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School-based Health Centers Stare Down Substance Use Disorder 

September 27, 2023

Innovative STEP program empowers students, families without sacrificing education 

Denver Health Pediatrics at Denver Public Schools (DPS) has been a core service of Denver Health’s integrated healthcare system since 1987. The program serves approximately 15,000 students annually through a network of 19 school-based health centers (SBHCs)—one of the largest SBHC networks in the country—each of which are conveniently located on a DPS campus. 

Through Denver Health Pediatrics at DPS, any student with a DPS ID can go to any Denver Health SBHC to access, comprehensive health care services, including medical services, behavioral health services, sexual and reproductive health services, health education services, dental services, and insurance enrollment services. These services are also available to all siblings of DPS students under the age of 25, as well as children enrolled in any Early Childhood Education program—all at no charge to families. 

One of the behavioral health services offered by Denver Health SBHCs is STEP, which stands for Substance Abuse Treatment Education & Prevention. STEP is a substance treatment program which specializes in working with adolescents. While being an adolescent or teenager has never been easy, the COVID pandemic increased the strain on our young people, and many turned to substances to cope. 

“The need for this specialized service, especially post-COVID, has really increased,” said Dr. Sonja O’Leary, Director of Service for General Pediatrics at Denver Health. “Kids are using substances because there’s something that’s been unaddressed. STEP helps them get off the substance they’re currently using by addressing the underlying reason for using.” 

STEP first started in Denver Health SBHCs at Bruce Randolph School and currently operates in an additional seven SBHCs around Denver and at Denver Health’s main campus downtown. Students access STEP in several ways, including through a teacher or administrator referral, or a student self-referral. Denver Health Pediatrics at DPS is the only school-based health system in the state that offers a program such as STEP. 

“One of the main things we’re seeing right now that’s connected with increased rates of substance misuse and substance harm is opioids and certain types of pills,” explained STEP Supervisor Tyrone Braxton. “That is one of the main issues facing students right now.” 

O’Leary expanded on this current crisis. “It used to be that alcohol or marijuana use were the main substances used by student patients,” she said. “But as the opioid epidemic has spread out across the country, we’re seeing a lot more opioid use in our children. We’ve had to pivot so our therapists have NARCAN available to give out to kids, or fentanyl testing strips.” 

One of the advantages of operating STEP in SBHCs is time. Often when a student seeks treatment for substance use disorder at an outside therapist, several classes must be missed, and sometimes parents must take time off work to drive the student to therapy and then back to school. 

With STEP operating in Denver Health SBHCs, a student can meet with a therapist on campus, only missing the equivalent of one class period. 

“We reduce the time the student has to be out of class,” said Braxton. If a student is taking advanced or college-level courses, for example, SBHC STEP therapists work with the student to find the best time to meet. 

Innovation is key to understanding how Denver Health Pediatrics at DPS approaches school-based health care. The issues facing students are ever-changing and overlapping, and therapy methods must evolve to meet patients’ needs. 

“We have been partnering with Denver Health for over 30 years to operate our school-based health centers,” said Jade Williamson, Manager of Healthy Schools for Denver Public Schools. 

“One of things we’ve always valued about our partnership is continuing to find new and innovative ways to address the needs of our students,” he said. “When STEP first came on the scene, it was a new and innovative component of school-based health centers that could help us meet the needs of students who were struggling with substance misuse.” 

Philanthropy has been a key factor empowering STEP. The Daniels Fund and The Anschutz Foundation provided early support. A grant from Denver Post Community Foundation and its Season to Share partners earlier this year has had tremendous impact on the overall program in 2023. Denver Health Pediatrics at DPS would like to expand STEP into more SBHCs, and while physical space is often limited, O’Leary sees beyond that issue. 

“Schools are places of education. We’re just one part of what schools are trying to do to help our kids,” she said. “We think, ‘How can we provide services in new ways, to help the need but also to be innovative?’ instead of saying, ‘We can’t offer this service because there’s no space.’” 

Denver Health Pediatrics at DPS has recently begun implementing the SBHC Virtual Care Program, which provides virtual health services to DPS sites that have a DPS nurse, but no brick-and-mortar SBHC. During the most recent school year, the Virtual Care Program operated in 32 DPS elementary, middle, and high schools, and four Head Start schools. During conversations with DPS and Denver Health stakeholders, Denver Health Pediatrics at DPS identified the need to strengthen virtual behavioral health services along with virtual physical health services. 

Maintaining current SBHC operations, increasing mental health operations in all SBHCS, and opening a 20th SBHC at Northfield High School in the coming years are all critical to keeping our young people safe and healthy. 

The need is great. “Our therapists are completely booked from the very beginning of the school year,” revealed O’Leary. “It used to be that therapists would get booked maybe in October or November. But post-pandemic, they get booked up almost at the start of the school year.”

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