Through a first-of-its-kind SMART Plus Clinic, doctors and medical students from Brown's Warren Alpert Medical School are boosting middle schoolers' health outcomes, academic success and career preparation.
PROVIDENCE, R.I. [Brown University] - Before she began her clinical health elective at Calcutt Middle School in Central Falls, Rhode Island, Carolina Carrillo thought about school-based health care in the traditional sense - kids with bellyaches, a nurse to assist, quick referrals to parents or a doctor.
That's not what the fourth-year Brown University medical student found.
Working under the direction of a nurse practitioner, Carrillo diagnosed ailments, conducted medical tests, administered medications, treated wounds, wrapped ankles and performed other medical procedures.
Carrillo once aided her supervisor as she treated a student who'd scratched their cornea. Another day, she helped perform a digital nerve block procedure to remove a fingernail from a student who had an accident involving her pinky finger. The student only missed a few lessons; her parents were called immediately but didn't need to leave work.
"It all happened then and there at the clinic, which was amazing," said Carrillo, an aspiring pediatrician. "This isn't something that typically happens in a school nurse's office. Every school should have a fully functioning clinic like this, which enables such positive experiences between kids and health care providers."
Calcutt is one of just five schools in the state to have an on-site SMART Health and Wellness Clinic. Functioning like a doctor's office, each SMART Clinic - SMART is shorthand for School Health Model for Academics Reaching All and Transforming Lives - is staffed by a team of health care professionals, including a family nurse practitioner, behavioral health specialists, nurses and medical secretaries.
Even for the 16 neighborhood schools in four U.S. states that host SMART Clinics, only Calcutt has a partnership like the one the school maintains with the Warren Alpert Medical School of Brown University. Medical providers affiliated with Brown, and future physicians like Carrillo who work under their guidance, lead care delivery at the clinic every school day. The clinic at Calcutt serves as the inaugural site for SMART Plus, a program designed to spark interest in health care careers among the Central Falls students. After school, Brown volunteers host discussions about the path to medical school, teach kids about doctoring skills, conduct STEM tutoring sessions and lead trips to local educational and health care facilities.
Dr. Joseph Diaz, the associate dean for diversity and multicultural affairs at the medical school, co-leads Brown's participation with the SMART Plus Clinic and seeks ways for Brown faculty and students to leverage their clinical expertise to serve the school and surrounding community. At Calcutt, the model has boosted not just students' health, he said, but their academic success and career preparation.
"This opportunity provides Calcutt students access to ongoing mentorship and conversations about health and health care careers - in addition to improving access to health care," Diaz said. "It's been a game-changer, not only for Calcutt Middle School, but also for Brown."
Preventing issues before they start
The Calcutt SMART Plus Clinic launched in 2022 as the result of a partnership between Central Falls Schools, Ginn Group Collaborative and the Rhode Island Department of Education, with funding from the Warren Alpert Foundation and support from Brown's medical school.
"The SMART Clinic is a cross between a primary care office and an urgent care clinic," Diaz explained.
Clinicians at the school can treat lacerations, soft tissue injuries and sprains. Instead of referring students to a specialist, which would cause them to miss school, most emergencies can be treated on the spot. If a student has a sore throat, the SMART Clinic medical provider can test for strep, prescribe antibiotics and even administer the first dose - or, if the test is negative, confidently send the student back to class to continue to learn.
The goal of the embedded SMART school clinics is to positively impact the trajectory of students' lives by supporting academic achievement with on-site health care, said Melanie Ginn, the architect of the SMART Clinic model and president and CEO of Ginn Group Collaborative.
"We proactively conduct outreach, we screen for risk and barriers to academic achievement - including physical, mental and social-emotional - and then work to address those," Ginn said. "We're about wellness for all, so that every single student can reach their academic potential."
SMART Clinic staff begin each school year by screening more than 98% of students for health risks, Ginn said, allowing providers to identify concerns and assign appropriate interventions. For example, clinicians not only diagnose students with asthma but also counsel them on managing symptoms during physical activity; they monitor students with chronic conditions like high blood pressure or kidney disease to get ahead of emergencies.
"Depending on the results of the tests, the students' risks can be addressed to stop problems before they even start," Diaz said. "These are just a few ways that the SMART Clinic helps students stay in school and keep up with their education."
During the 2022-23 school year, there were 5,169 encounters with students at Calcutt's SMART Plus Clinic, which is an average of 29 per day. Over the year, attendance improved by 30%, and chronic absenteeism decreased by more than 18%, according to school records.
