Building Momentum for School-Based Health CareBuilding Momentum for School-Based Health Care https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Mary Kay Irwin, EdD Mary Kay Irwin, EdD https://pediatricsnationwide.org/wp-content/uploads/2021/10/072121BS0100_MaryKay_RetouchedHR-e1633359209513.jpg
- October 06, 2021
- Mary Kay Irwin, EdD
Pediatric health care and the United States educational system share similar goals, even if they don’t quite use the same words to describe them. Health care professionals often say they want optimal wellness for children, so they can thrive throughout their lives. Schools want optimal learning opportunities to prepare children to be successful, productive, happy adults.
The two systems have worked in parallel for children, but they haven’t often worked together in the ways they could. But an expansion the last 20 years in how these systems define their missions has caused all of us to realize that we can do more good in partnership than we can in our own silos.
In health care, that expansion is a heightened focus on “social determinants of health.” Those are factors outside of medical care, such as housing, workforce development and educational opportunity, that have a huge impact on a person’s overall wellbeing.
In schools, the expansion is the rise of the “whole child” model or framework. That’s the idea that a child can best achieve their educational potential when the child is healthy, lives in a safe environment and has access to the resources they need.
Social determinants of health and the whole child framework are the same idea through different lenses. Good health helps a child succeed in school – it’s hard to learn if you have to miss class for illness, or if you have difficulty concentrating because of a behavioral health concern. Educational achievement gives a child a better opportunity to become a healthy adult.
We’ve seen the health/education link clearer than ever during the COVID-19 pandemic. Countless children fell behind in school because of a worldwide health condition. Because so many children receive physicals, vaccines and other care as a condition of attending school in person, they fell behind in preventive care as well.
So pediatric providers and schools should work together to help children, and for children without a medical home, one of the best ways to do that is through school-based health care. A primary care clinic located inside a school building can help provide services that some children simply are not receiving otherwise — prescriptions, screenings, vaccines, links to more specialized care.
Oregon, Washington and New York have robust, statewide school-based health efforts. At Nationwide Children’s Hospital, where I lead the school-based health program, we operate 14 primary care clinics inside local schools, two mobile health clinics, vaccine clinics and a school-based wheelchair clinic. We have school-based asthma therapy in 254 schools across the 30 districts, wellness education programming with an annual reach of over 6,000 students, school nursing services, and we just launched our dentistry program this summer. In partnership with the hospital’s Behavioral Health Services, we provide integrated care including prevention services, therapy and telepsychiatry. New this fall, we will launch our Diabetes and School Health program in partnership with the hospital’s Division of Endocrinology.
We’ve seen dramatic decreases in emergency department visits for asthma, as well as other overall improvements in child health measurements. We also work hard to connect children we serve in schools to community providers, because we realize the need for young people to have a stable medical home.
It seems so obvious that health care and schools should work together, right? But as many who have tried the school-based health model can attest, it can be difficult. These are two distinct systems, with different ways of operating. They aren’t used to inviting each other to the table, or to taking guidance and suggestions from one another.
Our years of experience at Nationwide Children’s have shown us where the obstacles are, and how they can be overcome. This is what I tell school districts and systems who are starting down the road of school-based health:
- Get technical assistance from people who have successfully done this work before. They are naturally collaborative; they must be to create a school-based health model. They want to help.
- Realize this is not the same as outpatient medicine if you are the provider. It’s not just another clinic, because you are co-locating in school. You are a guest. You have to engage and build trust with the school community. Talk to the teachers, go to the football games. You need to be a part of the school culture.
- Choose clinic staff members who are mission-driven and willing to do many kinds of tasks. School-based clinics are small, often just a converted classroom, so there’s only room for a few staff members, which means staff in these clinics wear many hats.
- Conduct a collaborative, needs-based assessment of what the school and its students need. Can a school counselor, social worker or nurse be a part of the overall strategy? Who is in charge of the communications to students about health? School officials should be invited to clinic meetings; clinic staff should be invited to school staff meetings.
- Share data in an effort to build and maintain the school and clinic relationship. Is the school achieving results it wants, such as an increased attendance rate? Is the clinic achieving the results it wants, such as an increased vaccination rate? If not, what changes should be made?
I believe that as we slowly emerge from the COVID-19 pandemic, we have the opportunity to boost the momentum for school-based health. Federal, state and local governments are making funding more readily available. Schools and health systems see the benefit of collaboration. Nationwide Children’s and others who have entered the school-based health space have seen encouraging results.
Beyond the opportunity, we have an obligation as well. If we want to improve life for children, we should be working together to make that happen.
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