeod, CEO of First Choice.

“In Atlanta, there have been school-based health centers for several years started by some Emory pediatricians, and they were helping other communities plan and learn about school-based health centers,” McLeod said. “So we got a little planning grant.”

This led to a series of grants to open the Ingram-Pye clinic, and they get general operating support from the federal Health Resources and Services Administration and the W.T. Anderson Charitable Trust.

“The W. T. Anderson family was interested in this as far as it fits with his bequests to health services for low-income children,” McLeod said.

There are still relatively few school-based health centers in Georgia.

“At the time we started working on this one, Atlanta was the only place in Georgia,” McLeod said.

Now, there are several in Atlanta, northwest Georgia, Albany and Cordele, and more districts are experimenting with tele-health, which uses technology to allow doctors to work with patients in other locations.

Ingram-Pye was chosen because First Choice wanted a larger school in a fairly densely populated neighborhood. The proximity to public housing and a large community center were other factors.

“(Location) was probably one of our hardest decisions because you’re looking at all of Bibb County,” McLeod said. “You could argue the need is great in east Macon or south Bibb. We’d love to eventually be able to provide more school-based services in other parts of the county.”

Communication is a challenge

The school sits in one of Macon’s poorest neighborhoods and issues with transportation can affect everything from school attendance to groceries and health care.

“We know this neighborhood has a lot of challenges ... something like 25 percent of the families in this neighborhood didn’t have a private automobile,” McLeod said.

This can make a trip to the doctor an all-day or even all-night event if a parent works.

“If the parent can’t get off work or if they end up just go into the emergency room at night or to urgent care , (imagine) how disruptive that is not just to that child but siblings,” McLeod said. “It can disrupt not only that school day but the whole family can get turned upside down if somebody is spending the whole night at the emergency room.”

Ingram-Pye also has been the focus of wider community efforts to provide quality of life services that school families otherwise can’t access.

“It’s important for people to understand our children don’t come lacking skills — they have plenty of them,” Howard said. “It’s just we need to add different ones.”

One of the clinic’s biggest challenges has been communication. Even with a consent form, the staff prefers to notify parents before and after a visit, and some treatment requires the parents to follow-up with a pharmacy or even a specialist.

“I’ll do whatever it takes to treat the child. but when they go home, you know even if I’ve talked with the mom and I’ve said, ‘Hey did you know your child has strep, I’ve called them in an antibiotic, Can you go get that?’ ” Gaskins said. “You follow up a few days later, and you ask the child, ‘Hey are you taking your medicine?’’ and they are like, ‘What medicine?’ ”

“Sometimes you never know what happens,” Gaskins said. “I don’t know what happens when they go home.”

She also knows transportation can be an issue and tries to send prescriptions to pharmacies that will deliver.

Another challenge has been gaining the trust of families who worry a visit to the clinic might cause an insurance problem or usurp an existing relationship with a family doctor.

“That’s a common question as on the Medicaid cards (that asks) who your primary care provider is,” Gaskins said. “So a lot of parents think, ‘But if you’re not that person am I either A, going to get charged? or B, is it going to mess up my insurance?’ And neither of those are true. Those are both myths. You can see me ... on a sick visit basis as needed but still keep your primary care.”

The clinic does file insurance if a child has it, but accepts payment on a sliding scale for those who don’t.

“We have a fee sliding scale because about 40 percent of our patients in our entire organization have no insurance,” McLeod said. “So people can apply for this sliding fee discount, which is based on family income.”

Eventually, the Ingram-Pye clinic wants to add programs beyond traditional clinic care.

“That’s just gradually learning more about what’s needed and being able to offer some additional services to the staff of the school as well as the families,” McLeod said. “We know a lot of these children live walking distance we know we already have a lot of patients.”

This story was originally published January 2, 2017 at 12:25 PM with the headline "Health clinic a boost for students, neighborhood."