The Other 60 Percent

Districts push prevention with employee health clinics

Thousands of Poudre School District employees and their dependents will soon have access to a free walk-in health clinic not far from the Whole Foods Market in central Fort Collins. The clinic, along with a raft of related wellness efforts, is set to launch on September 3.

The site of the new walk-in clinic for Poudre School District employees, set to launch September 3.
The site of the new walk-in clinic for Poudre School District employees, set to launch September 3.

The clinic is part of a new effort by the school district and three community partners to change the way employees get and pay for health care, with the twin goals of promoting wellness and containing health care costs over the long term.

Poudre is not the first Colorado district to launch a free clinic for employees. Mesa County School District 51 launched its clinic in partnership with a local hospital in March 2012. Steamboat Springs School District joined the club in September 2012, creating a free on-site clinic in its administration building.

Still, as the state’s 10th largest district in its fourth-largest city, Poudre may well be the biggest player in the game right now and a key district to watch as its health care initiative unfolds.

“It’s a very exciting venture for all of us,” said Dan Robinson, CEO of Colorado Health Medical Group, a division of University of Colorado Health, one of the partners in the effort.

“I would think every school district would be looking at what Poudre School District is doing and would want to provide those same services to their employees.”

Focusing on prevention

Poudre’s new clinic, which will be called the University of Colorado Health Walk-In Clinic, has been in the works for around two years and envisioned for around eight, said Chuck DeWayne, the district’s executive director of human resources.

Currently, it is a public clinic and urgent care inside the central location of Miramont Lifestyle Fitness, another partner in the effort. In September, although its name will change and it will add Sunday hours, it will continue to be open to the public as it is now. For Poudre school district employees, the biggest change will be that they will no longer pay co-pays or portions of their deductibles to visit.

Instead, the visits will be free for all employees on district’s health plans as well as their dependents, nearly 8,000 people all told. Charges will apply for things like lab work or radiology, but those can be applied to the health insurance plan.

The clinic is not necessarily meant to serve as a medical home for district employees, rather a place they can go for same-day care for minor illnesses and injuries. It will be staffed by doctors and nurse practitioners from Associates in Family Medicine, the fourth partner in the effort.

“The goal is not to be a primary care clinic,” said Robinson.

The clinic is just one component of the district’s four-part health and wellness plan, dubbed the “Integrated Health Management System.” In addition to the clinic, the district plans to launch a program through Miramont providing one-on-one health and lifestyle coaching for employees who have or are at risk of chronic diseases. It already provides confidential mental health counseling for employees who are having trouble coping with work or personal problems.

Finally, the district will begin offering a series of free wellness classes at Miramont next month, covering topics such as weight loss, mindful relaxation and stress relief. The classes, like the mental health counseling, are open to all employees, not just the ones enrolled in district health plans.

Ashley Schwader, the district’s wellness coordinator, said the district previously offered occasional wellness classes at specific schools, say during a professional development day. The latest effort is meant to pull the offerings together at a convenient central location.

Paving the way

Although a handful of districts in Colorado, along with dozens nationally, are experimenting with some version of employee health clinics, it’s not a new concept. Some corporations have been doing it for years, and more recently public entities like cities and counties have added such amenities.

In District 51, talk of an employee clinic began in 2010 around the time Mesa County was preparing to launch its employee clinic. Health care costs were rising and the district was struggling to contain them by raising employee premiums and deductibles.

But that solution backfired, in part because rising deductibles prompted employees to delay or skip going to the doctor altogether, setting the stage for major health problems that produced enormous insurance claims.

About 18 months ago, the district contracted with Grand Junction’s Community Hospital to offer free appointment-based primary care services at an existing community clinic and $25 urgent care services at an existing urgent care center in the city. In addition, about 65 common prescription drugs are available at no cost and the district offers free health coaching to employees dealing with conditions such as obesity or diabetes.

About 1,900 of 3,000 District 51 employees are insured by district health plans and eligible to use the clinic, along with their dependents. District officials initially assumed about 40 percent of those eligible would visit the clinic, but the number is closer to 60 percent.

“A lot of people didn’t even have a physician and now they have a physician within the clinic,” said Sheila Naski, the district’s Risk Manager. “We are really encouraging health and wellness…We’re going to avoid those heart attacks or diabetic comas or whatever it is.”

In Steamboat Springs School District, which has 392 employees, the nearly-one-year-old clinic is somewhat smaller scale. Housed in the district’s central office and run by Healthstat Inc., it contains one exam room, is staffed by a physician’s assistant and receptionist, and is open three days a week for a total of 20 hours.

Clinic visits as well as common prescriptions available on-site are free for employees covered by district health insurance as well as their dependents. Unlike in District 51, the clinic is not meant to be a primary care facility.

“It is well utilized,” said Katie Jacobs, the district’s director of human resources. “They are very busy when they are there.”

Cost containment

The employee clinic in District 51 already seems to have made a significant dent in the district’s annual health care costs. In fiscal year 2010-11, those costs were $11.5 million and the following year they rose to $12.4 million. Then, in 2012-13, costs dropped to $10.8 million, a number that includes the $365,000 cost of the contract with Community Hospital.

She said the clinic is at least partially responsible for the drop in costs.

“It’s probably the combination of the clinic and a good year,” said Naski, noting that health care costs naturally fluctuate depending on the specific claims each year.

While the district’s two-year contract with Community Hospital will come up for renewal next spring, Naski said, “It’s just been so successful. I wouldn’t even think about taking it out of our plan.”

In Steamboat Springs, Jacobs said the district hasn’t yet calculated the return on its clinic investment since it hasn’t even been open for a year.

Still, she said, “This seems to be helping with those costs and keeping our costs down.”

In Poudre, annual health care costs are about $12-13 million, with average yearly increases of about three to four percent, said DeWayne. While that annual increase is relatively modest, he said the district does incur high costs in cases where employees visit the emergency room for problems that could be handled in a clinic.

Therefore, officials anticipate that it will be cheaper to pay for the employee clinic on the front end rather than for the emergency room claims on the back end. DeWayne noted that the $650,000 the district is spending on the new clinic and its other wellness efforts doesn’t represent an additional expense.

“It’s money we already spend. We’re just spending it on the prevention side,” he said.

How I Help

Why this high school counselor asks students, ‘What do you wish your parents knew?’

Today, we launch a new series called “How I Help,” which features school counselors, social workers and psychologists across Colorado. It is a companion to our popular “How I Teach” and “How I Lead” series.

Through “How I Help,” we hope to give readers a glimpse into the professional lives of school staff members who often work behind the scenes but nevertheless have a big impact on the day-to-day lives of students.

Our first “How I Help” features Cassie Poncelow, a counselor at Poudre High School in Fort Collins. She was the 2016 Colorado School Counselor of the Year and is one of six finalists for the 2018 National School Counselor of the Year award.

Poncelow talked to Chalkbeat about how she creates a legacy of caring, what teens want their parents to know and why peer-to-peer mentoring is better than a social-emotional curriculum taught by adults.

This interview has been condensed and lightly edited.

Why did you become a school counselor?
I was incredibly fortunate to have many powerful educators shape my life in my time as a student, but none did more so than my school counselors. My counselor from high school remains a dear friend and mentor. I knew that I wanted to be a part of what is happening in education and loved the diversity of the school counselor job. They get to collaborate with so many different stakeholders, get to know students in really cool ways and be involved with so many aspects of making change.

Cassie Poncelow

Tell us about an effort or initiative you spearheaded at your school that you’re particularly proud of.
Three years ago, we noticed that students were dropping out continuously because they were short on graduation credits and tired of taking the same classes over and over again. I worked with a team to create Opportunities Unlimited, which is a dropout recovery program for students ages 17-21 that is focused on GED completion and concurrent enrollment opportunities. A fifth cohort started this fall and the program has graduated 26 students in two years.

Is there a tool, curriculum or program you couldn’t live without in your job?
Our Ambassadors program is in many ways the backbone of our climate and culture at Poudre High School. This program trains 50 upperclassmen to mentor freshmen through a year-long curriculum that includes topics like stress management, suicide prevention and sexual assault. This mentoring model means that every freshman has an ambassador that is connecting with them for almost three hours each month. The ambassadors deliver comprehensive, peer-to-peer education that is far beyond and better than any social-emotional learning curriculum that counselors could facilitate. As the co-leader for this program, I also couldn’t live without the hope that this crew gives me. They are the best part of my job.

What’s the biggest misconception you’ve encountered about your role in the school(s) where you work?
I am grateful to work in a place and with people who see the vital role of school counselors and are eager to partner with them. In my time at Poudre High School we have added two new school counseling positions, further demonstrating our school’s belief in the work we do. I have worked at schools in the past that created a lot of systemic barriers to accessing school counselors and I think this was based on a misconception that we were a more frivolous part of services for students.

You spend lots of time with students. Knowing what you know, what advice would you give to parents?
I often ask my students, “What do you wish your parents knew?” What I hear consistently is a plea for them to remember what it was like to be 16: How painful and awkward it was, how boys were all the rage and not getting invited somewhere really was the actual worst.

So, I advise parents to remember that. And remember that a lot of what they dealt with at 16 is even more complicated by the world our kids are experiencing. Social media wasn’t a reality when they were kids and our current students have never known a world where mass shootings haven’t happened often. I know it’s no, “I walked uphill both ways without shoes in the snow,” but this is a scary time to be student — different, but equally hard. Our kids need us to hear them in that. And believe that they can change it.

Tell us about a time when you managed to connect with a challenging student or a student facing a difficult situation. How did you do it?
At my core, I think we all thrive on authentic relationships and I do whatever I can to create these with my students. I want each of my students to feel like I am truly in their corner and a champion not only of what they do but more so of who they are. I hope to not only live this, but to model it for my students in ways that inspire them to do the same.

This semester I have a freshman boy who was consistently skipping class (who knew gas station tacos were such a draw?) and failing multiple classes. His “consequence” is that he has to spend a period working on missing work in my office. I also have a slew of seniors who have made my office their home during this fifth hour, many who are excellent students and are just looking for a place to study. They have taken this freshman under their wing and are committed to his success far beyond what I could ever be. They are constantly asking about his upcoming exams, what he needs help with and celebrating his rising grades with him. I think I have built really authentic relationships with these upperclassmen who then remember what it means to feel connected and cared for and are passionate about showing this student just that. I often stress “legacy” to my students and this seems like a clear picture of that.

What is the hardest part of your job?
Kid stuff is hard. I hurt for kids a lot, as I think all educators do. They live lives far beyond our walls and far beyond what we could imagine and ever control. That’s the hardest. Close second would be trying to operate in a system that seems to be driven by folks who aren’t doing the work. I recognize that there are so many moving pieces and would love to have some of the actual “decision-makers” come spend the day in our role and better understand the work we do.

Tell us about a memorable time — good or bad — when contact with a student’s family changed your perspective or approach.
A year ago, I had a student who was really struggling with some significant mental health issues. I knew that we needed to bring in a parent but the girl was very anxious about this idea, to the point where she had literally crumpled up on my office floor. After calling her mom to meet with us, I joined her on the floor of my office to talk more. Her mom walked in shortly after, assessed the scene and sat right down on the floor with us, despite the chair-filled room. This move shifted everything and I was so grateful for her wisdom to be where her kid was at. It was a good reminder to me to do that always: be where kids are at.

You spend your days trying to help students and staff with any number of things. How do you wind down after a stressful day?
A lot of my unwinding still includes my students as I announce volleyball games or attend other sporting events or performances. I love these opportunities because they let me see my kids in a different light and remind me how awesome they are. I also spend as much time outside as possible, whether it’s going for a quick hike with my pup or a bike ride. Beyond traveling and reading, I cheer hard for the CSU Rams! Go State!

Big money

Millions in grant dollars will bring more counselors to Indiana’s underserved students

KIPP Indy was one of several schools in the county to receive a counseling grant.

Scores of Indiana schools were awarded private grants that will allow them to bolster counseling services for students, many of whom are lacking help for an increasing portfolio of problems, including fallout from the state’s drug epidemic and basic needs like advice on college applications.

The $26.4 million in grants, decided last month, include six for Marion County districts and charter schools. They were awarded by Lilly Endowment, a prominent Indianapolis-based philanthropy founded by key players in the pharmaceutical giant Eli Lilly.

The grants went to 52 school districts and five charter schools, covering about a third of the state’s counties. Based on enrollment, they ranged from about $68,000 to almost $3 million.

Lilly began its push to help schools build better counseling programs last year.

“The response from school corporations and charter schools far exceeded the Endowment’s expectations,” said Sara B. Cobb, the Endowment’s vice president for education. “We believe that this response demonstrates a growing awareness that enhanced and expanded counseling programs are urgently needed to address the academic, college, career, and social and emotional counseling needs of Indiana’s K-12 students.”

As Chalkbeat previously reported, school counselors have been stretched exceedingly thin in recent years, both in Indiana and across the country. On average, each Hoosier counselor is responsible for 630 students, making Indiana 45th out of 50 states and the District of Columbia for counselor-to-student ratios. The American School Counselor Association recommends a ratio of no higher than one counselor for every 250 students.

So far, state-led efforts to expand counseling have fallen short; a bill proposed in 2015 to require a counselor in every school was withdrawn for further study, and the issue hasn’t resurfaced significantly in the legislature since. At the time, cost was the sticking point.

Schools and districts had to apply for the grants and show how they would use the money. Lilly reported that mental health and business partnerships, mentoring programs, improving curriculum and adding in more training for staff were all strategies that grant-winners have proposed.

Initially, 254 districts and charter schools applied, many pointing out how Indiana’s recent opioid crisis has increased social and emotional challenges for students. Counselors have to juggle those serious needs with college and career advising and, increasingly, responsibilities that have nothing to do with counseling, such as overseeing standardized tests.

Because of the level of interest, Lilly is planning a second round of grants, which would total up to $10 million.

“Because the implementation grant process was so competitive, the Endowment had to decline several proposals that had many promising features,” Cobb said. “We believe that with a few enhancements, many of these proposals will be very competitive in the second round of the Counseling Initiative.”

These are the districts and schools in Marion County that received counseling grants. (Find the full list here.)

  • Indianapolis Public Schools: $2,871,400
  • KIPP Indianapolis: $100,000
  • Lawrence Township: $1,527,400
  • Pike Township: $1,114,700
  • Neighborhood Charter Network: $68,312
  • Southeast Neighborhood School of Excellence: $99,870

IPS said in a news release that it planned to use the grant money to build counseling centers in each of the district’s high schools, which would begin operating in 2018 after IPS transitions to four high schools. Superintendent Lewis Ferebee said counselors are “critical” for students as they prepare to graduate high school and pursue higher education and careers.

“We’re thrilled that the students and families we serve will benefit from this gift,” Ferebee said.