In-school Health Clinics

“I had a child at one of my schools this year who was a refugee who didn’t have an OHIP card and the teacher came and said to me that the child had a terrible earache and was really suffering. She had taken him to the hospital and the hospital said it was $500 upfront or ‘We won’t see your child.’ The teacher then got hold of me and said, ‘Isn’t there somewhere we could send this kid where he could get his ear looked at?’ And that is exactly what we did. We did an emergency connection to the Sprucecourt [in-school] clinic and he was seen.” – TDSB Social Worker

Newcomers are integral fibres woven into the fabric that makes up Canada. As the largest school system in Canada and one of the most multiracial, multicultural, and multilingual school boards in the world, the Toronto District School Board (TDSB) serves a sizable proportion of students from immigrant and newcomer backgrounds.

According to TDSB’s 2011-12 Census, at least two-thirds of its students had both of their parents born outside of Canada. These families, especially the more recently arrived, face many migration- and settlement-related challenges that may hamper their children’s well-being and educational outcomes.

The Organisation for Economic Co-operation and Development (OECD) has reported that students from disadvantaged socio-economic backgrounds, including newcomers, are half as likely to achieve either their educational potential or a basic minimum level of skills (e.g. literacy, numeracy, communication). Societies have a shared responsibility to prevent such educational defeat, and public schools provide an ideal hub to partner with pertinent institutions or agencies to help mitigate these inequitable circumstances for marginalized students.

In 2006, the TDSB launched its system-wide initiative, called Model Schools for Inner Cities (MSIC), to address the needs of students who are disadvantaged by family poverty, unemployment and insecure housing. One hundred and fifty schools were identified as having the most external challenges and designated MSIC schools. Extra funding, resources, programming and community partnerships are granted to these schools as a systemic approach to narrowing the opportunity and achievement gaps for their disadvantaged students. One MSIC program is the Model Schools for Paediatric Health Initiative (MSPHI).

A health-education partnership
The MSPHI grew out of research revealing that, despite the existence of a universal health system in Canada, inequities and accessibility barriers related to health care do occur among disadvantaged families for a number of reasons. For example, the lack of health insurance (uninsured) in the case of newcomers or refugees, the lack of associated family doctors (unattached), as well as financial, language and cultural barriers, make accessing or navigating the health care system difficult.

To address this difficulty, the MSPHI was launched in 2010 with the opening of two in-school health clinics. Based on the success of these two pilot sites, a number of MSPHI clinics were subsequently added in different high-needs neighbourhoods. By 2015-16, a total of seven MSPHI clinics were established.

A cost-effective model
This integrated health and education model has proven to be highly cost-efficient and replicable. Its operational costs are minimized, as it leverages already existing resources:

• A shared/spare space (e.g. a vacant classroom) in an inner-city school converted, with some initial setup costs, to a simple health clinic
• A local health agency (such as a hospital or a community health centre) that is committed to health equity. These agencies provide the MSPHI clinics with medical equipment and supplies, as well as part-time health care professionals paid through the Ontario Ministry of Health and Long-term Care. For uninsured students, these health agencies will seek other avenues of funding through, for example, the Local Health Integration Network’s allocated budget for newcomers or hospital grants.

Even though these clinics are open only one to three times per week, together the seven MSPHI clinics served over a thousand appointments in the 2015-2016 school year, from not only the host schools but also students from neighbouring schools. Hundreds of their student patients were either uninsured or unattached.

By bringing health and education together under one roof, the in-school health clinics not only remove many accessibility barriers faced by these marginalized students, but also afford them more timely, comprehensive, and socially/culturally sensitive health care than they could normally access through regular channels.

For instance, wait times for developmental assessments, which would typically take two to three years, are notably expedited owing to the intra- and inter-sectoral partnerships between MSPHI clinic staff, their health agencies, and school staff – all of which allow for early identification, developmental assessment, diagnosis, and appropriate educational modifications within the same academic year.

Impact on students
According to MSPHI’s tracking records, the clinics diagnose and treat a wide range of acute and chronic physical health issues. Over time, these in-school health clinics also witnessed a steady shift from addressing mainly physical health issues to mental health concerns related to developmental, behavioural, and psychological health. As one secondary student put it:

“[The MSPHI clinic] basically helped me overcome the depression and gave me many options to heal… I’m feeling good… I feel like a totally different person.”

Aside from improving the health and well-being of student patients, a four-year study1 also shows reduced absenteeism, greater attentiveness to learning, and improved school performance for these students. They became more informed of their health status and learned how to navigate health services available to them. In fact, these in-school health clinics serve as an information hub and gateway to promoting health advocacy skills and medical autonomy, especially for secondary school students.

Ripple effects on schools and families
“Ripple effects” of the program are also positive. Educators testified that the in-school health clinics build capacity among school staff to better understand, recognize, and handle students’ well-being concerns. Some teachers have adapted their teaching strategies and learning environments accordingly. MSPHI health care professionals also support educators and students through their participation at school Support Team meetings, by identifying, triaging, and referring students to their MSPHI clinic.

As well, the MSPHI supplements the roles of TDSB Professional Support Services (school psychologists, social workers, counsellors, etc.) by helping to bridge the gap for timely mental health support for students in need. As explained by a school guidance counsellor:

“There’s medical support for us because a lot of it is beyond our training and ability… I can only do so much for the students and so this gives us the reassurance that we’re doing everything we possibly can to support them.”

Families, too, benefit from the in-school health clinics. The research shows that the MSPHI helps raise parents and caregivers’ awareness, knowledge, and understanding of their children’s health concerns. Interviews revealed that they are more engaged in learning about and leveraging support services in the community, and are eager to share their knowledge with other parents in their community.

Different stakeholder groups also observed that the in-school health clinics reduce the burden placed on families by making health care accessible and comprehensive – and not just for families who are uninsured. A school guidance counsellor observed,

“In a lot of cases too, the parents appreciate the fact that we have the clinic here because they’re working two jobs or they’re working night shifts… They don’t have time to take time off work or they don’t have a job that allows them that flexibility to take their child to the doctor.”

The in-school health clinics remove many accessibility barriers faced by these marginalized students.

Improved family dynamics is an additional benefit. For instance, MSPHI staff foster positive parenting skills among parents and caregivers, who reported being better able to support and engage their children at home. One new mother to Canada shared the impact of the in-school health clinic on her interactions at home:

“I am treating [my son] differently now. I am controlling my anger. I am talking to him more. I am praising him more. So I did see changes at home when I started to act differently, after I got to know what’s going on with him and that he has ADHD.”

The MSPHI Program has demonstrated many benefits, not just to students’ physical health, but to their overall well-being and learning. This is particularly the case for inner-city students who often face adverse determinants of health along with accessibility barriers to medical services. These in-school clinics offer more accessible, timely, thorough and holistic health care support for students from underserved communities, and also provide valuable support to students’ parents and to school staff. As starkly remarked by a newcomer high school student who came to Canada without her parents and experienced physical health and emotional difficulties due to her settlement issues:

“The clinic has saved my life; otherwise, I would be dead by now!”

En Bref : Les élèves des quartiers urbains défavorisés et les élèves nouveaux arrivants font souvent face à des déterminants négatifs de santé ainsi qu’à des obstacles d’accessibilité aux services médicaux. Cet article traite de l’initiative de santé pédiatrique dans des écoles modèles (Model Schools for Paediatric Health Initiative) de la Commission scolaire de Toronto, qui a ouvert un certain nombre de cliniques médicales dans des écoles de quartiers défavorisés. Ce programme innovateur intégratif offre du soutien médical plus accessible, opportun, complet et holistique aux élèves de collectivités mal desservies, que les mailles du filet des services médicaux existants auraient sinon pu laisser échapper, nuisant à leur parcours éducatif.

Photo: Courtesy Stefanie De Jesus

First published in Education Canada, March 2017

[1] M. Yau, S. De Jesus, G. Tam, and L. Rosolen, “Model Schools Paediatric Health Initiative: In-school health clinics, phase IV: Summative evaluation,” Research Report No. 15 (Toronto: Toronto District School Board, 2015), 16-14.

Meet the Expert(s)

Maria Yau

Maria Yau, an educational researcher with the Toronto District School Board for nearly 30 years, has tirelessly advocated for equitable learning opportunities and resources in high-needs schools. Her research background related to equity and diversity includes studies on immigrant and refugee population, racialized groups and inner-city students.

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