In 1994, Memorial was actively in the midst of identifying community needs as they related to the institution’s role as a local partner. Mark Chambers, Memorial Health Foundation Vice President, said that as they researched possible community partnerships that would expand health awareness and benefits, school sites figured prominently as areas with potential. Coincidentally, the Hospital had already invested in a clinic next door to an inner-city elementary school, Studebaker.

"We began conversations with the folks at Studebaker and really began a school and community visioning process... where we involved faculty and some families and some community members in a process," said Mark, "Rather than focusing specifically on health we were trying to get them to give consideration to what they wanted their school and their neighborhood to be."

Even though the issue of medical health did not start the process, out of the more than fifty items this "visioning" group came up with in their recommendations for their community, many were linked to physical health and welfare. "One thing that came out real strong," said Rosalind, "was the need for more comprehensive health services."

"About the same time, a broader community-wide interest in school health was emerging," said Mark, due in large part to changes in how school health programs were funded. The changes effectively limited school nursing services, focusing them mostly on meeting state mandated screenings. Clearly students had other needs as well. School corporation staff sited a need for families to be connected to primary providers, the high absentee rate due to illness, a high family transience rate that sometimes made meeting medical needs difficult, and most often, the need for a consistent nurse presence in every school.

And so, a broader school health initiative began to develop, originating with the School Health Partnership committee, a group convened in 1994 by CONNECT, The Coalition for Educational Success. CONNECT had also hosted two interactive forums that brought together representatives from education, healthcare, and other community leaders to discuss issues of health and schools.

The committee included local health providers and schools, both public and parochial. As a result of the committee’s work, health providers were paired with schools, in the hopes that formal partnerships would pool resources and ideas, ultimately increasing each community’s capacity to improve the health of its schoolchildren. School nursing became a focal point of this effort, because of the increased nursing services need and the community identified issue of health.

These developments affirmed to Memorial the need that existed for health to be addressed through schools. The formal partnership also provided an outlet for programming and support. Most importantly, the partnership brought together new resources and possibilities, increasing the benefits that local children could reap through programming.

"CONNECT’s role in making sure there was still a viable school health program existing in the schools was an important one…," said Mark, "Memorial probably wouldn’t have done anything differently in the South Bend School Corporation,…but the fact that CONNECT brought in the other school corporations, the other health care systems – I think on a county-wide basis there was greater benefit. The availability of resources for all the school corporations for the county were enhanced."

Memorial was partnered with South Bend and New Prairie schools. The New Prairie system was a five school corporation spanning kindergarten through high school, while South Bend was significantly larger. Prior to the SHP Program these schools had part-time school nurse coverage, with most nurses dividing their time between as many as three or four schools.

"It was chaotic," said Barbara Ethier, a South Bend school health nurse who once shuttled from building to building. She cited the difficulty for students and staff when a nurse is available certain days and certain hours only. Many in the program concurred, expressing frustration at the difficulty in simply meeting screening requirements for hundreds of children at different schools. "Immunizations -- they were incomplete or non-existent," Barb said, "It was crazy...I had three schools. I came in October and school had started in August. I had piles of registrations at each school that I was at... piles and piles of new registrations..."

Memorial targeted three inner-city elementary schools in South Bend, including Studebaker, adding Muessel and Harrison schools. These sites were chosen primarily because of their high need status. In the Studebaker district alone, median family income was lower than the city as a whole (1990 Census). In one Census tract of the district, almost 46% of children under age 18 lived in below poverty level in 1989 (1990 Census). In 1993, fourteen percent of entering Studebaker kindergartners had presented all documentation required by the school corporation, which included immunization records and health histories.

Ultimately, the Hospital provided funding for three full-time nurse positions at all three of these South Bend elementary schools. The school corporation continued to provide nursing services in other schools on its own.

In New Prairie, a system-wide approach was implemented that included the addition of one full time nurse and five certified nurse assistants, funded for a three year declining grant period. A community very different than the South Bend area, the New Prairie School Corporation uses their partnership in ways to match their school families. Michael Harding, New Prairie School Superintendent said, "In a small community like this, people have to travel so much." Their SHP Program has allowed community health fairs that can often bring families information and services, rather than families having to seek them.

The hospital works in an on-going way with the schools, helping when it can to anticipate needs. Health aides, who assist school health nurses, have since been supported by Memorial Hospital corporation-wide in South Bend. Every year at Studebaker, Harrison, and Muessel, the school nurse, supported by an aide, the school, and the hospital, put on a fair to promote healthy behaviors among their school and neighborhood families. Memorial has assisted as needed in such tasks as refurbishing school nurse offices, and linking the nurses with resources like refrigerators for medications and other equipment.

Carl Ellison, Vice President, Community Affairs at Memorial Hospital, stresses that even though the partnership has been most beneficial to certain South Bend schools, the school corporation has always been working to improve services everywhere, and continues a plan for improvement that the partnership is there to support. "We’re talking about a school system where sixty percent of the kids are at free or reduced lunch," he said, "so no matter where you are in the system, there are poorer kids who need enhanced support." The corporation still takes on the "lion’s share" of such a task, he emphasized, but the partnership will allow for expanded team efforts in the future.