School Districts Make Room for Telehealth

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Type: Article

Topics: Health & Wellness, School Administrator Magazine

January 01, 2024

Appears in January 2024: School Administrator.

A solution for reducing inequities in addressing the health needs of students, especially in rural America

Telehealth has exploded in popularity in recent years, especially during COVID-19, establishing a presence in a growing number of schools. Ideally, it should be affiliated with a health system that can provide standards and guidelines for use.

School leaders in rural and more remote regions where access to health care is limited at best say their telehealth programs help them keep their students healthy, ready to learn and in school, a small victory in the battle against chronic absenteeism.

Estimates from the year before the pandemic suggested about 2 percent of public schools nationwide had access to telehealth services. A year into the pandemic, the School-Based Health Alliance reported almost 90 percent of school-based health centers had a telehealth option.

The 18,000-member National Association of School Nurses considers public schools “ideal locations to implement telehealth.” The American Academy of Pediatrics recognizes the value of telehealth in a variety of settings as a strategy to reduce inequities in health care.

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Author

Jennifer Larson

Freelance writer, Nashville, Tenn.

Virtual School Nursing Takes Off in Remote Communities

A shortage in the number of school nurses across the country has left many public schools without a dedicated nurse on site.

The problem is particularly acute in rural areas. According to the National School Nurse Workforce Study 2.0., published in 2023, only 56 percent of rural schools have a full-time school nurse. Among urban schools, 70 percent employ full-time nurses.

Rather than limp along without a nurse, some schools are turning to virtual nurse programs to offer certain types of care to their students.

Paraprofessional Role

The South Heart School District in North Dakota, a rural system of 400 students without a full-time school nurse on site, had relied on a community agency to provide health services, but it was becoming overwhelmed with demand in the wake of COVID-19.

When several students were diagnosed with diabetes, South Heart leaders looked for a way to provide nursing services to students. The district established a partnership with Avel eCare, a proprietary program that connects nurses with school district’s students through telehealth. The arrangement launched at the start of 2021-22.

The virtual nursing program works this way: One of the school’s trained paraprofessionals accompanies a student into a small, dedicated room, where the telehealth equipment is stored. With the paraprofessional’s help, the student logs onto the system to consult with a nurse virtually and to obtain an evaluation.

Avel eCare’s virtual nursing attends to urgent health care needs due to injury or illness; daily diabetic care or other chronic care needs; and medication administration.

“In some cases, it’s helped keep students in school because [the virtual nurse] determined that it wasn’t serious,” says Calvin Dean, South Heart’s superintendent. “And in other cases, it was serious enough to contact the parents.”

Dean estimates South Heart students have contacted the virtual nursing service more than 100 times per month. The district is funding its virtual nursing services with grants, but even after that funding ends, the district plans to sustain it. The program costs $10,000 to $15,000 to operate annually, which will come out of his district’s $5.5 million budget.

“It’s money well spent,” Dean says.

Mobile Cart

The Deubrook Area School District in White, S.D. is another one of Avel eCare’s 66 district clients located in 12 states.

Shortly before the 2017-18 school year started, a student in the Deubrook system was diagnosed with out-of-control diabetes and needed support at school. But the 386-student district serving three tiny communities didn’t employ a school nurse. “It would have been very difficult for me to find somebody,” says superintendent Kimberly Kludt.

Both of Deubrook’s schools designated a space for students’ telehealth sessions that housed a mobile technology cart with a tablet, heart monitor and other tools to use for private sessions with a nurse. The program, which costs approximately $20 per student, has worked well, says Kludt. “It’s a powerful use of technology to help us keep our kids healthy and safe.”

— Jennifer Larson

Telehealth Makes In-Roads in Howard County Schools

By Ilise D. Marrazzo and Ambyr Klink

A half dozen years before the COVID-19 pandemic made telemedicine visits a common practice, the Howard County Health Department in Maryland created a telemedicine school-based health center program.

This cutting-edge program, established through funding from county government and in partnership with Howard County Public Schools, was the first of its kind in Maryland. It started in five elementary schools serving students in prekindergarten through 5th grade. During the 2023-24 school year, the program has expanded to serve six elementary and two middle schools in the 56,500-student school district.

The delivery of telemedicine at school locations is improving educational outcomes by raising students’ return-to-class rates.

All students enrolled in the participating schools are eligible to receive both in-person and telemedicine services in the school-based health centers, provided the parent/guardian completes and submits enrollment and consent forms. Nurse practitioners provide in-person primary and acute services to students two days a week, with telemedicine services available to enrolled students the remaining days.

Medical care is not provided to caregivers, siblings or school employees.

Coordinated Process

Implementation of the telemedicine program is a collaborative approach, with professionals at the county health department, school district and community pediatricians ensuring access to care. When an enrolled student visits the health suite, the school nurse handles triage to determine whether they are eligible for telemedicine. Telemedicine visits are ideal for common childhood illnesses that involve the eyes, ears, nose, throat, lungs and minor strains and sprains.

If the child meets the criteria for a telemedicine visit, the school nurse contacts parents to ask if they want to join the meeting and then contacts a nurse practitioner or the student’s health care provider if they participate in the telemedicine program. The school nurse may conduct a rapid COVID-19 test, rapid strep test and throat culture prior to speaking with a provider.

With guidance from the medical provider, the school nurse uses a room camera, an electronic stethoscope and otoscope to help the provider assess the patient. Prescriptions are sent by the provider directly to the pharmacy so parents can pick them up. When appropriate, medication can be given to students to avoid their exclusion from school.

A study titled “Effectiveness and Cost-Benefit of an Elementary School-Based Telehealth Program” in the Journal of School Nursing in 2021 found the Maryland telehealth program was associated with a 7.7 percent reduction in student absences. In addition, the study found the original program had an annual net benefit of $195,873 per year, demonstrating that the use of a telehealth exclusive school health center can improve student health and attendance while delivering cost savings to the community.

Expanding Access

While there was a decrease in enrollments in school-based health centers during the height of the pandemic, the program rebounded during 2022-23. The county health department attributes this increase to school nurses and administrators promoting the program to families. Additionally, during the pandemic, parents had telemedicine visits for their children and realized how an assessment could be done virtually. The program obtained a return-to-class rate of 98 percent in 2022-23.

The Maryland Department of Health provided a grant to the county health department in 2022 that enabled significant expansion of the program. Three nurse practitioners, a medical assistant and administrative staff were added. The health department is working with a vendor to develop a web-based registration system to integrate our electronic health records, allowing parents to enroll their child in the program without having to complete and return to school the paper forms.

With the addition of nurse practitioners to the program, we expect telemedicine to prove integral to a wider population of students and their families.

Ilise Marrazzo is director of the Bureau of Family Health Services at Howard County Health Department in Columbia, Md. Ambyr Klink is a nurse practitioner at Talbott Springs Elementary School in Columbia, Md.