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Mary Newell has seen firsthand that students with unmet health needs have a hard time learning.
A student with poor vision is likely to fail his math test if his parents can鈥檛 afford the eyeglasses needed to see what his teacher is writing on the whiteboard. Another student may fail if repeated bouts of strep throat, which could be easily tackled through antibiotics, keep her out of the classroom.

Ms. Newell, a former nurse educator, started working with the Kent, Wash., district as a volunteer. Her passion for the integration of health and learning grew, and she eventually became director of nursing for the 27,500-student district. In her position, she tackled the needs of its high-poverty student population by establishing an in-school clinic for , the district鈥檚 alternative high school, and she supervises a staff of 25 nurses who help draft health plans for students with chronic illnesses, such as asthma.

The clinic, widely used by the students there, has become a crucial part of its host school鈥檚 comprehensive plan to help students at risk of academic failure earn diplomas, Principal Merrilee Lyle said.

鈥淚 have said more than once, if you close the teen clinic, you might as well shut down our school,鈥� Ms. Lyle said.

Ms. Newell, who conceived of the clinic through a fellowship with the Princeton, N.J.-based , has raised awareness about the mental- and physical-health needs of students in the Evergreen State through her research and advocacy efforts, colleagues say.

Raised in Wisconsin, Ms. Newell, 54, initially thought she would be a teacher. When it came time to select a path of study in college, however, she chose nursing.

鈥淕oing through school, I had always wanted to combine the two, to be a teacher or a nurse,鈥� she said.

Volunteer to Career

The combined interests eventually led her into nursing education. She earned a master鈥檚 degree and doctorate before she taught at a community college and led professional development at a Baptist hospital before she found her way into school nursing.

Ms. Newell took a sabbatical from teaching when her son, Cameron, started kindergarten. Born at 25 weeks, he had kidney problems and had to have his catheter changed regularly. Because the school didn鈥檛 have a full-time nurse to do the job, Ms. Newell did it herself.

She never returned to teaching. Ms. Newell quickly became the school鈥檚 nurse and then the district鈥檚 nursing director, a position that requires her to write health plans for students that mesh with the classroom plans of teachers. For example, she might meet with a mathematics teacher to coordinate a student鈥檚 insulin injection and testing schedules.

鈥淚t is probably the most rewarding career you could ever have,鈥� Ms. Newell said of nursing.

More than half the students in the Kent district鈥攍ocated in a city of about 120,000 people 19 miles south of Seattle鈥攓ualify for free and reduced-price lunches.

The idea for the in-school clinic grew out of experiences that Ms. Newell had navigating the unique needs of individual students. Some had unusual health conditions that required extra help during the school day, and some had needs that were going unmet because of their parents鈥� circumstances.

For example, Ms. Newell once grew concerned when a boy began failing school because he was chronically absent鈥攎issing 60 percent of school days鈥攁nd he couldn鈥檛 keep up with his lessons.

During a home visit, she discovered that the boy and his mother both had severe asthma and lived in an apartment that was infested with mold and mildew.

鈥淗e stayed home so they could share the asthma inhaler,鈥� Ms. Newell said.

District leaders contacted public-housing officials, who helped relocate the family, and Ms. Newell helped the student buy his own inhaler.

Link to Absenteeism

Asthma, which affects about one in five students in the district, is a major contributor to absenteeism, particularly for poorer students, who may live in older dwellings with air problems and may go longer without a diagnosis or treatment, Ms. Newell said.

The district鈥檚 nurses meet with classroom teachers at the beginning of each year to discuss how to identify and respond to life-threatening conditions鈥攊ncluding allergy, asthma, and seizures. Because of Ms. Newell鈥檚 leadership, the gave her an award for asthma management in 2003.

School staff members have a special insight into students鈥� health needs, Ms. Newell said, because they consistently see them at the students鈥� most active point in their day.

The district鈥檚 nurses work to take advantage of that perspective, she said. At one point, following complaints from school staff members that a student repeatedly visited the nurse鈥檚 office unnecessarily, a nurse listened to her lungs and discovered undiagnosed asthma, a condition she immediately reported to the girl鈥檚 parents.

鈥淭hey鈥檙e not always coming in just to get out of math class,鈥� Ms. Newell said. 鈥淭here鈥檚 usually something underlying that鈥檚 bringing them there.鈥�

That same whole-child approach became central to conversations about the design of a new alternative high school that the district planned to launch, said Principal Lyle.

鈥淲e looked at the risk factors [for dropping out], and so many of them were really around the social, emotional, and physical health needs of students,鈥� Ms. Lyle said.

鈥淚f students aren鈥檛 healthy, if they鈥檙e having [post-traumatic stress disorder], if one parent has just killed another parent鈥攍iterally, these are cases that are in our schools鈥攊f somebody doesn鈥檛 work with that student, and talk to that student, and help them keep healthy, they鈥檙e not going to be able to do high school.鈥�

A team of district administrators charged with planning the alternative high school listed 15 risk factors for dropping out and decided what programs to pursue based on how many risk factors those programs addressed. The Teen Health Center, as Ms. Newell鈥檚 program came to be called, addressed 13 of those factors.

Care on Site

The school, Kent Phoenix Academy, also provides emergency food supplies and hosts credit-recovery and online programs.

The clinic, staffed by a part-time nurse practitioner and a full-time mental-health therapist, is underwritten by a grant from the Washington state health department. It also accepts insurance if students have it.

Ms. Newell devised plans for the clinic as part of her participation in the Robert Wood Johnson Executive Nurse Fellows program, a competitive, three-year leadership program.

The program鈥檚 leaders selected Ms. Newell, a rare school nurse fellow, because it was clear that she had influence outside her district, said program director Mary Dickow.

鈥淲e had that unique case of having a school nurse in what we saw as a very influential position,鈥� Ms. Dickow said.

Last year, about 75 percent of the school鈥檚 400 students used the Teen Health Center at least once, and about 75 percent of visitors came more than once, Ms. Newell said.

While the clinic is primarily designated for the alternative school鈥檚 students, it also offers limited appointments to students from a nearby campus.

About seven out of 10 clinic visits are related to chronic or ongoing conditions鈥攕uch as asthma and diabetes, district data show.

The staff there have helped students with suicidal thoughts come up with safety plans, referred students to optometrists who fit them with their first set of glasses, and diagnosed anxiety disorders鈥攁ll conditions that threatened to keep them out of the classroom. Clinic staff members also help students make plans to discuss their health situations with their parents, which can be daunting for some, Ms. Newell said.

鈥淚 think we鈥檙e looking at it from the holistic perspective,鈥� she said. 鈥淗ealth is not just physical health, it鈥檚 also mental health. In order to be successful at school, one needs to be successful at home.鈥�

The program reduces out-of-class time for students, even offering on-campus prenatal care for pregnant girls, and lessening the need for them to travel to off-site clinics for care, Ms. Lyle said.

鈥淢ary is just a collaborative leader that is insightful to the needs of the community and its students,鈥� the principal said. 鈥淲e talk too much about academics only, especially with the challenges students face.鈥�