School is back in session for Toronto kids and for the St. Michael's Model Schools Pediatric Health Initiative. Back in 2011, St. Michael’s pediatrician Dr. Sloane Freeman was invited to participate in a pilot program, a full-service health clinic within an elementary school, which would take care directly to Toronto’s most vulnerable and underserved children living in the inner city. The project came about in part because of a disturbing trend that emerged during hearing and vision screenings across Toronto public schools: 26 per cent of inner-city students did not have a valid OHIP card or any health insurance. Six years later, the program is still running, thanks to generous donors, and needed more than ever.
Dr. Sloane Freeman speaking at the opening of a health clinic at Nelson Mandela Public School in 2015.
Low-income Canadians lack access to many of the factors that determine good health: education, employment, stable housing, healthy neighborhoods and social supports. Poverty and marginalization causes serious health problems that lead to premature disability, shorter life spans, and high rates of health care use. In Toronto, this is especially the case: one in three children live in poverty, and 30% of children starting school in senior kindergarten are not ready to learn. Left untreated, health issues can prevent these kids from doing their best at school.
Taking Health Care to Children in Inner City Schools
St. Michael’s Model Schools Pediatric Health Initiative was launched at Sprucecourt Public School in Regent Park. Students are referred by parents, teachers and school support staff for various medical concerns. The pilot, created in partnership with the Toronto District School Board, received a tremendous response from the community, and the demand was so great in the first year that the clinic started to care for students from nine surrounding schools. A second clinic at Nelson Mandela Public School was added in 2015.
When doctors see the children at a school health clinic, their parents are always present. The program serves an important role in helping these parents understand their child’s health or developmental concerns and navigate the health care and education systems. One year into the project, the team found that while acute infections were common among students, learning disabilities and mental health issues were also routinely detected.
Early detection is a critical step in obtaining specialized diagnosis and treatment for conditions like autism or attention deficit hyperactivity disorder (ADHD). Once physicians determine that a child has special needs, an Individualized Education Program (IEP) is developed. This is the educational road map for children with disabilities; it outlines the exact education, services, and supplementary aids that the school must provide for this child and lasts as long as treatment is required. Experts have shown that if a child showing signs of a developing problem is helped by grade two or three, they will have a much better chance of fulfilling their potential.
Members of the St. Michael’s team regularly attend special school-based meetings with board psychologists and special education teachers to discuss students who would benefit from a developmental assessment. Previously, it might have taken 18 to 24 months for a problem to be recognized and treatment started – a dangerously long time in the development of a child. With the clinics in place and doctors advocating for access to treatment, that period from diagnosis to treatment has been reduced signiﬁcantly.
Now in its sixth year of operation, St. Michael’s Model Schools Pediatric Health Initiative operates two school-based health centres providing care for children from 40 schools in South East Toronto. The clinics are staffed by two pediatricians, a family doctor, a development specialist and a multilingual clinic coordinator. The program recently expanded to 8 new inner city schools in the West End of Toronto that will be served by St. Joseph’s Health Centre.
An eight-year-old boy was referred to the St. Michael’s clinic by his teacher for behavioural and academic problems. Assessments revealed that he was actually deaf and no one had ever known. He has now received hearing aids and is thriving at school.
A five-year-old girl was referred to the school clinic by her teacher for concerns with hyperactivity. When examined, she was found to have a loud heart murmur. The St. Michael’s team sent her to the cardiologist right away and she was found to have a very large hole in her heart which required immediate repair. She was operated on shortly after that and she is now healthy and thriving. The team continues to see her at the clinic on a regular basis.
A ten-year-old boy who recently came to Canada as a refugee was sent to the clinic because he was having academic problems and did not walk well. After assessment at the clinic he was found to have cerebral palsy and delays in his academic functioning. His mother had never heard of this diagnosis before. The team immediately connected him with rehabilitation services and ordered more testing to further understand why he had cerebral palsy, including an MRI. He now has orthotics and mobility aids as well as physiotherapy and speech and language therapy and is doing much better at school.
Proof of Concept
St. Michael’s Model Schools Pediatric Health Initiative is conducting a study designed to show that reducing wait times between diagnosis and intervention (i.e. three months instead of 18-24) makes a significant difference in a child's academic performance. The goal of this study is to prove to policy makers that putting pediatricians in schools improves health care access for inner city children, ensuring they are ready to learn.
Without donor support, the St. Michael’s Model Schools Pediatric Health Initiative clinics could not operate. If you'd like to give inner city kids access to the health care they need to reach their potential at school, please donate online or contact the Foundation at 416.864.5000.