Howard County's school-based wellness center program expanded to its first high school location earlier this month at Wilde Lake in an effort to increase accessible health services for adolescents.
The program is a partnership between the Howard County Health Department and school system, and began operating its newest wellness center on Oct. 2. Wilde Lake High School is the ninth school to open a wellness center and follows seven at the elementary school level and one at the middle school level.
Health department officials, school staff and Howard County Executive Allan Kittleman celebrated the opening of the Wilde Lake High wellness center on Oct. 24.
"We're providing access to care for adolescents, who generally don't seek medical care and may not always tell their parents how they're feeling," said Maura Rossman, a health department officer. "I think placement in a high school will create many more opportunities for this particular group, who, developmentally, have some risky behaviors and other reasons why they may not share some health issues with their families."
Risky behaviors can range from not doing homework to thinking about drinking or drug use, Rossman said.
"This is a period of time when adolescents are trying to separate from their parents through this normal developmental process," she said.
Parents can enroll their students in the school-based wellness program by completing medical documentation available on the school's website or at the school's health office.
Jacqueline Douge, the health department's child health medical director, said the program follows traditional or telemedicine models, the former only offered at Bollman Bridge Elementary, Patuxent Valley Middle and Wilde Lake High.
Traditional models have an independent pediatrician and a health department nurse practitioner on-site to provide physicals and health education; diagnose and treat acute illnesses, like strep throat, and minor injuries; and manage chronic health problems, such as asthma. Telemedicine is offered at six participating schools, where school nurses perform no-contact assessments and, if needed, schedule video chats between students and doctors with Howard County General Hospital's pediatric emergency room.
The county funds both models, said Kerrie Wagaman, the school system's health services coordinator. A traditional wellness center costs roughly $100,000 a year to operate, including staff salaries, supplies, licensing and liability insurance. Telemedicine machines cost between $20,000 and $30,000 and are limited to one per participating school.
"The downside is you don't have a practitioner on-site who can actually do physical, hands-on exams, which limits the number of services you can provide," Wagaman said. But, doctors can address symptoms like headaches, sinus problems, chest congestion, sore throat, pink eye or skin rashes, she said.
Parents are notified of student visits and complaints, Wagaman said, and the health department would be liable for a misdiagnosis or incorrect follow-through of treatment.
Wagaman said the wellness center program launched with its traditional model in 2014 to increase accessible health services to students who may not have direct access to doctor's visits or regular check-ups. The program started at Bollman Bridge Elementary, where renovations expanded its health suite to include more space, and later expanded to Patuxent Valley Middle.
During the pilot, Wagaman said the health department and school system partnered with the University of Maryland Medical System, which provided emergency room physicians on-site at the schools. Shortly after, the health department partnered with nine private pediatrician practices in Howard County that expressed interest in the program.
"We used Howard County General Hospital as the default provider and nine pediatricians joined for free," Wagaman said. "There's a licensing fee and insurance that's involved, so after the first year, they had to pick up the costs.
Two community private pediatric practices, Columbia Medical Plan and Klebanow and Associates, are still enrolled in the program.
Sharon Hobson, the school health program administrator, said the program's enrollment and student visitation numbers have increased over the past three years. In 2014, about 633 students were enrolled in the telemedicine program at the five participating schools and about 94 students used its services. Telemedicine enrollment jumped to 1,144 students the following year – including expansion to a sixth school – and about 150 students received help.
According to the school system's data for the traditional model, 704 students were enrolled and 489 students visited in the 2015-2016 school year. Last year, enrollment and visitation numbers increased to 834 and 516 students, respectively.
So far this year, Hobson said 1,838 students are enrolled in the telemedicine program and 29 student have visited. As of Sept. 30, 709 students were enrolled in the traditional program and 83 students have sought health services countywide.
At Wilde Lake's new wellness center, 242 students were enrolled and 12 students have used its services as of Oct. 17. The wellness center is only open on Monday and Wednesday mornings when school is in session.
Wagaman estimates the return to class rate was about 77 percent before telemedicine. The adjusted return to class rate for both programs varies from 96 to 100 percent.
Douge described each wellness center as "a doctor's office in a school," providing health services to students regardless of their health insurance status. Health insurance companies, including Medical Assistance, are billed for the center's health services.
However, Douge said, no student will be denied care if they can't pay or have an outstanding bill.
"Our main goals are to keep kids healthy and keep them in schools, so that they're able to learn," Douge said. "The nurse does a great job of assessing the child, but the nurse can't diagnose or write a prescription. [These services are] complementing the existing nursing services."
When students go to the health room, Douge said school nurses can perform health assessments and check immunization records, but cannot diagnose or treat students. Rather than sending students home, sometimes undiagnosed, wellness center practitioners can possibly diagnose and prescribed medication for students, who may be able to return to class.
"If the child comes to the health room for ear pain, instead of going home, they can see the provider and the provider can say, 'OK, does the child have an ear infection or do they just need Tylenol or Motrin?'" Douge said. "The diagnosis can be made and the prescription can be sent to the pharmacy, so the parent can pick it up at their convenience."
Carolyn Fleming, a school-employed cluster nurse at Wilde Lake, said the wellness center should keep attendance numbers up since students can be treated for acute problems, like migraines.
"Sometimes, if they can have some medication and rest a little while, they can go back to class," Fleming said.
Principal Rick Wilson said a high school-based wellness center is "long overdue" and Wilde Lake is a good place to start.
"Everybody is so busy and the more service we can provide here during the school day, the better the attendance rates are," Wilson said. "Students will stay in school. What more could you want?"