The Key to Improving Health Outcomes Among At-Risk Youth

All Kids Can spoke with Dr. Beata Nelken, Pediatrician and Medical Director of Community Health Programs at Thundermist Health Center in Rhode Island, about her role in supporting families and children in her community, and Links to Successthe organization’s newest program targeting at-risk behaviors in young adolescents.  CVS Health is a long-time supporter of Thundermist and recently awarded them a $60,000 grant through the CVS Health Foundation.

All Kids Can blog: As a health care provider, what are your biggest concerns as you prepare to begin the new school year?

Dr. Nelken: One of my biggest concerns is that not all students are receiving annual examinations. Too often, life gets busy and parents are not able to make it in every year for their children’s annual check-ups. For younger kids, this means missed immunizations and developmental screenings that can impact a child’s education. Among teens, it is particularly concerning since they are often physically healthy, but are making risky decisions in social settings.  When we get the chance to meet with these youth, we are able to screen for various conditions and risks and treat or counsel them accordingly. 

AKCB: Are there any trends or health issues (mental, physical and/or emotional) that you see as the most prevalent among underserved youth?

Dr. Nelken: Asthma is very common among our young patients and may be worsened by crowded or sub-optimal living conditions.  We regularly provide care for students who are exposed to second-hand smoke, insects, mold, pets, and other triggers that exacerbate their asthma and other health concerns. 

There is also a high prevalence of speech and developmental delays in our underserved populations.  This is concerning because of its implications on a child’s early stages of development.  When these conditions are caught early, a high level of improvement can be accomplished by the time the child enters kindergarten.

AKCB: What do you think are some of the biggest challenges in serving today’s youth? Have you run into any major communication barriers in discussing their health and well-being?

Dr. Nelken: In practicing medicine in an underserved area, we tend to see a great deal of social issues that kids deal with -often silently- including depression, anxiety, and trauma. The challenge is to develop enough trust with families so children and teens feel comfortable enough sharing their experiences.  If we are not having open discussions with children and their families about the stressors in their lives, we will miss opportunities for real change and growth among our patients. 

AKCB: Thundermist Health Center was recently awarded a grant from the CVS Health Foundation, in partnership with the School-Based Health Alliance, to help fund Links to Success, a new school-based initiative. Can you tell us more about this pilot program and how it’s going to help combat some of these challenges?

Dr. Nelken: Links to Success specifically targets chronically-absent and other at-risk youth entering high school in Woonsocket and West Warwick, and focuses on identifying and addressing the root of their high-risk behaviors. 

We are collaborating with the schools’ truancy officers, principals, guidance counselors and parents to enroll these students one-by-one in the program, and using our School-Based Health Center’s full-time social workers and nurse practitioners to help create individualized plans for each and every student in the program. These plans are then signed by the student, their parents, and their guidance counselor, ensuring that they have the support they need to be successful.

Links to Success helps students take advantage of an array of services, including at-home visits, counseling, medical screenings, case management and tracking, peer tutoring through the National Honor Society, after-school homework clubs and the Botvin LifeSkills Training Curriculum, which provides prevention, intervention, and coping skills for at-risk behaviors such as smoking, bullying, relationship violence, peer pressure, and substance abuse. The program takes a holistic approach to addressing mental, physical, and emotional health issues that could be causing turmoil in the lives of youth, and provides them with the support and resources they need to succeed.

We launched this program earlier this summer in Woonsocket, and enrollment just recently began in Warwick in advance of the new school year. To date, 50 students have joined the program, and we hope to be able to support more than 80 students in both Woonsocket and Warwick within the next year. 

Thanks to the CVS Health Foundation and the $60,000 grant they’ve awarded to the Thundermist Health Center, we’ve been able to not only launch this entirely new program targeted to help some of our most at-risk students, but also tap into an array of local resources in order to address the core issues causing turmoil in the lives of local youth in need.

AKCB: What is unique about this program?

Dr. Nelken: Links to Success gives us the ability to address the main source of our patients’ high-risk behaviors.  We can offer at-home therapy for students and their families, as well as referrals, and are able to collaborate with schools and community resources to provide the best services possible, based on each student’s individual needs.  We work in conjunction with the Departments of Education in Woonsocket and West Warwick to supplement their efforts in guidance and social work, and function as their extension within the community.  While there are programs in Rhode Island focused solely on academic support for students, and others focused on social support, Links to Success

is the first to encompass both aspects, while also addressing students’ and families’ ongoing and intermittent medical needs.

AKCB: Why do you think it is important to offer these types of community-based services?

Dr. Nelken: It is important for community health centers like Thundermist to assist local schools with the overwhelming number of health and related behavioral issues that present themselves within a school setting. In Woonsocket High School alone, there are nearly 650 students who are chronically absent each year, and hundreds more with ongoing behavior and discipline issues.  Meanwhile, there is only one Truancy Officer to cover the high school and two middle schools in Woonsocket, and a small team of social workers and guidance counselors to address all behavior concerns. 

Schools are a vital resource for adolescent needs, and they need community partners to help combat their health, social and environmental issues.  By addressing barriers and strengthening students’ performance in school, we help them become engaged and successful citizens, both in school and at home, which will in turn prepare them as they get ready to enter the work force and become successful and happy adults. 

AKCB: Do you have any personal stories about the impact of the school-based health centers and/or the new initiative that you’d like to share?

Dr. Nelken: Our nurse practitioners at our school-based health centers have shared many stories of success in their ability to have private, honest conversations with teens about their health and social lives that have made a meaningful difference. Students in our community are able to seek counseling for stressors they deal with on a daily basis and get treatment for related concerns.  They can initiate their own physical examinations and treatment for illnesses without having to rely on an adult or a scheduled appointment, or wait around to be seen for a sick visit in a regular doctor’s office.  They can have open discussions about their concerns and preventative measures, and most of all, it allows them to be advocates for their own health—a skill that is critically important as they develop into young adults. 

We hope many students will take advantage of this great resource as school resumes this year!

All Kids Can thanks Dr. Beata Nelken for her continued support of local children and their families, and for helping exemplify our purpose of helping people on their path to better health. 

Dr. Beata Nelken has been a Pediatrician at Thundermist for more than nine years, and has served as Medical Director of Community Health Programs for the last four. As Medical Director, her responsibilities include the management of the organization’s school-based health centers, ongoing medical services and programs, as well as health fairs, and local community outreach and engagement.  Dr. Nelken also serves on the Board of Directors for Community Care Alliance, Woonsocket Prevention Coalition, and the Skip Nowell Leadership Academy.

Thundermist Health Center operates two school-based health centers, one at Woonsocket High School, and the other at John Deering Middle School that also serves its neighboring West Warwick High School. Each center is called The Health Hut and provides services to all students at no out-of-pocket cost. Services at each Health Hut location include physical exams, immunizations, sick visits, treatment of minor injuries, health education, chronic care management, and dental services. The school-based health centers also offer prevention programs specifically geared to adolescents, including nutritional education, behavioral health counseling, and preventative education for at-risk behaviors.