School-Based Health Care Centers Pivoted to Telehealth During COVID-19

The COVID-19 pandemic forced school closures across the US, unexpectedly canceling in-person, school-based health centers (SBHCs) for millions of children and adolescents. The transition to virtual SBHCs was challenging but also created many innovations and positive outcomes, according to a qualitative study, “Listening and Learning,” published in the Journal of Pediatric Health Care.¹

“Telehealth implementation can support schools and communities and mitigate future strain on the health care system by keeping youth from over-burdened emergency departments and providing needed mental health care,” the National Association of Pediatric Nurse Practitioners (NAPNAP) said in reaction to the study.² “State and federal policy changes can ensure the continued provision of telehealth by SBHCs for disadvantaged youth.”

The purpose of SBHCs is to provide health care to students who may not receive it otherwise. “SBHCs provide a minimum of primary medical care but frequently also include integrated mental health care, social services, vision care, dentistry, and health education,” according to the study authors.

More than 89% of SBHCs offer health care to vulnerable children in Title I schools. In addition, “an average of 70% of the 6.3 million students in the United States with access to an SBHC are eligible for free or reduced cost lunch,” noted the researchers. However, the transition from in-person health care to telehealth was not always a smooth one.

“During the coronavirus outbreak, many SBHCs were able to transition to complete telehealth service delivery quickly, but others faced difficulty in telehealth implementation for some or all services,” noted the researchers of the study.

“However, for SBHCs that successfully transitioned to or continued providing care via telehealth platforms, students were able to continue receiving much needed primary and behavioral health services in the months immediately following COVID-related school closures.”

The School-Based Health Alliance (SBHA) launched the “Listening and Learning” online meeting series to assist SBHC during “unprecedented times.” The sessions were held between April and May 2020 and included 3 sessions for SBHC clinical providers and 3 for sponsor and administering organization staff, each covering topics such as telehealth, reentry, and mental health. Participants represented 41 states and each session allowed up to 150 participants.

The sessions yielded 3 telehealth delivery models: launching telehealth services, expanding existing telehealth services, and altering existing telehealth services and protocols. Numerous participants noted that launching telehealth was very innovative as they never had such a program before. The challenge was to quickly establish a platform for primary care providers and telebehavioral health services.

SBHCs that offered telehealth as an option before the pandemic were challenged with expanding services and the delivery model in response to COVID-19, including offering services to broader communities and expanding services such as acute care and mental health. Notable examples included:

• A collaboration with an in-person pediatric obesity specialty clinic to launch telehealth to rural student populations.
• Immediate telehealth access to a nurse practitioner for all students enrolled in school, with real-time referral to behavioral health providers if needed.
• Conducting “senior transition” visits via telehealth, which involved reviewing and updating medical charts with graduating seniors to ensure a seamless transition to adult care.

Altering existing telehealth focused on making changes to delivery. “To minimize in-person exposure time, providers employed telehealth for triaging or collecting a medical history before an in-person visit,” reported the researchers. Other examples included transitioning in-person therapy sessions to telebehavioral visits. SBHC also noticed an increased number of acute care telehealth visits resulted in referrals to the emergency room than would have if they were conducted in-person. Most of these were related to acute abdominal pain, where appendicitis could not be ruled out, or acute asthma attacks.

Based on information gathered from the sessions, delivery care strategies were improved. Delivering resources to students’ homes was reported by several states. “Montana SBHCs reported mailing worksheets and art supplies to students involved in brain spotting, dialectical behavior therapy, or expressive arts therapy as part of treatment,” the researchers noted.

An increase parent involvement was also reported by clinicians. “Although SBHC services increase access to care for students, parental involvement is often a challenge,” noted the researchers. “However, parents became telepresenters during visits in a variety of ways. Shared experiences included parents using the phone camera for assessments or using at-home thermometers and scales to assess and report vital signs. They assisted in counting respirations for providers as well as oropharynx flashlight illumination for telemedicine and teledentistry.”

As seen with telehealth, SBHCs are working to address changing circumstances as states prepare to reopen schools. “The use of telehealth by SBHCs during the pandemic and other extraordinary circumstances can bridge the care gap for students who need and rely on SBHCs as their primary source for health care,” they concluded.

References

1. Goddard N, Sullivan E, Fields P, Mackey S. The future of telehealth in school-based health centers: lessons from COVID-19. J Pediatr Health Care. 2021;S0891-245(20)30309-6. doi:10.1016/j.pedhc.2020.11.008.  

2. Study reveals implementation of telehealth in school-based health care setting provides large beneficial impact. News Release. National Association of Pediatric Nurse Practitioners; May 19, 2021. Accessed May 21, 2021. https://www.napnap.org/study-reveals-implementation-of-telehealth-in-school-based-health-care-setting-provides-large-beneficial-impact/.

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This article originally appeared on Clinical Advisor