Doctors visits can be time consuming for students, taking them away from the classroom for hours sitting in traffic and waiting rooms. But at some Howard County public schools, a pediatrician is just a click away.
At the county’s 11 school-based wellness centers, students can receive onsite physicals and screenings and, at eight of the locations, connect with a local provider remotely via a telemedicine appointment.
Using specialized electronic instruments at the centers, school nurses give pediatricians a look inside a students’ ear, throat and nose to diagnose an illness and prescribe treatment. Parents can even be patched into visits through a secure video link.
“I would say well over half the [telemedicine] visits are easily treatable and the child can stay in school,” said Dr. R. Scott Strahlman, a pediatrician at the Columbia Medical Practice, which administers the telehealth visits at no cost to students and their families. “The parent doesn’t have to leave home or work, the child doesn’t have to leave school and appropriate medical care is provided.”
In addition to reducing missed class time, the school-based wellness centers, which operate in partnership with the Howard County Health Department, aim to provide medical access to uninsured students.
Last month, HCHD announced the expansion of services across school-based wellness centers after a $815,000 grant from the Maryland Department of Health, in an effort to further realize that mission. The county health department is using the funds to hire two new nurse practitioners and additional staff to bring onsite health care to the eight centers that previously offered telemedicine-only services.
With the expanded services, the more than 3,200 students enrolled in the centers will have access to comprehensive health care and chronic disease management to address issues ranging from ADHD to obesity.
“I think all children in Howard County should have the right to getting health care in school,” said Sharon Hobson, the program’s administrator for the Howard health department. “No matter if they’re insured or not, every child should be able to receive needed health care in school to keep them in the class and learning.”
Addressing health disparities in the school system
County and school officials said they hope the wellness centers will help address health care disparities within HCPSS, where nearly a quarter of students are enrolled in the Free and Reduced Price Meals program.
“The initial goal of this program was to reach out to either uninsured or underinsured populations in our schools,” said Kerrie Wagaman, director of health services for county public schools. “We wanted to reach those families, figuring that the FARMs rate would correlate with being uninsured, underinsured or financially challenged in some way, shape or form.”
The first five telemedicine-only sites launched in 2014 at Title I elementary schools, where at least 40% of students receive free or reduced-price meals. The school-based virtual program was the first of its kind in Maryland.
Hobson said the wellness centers came at a critical time, as the health department saw an increasing number of undocumented immigrant families whose uninsured children needed health services. The county’s only Federally Qualified Health Center at Chase Brexton in Columbia was overwhelmed and kids were missing school.
“[These students] are coming with a lot of needs and they’re already behind academically,” Hobson said. “In a lot of cases, some don’t speak English. Those kids particularly need to be in school and learning.”
With a small grant from Howard County General Hospital, the health department contracted out Strahlman’s Columbia Medical Practice to conduct school-based telemedicine visits for uninsured students. No visit is billed unless a student sees their own private provider via the telemedicine platform.
“We’re providing those visits as a free public service to keep the kids in school and to keep the kids healthy,” Strahlman said.
Despite practicing medicine in the county since 1985, Strahlman said he wasn’t aware of the extent of health care disparities among the student population until he began the partnership with the school system.
“I never really knew before participating in this program that there was this population of students who didn’t speak any English, and their parents didn’t speak any English and they didn’t have medical insurance,” said Strahlman, whose fluency in Spanish allows him to connect with ESL families for visits. “Through this, we’re able to provide those students with a true medical home.”
Consistent care and chronic disease treatment
With the new MDH funding, students at all 11 school-based wellness centers can receive acute care management, either through a nurse practitioner or telemedicine service when a provider is off-site. These services have been helpful in addressing health care gaps in the wake of the pandemic, Wagaman said.
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“No one wanted to leave the house, no one wanted to go to the doctor where sick people are,” she said. “We had a lot to really play catch up on over this last year when schools reopened to get students vaccinated, to get students treated, to get students getting their physicals.”
While Bollman Bridge Elementary School and Patuxent Valley Middle School administered nearly 600 onsite vaccinations of all types last year, the other wellness centers are waiting for approval from the Maryland Vaccines for Children program to provide vaccines to students, Wagaman said.
Officials say the expanded wellness centers will help identify and manage chronic diseases early, while offering regular care for students from all backgrounds.
“The potential is there for these telemedicine visits to improve quality of care for various chronic illnesses,” said Strahlman, adding that technology allows him to see how medication is affecting a child in real-time during the school day. “We can follow up on obesity, we can follow up on mental health issues, we can follow up on asthma without taking the kid away from school.”
Hobson ensures inhalers are included in the centers’ budget, since the devices can limit severe asthma attacks and save uninsured families a costly emergency room visit.
Despite the challenges of the pandemic, she said he is hopeful the school-based centers will prevent more students from falling through the coverage cracks. Hobson said she would like to see the model replicated across the country.
“It is the ideal way to help kids because we’re right with them when they’re in school,” Hobson said. “The local health departments and the school systems working together is the best model for the kids’ needs, whether you have insurance or not.”