Billings Public Schools, health department expanding in-school clinic model

This isn’t your typical exam room or clinic. The magazines haven’t been there for years and there’s no “Good Housekeeping.”

Students can stop by and add pop culture words on a bulletin board of intergenerational slang. And when they go into the exam room, there’s a traditional exam table, or a large bouncy ball, not so unlike the kind you’d find at a gym — take your pick.

It has a machine that takes vitals, like blood pressure and temperature, but it’s what you’d expect when you merge a medical clinic with a high school.

The small, in-house clinic looks and feels like it’s been there for longer than a few months, and the concept has been around for years, even in Billings Public Schools, which opened its first school-based clinic at Orchard Elementary a decade ago with its partner, RiverStone Health, the county’s public health agency.

The concept is spreading throughout the country with more than 3,900 in-school community clinics, but the program is still relatively new in Montana, which struggles to have adequate clinics across its vast expanse of rural areas, let alone in the heart of the largest city of the state.

However, research has backed up the power these small, primary-care clinics can have when they’re housed inside a school, which often serves as a common community center. The concept is simple: Putting clinics inside of schools, especially in ones that have students dealing with poverty, lowers the barrier to healthcare access, making it easier for students to see a doctor, get a physical, or see a mental health counselor for depression or even suicidal thoughts.

The program in Billings Public Schools, the largest public school system in the state, started a decade ago with the clinic inside of Orchard Elementary. It has grown to include Medicine Crow Middle School and now has expanded because of the success into Billings Senior High.

The numbers from RiverStone seem to demonstrate the program has been a success by several measures. In 2016 at Orchard Elementary, the clinic saw 584 patient visits. In 2023, visits had nearly doubled to 910. This year has already eclipsed last year’s mark and currently sits at 954.

The second clinic has mirrored that meteoric start. At Medicine Crow Middle School in 2018, the first year it was open, there were 334 visits. In 2023, there were 1,562 visits. In 2024, there has already been 1,548.

Billings Senior High was chosen because of the number of students without healthcare access, although any student can use it. Primary care providers as well as mental health providers see students. The clinics specialize in anything from illness, injuries sustained while in school, physicals, and vaccinations, as well as appointments for mental health and information about other health conditions. Some of the providers say that it also lessens the barriers for teachers who may need to see a provider but are stretched for time. Already, medical staff at the Senior High clinic have done bloodwork, blood pressure and staff checkups.

Providers say that students, parents and staff members may not want to go through the hurdles of setting up appointments, then taking time off to go to those appointments, so may ignore their own health. By putting the clinic on site, it lessens all of those, and Katie Keith, a nurse practitioner at Billings Senior, said they’re often able to schedule appointments so that students don’t even miss class.

“We want to be expanding services and clinics,” said Billings Public Schools Superintendent Erwin Garcia. “We know it is so critical that we have these services and the mental health component.”

Already, Garcia said there are more than a dozen students in the district who have severe mental health issues but are able to stay in school because of the support these clinics can provide. Right now, Garcia said he’s continuing to look for ways and funds to expand the concept across the district to more schools.

Jon Forte, the CEO of RiverStone Health, said that this model is expanding across the country, as it is in 49 states, and that community-needs assessments throughout Billings show that students need more support as they face mental health issues as well as substance abuse. The clinics do not cost the school district or the taxpayers a dime, thanks to grant funding from the Montana Healthcare Foundation.

“I promise you this is only the beginning and we’re looking at other ways that that we can create these school-based health clinics not just for (Billings Public Schools) but for the county and our rural schools,” Forte said.

Dr. Megan Littlefield of RiverStone said that the community-based model has been around since the 1970s and grown steadily.

“School is often a safe space for our youth and the health outcomes are tied to other success,” she said.

Healthier students mean they can tackle mental health or physical issues better, which leads to higher academic performance and fewer dropouts.

“Chronic illness and mental illness play a big part in why kids drop out of schools,” she said. “These clinics have a profound impact on students and their families, and the users are more likely to access mental health and that reduces absenteeism.”

Keith gave a brief rundown of her day, which begins before class starts. She said teachers are more willing to fill out mental health questionnaires for students because they know the providers. She said teachers and students naturally gravitate toward the providers, and she gave an example of a teacher who had a student come to her with a health question. Together, the teacher and Keith were able to answer before class.

“We’re encouraging students to maybe ask these questions of a professional health professional instead of TikTok,” Keith said.