Filling the Treatment Gap: Florida Keys School Health Initiative

Keith Harris, MPH, Director of Professional Education

Florida Keys AHEC/MRC

Provider Liz Hussey, ARNP examines a patient.

Provider Liz Hussey, ARNP examines a patient.

The Florida Keys comprise 120 linear miles from Key West to Key Largo. Access to care is a frequent and predominant issue among impoverished children in the Florida Keys. Approximately (37.3%) of school aged children in the county are enrolled in the Medicaid or MediKids program. Families of these children make up a large portion of those living below (11% under 100% of the federal poverty linke [FPL]) or at (29% under 200% of the FPL) poverty levels. With only five pediatricians in the county with capped Medicaid enrollments in their private practices, a significant barrier to accessing basic health care services has developed. The Florida Keys Area Health Education Center (AHEC) Inc. opened school-based primary care clinics in Key West and Key Largo, but a gap remained in the middle Keys. For children in the middle Keys to access primary care services, they would need travel a minimum of 50-60 miles. With funding from the National Association of County and City Health Officials (NACCHO) Medical Reserve Corps (MRC) Challenge Awards, the Florida Keys MRC joined Florida Keys AHEC to develop the School Health Initiative to address this gap in accessible care in Monroe County. This initiative brought the Junior MRC, the Monroe County School District, the local Federal Qualified Community Health Center, the City of Marathon, the Health Foundation of South Florida and the Florida Department of Health together to establish a part-time primary care clinic at Marathon High School. The clinic services Marathon High School, Stanley Switlik Elementary, Marathon Middle School, and the charter school Big Pine Academy.

Florida Keys AHEC developed this program based on a similar effort in the Miami-Dade School District, which arose via a collaboration between the University of Miami and the Community Health of South Florida Inc. Florida Keys AHEC advertised the clinic by providing cards about the clinics to the teachers in the affected schools. Teachers handed out cards to their students for them to take home to their parents. As of this year, the clinic now operates full- time.

After receiving funding, the project’s short-term goal was to hire and train a nurse practitioner and see the 35-40% of students from families enrolled in Medicaid and/or living below the federal poverty line. The School Health Initiative accomplished both goals. After evaluating a wide pool of applicants, Florida Keys AHEC hired a nurse practitioner to staff the project. The nurse practitioner worked eight hours (one day) per week during the Spring Semester and then quickly expanded to 16 hours (two days) in the Fall Semester. During the first year of the project, she saw 500 students, which met the goal of seeing roughly 35-40% of the 1,500 students enrolled in the middle Keys. The nurse practitioner provided any service that fell under primary care including physicals, sick visits, minor wound care, obesity interventions, oral health screenings, and immunizations. If the clinicians encountered a health issue they could not approach, the nurse practitioner was able to refer patients to the Federal Qualified Community Health Center where students could receive care for free or on a sliding scale.

The clinic also served as an educational opportunity for the Junior MRC volunteers to shadow a medical professional and gain valuable experience in a healthcare setting. This shadowing opportunity helped restore some of the role played by a local health careers class that recently lost funding.

Although the School Health Initiative continues to be a success, the process did include some challenges. The project lost funding from the Florida Department of Health, which forced the team to acquire additional funding. While the loss of the funding was a considerable blow, it induced the team’s efforts to file for Medicaid and to begin accepting insurance at the clinic.

The middle Keys school-based primary care facility in Monroe County aims to subsist on local partnerships alone, without outside funding, in a few years. A community can bring such an intervention to their community with proper research into what other similar counties and communities have done to bring primary care facilities to their schools.

Learn more about NACCHO’s MRC Challenge Awards at




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