Speaker 1 (00:01): Highlighting the amazing stories from inside the North Clackamas School district. This is the proud To Be NCSD podcast, hosted by longtime principal and current community relations director, Curtis Long...

Speaker 2 (00:17): Baby - Justin Bieber song.

Curtis Long (00:18): Ah, yes. We're starting this episode by flashing back to 2010 when the world was introduced to Justin Bieber. In fact, if you were a high school student in North Clackamas in 2010, the Biebs wasn't the only thing you'd recently discovered. As his smooth sounds streamed through your iPod nano, you were counting down the hours until the next American Idol and you couldn't believe that Simon Cowell was actually leaving the show.

Speaker 4 (00:41): You have one of the worst voices I've ever heard. Truthfully, it is absolutely terrible. You can't sing

Curtis Long (00:45): Despicable Me had just come out in theaters and you just can't get enough of those lovable little minions.

Speaker 5 (00:53): No, no, no, no, no. Boy,

Curtis Long (00:56): Taylor Swift just won her first Grammy, but you figure she won't last very long. After you get home and do your homework, you play a game of angry birds

Curtis Long (01:10): And things are good. But in 2010 in the North Clackamas School district, there are concerns around student health at all levels, elementary, middle, and especially high school that aren't so good. Kids are arriving at school without access to state mandated vaccinations. Others are trying to get through each school day with extreme dental pain and don't have access to an affordable dentist. Still others are struggling with mental health issues but can't find a mental health specialist with an open appointment for months. So in 2010, NCSD did its best to put the breaks on students inabilities to access readily available healthcare. And a grassroots effort landed a medical bus in the parking lot of Milwaukie High School. On board the bus. Students could receive medical care without families worrying about making an appointment across town, worrying about transportation to that appointment, and perhaps most importantly, worrying about the cost of that appointment.

Curtis Long (02:01): 13 years later, what started as a bus in one high school parking lot has gradually transformed into four professionally staffed student-based health centers located within Milwaukie, Rex Putnam, Clackamas, and Adirenne C Nelson High Schools. Today on the Proud To Be NCSD podcast, we learn the amazing story behind these student-based health centers in North Clackamas, including how they operate, who manages them, and how they continue to provide healthcare to countless NCSD students who otherwise would have nowhere else to turn. And to help tell this amazing story, we have a combined nine North Clackamas employees and district partners. Let's start by having them all introduce themselves along with their official titles.

Lilly Hankins (02:39): I'm Lily Hankins, I'm a mental health therapist with Clackamas County, and I work at the Adrienne C. Nelson School-based Health Center.

Ben DeGuilio (02:46): I'm Ben De Julio, I'm the mental health program supervisor for Clackamas County Health Centers.

Jenn Lucas (02:51): And my name's Jenn Lucas. I'm a family nurse practitioner in the school-based health program with Clackamas County Health Centers.

Sienna Day (02:59): My name's Sienna Day. I'm the site coordinator at the Milwaukee School-based Health Center with outside in.

Natalie Parks (03:03): I'm Natalie Portis. I'm the school social worker for the Putnam feeder.

Max Penneck (03:07): My name's Max Pennick, I'm the outreach intern at the Milwaukie School-Based Health Center with Outside-In.

Tami Gilbertson (03:12): I'm Tami Gilbertson. I'm the school-based health center program supervisor for Clackamas County.

Barnaby Gloger (03:17): I'm Barnaby Gloger. I'm the Associate Director of Student and Family Services with North Clackamas.

Speaker 14 (03:23): I'm Claire Davis -Thran and I'm one of the school district nurses and I work at Rex Putnam High School.

Curtis Long (03:27): So as you can tell, we have quite a few people participating in this podcast. I'm excited to get started now. I apologize. It sounds like in our introduction that we called them student based health centers. We wanna make sure we're clear on our language. Technically these are called school-based health centers. We'll make sure to refer to them as school-based health centers from now on. But for those of you that are in our district and you maybe see those on the facades outside of our buildings, school-based health centers, that's what we'll be using from now on. Now I know not everyone here was around in 2010 and I apologize for that opening musical reference to all of you who are not "Beliebers". Now, Claire, you've been with the district before 2010 and as a school nurse you noticed some things happening in schools and some needs of students where maybe North Clackamas needed some extra help to meet the needs of these kids.

Claire Davis-Thran (04:10): Definitely back when I first started school nursing, there wasn't school-based health centers and very little resources, very few resources for students in need as a team of nurses. We did some little fundraising on the side to try to meet copays or pay lab fees for some students and we would just find dentists and doctors in the community who were willing to see students. But there was no overall help that we could reach out to.

Jenn Lucas (04:34): And I think what happened from there is an incredible story of community support from school administration, community members, community leaders, families and students to get a program going in the North Clackamas school district. You know, the research really says that healthy students achieve more and that's the main driving force between this story that's brought us here today.

Curtis Long (05:02): And Jen and Claire, you guys both know about this. We give credit to Milwaukie High School for having that bus, but it was also at New Urban High School. We don't wanna leave them out.

Jenn Lucas (05:10): It was outside in, was the first medical sponsor for the school base health centers in the district and they brought a medical van there, which is a fully equipped moving exam room and clinic and started seeing patients there.

Curtis Long (05:25): So we've come a long way since 2010. There aren't any medical buses in school parking lots now I'm sure many of our families have seen school-based health centers labeled on the outside facade buildings or you might see health and wellness center or health center. In simple terms, what is a school-based health center and what type of services does it provide for our NCSD students and families?

Ben DeGuilio (05:45): Well a school-based health center could be exactly what you would see outside in your community for any health center or primary care office or mental health center. It is a clinic staffed by clinicians, support staff therapists who provide services specifically to the students in the school. I guess the big difference is that a lot of the decor and a lot of the decorations, furniture, all that kind of good stuff was actually chosen by some students. They had a big part in designing some of the interior. So it might look a little bit cooler for the students. This specific services that are provided there. Again, like anything else that you would find in the community, primary care needs ranging from well visits to sports physicals, immunizations, things like that. And much more. We also provide a pretty robust mental health treatment. Not just screening and triaging, but as well as full assessment treatment planning and mental health therapy and group therapy in some cases. Beyond that, we do have dental chairs available in two of our school-based health centers and I think they start with general hygiene and I believe can also navigate to other external sources.

Jenn Lucas (06:51): Milwaukee High School also has a dental suite at their clinic and see patients for cleanings and screenings there as well.

Curtis Long (06:59): So it really sounds like the big advantage to a school-based health center is access. It is right there at the school. And we mentioned it at the top too, where students who maybe don't have the access to a family doctor or can't make the appointment or can't get an appointment for a long time, this is available for them right there at their school. They can just walk down the hallway.

Ben DeGuilio (07:17): Yeah, the barriers of having to take time away from work or school have certainly been removed. And also just the barrier of time, the moment that you feel like you need a particular service and then the time it takes to actually get connected, that barrier gets removed too when that health center is right there on your way between classes.

Barnaby Gloger (07:35): So I think what's amazing about these school-based health centers is not only are they removing the barrier of time and transportation and access, but it's also, it's a freeway for students to access healthcare. And so we think about all the expenses that families face, especially these days, having the barrier of finances, having the money barrier removed is amazing and that's a huge part of it too. So a lot of what was part of the original design, the why behind these school-based health centers, that goes back to 2006, 2010 and and up till now, the why behind it is really how do we remove barriers to allow students to access services so that they're healthy and they're well mentally, physically, emotionally, so they can be in class so they can do well in school and be the best that they can be. So that's the, I think the really exciting part of all of it.

Ben DeGuilio (08:21): That made me think too, I feel like another barrier that is sort of removed by having it placed inside a school like that is, it's kind of a stigma barrier. The idea that I can't ask for help, I can't go get help or anything like that. But when you're seeing that in your environment, you're hearing about your peers who have been involved in it and have gotten help that way it gets rid of some of the stigma that might come along with having to ask your parents or having to go out in the community and try to figure it out. It just makes it a little bit more approachable.

Jenn Lucas (08:47): Definitely. One of my favorite parts of the day is when kids come in in a group, one of them may be the leader of the spokesperson of the group and they may be concerned about one of their friends just struggling with mental health or physical health and they all come in together and sort of support each other and make the appointment and then they leave and say, that was so easy. No, I just love hearing that cuz it is really easy.

Barnaby Gloger (09:11): My background is in school, social work, and I remember one of the things that I learned early on in social work is that the biggest hurdle, the biggest obstacle on the way of people getting treatment, of people getting their needs met is just getting from point A to point B is just getting through the door. And so we think about when social workers or anyone, when we refer someone to something that's gonna help them and make their life better getting from their home or from their school to that office can prevent them from actually getting those services. And so the school-based health centers remove that and that obstacle and allows a student to literally just walk down the hall and walk through the door or a family to come in and bring their student in for their appointment. And so that allows student needs to get met. Student health and wellness needs. That's pretty amazing.

Curtis Long (09:54): Now Jenn, you had mentioned do kids make appointments to visit the school-based health center?

Jenn Lucas (09:59): Yes. Students can make their own appointments. Parents, family members, guardians can also make appointments. Sometimes we'll get referrals from the athletic trainers in school to do concussion follow ups for them. Really kids come in from a variety of sources. One thing I do wanna point out that's really a benefit to families from school-based health centers is that we aren't designed to take the place of a student's primary care provider, but we can work closely with them. So I see kids who maybe are struggling a little bit with using their asthma medications as they should, and their asthma is not as well controlled as it should be. Their primary care provider can have them come in and I can see them and check in with them, do a little bit of counseling, and then communicate back with the family and the primary care provider about how that student's doing.

Curtis Long (10:51): And then that student goes right back to class.

Jenn Lucas (10:53): Exactly.

Natalie Parks (10:54): This is Natalie. I know we've spoken a lot about the placement of these school-based health centers in high schools, but I just thought it was important to highlight how as a feeder pattern social worker, I'm working with families across every level of education. So that would be, might include like a second grader, a sixth grader, and a ninth grader. So having one place to meet the entire family family's need is really, really amazing.

Curtis Long (11:17): Natalie, we'll talk about that a little bit later too, but that's true, right? It's second grader or sixth grader can go to big sister's high school to get that treatment that they need.

Natalie Parks (11:24): Right.

Ben DeGuilio (11:25): This is Ben to mention the school-based health centers that are opened up in the high schools that we're talking about, they are open to any student enrolled in the district or living in the district and enrolled in online courses. So it's not, even though they're in the high schools and I would say they primarily serve high school students, they are open to any student of North Clackamas.

Curtis Long (11:44): Right. So a student at say Riverside Elementary, who would eventually go to Rex Putnam High School, they can visit the Putnam Student Health Center. Absolutely. Yeah. School-based health center. I keep getting that wrong school-based health center. Yep, that's right. Now for those of you who work in a school setting, how nice is it knowing that you have a professional medical clinic right down the hall and how often does that come into play for you?

Claire Davis-Thran (12:03): It's amazing to know that there's a professional right down the hall and if I happen to be seeing a student and a medical need comes up to know that if it's dental pain or like we've already touched on uncontrolled asthma, a student maybe who needs an evaluation for concussion or cleared so they can return to sports. Students who are in need of immunizations or students that for whatever reason are just in between providers and maybe have run out of a medication they've previously been prescribed and don't have anywhere to go. Those are all reasons that I've walked a student right down for an appointment. So

Curtis Long (12:36): Claire works in a school health room. Natalie, you work in a school counseling office, but it's often the same situation for you.

Natalie Parks (12:41): Yes, absolutely. So as a social worker, we look at the entirety of a person, in this case a student, which includes their physical and mental health. And so I would say the bulk of a lot of my referrals over to the school-based health center is for mental health services. And there's actually a really cool thing going on here now, which has met a lot of needs, which is there is a therapist over there who provides kind of brief therapy. So a lot of students are not interested in, you know, months and months and months of ongoing therapy, but they just would like someone who can do, you know, six to eight sessions. And so between me and that person, we can kind of meet a lot of the mental health needs. And then of course there's other clinicians there that can provide that ongoing high acuity support.

Curtis Long (13:23): And we've talked about mental health needs a little bit already and we wanna talk about those a little bit later on too. And as Ben has mentioned before, it could be an entire new podcast. We could do all on student mental health needs. Jenn and Sienna, what are some of the most common things that you see working at a school where students are coming for their health needs?

Jenn Lucas (13:41): This is Jenn. It can really be anything. I always explain to people, friends, family, community members that I see patients in the clinic and do the same thing that I did when I worked in the community in a regular family practice or a pediatrics office. So there's a huge variety of things that I do over the course of a day. Right now we're really busy getting students caught up on their vaccinations so that they don't get excluded next week for not being up to date. But I'll do things like diagnosing strep throat or mono, you know, writing prescriptions for urinary tract infections, ear infections. Sometimes I'll need to splint up a sprained ankle, uhoh order an x-ray or some blood work. So it really runs the gamut. Every day is different.

Curtis Long (14:29): So Jen, did you say you can write a prescription right there at school? A kid can come to the school-based health center. Mm-hmm. <affirmative> have a prescription written form, so they didn't need to see any other right appointment anywhere else. And they can take that prescription to the pharmacy.

Jenn Lucas (14:41): That is correct.

Sienna Day (14:42): Well, and it's true at over at Milwaukie High School, 90% of the prescriptions that we dispense are onsite. A lot of students, the issue is for transportation. Mm-hmm. <affirmative>. And we can offer those there. When we're talking antibiotics, things that need immediate treatments, we can just hand them to the student right at that visit. I feel like a wide variety of the things that we see are general. So people come in for an injury, sprained ankle, sports, physical, and then they leave feeling empowered to ask more health questions. I think one of the best services the health center provides for students is that access, but also that empowerment and feeling like you can ask your provider whatever you want.

Curtis Long (15:17): And that's Sienna at Milwaukee High School. And I imagine you've become a pretty familiar face to some students who like to make frequent visits.

Sienna Day (15:24): It's true. We get a lot of the same students every day. We also have a food pantry that we offer with lots of snacks, which I think is a great place to start. But I see those same students come in and they get more and more empowered to ask me medical questions and I sure don't know the answer, but they love to ask and I can end up with referrals and explain things and it's a great position to be in at the front desk.

Curtis Long (15:43): Okay. I gotta ask, as an elementary school principal you know, having little kids that come down to the health room just because maybe they didn't want to do their math assignment. Claire can probably relate to that. Do we have high school students doing the same thing? Do they make trips to the school-based health center because maybe there's a a big test coming up?

Jenn Lucas (15:59): Well you know, that's such a great question. I'm so glad you asked because we do have students that will come in and maybe hang out at the front desk and look through the stickers and they may be kind of quiet or hesitant and a lot of students come in who may be having feelings of anxiety or depression for example, but they don't know exactly that that's what they're feeling. That's a great point. And so I think what's behind a lot of those visits is that there's a need there that's unmet and that the student just doesn't have the words or the skillset yet to ask specifically for what they need. And we see those types of kids come in and they may be really, really anxious and really struggling and with enough support after a while they're attending class, they're feeling better, they're more engaged with school. And so it's really a good support for those types of students

Curtis Long (16:59): Hoping to learn more about our district's school-based health centers. This Proud To Be NCSD podcast is just the prescription. During our visit so far we've learned how this innovative approach to student healthcare started with a bus in a parking lot and how a unique partnership with local medical sponsors opened the door to students receiving services quickly and efficiently. But how do students play a role in SBHCs and what are the laws around student privacy when it comes to receiving treatment? Those answers and more just down the road in the second half of the Proud To Be NCSD podcast right after this.

Mitzi Bauer (17:35): Hello, I'm Mitzi Bauer, chair of the North Clackamas School District School Board

Jena Benaloga (17:40): And I'm Jena Benaloga, one of six other directors on our current board.

Mitzi Bauer (17:44): We are committed to listening and serving North Clackamas residents as we work together, together to provide the best possible learning environment for the students

Jena Benaloga (17:53): We serve. As members of the North Clackamas school board, we believe it is our duty and responsibility to increase student achievement, recognize and reward quality in educators, empower school leaders through policy governance and professional development, and communicate with the public legislators, business leaders, cities and parents.

Mitzi Bauer (18:11): We invite you to join us online at our bimonthly board meetings held on the second and fourth Thursdays of most months. For more information, you can visit the North Clackamas District website.

Jena Benaloga (18:21): With parent and community input and support. We will continue our work to give students every opportunity to succeed in all North Clackamas school district schools and beyond.

Mitzi Bauer (18:31): Thank you for your support. We look forward to seeing you soon.

Curtis Long (18:34): These centers are kind of a partnership, aren't they? The district provides the facilities and equipment. For example, both Clackamas and Nelson's SBHCs were built as part of our district's 2016 Capital Construction bond. And a medical sponsoring team provides the care and services. Who are these medical sponsors? How does that work?

Tami Gilbertson (18:49): Tami here, Clackamas County Health Centers are the medical sponsors for five school-based health centers. Three in North Clackamas School District, Clackamas Nelson and Rex Putnam. And the schools provide the space and most of the equipment and we provide funding. We get funding from the state and funding from the health centers.

Curtis Long (19:10): Okay. So as Tami shared that Clackamas County is the sponsor of Clackamas High and Nelson High and Rex Putnam. But Sienna Milwaukie High School has a different sponsorship. Explain that for our listeners.

Sienna Day (19:22): Yeah. So over here at Milwaukie High School, we're sponsored by Outside In, which is a nonprofit that operates downtown and out in Gresham. We have a few sites, this is our only school-based health center. We funnel a lot of resources into it. We're really excited about it and it's really neat to work with the county when we're thinking about it. We're thinking about serving the same student population. We're all working towards the same goals and it's really powerful that any student within the district can go to any health center. So if a student is actually closer to a different health center, we're gonna encourage them to go there If they can get a sooner appointment, please. Mm-hmm. <affirmative>, we are all working together as a team. What

Curtis Long (19:55): About cost to students or families? Can insurance be a barrier at SBHCs?

Tami Gilbertson (20:00): Great question. We are the best kept secret and one of those

Curtis Long (20:03): Not anymore secrets

Tami Gilbertson (20:05): Are, there's no barrier for insurance. We take any insurance, we bill any insurance, but there is no out of pocket cost for students and families.

Curtis Long (20:14): So a student does not need to come to the S B H C with an insurance card or ask family for the insurance card?

Tami Gilbertson (20:21): Yes. Good. Let me clarify. Yes, we will bill insurance and it will go towards your deductible. However, if there's copays, we waive the copays. Again, no out of pocket cost to student or families.

Curtis Long (20:31): So insurance is not a barrier at school-based health centers. Is there any reason at all that a student would be turned away from an sbhc?

Tami Gilbertson (20:39): Absolutely not. We take all insurances, no money changes hand. We don't ask for money. We don't ask parents or guardians for money. No. If we can't help a student, we figure out who can. That's one of the best qualities of a school-based health center.

Sienna Day (20:52): Another thing is that's regardless of citizenship status, a lot of people are highly concerned, they don't have a social security number. Am I still gonna get care? We still offer care regardless of citizenship status, regardless of insurance status, regardless of sexual gender identity, race, ethnicity, we don't care. Come in, ask questions. We can don't know the answers. Someone will.

Tami Gilbertson (21:09): Yeah we call it an all comers model.

Curtis Long (21:11): But medical professionals aren't the only ones making big decisions at a school-based health center. They each have a student advisory council. Let's learn more about that. And Max, as a student at Milwaukie High, you are a part of that student advisory council and you still participate in it today. So tell us a little bit about what the Student Advisory Council is and what you've done as a part of that.

Max Penneck (21:29): Yeah, so I was with the Yak at Milwaukie High School for all four years when I was there. And now I still help facilitate when I can in my current role at the health center. And those take different forms at different clinics. They could be called a shack, a swat, a yak, the end of the, they all serve the same purpose and that's to inform the work that we do at the clinics. So that's to make support staff and providers aware of the realities that the student body faces. Ultimately we're embedded in the community, but we don't know what students are facing on a day-to-day basis. We don't know what problems have arises, what stigmas they face. So it helps us get a better idea of what barriers they might have and how we can help them overcome. And also they serve as a bridge between the clinic and the student body. So we can be present at student events, but ultimately we want them to have peers present as well. So Yak is an opportunity for us to go out with students and have them interact with their peers, help them connect to our services and be present in the community.

Curtis Long (22:27): And Max, you call it yak, I'm gonna assume that is youth advisory committee. It is Youth Advisory Council. I wanna make sure I get everything correct. And you said Shac, so let's see, that would be Student Health Advisory Council? Yes. Oh, so tell me a little bit about, so it's actually students who are advising the medical professionals about maybe some things that teens or students are facing in the world around them that maybe the medical professional wouldn't be as aware about? Yeah,

Max Penneck (22:52): It goes both ways. The students are an avenue for us to get to know what problems the student body's facing and also allows students to have an inside look at what the providers are doing in the clinic. But ultimately a yak is shaped by the students who participate in it. That's something that we really push for is for the group to be student driven. So the projects that RAC will take on at the Milwaukie clinic are entirely shaped by their decisions. And we recognize that there's students that come to us with different needs. Some people are there because they want to enter the medical field. Some people just need community service hours and some people just want to have a snack after school. Mm-hmm <affirmative>. And we try and make a safe space for all those students to fulfill those goals.

Curtis Long (23:28): I love it. So it's inside a high school and it's the students making those big decisions to help advise the medical professionals. Max, thanks for your insights on that. Absolutely. So we get a lot of students who listen to this podcast. If there's a student listening now who wants to be involved in their school-based health center as part of the advisory council, how do they do that?

Max Penneck (23:46): Yeah, at Milwaukie High School, it's as simple as coming to our conference room after school on Tuesdays. And I'm sure you could go to the front desk at the other clinics and we'd love to have you just, if you need a safe place to be after school, if you have an idea or a concern regarding the clinic, we'd love to hear your voice.

Curtis Long (24:01): Okay. We've been talking mostly so far about physical health, but what about mental health needs for today's students? How are those addressed? And I imagine we could create a whole additional podcast about the importance of mental health for today's kids. So Lilly, you were gonna talk a little bit about that and kids' mental health needs.

Lilly Hankins (24:15): Yeah, definitely. Youth mental health I think is getting much needed attention in the news in the last couple of years. And I think, you know, most folks that are listening have probably heard or read news stories talking about just the high numbers of teens and even younger than teens who are experiencing things like depression and anxiety. When we talk about youth mental health, we're also talking about anything from like relationship pressures, peer pressure, family issues, any number of different things. And we are definitely seeing a really high need for mental health support for teens currently. And if you just think about what it was like when you were in high school, the kind of things that you were dealing with, and then add on top of that, the impacts of a pandemic where you had to go in online school and all of your social connections were pulled out from under you. And the impact of social media and the pressure that that can add onto it that lays the context for the mental health situation of youth that we're dealing with today.

Curtis Long (25:07): Are we finding that kids have the courage to come down to the school-based health center and say, Hey, I, I've got a problem, I need some help.

Lilly Hankins (25:13): That is such a good question. I appreciate that you use the word courage because I think it does take courage to admit, hey, there's something going on inside that doesn't feel quite right. And I think that's one of the great things about actually doing full on outpatient mental health therapy inside of the school is that it doesn't require somebody to, you know, necessarily talk to their parent and set up an appointment a month later at a different clinic outside of the school. It can be as simple as in a conversation with their school counselor who they already know. They mention, I've been feeling really overwhelmed lately. And the school counselor can say, oh, did you know that the health center across the hall has therapist that you can talk to? Have you ever thought about that? And even if they're feeling unsure about it, they can come over, they can meet myself or one of the other therapists and get a sense for what this might feel like without having to sort of commit to saying, I am going to see a therapist. Which can be a really scary thing to do.

Ben DeGuilio (26:00): I think that this year really demonstrated that need by how many referrals we got at the beginning of the year. We always have some students coming back after the summer and we're able to provide some bridge services over the summer for students. But right at the beginning of the year, it doesn't take very long for us to get a serious amount of referrals. And now, and we are doing what we can't, uh, let those referrals keep coming. We're always available for at least questions or that Natalie mentioned before, some short-term work that we're able to do. But yeah, we definitely see the need year after year increase, especially over the last three years.

Curtis Long (26:33): I can imagine. And and you see that at all levels, not just high school, we're talking high school, but our middle school students and our elementary school students feel the strain of that as well.

Ben DeGuilio (26:41): Yeah, absolutely. I think we've also got quite a few calls to try to help out with different screening processes that you might see for younger students like ADHD or things like that. And although there would be, you know, ideally we could do a lot more with that, we're just really not capacitated for it. But again, we're really good at connecting to outside primary care providers as Jenn Lucas mentioned before. And so that's some of what we will do. We will help coordinate what we can gather with what they can gather with other school counselors and IEP coordinators at the school.

Lilly Hankins (27:13): Another great thing about being an actual therapist inside of a school-based health center is that we can work so directly with the school supports that exists. So school counselors but also school psychologists and special education teachers for students that are needing support around accessing an I E P or a 5 0 4 plan or things like that. We're right there in the school and can do that. And the only other thing I was thinking about saying too is that if you know any students out there are listening or or parents and are considering the idea of being in therapy or if a parents, if a student tells you I wanna see a therapist or I started seeing a therapist, don't be worried. Don't be afraid. That doesn't mean that there's something big like wrong with anybody or anything like that. Being a teenager is really, really hard. And being a teenager right now is even harder I would say, than it has been in the past. And at the school-based health center is a really great place to try out this idea of getting some help, getting some therapy. If you've been thinking about it.

Curtis Long (28:02): Are there any laws, especially around student privacy that families should know about when care is provided at a school-based health center? And I think it's important, Jenn, that we realize that some of these laws are not North Clackamas rules. These are state and federal laws that we have to follow.

Jenn Lucas (28:15): Oh gosh, yes, yes, you're absolutely right. All school-based health centers, whether they're in North Clackamas school district or other, you know, cities and towns in Oregon or across the country, we all follow very specific federal and state regulations as far as providing care to our patients. I think one concern sometimes that families have is that the student may come in to schedule an appointment and they haven't told their parent that they're going to be seen. And I think it's really important that families understand that part of our jobs as either medical or mental health providers working with adolescents is to be talking with each and every student about how they can talk about issues within their family. And we work really hard to bring families into that student's care. Sometimes they're just nervous, you know, parents are really busy and stressed out and sometimes they're just nervous to say, I want an appointment someplace.

Jenn Lucas (29:18): I get that I'm a parent of three teenagers, I've probably said that to my own kids. Mm-hmm <affirmative> honestly during a busy week. So, you know, I block off time every day where I'm making parent phone calls and after I talk to students and kind of figure out what their concerns are, I'm usually able to address them really easily with them and then loop the families in. And I get a lot of positive feedback about that. Parents are relieved that they're being kept in the loop and students don't have to be stressed out about how to have the conversation with their parent.

Curtis Long (29:50): So it's certainly not a case of any S B H C trying to be secretive about anything.

Jenn Lucas (29:55): No, no. We're not secretive. I think one, you know, surprised that parents of adolescents run into, especially you know, with their first child when they become a teenager is that some of the privacy laws do change around the sharing of information. Right. And that's always a shock. It's just like when they get their driver's license or their permit, it takes a minute to get used to. But again, those are federal and state regulations that we're required to follow and we of course do that.

Curtis Long (30:25): And I'm sure some of our listeners are thinking right now, well what are some of those federal and state regulations Now I know some of those are related directly to a student's age, is that correct?

Jenn Lucas (30:33): That is correct. There are three different kind of categories under that that we follow regulations in the state of Oregon for medical and dental services say that minors who are 15 years or older can consent to services without parent consent.

Curtis Long (30:52): So a 15 year old can have dental issues come down to the health center. You don't need parent consent to make sure you help them.

Jenn Lucas (30:59): That's correct.

Ben DeGuilio (31:00): Ben DeGuilio here in regards to the mental health services, that age of consent is 14 years old.

Curtis Long (31:05): 14 years old for mental health.

Ben DeGuilio (31:06): As a general practice, our clinicians make attempts to reach out to parents when indicated by the student that they like. Yeah, go ahead. And we make really sure like we're not gonna tell 'em what you're talking about in here. Right. We're just gonna let 'em know that you're here. We're gonna introduce ourselves so you can understand that our role is different than that of a school counselors. We're in the school. Mm-hmm <affirmative>, we are not the school. Mm-hmm. <affirmative>. And so that's always been our practice and several times this turns into family therapy, which is also something that we could do. We can actually have sure parents come in and be a part of those sessions. When you're talking about mental health among teens, that could be very helpful in a lot of cases.

Curtis Long (31:40): And I can imagine sometimes you have parents that are on the other line, very receptive for that saying, oh thank goodness cuz my son or daughter wouldn't talk to me about that. I'm glad that they came to you for help.

Jenn Lucas (31:49): Absolutely. Absolutely. The third component of confidentiality laws in Oregon is the access to age appropriate reproductive healthcare. All school-based health centers follow the Oregon state law here. Minors of any age are allowed to access birth control related information and services as well as testing and treatment of sexually transmitted infections. Again, part of the conversation is with young people who may be engaging in risky behaviors is how to keep them safe and how can they involve their parents or families in that discussion.

Ben DeGuilio (32:26): Another regulation that we need to follow is a student is a serious harm to themselves or to others. Mm. Or there are serious concerns about the safety of anybody that has seen we will reach out to, to guardians. Mm-hmm immediately.

Jenn Lucas (32:39): Yep. Just like anyone who works in a school or is working with young people, we're all mandated reporters. So if a young person is at risk of harming themselves or is being harmed or is thinking about harming another person, we follow all the same guidelines in reporting that to the appropriate people

Curtis Long (32:58): As we start to run out of time. I just have to say that when you look back at the past 13 years, this is really an incredible achievement by the North Clackamas School District and its partners outside in in Clackamas County. For those of you who have been along for at least part of this ride, what are you most proud of? Looking back to 2010 to where we are today?

Sienna Day (33:14): I think I'm most proud that I'm still here. I'm really surprised that I stuck around this long, but I'm really happy I did. Every day I come into the school and I have this panic where I feel like I'm still in school, but when I get there I realize I'm delivering the services I still love and cared about and needed when I was in school. And I'm really proud of myself for continuing to do that through university and figuring everything out. I think I'm also really, really proud of the students that I've helped, especially throughout the pandemic, watching them come in, I try and figure out how to schedule an appointment, helping them fill out paperwork and watching them leave and already having appointments scheduled, ready to do things, ready to like get down to their medical business and focus on school or work or whatever they wanna do. I'm just really proud that I got to help in that process.

Jenn Lucas (33:58): This is Jenn. Gosh, it's hard to pick just one thing, but what I would say to that is that it's absolutely remarkable when you look back and see the amount of individual students, community leaders, school administrators who have all come together to make this program better every single year. You know, the community partnerships that arise through the Youth Advisory Council or through just having conversations between different disciplines is amazing. And this, you know, there are school-based health centers all over the country, but North Clackamas really has something special here.

Ben DeGuilio (34:37): This is Ben here. I would say that I've been with Clackamas County now for five years and have worked with clinicians, therapists out of the school-based health centers that entire time. And I just have to really remark on how well these clinicians have navigated every twist and turn that's been thrown at not just the mental health field, but the school as well. Especially in the last three years. Clinicians already have a challenging jobs of holding the hope of the people that we serve. And then when you couple that with every dynamic that happens in a high school within a student's life and with such smaller clinics as you would experience outside in the community, really a lot of rides on them to be able to do that. And I am just always stunned how they navigate those challenges and all, all the while doing it with the student's best interest in mind.

Max Penneck (35:26): I think one of the things I'm most proud of is about creating an environment where students are comfortable just to be. Everyone's able to plop down a building, plop down an office and say, here's a health center. But it's entirely different thing to foster a space where students feel like they belong. And I think we see that every single day. It's only about half the people that come into the health center that are actually making appointments. The other half are coming in to say hi to Sienna or dig through our goodies and grab a toothbrush or chapstick or whatever they need that day. Ask for a snack or just a quiet space tea for a few minutes.

Barnaby Gloger (35:57): Barnaby here. I think the thing that makes me most proud and the thing that makes these school-based health centers so amazing is not something that we can see or know, but when we think about the reason why we have them, it's to meet students' needs. And we think about the students who've received care from the school-based health centers, medical or or mental health. The care's been there, they've received those services. We'll never know what would've happened if they didn't have those services. So when we think about how amazing our students are that have received services from the school-based health centers and how they are still with us and they are still present and they're still going to class and they're still getting uh, their needs met, but also being successful. That's what I'm proud of. I'm proud to know that because the school-based health centers have met these student needs, that our students are healthy and well. Because of that, you can't really see that. You can't see what's missing or what could have happened. And so I'm really proud to have these here to meet these student needs.

Curtis Long (36:50): Well, it was 2010 when the school district started this journey toward more effectively supporting our students' physical, emotional, and mental health. And we mentioned before that 2010 was the year of the minion

Minions (37:00): <laugh>.

Curtis Long (37:03): You know what else came out on the big screen that year? So long partner Toy Story three. Come on, admit it. You cried when college bound Andy handed his beloved cowboy Woody and Buzz light year off to bright eyed, bubbly Bonnie. So a new generation could enjoy his childhood friends for many years to come. Well, thanks to the efforts of our guests today, Lilly Hankins, Jenn Lucas, Ben DeGuilio Sienna Day, Max Pennick, Natalie Parks, Claire Davis-Thran, Tami Gilbertson, and Barnaby Gloger, NCSD students and families for many years to come will have readily available access to physical, emotional, and mental healthcare. All of you truly make us proud to be NCSD. For more information about any of our district's school-based health centers, you can visit the websites of any NCSD high school. And big thanks to all of our listeners today. Thank you for continuing to find the Proud To Be NCSD podcast on the websites of your favorite podcast providers. You can count on another episode next week. I know how you loyal listeners feel when you don't see the latest episode right away.

Toy Story characters (38:00): Hold on. This is no time to be hysterical. It's

Toy Story characters (38:02): The perfect time to be hysterical.

Toy Story characters (38:04): Should we be hysterical now? Yes. Maybe. Well, not right now.

Curtis Long (38:08): We'll talk to you then.

Curtis Long (38:10): Thanks for listening to The Proud To Be NCSD podcast. In North Clackamas, We know that education is a community effort and we're so thankful that you and your family are a part of our community. Until next time, remember, there are always great things to see wherever you go in N C S D.