Katie Upright regularly drove 45 minutes from her Montrose home across the New York border for her children’s doctors’ appointments.
Her new “commute” to healthcare takes minutes.
Now, Upright meets her children down the hall from the classroom where she teaches special education at Elk Lake School District for their appointments, as well as her own.
Upright and her children receive their care at a health center located in Elk Lake School District run by Susquehanna County- based nonprofit NEPA Community Health Care.
The inconvenience of crossing state lines for healthcare typically forced her to take at least a half day off work, but in many cases a full day was needed. Her children’s pediatrician’s office would only schedule two consecutive appointments, so with three children, she would be making the commute at least twice in a given week for regular checkups and other specialized care.
“NEPA [Community Health Center] is convenient for our family,” Upright said. “I have scheduled appointments before school, immediately following, and during the day. While the during the day appointments do impact my work schedule, leaving my classroom for an hour– commute included– is far better for me and my students than a half or full day [off].”
Elk Lake’s school-based health center opened first in 2017. It closed during the pandemic before reopening in 2023. It’s open 40 hours a week from 7 a.m. to 5 p.m. every day during the week (except for Wednesday) to ensure students, staff and families can get to appointments before, during and after the school day. Regular staff include a medical provider, nurse and front desk receptionist.
Lack of accessible care
In rural Susquehanna County, the closest healthcare to the school, the Endless Mountains Health System in Montrose, is nearly 15 miles away. The other closest facility, the Barnes- Kasson Hospital in Susquehanna, is almost an hour away from the school.
Elk Lake's superintendent Bob Galella wants community members to view the school as a gathering space, rather than just a place their children go to learn.
“We are the main hub for our school district,” Galella said.
Just because Endless Mountains Health System is relatively close to the school, doesn’t mean that it is close to students’ homes. According to Galella, buses start picking students up at 6:10 a.m. for an 8:15 a.m. start to the school day. Students travel at most 45 minutes to an hour to get to school.
“[Endless Mountains Health System is] about 12 to 14 miles [away from the school], which isn't too bad, but when you're looking at a low income community with transportation restrictions, that can be pretty daunting,” said Kristen Follert, the CEO of NEPA Community Health.
Her organizations’ goal is to reach underserved communities with accessible healthcare. Transportation is just one of many barriers to care that rural Pennsylvanians face.
'In rural communities, we see a lot of people struggle to get to doctor's appointments because of transportation, because of work, because of child care situations. And then, we also have barriers such as financial and insurance coverage, but by placing health centers in the school environment, we're able to bring care closer to the communities so that they don't necessarily have to travel as far,' said Kristen Follert.
“In rural communities, we see a lot of people struggle to get to doctor's appointments because of transportation, because of work, because of child care situations. And then, we also have barriers such as financial and insurance coverage, but by placing health centers in the school environment, we're able to bring care closer to the communities so that they don't necessarily have to travel as far,” said Follert.
Even if students travel to Scranton for care, they might not find what they need. There is a lack of pediatric care that came with cuts to the Community Health Systems owned hospitals, Regional Hospital and Moses Taylor Hospital.
“I was a pediatric nurse before this at Moses Taylor, and we've since lost that unit,” said Chelsea Hafner, a family nurse practitioner and a primary care provider at The Wright Center’s school-based health center located in West Scranton Intermediate School. “There's not much around, we don't have a lot of pediatric specialists. We may have pediatricians, but we lack pediatric specialists, so it's really tough in this area to actually get the care sometimes.”
The Wright Center’s Scranton school district locations are along bus routes. The center at West Intermediate is also within walking distance of West Scranton High School. Students can walk between buildings to the health center with parental permission.
“We are on the bus route,” Hafner said. “We're right up from West Scranton High School. We're very fortunate that when we work with our community health workers, we do offer bus passes for those that do need help with transportation.”
Elk Lake’s health center offers primary care, sick visits for acute illness and OBGYN care.
According to the Hospital and Healthsystem Association of Pennsylvania, Susquehanna County is at risk of being a maternal healthcare desert.
The Hospital and Healthsystem Association of Pennsylvania found that, “47.6% of women in rural counties live more than 30 minutes from a birthing hospital.”
Many Susquehanna County residents have to travel to Scranton or over the New York border to give birth. Two of Upright’s children were born in New York. Having gynecological care at the school has helped provide county residents with the option of prenatal checkups close to home.
“We have no hospitals that do deliveries, so our patients still have to travel upwards of an hour to go deliver their babies, but at least now they can get their prenatal care closer to home. And that really encourages the people who live here to engage in that very important prenatal care otherwise they go without,” Follert said.
The Wright Center tries to offer as much treatment to pediatric patients as possible, so they do not have to go elsewhere for further treatment.
“Patients with asthma, those with childhood obesity, issues like that, if we can kind of tackle them here in the home based setting, then they may not need that specialist referral, because a lot of our patients don't have the transportation or the means to actually get to these appointments,” Hafner said.
Serving underprivileged communities
Both school districts are Title I schools, which fall under a certain poverty level and receive federal funding to improve outcomes for students in low-income school districts.
The districts’ residents cover both ends of the insurance spectrum. Both The Wright Center and NEPA Community Health Care serve even uninsured patients.
“We have different levels on the scale, the lowest level being, we won't charge someone anything,” Follert said. “They can come and receive their care for free. Our collective mission is to provide good quality health care to underserved areas and underserved people.”
At Scranton school-based health centers, people are served regardless of their ability to pay.
“We see all and we do not push anybody away,” Hafner said. “We see those that are insured and uninsured. We see all insurances. We see pretty much anybody and everybody we can, because we want to make sure that everyone should get the care that they do deserve.”
NEPA Community Health Care receives section 330 grant funding from the federal government to help offset uninsured patients’ costs or those with the inability to pay out of pocket costs once insurance has been applied. The organization is considered a Federally Qualified Health Center, or FQHC.
Elk Lake does not charge NEPA Community Health Care rent. The district provides them with internet, electricity and heat to run the clinic. This helps the nonprofit cut costs and compensate for patients that are unable to pay their bills.
Having health centers in the schools also makes appointments more convenient for parents, many of whom cannot afford to take off of work.
“A parent can call in or video conference in when they're when their student is coming to the health center for a well-child check or whatever. It saves them from having to take a day off work or pull the child out of school to go to an appointment,” Follert said.
Galella, whose role as superintendent in a district with a student population of 1,100 has morphed into both a community leader and public health official, is proud of the services his district is able to provide to the greater community, even with limited resources.
“We are a poor, rural school district,” Galella said. “We have to get creative and innovative to find ways and measures on how to provide the best education and the best resources to our kids. And when I look around, we struggle financially, however, what we're providing to our community and right here in house, I'm so impressed with what has been going on in this district.”
Mitigating safety concerns
School-based health centers, especially those that treat patients with no connection to the school district, raise concerns about student safety.
To mitigate those concerns, Elk Lake’s health center is a locked unit with a completely separate entrance from the school buildings.
“It was so important to us that we be able to establish an external entrance that was secure in relationship to the school, so that we could see individuals who live in the community, who don't necessarily have a connection to the school themselves,” Follert said.
In urban school districts, safety is an even larger concern.
“[Safety] is a big factor for most people, because the concern for the children's safety as well as anyone else's safety, since it is an outside door accessed into a school where their children might be,” Hafner said. “We are a locked unit, so all of our doors are locked.”
Neither district has had safety scares as a result of patients coming for care at the school health centers.
Measuring success
As a superintendent, Galella promotes programming like the health center to the community. If he’s able to get the community on board, he feels he’s doing something right.
“I have to be able to explain to taxpayers, people that are moving into the area, what we have,” Galella said. “I say to teachers all the time, we are in customer service. That's what we do in public education. We are trying to provide the best service possible to our students. Our most valuable resources are our students, and then, of course, to their families.”
According to NEPA Community Health Care, the Elk Lake location saw growth in the past year that far exceeded expectations. When the center first opened in 2017, it saw less than 100 patients in that first year and again in 2018. In 2024, the organization served 993 unique patients, which far exceeded the goal of 30% growth from those initial years.
With a student population of 1,100, Galella is happy to see such high numbers, knowing that many of his students are taking advantage of the services offered in- house.
Some of the goals are less tangible.
“We can hopefully reduce people's vaccine hesitancy, because we do come from a community that has a lot of vaccine hesitancy throughout it,” Follert said.
Long-term measures of success will analyze how the quality and accessibility of care impacts overall health outcomes in the community.
“Our hope is that with the level of preventative care that we are providing, we can help reduce obesity. We can help reduce chronic illnesses like hypertension and diabetes,” Follert said. “We can increase awareness for cancer screenings and healthy living and vaccines. By building a healthier community in the future, we can hopefully positively impact the public's overall health and well being.”
Since the opening of The Wright Center’s Scranton school district locations in Sept. 2017, the clinics have seen 6,268 unique patients. Out of those patients, nearly 3,500 were covered by Medicaid or Medicare.
6,268 unique patients since opening in Sept. 2017, nearly 3,500 covered by Medicaid/ Medicare.
Planning for the future
The Wright Center wants to expand the model to other districts. In December, they held a community information session at Lakeland School District to inform the public and answer questions about school-based health centers. The organization is still in early conversations with the district about potentially opening one there.
Galella already started fielding calls from superintendents of neighboring districts with questions about his district’s school health center. He is happy to provide information and advocate for the model.
Follert hopes the center will offer more of their services in the future.
“(That includes) bringing our mental health and counseling services and bringing our dental services,” she said. “The next step for us would be the mental health and behavioral health services.”
