A Case Study: Public Health’s Role in Student Success in Mancelona

Erika Van Dam

By Erika Van Dam, MPH, Deputy Health Officer and 


Mike Swain

Mike Swain, MPH, Public Information Officer

Health Department of Northwest Michigan

DashBoard, April 12, 2017

A student was just 16 when she left her home in Vietnam to spend a year in the United States, as part of a sponsored exchange program. She found herself in northern Michigan, living with a host family in Mancelona, where she was also to attend school.

Just a few weeks after her arrival in the states, the student needed a physical exam to meet school requirements. She went to the Ironmen Health Center, a school-linked child and adolescent health center in Antrim County, operated by the Health Department of Northwest Michigan. Though it was a routine exam, her clinician detected a heart murmur that had never before been discovered.

The student was then referred to McLaren Northern Michigan, in Petoskey, for a student heart screening that is offered to students in grades 9 through 12. After electrocardiogram and echocardiogram testing, and a consultation with a cardiologist, the student was diagnosed with an Atrial-septal defect—a hole in the wall between the top two chambers of the heart—which can lead to complications and, eventually, heart failure if not treated when the patient is young.

Unfortunately, following the discovery of the heart defect, the company that sponsored her U.S. exchange withdrew its coverage, and stated that she needed to return home to Vietnam.

That’s when McLaren referred her to C.S. Mott Children’s Hospital in Ann Arbor, where her ASD was declared to be “significant” but correctable. Her doctors felt that she needed charitable care and, thanks to the hospital and the International Children’s Fund, her heart surgery was fully covered. She was able to return to northern Michigan for cardiac rehabilitation in Petoskey at no charge.

Effective coordination between the school, the child and adolescent health center, the host family and the two medical centers made this positive outcome possible, where the student can now look forward to a full and healthy life.

For decades, the Health Department of Northwest Michigan has worked closely with school districts to improve health for students and their families, such as in the story mentioned above. Health department staff share a similar mission with school staff and board members—removing barriers and supporting students in achieving academic success.

With school health centers operated by the Health Department of Northwest Michigan in Mancelona, Boyne City, Gaylord and Pellston, thousands of students are able to receive free health services, such as immunizations, acute care visits and physicals. School health centers have been associated with not only improved physical health outcomes but also better emotional and behavioral outcomes. School health centers also go beyond common health care services; mental health professionals provide services for students and families, an onsite nurse practitioner screens each client for risk-taking behaviors, provides counseling and teaches in classrooms, and community health workers help families sign up for health insurance.

Since the 1990s, a collaboration of stakeholders, including our local health department, the Kellogg Foundation, the Michigan Department of Community Health (now MDHHS) and Communities in Schools have made major health investments in the Mancelona community leading to improved outcomes in academic success and health among Mancelona’s student population. Prior to public health investments in the district, the area had some of the state’s highest rates of child abuse and neglect, teen pregnancy and substance use. Jointly, school and health officials responded to the crisis through a comprehensive approach of providing health, social, educational and economic services to address the clinical and social determinants of health. Resources were brought directly to the school campus, ranging from a health center to a dental clinic to a classroom for pregnant and parenting teens, with staff including nurses, a midlevel provider and community health workers who are available year round. Since the work began more than 20 years ago, the four-year graduation rate now hovers around 90 percent—up from 39 percent in 1995.

The Health Department of Northwest Michigan has moved beyond offering only services delivered at the individual or family level and is working with local school districts throughout the northwest region on school-community efforts, such as: employee wellness programming for school staff, health education programming on nutrition, physical activity, comprehensive sexual education and substance use prevention, and working with the municipality and the school district on Safe Routes to School to make major infrastructure changes in the community that allows safe and active commuting to school.

The relationship and partnership between school districts, public health entities and human service agencies continues to prove mutually beneficial. Health agencies bring to the school district an expertise in providing a comprehensive approach in addressing social determinants of health, as healthy students learn better, better learners graduate and students that graduate go on to lead more successful and healthier lives. The outcomes achieved in Mancelona—from the detection of a simple heart murmur that can save a life, to a decline in teen pregnancy, substance use, child abuse and a substantial increase in graduation rates—all prove what is possible when local health department services are brought to schools and when strong partnerships with the school last the test of time.

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