Healthcare for a well community

Harvard University Health Services is committed to an informed, healthier campus community

Harvard University Health Services provides access to quality healthcare for the Harvard University community. (David Stone David Stone for On Call)

When Maria Francesconi, RN, NP, hears the phrase "in sickness and in health," she thinks of more than traditional wedding vows. She thinks of when she would like to see her patients.

Francesconi is chief of nursing at Harvard University Health Services (HUHS), which provides healthcare for a population of 35,000 ranging from newborns to older adults. The healthcare professionals who work at HUHS strive to ensure that students graduate not only with superior academic qualifications, but also with a superior understanding of and a proactive attitude toward their own healthcare.

A rarity among health services
In addition to its main location at Holyoke Center in Cambridge, HUHS has three satellite clinics - on the business, law, and medical area campuses - as well as a mental-health center and a 24-hour urgent-care hotline. For over a century, its mission has been to provide "high quality, comprehensive health care to students, staff, faculty, retirees, and their dependents - 24 hours a day, 365 days a year."

As Francesconi points out, HUHS offers students a convenient way to receive high-quality healthcare. "They don't have to worry about going into downtown Boston or trying to navigate an outside healthcare system," she says. "I think it also allows us as healthcare providers to have a greater understanding of the unique stressors that are part of being a student."

The services offered by HUHS extend far beyond physicians and nurses treating flu or providing contraception to sexually active students. Their specialties range from neurology, pediatrics, allergy, and dermatology to psychiatry, obstetrics, physical therapy, and radiology; they're equipped to offer surgical services, too, and even maintain onsite eye and pharmacy departments. In addition, through HUHS, members of the Harvard community have access to health and wellness resources as well as a 10-bed infirmary.

From broken bones to post surgery
"As a whole," Francesconi says, "the staff at Health Services is committed to making life better for you not only in sickness, but in wellness - and to doing outreach to provide health education." Francesconi calls HUHS a "rare breed." She cites MIT and Yale as two New England centers with similar resources, but says, "There are only a few of us left in the nation who actually look like this." The fact that HUHS serves such a large and diverse community, she says, allows it "to offer services that most colleges wouldn't be able to."

One of those services is physical therapy, which only a handful of colleges across the country offer on campus, according to Ellen Tulchinsky, MS, PT, chief of PT services at HUHS. The physical-therapy staff operate on a schedule designed to make access to therapy convenient for undergraduate and graduate students as well as for faculty and staff. "Patients can come between classes if need be, or whatever's convenient for their schedule," Tulchinsky says. "It's convenient for the staff as well, as they are on campus. It's easier for them to get their medical care at lunchtime or before or just after work. We can catch them before classes or, for patients who are working or starting work, we have later hours so we can accommodate them."

Because of the age range and diversity of patients, Tulchinsky says, the problems addressed by the physical therapists run the gamut. "We see all sorts of injuries," she says. "Everything from broken bones, wrist fractures, ankle fractures, to all different kinds of muscular and skeletal injuries. We work with ankle sprains, shoulder injuries, and hand injuries. We also see a lot of people who have had surgery and who need therapy afterwards to get back to full function."

Addressing problems of transition
Theresa Cohen, LICSW, has been at Harvard University for the past four years. She completed a two-year fellowship in college mental health and then became a full-time mental-health clinician two years ago at the Holyoke Center clinic.

Cohen says the transition to college can be difficult for new students, especially at a competitive Ivy League school such as Harvard. One of the main stressors is the fact that the student body comprises primarily those who have been the top performers throughout their educational experience. "Obviously, they can't all stay number one," Cohen says. "The idea that for 12 years you were number one and then you come to college and are not number one can be difficult for a lot of students."

In addition, coming to Harvard may be the first time students have lived away from home and have had to manage their own lives academically, financially, and socially. "They are really discovering who they are personality-wise, sexually, and even in terms of health and nutrition," Cohen says. "There's a lot of apprehension, questions, and trying to navigate the waters by themselves. So having a mental-health service at their disposal is really helpful."

Help from professionals and peers
HUHS employs psychologists and social workers who offer psychotherapy, along with a psychiatrist and psychiatric nurse specialist who can prescribe medication. Clinicians, social workers, and therapists also run groups for students free of charge. "We run interpersonal groups, depression groups, anxiety groups, eating-disorder groups," Cohen says. "We have all sorts of group work in addition to individual therapies and medication."

A clinician or psychiatrist is on call 365 days a year, 24 hours a day, and HUHS offers outreach services to encourage students to seek help before anxiety becomes debilitating. "When students come in as freshmen, we talk to them about depression, about how to manage stress and anxiety, about substance use. And we go out to the houses to educate students the best we can about different things to be careful about and different ways to cope," Cohen says. "Obviously, we encourage students that if at any point they want someone to talk to, to please come in. It doesn't have to be when things get out of control."

HUHS also offers a spectrum of "peer-to-peer" programs. One of the most important is the 24-hour hotlines manned by undergraduate students who volunteer their time and are supervised by one of the mental-health staff. This program includes an eating-disorder hotline, a contraceptive hotline, a question-about-sexuality hotline, a sexual-assault hotline, and a general mental-health hotline.

Another peer-to-peer program involves students who have been seen in the mental-health department and who have learned to overcome problems such as anxiety, depression, an eating disorder, or bipolar disorder. Trained by a psychiatrist, these students have volunteered to speak to other students who might be dealing with a similar issue for the first time. "If you have a freshman coming in who was recently diagnosed with bipolar disorder, this can obviously be very scary and overwhelming. The clinicians are here to help them and give them services," Cohen says. "But if they want to talk to a peer who has gone through the same thing, they can contact one of these people in the peer-to-peer program."

Rounding in the dining hall
HUHS strives to help students be proactive about their healthcare. Not only do new students receive orientation, they also receive a DVD about health services and a daily planner called "Empowering You," which includes healthcare tips. Freshman parents are also invited to a panel discussion with the medical director of HUHS, the chief of medicine, and the chief of the behavioral health department.

"One of the reasons we do the orientation for parents," says Francesconi, "is that we know there are students who call and look to their parents [when they are ill], and we have parents who say, 'OK, you need to go to health services. Do you remember how to get there? Do you remember what to do?' And they can oftentimes refer them or direct them so that they get the healthcare services they need."

Students from foreign countries have an orientation geared to the specific challenges of negotiating the United States healthcare system. They learn what medications are sold over the counter and what medications require a prescription. They are also given assistance to help them become familiar with American terms and practices such as primary care teams, nurse practitioners, and clinical nurse specialists.

"In many other countries, those systems just don't exist," Francesconi explains, "so they have no idea there is an opportunity to see a nurse practitioner sometimes sooner than there is an opportunity to see a physician. We need to do the education so they understand the nurse practitioner can also diagnose them and prescribe medications if necessary and do lab tests."

Currently, each Harvard resident hall has a wellness coordinator from "the community health initiative," a student-based group run out of the HUHS Center for Wellness. The coordinator helps people find the services they need, and they provide health education within the resident halls, Francesconi says.

In September of 2008, HUHS plans to begin a pilot dinnertime program targeted toward freshmen in Annenburg, the main freshman dining hall. The program will make a nurse from health services available once a week to answer questions, give tips about self-care in the New England autumn, and explain what people need to know about cold and flu. "We think nurses are the perfect people to do it," Francesconi says, "because the students really seem to connect with our nursing staff, and it seems like a good way to get the word out about what we do."

She adds, "We are hoping to really reach students and spend a couple of hours mostly sitting at a table trying to do a little bit of outreach. We want to give them information but also be available for questions that are health related. And we are thinking of doing it mid-September through early November because we find that students come up with questions when they are in week six of their semester. That is when we start to see people dealing with issues such as homesickness or roommate [conflict] or actually coming down with colds and not feeling good."

Francesconi says she thinks the program will not only address the needs of these students but also help the nurses in health services who take great satisfaction from working with a college-age population.

Linda Wessling is a freelance writer and a frequent contributor to On Call.