On an ordinary day at the LIFT Center, the small pediatric clinic might see patients for routine immunizations or school sports physicals, or to examine a sore throat or earache.
But the clinic isn’t in an office building filled with medical professionals. This health center is attached to Fallon Park Elementary School in Southeast Roanoke.
The LIFT Center — the name stands for Local Impact for Tomorrow — began its second full school year in operation this fall. Its goal is to make it easier for families to access medical care, as well as other health and wellness services.
In the Fallon Park neighborhood near the clinic, 1 in 5 people don’t have health insurance, based on Census Bureau data. And 1 in 4 families live at or below the federal poverty level, which for a family of four in 2022 was an income of $30,000 or less.
It’s commonly acknowledged in the pediatric medicine field that growing up in poverty can exacerbate a variety of health issues throughout a child’s life.
“The majority of school is based on the academic side of supporting a child,” said John Otey, principal of Fallon Park Elementary. “But having this community clinic in the building is going to help work on the whole child.”
LIFT is a private-public partnership. It’s operated by Carilion Clinic, which is working with the Delta Dental of Virginia Foundation and Freedom First Credit Union along with its host, Roanoke City Public Schools.
[Disclosure: Carilion is one of our donors, but donors have no say in news decisions; see our policy.]
Together, the partners hope the clinic can be a model for other schools in Virginia.
Addressing a neighborhood’s health needs
School-based health centers that make it easier for students and families to access medical services aren’t new — about 2,600 existed across the country as of 2017, the latest data available from the nonprofit School Based Health Alliance.
Last school year, the Community Health Center of the New River Valley started offering dental health services to students and faculty in Giles County and Radford public schools, along with medical and dental services for Pulaski County schools. And Southwest Virginia Community Health System offers care at schools in Bristol, Saltville and Chilhowie. For both programs, patients can use their medical insurance or pay on a sliding scale if they’re uninsured and low-income.
In Roanoke, Carilion also operates adolescent health centers at Patrick Henry and William Fleming high schools.
But LIFT’s wide range of services and its partnership model make it the first of its kind in the area.
“We are working from within our community with partners to be a stronger center than we could be if we didn’t have partners,” said Heather Millar, program manager for the LIFT Center.
The clinic has three exam rooms, a lab and a conference room for classes or events. It’s staffed by a registered nurse and a pediatric nurse practitioner, Amy Barker, who splits her time between the LIFT Center and Carilion’s pediatric medicine practice. When she’s not at the LIFT Center, Barker can see patients by video with the aid of telehealth tools that allow her to see swollen throats or aching ears up close.
A caregiver can call to make an appointment for their child at the clinic. But the school nurse can also refer a child if symptoms arise. If a parent or guardian can’t be there in person during the school day, they often can attend the visit by phone.
A community health worker is also based at LIFT to help the school community connect with additional medical help and other services such as safe housing referrals. And starting this fall, mental health professionals will be on site three days a week to work with students.
Families can visit the clinic to pick up free dental supplies, lice removal kits, digital thermometers and gun locks. They can also attend English language lessons or financial skills classes.
LIFT recently added a Little Free Library just outside its front door, where anyone can select a free book.
Through its regular community health assessments, Carilion Clinic has recognized the need for additional health services in Southeast Roanoke, where its flagship Carilion Roanoke Memorial Hospital is located. The 2015 survey revealed that the city’s Southeast quadrant had the highest use of emergency room care, for both children and adults.
The challenges to health, financial well-being and physical safety in the area around Fallon Park Elementary are thought to contribute to a life expectancy of just 68 years, compared to the statewide life expectancy of nearly 78.
Rita Bishop, the superintendent of Roanoke City Public Schools from 2007 to 2020, had been aware of the challenges facing students and their families in Southeast Roanoke. When the school division started making plans to rebuild Fallon Park Elementary, Bishop reached out to Carilion to talk about teaming up to improve some of the area’s health disparities.
“This is the neighborhood of our largest health care facility in Carilion’s footprint,” said Shirley Holland, Carilion’s vice president of planning and community development. “It just seemed like a great opportunity to step up and be a good neighbor and to address together some of the things that we’re mutually experiencing in our community.”
Holland said the key driver for deciding to put a health clinic at the elementary school was feedback from caregivers who said they needed closer health care options for their kids.
The partners raised about $1 million to establish the clinic, which originally was planned to open in the 2020-2021 year in tandem with the reopening of the newly renovated school. Construction was delayed due to higher-than-expected costs, but Roanoke City Public Schools agreed to provide additional funding and contributed $320,000 toward the 1,700-square-foot clinic, which opened its doors in spring 2022.
In its first year, LIFT logged 225 visits for medical care.
It also saw 230 preventive dental care visits through Smile Programs, a mobile dentistry initiative that contracts with the school division to provide dental cleanings to students. The program uses LIFT space during its Fallon Park visits twice a year.
LIFT’s community health worker helped 76 clients access health-related services, and the clinic offered 60 classes for English language learners and 80 financial empowerment classes.
Holland said she’s excited about the possibility of expanding the concept’s reach. “The nice thing about this initiative is that it can reach a lot of other children without having to build a new building every time we reach out to another school.” Telehealth tools can help bridge gaps in service, along with having availability for children in other division schools to visit the existing clinic.
Health clinic’s biggest challenge: trust
People involved in opening the LIFT Center said building momentum around the clinic has been more challenging than they initially expected.
For one, families need to become familiar with LIFT and its offerings before a child in their household shows signs of illness. And many people living in the school’s footprint may have had negative experiences obtaining health care or dealing with the costs of care.
A 2023 report from the American Academy of Physician Associates found that affordability is the primary obstacle for more than two-thirds of Virginians seeking health care, regardless of income level. And when they can get an appointment with a health professional, about half of adults in the commonwealth said they don’t feel that their health providers always listen to their concerns.
“The trust building piece has been probably one of our biggest lessons,” Holland said. “We’re learning about what families respond to and how to engage.”
Millar said that building trust with the school community has been a slow process. A major realization occurred in May, she recalled, when the clinic hosted a party to celebrate the end of the school year. Instead of having an educational health and wellness focus, the party featured bubbles. Lots and lots of bubbles — everything from individual bottles to large wands and string to make giant bubbles.
The party also featured ice cream and a DJ. Two hundred and fifty people showed up.
“I can’t tell you how many times I heard kids say, ‘I can’t wait for the bubble party,’” Otey said. “And it was an amazing evening.”
“People need the relief and the fun and the face time,” Millar said of the lesson she took from the party. “And once we build trust in those ways, [families] may be more apt to come to us for help.”
LIFT Center looks forward to strengthening relationships, impact
Clinic leaders acknowledge they’re just getting started. Christopher Pierce, interim chair of pediatrics at Carilion, explained it this way: “When you step back and look at it and what’s going on, it’s unfortunately only a small place in the grand scheme of things. But it’s a big place for that school and that neighborhood community area.”
This year, about 40 Fallon Park students who have asthma have enrolled in a study to determine ways to reduce their symptoms through LIFT Center programs and other wraparound services. Carilion had hoped to start work on the project even before the medical clinic was up and running, but the pandemic delayed it. Barker, the nurse practitioner at LIFT, specializes in pediatric pulmonology.
Mental health is another area of focus at the clinic this year, for both children and their families. Carilion won a $230,000 grant from United Health Care to implement mental health counseling for 30 students. On top of that, the nonprofit A Tree Planted will be on site three days a week for additional mental health sessions plus group activities for some students.
Additional programming this school year will be selected based on needs identified by adults in the Fallon Park community in a spring 2023 survey. Respondents’ highest areas of need included help around healthy behavior, financial wellness, mental health, parenting and healthy relationships. Almost a quarter of respondents said they need help dealing with stress, and 23% said they need help managing a child’s behavior.
Del. Sam Rasoul, D-Roanoke and a longtime advocate for using schools as a hub for their communities, hopes more schools will consider ways to integrate health services into their facilities. Recent attention to school renovation needs and as well as ongoing COVID-19 mitigation efforts provide the opportunity to think about ways schools could better serve community health, he said.
“LIFT serves as a great pilot project that we can point to, it has measurable outcomes, and is now something we can highlight moving forward,” said Rasoul, whose district includes most of Roanoke.
The Virginia Department of Education did not respond to a request for information on the number or location of school-based health centers in the commonwealth. The state Department of Health does not track that information, a spokesperson for the agency said.
The LIFT Clinic also has the potential to boost school attendance, one of the pillars of the “All In VA” plan to boost academic achievement announced by the governor’s office shortly after the release of the latest Standard of Learning test scores.
Fallon Park Elementary had a 22% chronic absentee rate in 2022-2023, meaning 1 out of every 5 students missed more than 18 days of school. The statewide absentee rate across all grade levels was 19.5% last year.
Quick access to medical care can help reduce absences or prevent them altogether. “Any time I can have students in the classroom, there’s a benefit there,” Otey said.