School health centers evolve to meet students’ social needs 

Ashley Randall remembers being cheer captain, homecoming queen and prom queen at Jennings High School.

She also remembers homecoming parades rolling down Jennings Station Road and a school community that felt connected.

“There was more community,” Randall said.

Today, Randall is back at Jennings High. But now she is a social work caseworker inside The SPOT, the school’s health and wellness center, helping students navigate homelessness, suicidal thoughts, unstable housing, anxiety, family stress and isolation.

From Jennings to North St. Louis to University City, school leaders and health care providers are increasingly turning schools into hubs for health care, counseling, food assistance and other services once handled by separate institutions. What began as an effort to improve access to medical care has evolved into something larger: an attempt to help children overcome the barriers that prevent them from learning and thriving.

One recent student came to Randall in distress. The teenager had been moving among relatives and friends. She worried about food, housing and whether she was becoming a burden.

Randall listened.

She connected the student with food and hygiene supplies. She helped her think through housing and job-training options. She encouraged her to focus on what she could still control: getting to school, treating others well and staying engaged.

Weeks later, the student returned with good news.

Her housing situation had stabilized. She had been accepted into a training program. She had won recognition in band. Then she proudly showed Randall her report card.

Four A’s.

“That was emotional for me,” Randall said.

Then she offered a sentence that may explain the importance of school-based health care better than any statistic.

“They’re determined to live,” she said of the students she serves. “Despite everything that may be going on, they still choose to show up each day.”

The clinic where Randall works reflects a growing recognition that schools increasingly serve as front-line social infrastructure. They are still places of learning, but in communities facing poverty, trauma, violence, housing instability and health disparities, they have also become places where young people encounter mental-health support, medical care and trusted adults.

For the St. Louis region, the rise of school-based health care is not simply a medical story. It is also an education story and a post-Ferguson story.

Dr. Sarah Garwood, who helps lead The SPOT through partnerships involving Washington University and St. Louis Children’s Hospital, said the Jennings program began in 2014, around the time Michael Brown was killed in Ferguson.

“We kind of started in a very tense climate,” Garwood said.

Students were grappling with trauma, grief and national attention focused on their community.

The clinic now provides medical care, behavioral-health support and case management.

Garwood said many students arrive with needs that traditional health care often struggles to address.

Some have never received regular preventive care. Some have untreated dental or vision problems. Others are struggling with anxiety, depression or the effects of violence and trauma.

“I was somewhat surprised by the number of kids who had experienced community violence,” she said.

A school-based clinic removes barriers that often prevent young people from receiving help. Students do not need transportation. Parents do not need to miss work. Providers can follow up regularly.

Randall sees the impact every day.

Some students come seeking counseling. Others need deodorant, snacks or information about health services. Some simply need a safe place to sit quietly for a few minutes.

One student routinely spent lunch alone in the clinic to avoid the cafeteria. Randall worried that hiding from peers every day would only deepen the student’s isolation.

She encouraged the girl to take a chance and spend time with other students.

The girl resisted at first.

Later she returned and wrapped Randall in a hug.

“I made friends,” she said.

After graduating in 2010, Randall earned degrees in criminal justice and social work. She worked in juvenile justice, hospitals, schools and crisis intervention. Yet she always hoped to return to the community that helped shape her.

“You grow where you’re planted,” she said. “I wanted to come back to the community and let them know, you may be rooted here, but you can still grow and sprout and go to other places.”

Returning has also shown her how much the community has changed.

Yet she rejects any suggestion that Jennings students are broken.

She believes many are stronger than earlier generations in one important way.

When she was growing up, mental health struggles were rarely discussed openly. Students suffering from depression or suicidal thoughts often kept those feelings hidden.

Today’s students are more likely to ask for help.

“That takes strength,” Randall said. “They are courageous. They are determined to live.”

This story was commissioned by the River City Journalism Fund.

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