School-based health center set to bring pediatric care to town without any practices

Randolph partners with Codman Sq. Health Center to offer much needed health care services

For families in Randolph, taking their kids on a trip to the doctor is often a trek. In the town, which has little to no regular pediatric care, even something as routine as a school sports physical can turn from a simple health care visit into an all-day affair.

“There are still no pediatric practices in Randolph,” said Michelle Tyler, director of planning for the town of Randolph. “You’re carting your kid to wherever your pediatric services are in an adjacent community. Compound that with potentially you need public transportation to get to where you need to be, so now you have your sick child on an MBTA bus going to pediatric services. If you’re using a community health center, that’s Brockton, Quincy or Dorchester.”

It’s a town that has, in recent years, seen increasing diversity as residents from neighborhoods like Dorchester are pushed out as Boston prices increase, and as migrant families continue to arrive in the state. As a result, Black and brown or immigrant residents looking for culturally and linguistically competent health care providers may have to travel to Boston — a 30-plus minute drive or a trip that can take an hour or more by bus.

“That becomes even more of a challenge in obtaining health care for their child, let alone for themselves,” said Tyler.

But a long-brewing project is set to take steps to address the gaps left by the limited health care access.

Through a partnership between the town of Randolph and Dorchester-based Codman Square Health Center, alongside the local school district, the town’s high school will soon host a school-based health center, a satellite clinic run by Codman Square Health Center, which will focus on providing care to patients from three to 24 years old across the district as well as their families.

The clinic will house four exam rooms plus lab space, meeting areas and administrative offices. Secured doors will lead directly into the school, while another entrance will open directly onto the street, and will provide vaccinations, wellness exams, physicals and behavioral health services.

Thea Stovell, superintendent of Randolph Public Schools, said that the work with Codman Square is bringing important health access directly to the town’s residents.

“This initiative not only reduces health inequities, but it is bringing health care to the doorsteps of people in Randolph who need it,” she said.

Codman Square Health Center declined to make staff working directly on the project available for comment for this article, but in a May 2023 interview with the Banner, Tarsha Weaver, Codman Square’s chief project officer, said the effort at Randolph High School is the latest step the health center has taken in bringing care to communities who may otherwise struggle to access it.

Randolph High School will soon host a school-based health clinic run by Codman Square Health Center, which will focus on providing care to patients from 3 to 24 years old across the district. PHOTO: The Town of Randolph

“Codman Square Health Center has, like many other community health centers throughout Massachusetts, been at the forefront of supporting communities that are often marginalized, to make sure they have access to care not only supporting their health needs, but also addressing the social determinants of health,” said Weaver, who, alongside Stovell, has been leading the effort to open the clinic at the high school.

In an interview with the Banner when he took over leadership of Codman Square Health Center in August, CEO Dr. Guy Fish said the effort in Randolph stemmed from following the movement of the health center’s patients who found themselves priced out of the area surrounding its main location.

“Dorchester is gentrifying,” Fish said. “When gentrification happens, people who have been here for a long time sometimes are moved out, forced out, or want to get out. A large contingent of those are actually finding themselves in the Randolph area.”

It’s a project that has also received federal support in the form of $1 million in community projects funding — formerly known as earmarks — directed through Rep. Ayanna Pressley’s office.

In a press release when she delivered the funding, in April 2022, Pressley said the school-based health center will help close shortages in care as well as address gaps that were highlighted by the COVID-19 pandemic.

“This community-driven project will help us make strides toward addressing the health care shortages we’ve heard about in Randolph and move us closer to a just and equitable pandemic recovery that leaves no one behind,” said Pressley in the statement.

When the town government proposed the idea, opening Randolph High School to the project was a no-brainer for the school district, said Stovell, though the specifics of what that would include initially didn’t cross her mind.

“My immediate response was ‘Yes,’ because I knew the benefits that would come to my students and their families,” Stovell said. “But even with saying, ‘yes,’ I hadn’t really thought through what that’s going to look like.”

Figuring out what that really looks like has been a longer process than anticipated. The school-based clinic was initially slated to open in January 2023. Now that timeline has been pushed back.

Much of that comes from how many groups must sign off on the process. Stovell said that the process of negotiating the requirements from the state’s Department of Public Health and the guidelines from the Department of Elementary and Secondary Education in addition to the town’s rules around construction has been a balancing act. Add to all that the expected challenges of renovating an old building.

The project has also faced hiccups with funding. Initially, the $1 million from Pressley’s earmark was expected to cover all the needs. Now the costs have risen to $3.2 million, Tyler said.

But Stovell said that the expected outcomes from the project have kept them going.

“We all felt the outcome is so beneficial that we felt we had to stay the course,” she said.

Tyler said the town is now aiming to establish a construction contract by the end of December and to start work by the end of January. She said the work is estimated to take about eight months.

Though the physical space will house the school-based clinic isn’t ready, Codman Square Health Center has already begun providing some services to students in Randolph.

In the interim, behavioral health staff from Codman Square have begun working with Randolph students and the center has started offering other services like athletic health exams and vaccines.

Also, the health center has been engaging families from diverse backgrounds who might otherwise struggle to enroll without the proper medical care and services. Stovell said that in two families that were looking to enroll, the children had tuberculosis, which staff members from Codman Square Health Center were able to catch and treat.

She said that staff from the health center — which has long had a focus on other drivers of health outside of direct medical care — has been supporting families in other ways to not just provide health care but to improve quality of life. For example, helping immigrant families get to court proceedings.

“When I think of what we do as a school, Codman has been so much a part of what we’ve been doing in the last few years that I can’t even imagine doing this work without them at this point,” Stovell said.

That sort of impact isn’t new for the health center, which already has one school-based clinic at TechBoston Academy in Dorchester. That clinic has been around since 1995 and has lasted through multiple schools that have occupied the campus before TechBoston opened in 2002.

Gisely Rivera, the family liaison at TechBoston Academy, said the clinic is a “really great thing to have” that benefits a lot of the students at the school. Not only does the center provide physicals and administer vaccinations, it also houses a dentist and an eye clinic. Many of the students at the school already are patients at Codman Square’s main location, making the experience comfortable.

And it helps keep students from missing as much class time when they leave campus for medical care — a benefit that Stovell is looking forward to from the pending school-based clinic in Randolph.

Rivera, said she’s seen the clinic serve as a valuable resource for the students she works with and, as an alum of TechBoston Academy, had her own experiences accessing care from the clinic.

“They’re always here and always willing to help and do the most,” Rivera said.

A legacy of need

The school-based clinic is not a solution that came out of nowhere. Access to care in the town — especially care that reflects the culture and language of residents — was identified as a priority in a community wellness plan developed by the Metropolitan Area Planning Council and published in January 2020.

At the time, the report identified several primary care providers in Randolph, but none of whom focused on kids. There were no outpatient facilities, lab services, medical specialists or urgent care centers in the town (since then, an urgent care facility opened in August 2023).

The report identified that there were no community health centers or affiliated satellites within town limits.

While Randolph falls in the primary or secondary service areas of four hospitals, in 2019 when the MAPC was working on the community wellness plan, residents said that, generally, they didn’t feel as welcome at those facilities — something Sharon Ron, assistant director of public health at the MAPC, who worked on that report, acknowledged could have changed in the time since.

“In 2019, the lack of advertised translation services, the feeling that when you went to the doctor, there wasn’t someone there who spoke your language or you didn’t feel welcomed, was really highlighted,” she said.

At the time, residents reported traveling to Boston Medical Center or Codman Square Health Center to receive care.

Claire Hoffman, a public health planner with the MAPC who works with Randolph now, said that need for language access has been constant.

“Randolph is a town that has welcomed a lot of new arrivals, and so there are a lot of folks now that are looking to receive health care services in a language that is not English,” Hoffman said. “Really being able to provide that support has become even more essential given the increase in people who don’t necessarily speak English as a first language.”

At the time of the community wellness plan, 32% of residents were foreign-born — with the town’s first-generation immigrant communities largely being composed of Haitian and Vietnamese immigrants.

That was especially diverse compared to its neighbors. The population of the rest of Norfolk County, where it’s located, was about 17%, comparable to the 16% of the population statewide.

But the legacy and recognition of need goes back to before the wellness plan. Even before the report, town leadership identified a need for local, easily accessible health care. In the mid-2010s, then-Town Manager David Murphy and Tyler pushed for the development of a community health center on town land.

Murphy said that sort of project — addressing the health of the community itself —struck him as part and parcel of the work of a municipal government to its residents.

“If you have a family that has either limited transportation, limited health care access, and you can provide that type of service to the people that you represent, I think that is a critical improvement in the overall quality of life of the community,” he said. “Not everybody has the ability to jump in a car and go to primary care. Sometimes that lack of access or lack of transportation can be a deterrent to getting critical preventative health care.”

As it shaped up, the proposal focused on a plot of land in Randolph that housed an elementary school which had been vacant for about a decade.

Murphy and the town put out a request for quotation — the official process to get a proposal to fill the site — and got back what seemed to be a good fit for the space.

“We did get a response to the RFQ that I thought fulfilled the need that we expressed that we had,” Muphy said. “We said, this is what we want; the RFQ came back with, this is what we can do”

That plan included housing a community health center run by Mattapan Community Health Center and a nursing program run by Massasoit Community College. The proposal also included housing for adults aged 55 and over — an addition that Murphy called a “missing piece of the puzzle for quality of life in the community.”

As the process moved along, a preliminary deal was established and an acquisition price was set, Tyler said.

Then it fell apart.

Murphy didn’t speculate why the town council didn’t vote to approve the project. Tyler said she thought it ultimately came down to an issue around zoning.

To put the proposal into effect, the land would have had to be rezoned. That proved to be a “highly contentious conversation,” Tyler said. Though situated behind a commercial area, the plot of land — which now houses the new, updated North Randolph Elementary School, for which the town cut the ribbon in August — is nestled in a more residential community.

Tyler said that neighbors raised discussions about the impacts the health center and nursing program would have, especially on traffic in the area. The town’s legislative body denied the zoning changes, and the town government returned any deposits that had been paid and the project died.

A broader health access push

The school-based health center comes as part of a broader effort to address the health needs of the town’s younger population.

In September, the town of Randolph, with Codman Square Health Center, the public school district and the Boys and Girls Club received a $1 million grant from Boston Children’s Hospital as part of its Healthy Communities initiative.

Through it, leaders and community members in Randolph will work to allocate that grant funding to improve health access for the town’s youth.

The specific project the town will plan to tackle has yet to be decided, but it’s getting started on considering ideas as it analyzes data on community needs that the town has collected and as it finds and onboards a dedicated project manager — a lesson learned from the work of installing the school-based clinic.

“What we don’t want to see is what we saw in this project [at Randolph High School] with a lack of a project manager,” Stovell said. “There’s a lot of partners; someone’s going to have to bring us together so that the collaboration happens routinely, regularly.

While details have yet to be established, Stovell said they’re looking to get started quickly and to develop a project that will create broad-level change that will have impact beyond the duration of the grant program.

“I think we’re at a day and time where funding is low, and so we’re struggling to manage our schools and take care of what we need to take care of and fund all the things that need to be funded,” she said. “When we get funding like this, we want to make sure we use it in a way that it will be beneficial over a long period of time, and not just for the five years.”

That work, she said, will probably focus on making healthy habits a way of life for residents. Options under consideration are generally “very big picture,” she said, things like efforts to reduce vaping, create more walking trails, addressing food scarcity and nutrition.

Through any of it, she said the goal is to engage community members to help get the message out, to make the solution something they want to share with their children or their peers.

“We don’t want to create these fly-by-night responses or solutions, but we want people to be in a place where they’re literally taking these healthy habits on, and they become a way of life for them,” Stovell said. “We’re hoping to create sustainability by getting voice of everyone involved.”

Down the line, for town leadership and others involved in the project, there is hope that work on the school-based clinic could be the start of a new push for a full federally qualified health center in the town.

Tyler said she is working on starting conversations between organizations that could play a role in getting to that goal. From the perspective of the town, Codman Square Health Center could be a good candidate to partner with for that full facility, but she said she didn’t know if the health center is interested or if they have the resources for that project.

In his August interview, Fish, from Codman Square, said partnering with the town on a full health center was something the organization was considering.

Ron, from the MAPC, pointed to the importance of federally qualified health centers as key partners not just for providing clinical care, but serving as a front door for community members who otherwise might not be connected with health resources to access medical care and other resources like access to nutritious food and other elements of wellness.

The MAPC’s Hoffman said that a full health center would make a “monumental splash” in the town, with potentially broader impacts across the area, giving residents in nearby communities another local care option.

“I really see it as instrumental in increasing access for families and individuals who are currently struggling to receive affordable health care in a language that is their preferred language,” Hoffman said. “I think it would really be a huge win for Randolph.”

Because, even as the town works on expanding access to health care, Tyler says the need that existed when she and Murphy worked on the first push for a community health center remains.

“The answer was ‘yes’ 10 years ago,” Tyler said. “The answer remains ‘yes.’”