Telemedicine in Howard County: Where are we today?

The Howard County Health Department School Based Wellness Centers Telemedicine Program is in its second year of providing acute health care services to the children attending five, Title I elementary schools in Columbia. The main goal of the program is to decrease missed school time for children with minor health complaints. Health problems eligible for a telemedicine visit include common childhood symptoms involving the lungs up to the eyes, typical headaches for children with an established headache diagnosis, and exposed skin. Plans for community providers to see their patients for ADHD and medication management are being developed.

Telemedicine programs are multiplying exponentially across the country and the world. Some leaders in school-based health believe that “telemedicine is the next frontier for school health.

A new provider model has been introduced this school year in which children are able to receive care from their primary care providers. Nine community pediatric practices have joined the Health Department’s telemedicine provider network and see their patients via telemedicine. These practices directly bill the health insurers and families. Howard County General Hospital pediatric emergency room pediatricians provide care for children whose providers are not in the network or are unavailable. Another program change for this school year is the addition of a sixth school in mid-November, Ducketts Lane Elementary. To date, there are 966 children (30.8% of the combined schools’ populations) enrolled in the telemedicine program and there have been 66 visits in this school year. The current return to class rate is 92.7% for students whose diagnoses did not require school exclusion as per Howard County Public School System policy. The telemedicine program has been very popular with parents who report the program being “very helpful to busy families” and saving them from missing work and their children being absent from school.  Satisfaction surveys from parents report high rates of satisfaction and willingness to re-use the program.

The School Based Health Alliance reports 7.3% of all school-based health centers completing the 2013-2014 national survey use telemedicine and the number is growing. The list of health services that can be provided through this technology are rapidly expanding and include mental and oral health. Telemedicine visits are reimbursed by Medical Assistance in Maryland and many private health insurers.

Thank you to Sharon Hobson,  School Based Wellness Center Administrator and Telemedicine Program Coordinator, Howard County Health Department for contributing to this post 
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KIPP Baltimore

KIPP Baltimore: The Ruth and Norman Rales Center for the Integration of Health and Education

og-profileSchool Based Health Centers are a change agent for students all across the county. Students that attend schools with an SBHC have increased access to and use of primary care services, have better attendance and lower rates of disciplinary problems. Starting this school year, students at two KIPP Baltimore Schools (Harmony Academy and Ujima Village Academy) will have access to a new and innovative SBHC model. They will be the first schools to pilot the Rales Educational and Health Advancement of Youth program (READY).

READY is a new pilot that will launch this year by the Johns Hopkins Ruth and Norman Rales Center for the Integration of Health and Education. The Rales Health Center is the school-based health center co-located within Harmony Academy and Ujima Village Academy that is part of the READY program. The overarching goal of the READY program is to unite health care providers, teachers and parents, all to benefit children. A unique piece of the Rales Center model is that it will operate both traditional school health services as well as the School Based Health Center at the site. Collectively, the two participating KIPP schools enroll more than 1,500 predominantly African American students in grades K-8 living in under served communities.

The READY Program takes on a population approach which may differ from the traditional SBHC model in which services are based on enrollment and students having to seek out services. Traditional SBHC programs often have little capacity to seek out and follow those children most in need of health services. Staffing constraints limit their ability to provide a stable source of primary care. READY, by contrast, fully integrates health into the school environment, curriculum and activities that engage students on a daily basis and also has the resources to have a more robust staff.

The READY program will provide a full service health and wellness program. This health center will be staffed by a physician, nurse practitioner, school nurses and a medical assistant. Health center services will include:

  • Routine assessment of students’ health and developmental progress
  • Screening for behavioral problems
  • Monitor children with chronic conditions and teach them to self-manage symptoms of asthma or diabetes, for example
  • Prescription medication delivery to the school for patients in the health center
  • Future implementation of individual and group mental health counseling.
  • Nutrition education including incorporating healthy and appealing foods into school and home menus and encouraging healthy eating.

The READY model will bring health to the students in the form of health and wellness curricula, increased physical activity opportunities and other health campaigns; including dental and vision screenings and services and preventative mental health services. The READY program will also provide professional development to teachers and staff on health issues. Teachers and staff wellness will include stress reduction, yoga, and mindfulness.

A parent advisory group has been instrumental in the design of the READY program. The program will also include parent education on health issues and stress reduction activities. In order to engage parents and families, the plan includes parent – teacher conferences with an individualized student health review, led by a health center professional who knows the student. Student families will have access to a “parent liaison” in the school that will conduct home visits and will be responsible for connecting families with supportive community resources such as adult health programs, mental health services, pharmacies, community athletic facilities and healthy cooking classes.

In preparation for the first year of the READY program, the health center underwent major renovation and expansion. The READY program is made possible by strong partnership with the schools, the parent advisory group, and generous funders.

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Washington County

Washington County currently operates two SBHC’s at South Hagerstown High School and Western Heights Middle School. Meritus Health assumed administration of the Washington County SBHC’s in 2013 in conjunction with the Washington County Public School System and the Washington County Government. Since the beginning of the 2014-15 school year, there has been a 40% increase in enrollment in the program with a current total of 253 students. In the 2013-2014 school year there were a total of 647 SBHC visits. This school year, the SBHC’s have already recorded 307 health visits.

In addition to medical care and preventative education, students have access to mental health services through Brook Lane, dental care through the Walnut Street Community Health Centers Mobile Dentistry program, and nutritional services through the Meritus Community Outreach Program. The Washington County SBHC’s are currently staffed by one nurse practitioner and one licensed practical nurse 4 days a week, 2 behavioral health counselors 2 days a week each, a nutritionist by appointment. The mobile dentistry program sees students on a rotating schedule. The SBHC is available to all students enrolled in each school and services remain free of charge to all. Students are seen for chronic health management as well as acute illnesses, injuries and preventative health services.

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