It's the start of the school day at Mound STEM Elementary School in Cleveland's Slavic Village. The halls are busy with kids making their way to class. 6-year old Anthony is among them. But before heading to his kindergarten class, he makes a stop along the way.
Inside a converted classroom,Dr. Christine Alexander is on hand to give Anthony his annual wellness check. Alexander helps him onto the examining table and speaks to him soothingly as she moves her stethoscope around his chest.
"Your heart sounds nice and strong to me. Now we're going to listen to your lungs and see if we can hear any of that asthma down there. Big deep breath…" Alexander says, "like you're blowing out candles."
This health center at Mound opened just last fall. It's the first of 20 such facilities planned for the Cleveland school district that will have doctors on hand to prescribe medicines and treatments that school nurses can't.
While it's only open one day a week, it's expected to play an important role in helping parents keep their kids healthy.
On this Wednesday, Anthony's mother, Shannon Beard, watches as Dr. Alexander does a thorough check up. Beard was one of the first parents to sign up for an appointment when the center opened because taking the boy to his regular doctors at MetroHealth Medical Center across town on public transportation is never easy.
"Sometimes transportation doesn't arrive on time or sometimes they cancel, and then you have to get on the RTA, well I have to because I don't have a vehicle. Yeah, it's pretty hard sometimes," Beard says.
Anthony usually misses a day of school.
Nationwide, new school-based health centers have helped decrease absenteeism rates and improved the health of students.
"People now are beginning to think about what this system could contribute to the next set of kids health care. And clearly there is a recognition - not in all places, not at all times, that there are opportunities," says Julia Lear, a professor at George Washington University and an adviser at the Center for Health and Health Care in Schools.
Only 100 schools across the country reported having health centers in the 1980s. Today, nearly 2,000 exist, Lear says.
The growth occurred because large health systems saw a chance not just to help students, but also to recruit new patients, many of whom are covered by federally-supported Medicaid, she says.
And the partnerships are reporting success: Denver's schools have provided care to more than 10,000 children and school attendance has improved. In Seattle, researchers showed a decline in teen pregnancies. In New York, childhood asthma episodes decreased.
The Cleveland district is opening its twenty health centers with help from MetroHealth and private funding.
Back at Mound elementary school, Debbie Aloshen, head of nursing and health services for the district, says the openings can't happen fast enough.
Increasingly, she says, the hallways here - as in many urban schools - are filled with kids who suffer from asthma, diabetes, blood pressure problems and developmental challenges like attention deficit disorder and autism.
"We started out with boo-boos and Band Aids. And it used to be a big thing when someone had an asthma nebulizer in the school. That was huge. People went Oh My God we need a full time nurse because we have a nebulizer. Now, I'd be happy just to see a nebulizer," Aloshen says.
Aloshen's nurses are spread thin, with 30 covering 100 schools. The addition of health centers helps them do more and, if necessary, ask for help.
Dr. Alexander says that ability to work together is long overdue.
"The kids were behind on their immunizations, they had asthma that was poorly controlled, they were coming into the emergency rooms and urgent care centers to kind of get a lot of their basic health care needs met and so clearly by being stuck in the office and waiting for them to come to us, that was a model that wasn't working," she says.
Alexander hopes the new health centers will improve student health and reverse attendance problems in Cleveland school system. At the very least, she says, she can try to reach one student at a time.
After checking Anthony's heart rate and lungs, she tries to get in a little coaching on healthy eating, instructing him on the importance of eating plenty of vegetables. It's a tough sell for the quiet six-year-old.
"So sometimes if she puts something that's not on the diet on it, like butter or cheese that might make it taste better?" Alexander says.
Anthony interrupts and says "I don't like cheese."
"You don't like cheese?" Alexander responds. "Hmmm."
Maybe she'll have better luck at Anthony's next visit.