Recognizing that many school-age children do not have a primary care provider, Akron Children’s Hospital is expanding health care in two Northeast Ohio school districts as part of a pilot program.
“We are trying to meet students and families where they are, and children are in schools,” said Michele Wilmoth, director of School Health Services at Akron Children’s Hospital.
When classes resumed in August for students in the 9 school buildings in the Kenmore/Garfield cluster of Akron Public Schools (K-12) and 4 school buildings in Warren City Schools (Pre-K-8), families could opt in for participation in the program that will allow them to receive well-child exams (in person) and evaluation for illness (by telehealth technology) with a nurse practitioner. This could include complaints for sore throat, rash, pink eye, stomachache, cough, earache and other minor illnesses.
Services of the School-Based Health Centers (SBHC) will also include hearing and vision tests, screenings for depression, sports physicals, tips on eating healthy foods and staying safe, and anticipatory guidance for teens on topics like drug, alcohol and tobacco use.
“We know that as many as 25 percent of students in Akron Public Schools – and we assume the number is similar in Warren – do not have a primary care provider, so this program is targeted to them,” said Wilmoth. “We’re trying to bridge that gap and get those kids connected with preventative health care.”
Wilmoth said SBHC is a natural expansion of Akron Children’s Division of School Health Services, which was created 13 years ago and now covers 34 school districts and more than 300 school buildings.
This program advances the scope of practice of the school nurse with the nurse practitioner, who is able to offer more comprehensive evaluations and treatment plans.
“One of the benefits for us is already having established relationships with these school districts,” said Wilmoth. “That has streamlined the process for us. We know the school populations, and we already have a referral process in place should the child need ongoing care for something like asthma, an allergy or diabetes.”
Nurse practitioner Camilla Giallourakis will rotate through the 13 schools, aiming to provide about 4 well-child exams per day, as well as the telehealth exams for ill children as needed.
For example, if a child reports an earache, his parents will be called for consent to begin a telehealth exam. A nursing aide will use a handheld device (similar in size to a smartphone) to position in his ear and Giallourakis, in another building, using a laptop or tablet and a secure Internet connection, can see the inner ear and talk to the child about his symptoms.
“If the exam confirms an ear infection, a prescription can be called into the parents’ pharmacy of choice, and the child can begin treatment that day,” said Giallourakis. “This should cut down on missed school days for students and missed work days for their parents for minor illnesses.”
The pilot program is funded by a population health grant from Jim and Vanita Oelschlager, long-time benefactors of Akron Children’s.
Medicaid currently does not reimburse for school-based telehealth but Wilmoth says Akron Children’s hopes to prove it is a cost effective way to provide care for children who lack access to care.
“We are trying to be the safety net for those kids,” said Wilmoth. “A lot of children come to school sick because their families have no other options. They may lack transportation or have workplace policies that may make it difficult for them to leave their jobs to get their children to the doctor.”
Asthma management will be a particularly strong focus as it is the number one reason for children to miss school days.
Delivering preventative health care to children lacking it should reduce absenteeism and promote better learning.
With more than 2,000 SBHCs in operation around the country, research has shown, thus far, that at-risk students are receiving more well-child evaluations and immunizations and are using emergency rooms less for their day-to-day health care.
According to Health Policy Institute of Ohio, an elementary school in one of the poorest neighborhoods in Hamilton County has seen a 7.5% improvement on overall standardized test scores since Cincinnati Children’s Hospital began a SBHC in 2013.