Susan Franzetti was at wits end when she approached The University
of Texas School of Nursing to plead her case. It was 1995 and Franzetti
found herself in the unenviable position of being the one and only
school nurse for the approximately 5,000 students in the Del Valle
Independent School District (DVISD), a rural area that encompasses
174 square miles southeast of Austin. An alumnus of the School of
Nursing, Franzetti had a hunch that if anybody could help her with
the health care crisis, it was the nursing school.
She was not disappointed.
Dolores Sands, dean of 14 years in the School of Nursing, listened
to Franzetti’s dilemma and decided that intervention was necessary.
Franzetti had taken on the Herculean task of being nurse to an entire
school district, and the Del Valle population and school district
presented special challenges.
Most children in the area were medically uninsured. More than half
of the children in the district who started a school year there
moved before the school year was over. There was no pediatrician
in the district. Most of the families were Spanish-speaking and
employed in low-paying service-industry jobs that offered few or
no benefits. Some of the families lived in homes with no electricity
or running water. When a child was ill, those families fortunate
enough to have transportation drove to Austin and waited in a hospital
emergency room to get help for an earache or fever.
“There was very, very little in that district in terms of
services, and it was an impossible situation,” says Linda
Carpenter, assistant dean of student affairs and clinical affairs
in the School of Nursing. “Sometimes children would miss 2-3
weeks of school just in the process of trying to get the required
Although around 71 percent of the children in the district are
still considered to be economically disadvantaged, their parents
work in low-paying jobs and many don’t have transportation,
access to quality pediatric health care is one problem that’s
been crossed off of the list.
Thanks to a partnership between DVISD and the School of Nursing,
the school-based, nurse-managed Children’s Wellness Center
was born in 1996 with a Texas Department of Health grant. It is
Pat Budd (right) is a Pediatric Nurse Practitioner
and director of the Children’s Wellness Center.
“It’s been a wonderful arrangement,” says Sands.
“DVISD provided the site and facilities, which means that
we don’t have to pay overhead. We take care of operating expenses
and staff, and we get to utilize the center as a teaching and research
spot for our students. And, of course, the children in the area
get the best care.”
Situated in small portable buildings, the Wellness Center has offered
health care—including everything from well child exams to
sports physicals and acute care—to about 15,000 patients since
it opened and has provided 18,000 children with immunizations. In
addition to primary health care services, the center also provides
community outreach and behavioral health services for DVISD patients
from birth to 21 years of age. No child is denied medical care,
even if the family is unable to pay.
Pat Budd, a Pediatric Nurse Practitioner (PNP) and the director
of the facility, describes the center’s approach to health
care as “beautifully holistic.”
“It’s so wonderful to get to do things the way they
need to be done,” says Budd. “When a family comes in
with a sick child, our PNPs do more than just diagnose the problem
and send them on their way. The PNP or social worker asks how the
sickness is affecting their lives. If a family has no money or insurance,
how are they going to get a prescription filled? If they don’t
have transportation, how are they going to get to the drugstore
or clinic? Do they have running water or electricity at their house?”
Every effort is made by the clinic staff to see that each child
receives the best care possible. Prescription vouchers are given
to families that cannot afford to pick up their medicine, and taxi
vouchers may be provided if a family has no form of transportation.
“These families need to be able to follow through,”
says Budd. “We like to keep the ball rolling and get the children
well and back in school as soon as possible. We also want the families
to see that they’re not getting lesser care just because they
don’t have a lot of money.”
According to Sands, potential donors who have visited the clinic
have noted that the facility in no way resembles a health care center
for an “underserved” population.
For example, with a program called Reach Out and Read, every child
is given a book to take home at each visit. Also, in order to educate
parents as well as care for the children, Wellness Center staff
have been trained in a pediatric treatment style called Touchpoints.
Created by T. Berry Brazelton, internationally renowned pediatrician,
the Touchpoints method teaches that there are predictable places
during a child’s development where certain changes occur and
that if the family is taught to anticipate those changes, frustration
and confusion can be greatly reduced. When staff at the Wellness
Center explain developmental changes to parents, they find that
informed parents view even fussy or difficult behavior from a child
as exciting and wonderful because it signals that “everything’s
The compassion and commitment of the clinic staff has not gone
unnoticed by the community of Del Valle. In March of the first year
that the clinic was open, 84 patients were seen. In March of this
year, the clinic saw 470 children, an indication that the staff’s
efforts to raise awareness and their goal of becoming a vital part
of the community have been a success.
“It’s amazing,” says Carpenter. “Appreciative
individuals leave little donations and presents on the steps of
the clinic after hours. The neighborhood even created a butterfly
garden for them in front of the center.”
In addition to giving the community of Del Valle an invaluable
resource, the Wellness Center has greatly benefited the School of
Nursing. Each semester undergraduate and graduate nursing students
are placed at the center for well child and sick child care training.
Faculty and students also are able to conduct research at the clinic
and have done studies on obesity, asthma and risky sexual behaviors,
among other things.
“All three UT missions are exemplified in our work with the
Wellness Center,” says Carpenter. “It meets UT’s
commitment to respond to the community’s needs. It fulfills
the teaching mission - about 160 nursing students a semester are
placed there, along with students from other academic areas on campus
like business, social work, management science and information systems
and the Plan II program. And the center has endless potential for
Although the clinic has the enthusiastic support of the community
and The University of Texas at Austin, donations and volunteer workers
are always welcome. With a small staff and a seemingly endless supply
of children with ailments, the challenges the clinic faces can be
“Every one of us at the clinic is a jack of all trades,”
says Budd. “We work long hours, and we work hard, but it’s
the best job in the world. I don’t care what, if you’re
a kid in the Del Valle area, you’re sick and you come to our
center, you’re going to get care.”