Oakland students: Four free clinics are still open for you during the pandemic

A month into the fall semester, nurse practitioner Karen Gersten-Rothenberg asked a teenage patient a screening question that she always asks during the pandemic: How’s distance learning going for you?

“That’s when she told me that she didn’t have a computer,” Gersten-Rothenberg said. “She had already missed three and a half months of school, including the spring. Luckily, that was an easy problem to fix.” 

Gersten-Rothenberg works for La Clínica de la Raza, which operates six of Oakland’s 16 School-Based Health Centers (SBHCs) for OUSD students and community members. In addition to prescribing birth control, testing for sexually transmitted infections, and offering physical exams and vaccines, the centers provide mental health counseling and, in some cases, vision and dental care, year-round.

Located on school campuses, the centers are a refuge for many Oakland teens. In a normal school year, students can drop in between or during classes, at lunch, or after school and receive services in a safe environment—all confidential and for free. 

But when campuses closed in mid-March, all but four of the health centers closed as well. Clinicians quickly started providing the same services via telehealth (telephone and video appointments) and in-person when needed,. but today, La Clínica’s school-based clinics are seeing only about 60% of the number of patients as before. 

“That makes me worry about the other 40%,” said Amy Blackshaw, manager of La Clínica’s school-based health clinics in Oakland. “A lot of kids rely on us for physical and sexual health care. On the mental health side, there’s so much more need. Young people are going through a lot of grief and loss, isolation, and fears around COVID.”

The problem? Many students don’t know the services are still available during the pandemic. Typically, SBHC staff visit classrooms to talk about the services available at campus clinics, but with schools closed, information doesn’t flow the same way. Many parents don’t get important emails or robocalls in their native language. Through fliers in food pantry bags, announcements in school advisory periods and word-of-mouth, clinic staff hope to reach teens in need of medical or mental health care.

“We are definitely concerned that there are students who aren’t able to access services they would be able to access if school was open,” said Mara Larsen-Fleming, director of health and wellness for OUSD’s Community Schools and Student Services. “I’ve also been concerned that students and families aren’t accessing care for non-COVID related issues and thinking about existing health disparities where our centers are a resource.”

A critical resource for students and parents

The impact of School-Based Health Center services can be deep and long-lasting. Former OUSD student Roxanne, who asked to withhold her last name, first visited a La Clínica center in her freshman year of high school. She was in a new relationship and needed birth control.

“If I had asked my mom for birth control or a condom, she would have gotten really mad at me. She would have told me not to have sex, instead of ‘practice safe sex,’” Roxanne said. She saw a counselor at the clinic every other week, which was when she found the courage to talk about sexual abuse she had experienced as a child. “I thought that I would carry that to the grave with me. But I felt happier and lighter when I was finally able to speak up about it.” 

Teenagers don’t stop having sex during a pandemic. Clinicians report a high rate of sexually transmitted infections (STI) affecting their teenage patients, so they’re making contact with sexually active clients a priority.  

Immigrants also continue to move to the U.S. and enroll their children in school. For these families, there can be big information gaps and SBHC staff can make critical connections to immunizations and other services. 

Hawthorne Health Center, near Urban Promise Academy middle school in Fruitvale, serves the neighborhood’s Central American immigrant population. Clinic staff includes an interpreter who speaks the indigenous Mayan language, Mam. Since schools closed, the Mam interpreter has reached out directly to families to make sure they know which services are available and how to connect with them.

“Some of the parents don’t know that they can get a computer for their child because most of the communications from the school have been email, and the parents can’t read at all,” said Claudia Ramirez, the clinic supervisor. “We tell them that the school can give them a computer and a hotspot, and we explain what a hotspot is.”

Making contact, and getting creative with care

Among the strengths of School-Based Health Centers are their strong connections to the school sites. With administrators, teachers, and clinicians meeting weekly to assess student needs, referrals come in regularly and communication with students and families is relatively smooth. So it’s no surprise that students who have already visited a center in the past are more likely to reach out now: Most of the more than 6,000 visits to centers from mid-March through July—in-person or over the phone—were made by returning patients. 

Across the city, clinicians and staff are working to build on those connections by reaching out to even more past clients.

“We follow up with patients who have asthma to make sure they have their inhalers and to see if they need a refill. Or maybe a student missed an appointment because they don’t feel safe coming to the clinic or they think we’re closed,” said Veronica Estrada, clinic supervisor at Fuente Wellness Center in San Leandro, which serves students and residents of deep East Oakland. 

While a telehealth appointment is better than no appointment at all, it does require providers to make the most of a brief, and remote, contact. As a family nurse practitioner at La Clínica’s Youth Heart Health Center, Gersten-Rothenberg does physical exams but also asks about mental health issues, safety at home, adequate food, and access to the technology needed for distance learning. When a student needs support that she can’t provide herself as a family nurse practitioner, she connects them with someone who can. 

Telehealth also presents a confidentiality challenge. It used to be easy for students to drop-in to the clinic on their school campus, knowing that their visit would be completely private. With telehealth appointments, clinicians have to work harder to make sure that patients are comfortable and able to talk freely. 

“We ask, ‘Are you in a place where you can talk?’” said Saun-Toy Trotter, mental health services program manager at Youth Uprising/Castlemont Health Center in East Oakland. When a teen can’t speak candidly or is struggling to open up, she said, clinicians have to get creative. 

“One therapist did a DoorDash and sent food to the young person’s home,” said Trotter. “Then they had lunch together over telehealth.” When a student couldn’t find anywhere private to talk, they came in to an open clinic for a counseling session, while the counselor spoke with them from her home via telehealth. Another therapist dropped off art supplies at a student’s front door and waved to them from the sidewalk.

With the barrier of distance, it can be challenging for medical staff to assess for sensitive issues, like sexual health, home safety, and mental health. 

“We always ask questions about drugs, sex, and alcohol,” said Dr. Javay Ross, a pediatrician at Youth Uprising/Castlemont Health Center. “Usually we ask the parent to leave the room, but we’re not able to do that now. I had a patient whose mother sat next to her the whole time. It was very awkward and no fun for the patient.”

“We have to get them engaged”

As it is for adults, the pandemic is putting pressure on teens and adolescents. Depression rates among teens and youth have spiked, clinicians say. Young people worry when their parents lose their jobs. They are isolated and miss their friends. They are afraid of getting COVID.  

“We know young people are coping the best they can,” said Trotter, but their choices are not always healthy. “We hear from young people, ‘Why does anything matter?  I’m just going to stay in bed, play video games, smoke pot.’ We have to get them engaged, get them into therapy, and let them know that we’re all still here.”

Some clinics have stepped up contact with patients using text, what Trotter calls “light, frequent touches.” La Clínica set up a hotline to help youth in Oakland make medical or counseling appointments or be referred to other needed services. 

But clinicians aren’t able to immediately help students in crisis the same way they could before. When a student recently told a friend that she wanted to kill herself, the friend reached out to a teacher, who contacted an administrator, who called Youth Uprising/Castlemont Health Center, which reached out to Alameda County’s mobile crisis response team.

“The teacher took all the right steps,” Trotter said. “We don’t have the capacity to be right there. We are just as far away as mobile crisis response, but we were looped in to wrap around that young person.”

As much as clinic staff members work directly with parents and students, they also engage with schools. Teachers face the challenge of assessing student health during Zoom calls, when many students might not even have their cameras on. A teacher at Fremont High School recently asked La Clínica to collaborate on a health workshop for students about coping with stress. The workshop will take place by zoom during an advisory period. Other clinics train youth to volunteer as peer health educators. Over the summer, a group of teenagers at Youth Uprising/Castlemont Health Center reviewed mental health apps and found the best free ones to recommend to their peers.

As the pandemic continues, with no end in sight, health care providers and educators worry about the students they haven’t contacted so far. Operating under challenging circumstances has only clarified the important role that school plays in the lives of teens and adolescents.

“We are just learning or relearning how important the school context is, for not only providing education but also supporting the holistic needs of students and families,” said Mara Larsen-Fleming. “That is what we want to do: Not just respond to crisis, but provide access to health care and health equity well beyond COVID.”