Diane Peltz – Contributing Writer
Macon County Schools will soon be getting a School-Based Health Center (SBHC). With a potential start date of January 2023, the Telehealth program is still in the developmental stage, but moving steadily toward finalization. This specific telehealth plan was proposed to Macon County Public Health and to Macon County Schools Superintendent Dr. Chris Baldwin, prior to applying for a grant. Approval was received from both to move forward. Once the grant was awarded, both Public Health and Dr. Baldwin were made aware of the receipt of the award and continued their support to move forward with implementation. The Community Health Grant from the Department of Health and Human Services Office of Rural Health awarded a $150,000 Community Health Grant for the startup year.
What a SBHC provides
Each school will receive equipment that will allow students and/or staff to connect via telehealth with a medical provider from the Health Department, to complete a visit from school. Dr. Donald Dewhurst, MD or Julie Rogers, FNPC [certified nurse practitioner] will be able to diagnose and treat illnesses such as sinus infections, sore throat/strep, ear infections, urinary symptoms, influenza, Covid-19, conjunctivitis (“pink eye”), etc., as well as help with management of known chronic medical conditions. Numerous benefits of the program include:
• Increasing access to care for students and staff;
• Convenience of appointments and scheduling with availability during every school day;
• Increased class time; for students and staff;
• Management of outbreaks;
• Reduction in health disparities in historically marginalized populations;
• Less time off work and lost wages for parents and school staff;
• Reducing transportation challenges; and a most important benefit, that the program is open to all students and staff without restriction or ability to pay.
Students will be able to be seen without payment becoming a barrier. For students and staff with insurance, their plan will be billed for the visit. More information on fee policies will be provided in the future with the goal being no out-of- pocket cost for the students. Parents will be responsible for the cost of prescriptions but the health department will make every effort to offer assistance, if needed, to local resources.
How it works
All children (and staff) will occasionally experience days where they don’t feel well. In the school setting, this typically leads to a visit to the school nurse or designated trained school staff to complete additional assessment of the complaint. Following the initial assessment, if it is determined the student/staff could benefit from a visit with a health care provider, the school nurse or trained school staff will contact the school-based health center (SBHC) for an appointment. Appointments are completed via telehealth, using not only audio/visual communication, but will also utilize telehealth equipment allowing the provider to complete a thorough assessment including the ability to visualize the inner ear, throat, etc., hear heart and lung sounds, etc. The equipment is called Tytocare, specifically TytoClinic units. Limited on-site rapid testing will be available for some health concerns including strep throat, flu, COVID-19, urinalysis, etc. This will involve a couple additional pieces of small equipment and testing supplies.
Once it is determined that a student or staff member needs a referral to a medical provider for additional evaluation and treatment, school personnel will first contact the parent to discuss the referral need and review their options to make an appointment with a primary care provider, SBHC, or decline the referral for additional assessment. A visit with Primary Care is always encouraged first. (Traditionally appointments are at times difficult to schedule due to availability of same-day “sick” appointments.) The Health Department will be providing clear and simple instructions in the near future of how to schedule a same-day appointment with SBHC. There is capability to include the parent, student and provider in a visit as a three-way view, but the parent appearance for the visit is not required as long as they have completed enrollment and given permission for the appointment. Following any visit with school-based health, a visit summary will be sent to the primary care provider on record for continuity of care and follow-up. If there is no primary care provider (PCP), information will be provided to encourage that they establish with a PCP. Once the program is ready to launch and a completed packet (including consent and medical history) are received, they can begin providing access to health care as needed.
Trained staff needed
In addition to all school nurses, schools will need two staff from each school willing to be trained as a patient presenter for an appointment to ensure daily access to the SBHC. Ideally the school nurse will complete the telehealth appointment. However, school nurses are not present at each school daily, or may be tied up with other student needs. It is important to have additional trained staff within each school. The visit itself should not require a huge time commitment with the average visit being 15 minutes. Ideally, a presenter would be someone that is not tied to a classroom as the only adult to monitor a class.
The Health Department understands that an educator’s purpose is to educate, not run a medical office. However, they also understand you cannot educate a child that is not well or not present. “First responders” are chosen in each school; thus, those individuals might be ideal staff to select for this task, if they are willing. All documentation pertaining to the visit will be completed by the provider. Confidentiality standards of HIPAA/FERPA do apply to the visit.
What presenters will do
Presenters will be asked to complete a set of vitals prior to the appointment: height, weight, blood pressure, temperature. The Tytoclinic units come equipped with automatic BP cuff, temp monitoring, and pulse oximeter. Height and weight tools are present in each school nurse office. Presenters will be trained to obtain basic specimens for routine on-site testing. All testing is simple and does not require medical training beyond “just-in-time” training. The tentative date range to schedule an all-day training session is currently Nov.7-10. Dates are subject to change based on arrival of equipment. Exact date within that week will be determined as coverage for selected staff is arranged and confirmed to be away for a full day.
Telehealth is already up and running in 10 counties in North Carolina.