A Whole-Person Approach to Care at School

A Whole-Person Approach to Care at School

Atrium Health Levine Children's has seen decreased emergency department use and shorter waiting times for behavioral health care.

By almost any measure, Atrium Health Levine Children’s Meaningful Medicine school program is a win for everyone involved.

Kids are seen for health conditions without leaving school, parents avoid missing work, and providers enjoy convenient hours and higher job satisfaction. Most importantly, kids get treatment sooner, avoiding emergent conditions.

Meaningful Medicine has two primary components: telemedicine and teletherapy. Kids with an acute episodic condition are seen and treated at the school by off-site providers, and middle and high school students can participate in weekly teletherapy sessions during the school day.

“It's all about creating access points within our community for the patients and the staff we serve in the schools,” said Megan Cody, MHA, assistant vice president at Atrium Health Levine Children’s.

The program has expanded to nearly 140 schools in eight districts since its start in 2017, averaging 600 visits a month. During that time:

Avoidable medical emergency department visits by students who attend schools enrolled in the program decreased by 24%.

  • 61% of students returned to class following a virtual medical visit.
  • Students get an initial teletherapy appointment in less than 10 days.
  • Depressive and anxiety symptoms decreased by 38% and 36%, respectively, among students who receive school-based virtual therapy.

A boon of benefits

While harder to quantify, the program’s intangible benefits are nonetheless impactful, Cody said.

Since sick kids don’t have to wait to see a provider, they can get started on medication sooner, which contributes to lower absenteeism rates.

Additionally, students in the program are connected to a medical home for preventive care.

“We really want to focus on getting them set up with a permanent medical home for wellness care. After we connect them to a provider, we monitor if they've had a wellness visit within one year and make sure we're following up,” Cody said.

Parents also benefit by not having to leave work to pick up their kids. “The fact that many kids who are seen by a virtual medical provider are able to go back to class and their parents can stay at work is a huge benefit to the families we serve,” Cody said.

Providers who work in the school-based program also report higher levels of job satisfaction. Seasonal advanced practice providers enjoy a schedule that mirrors the school year, and mental health professionals value the work-life balance the program offers.

“We've tried to leverage every opportunity to make it successful all around. We want to provide the care while also keeping our teammates and our providers happy,” said Sam McGinnis, administrative director for Atrium Health who helps oversee the school-based care program.

For a successful program, McGinnis said it’s important to meet each school where it is. “It takes a spirit of collaboration, identifying the school’s needs and developing your model around the needs. You can have a model, but you must be able to tailor your model to the school’s challenges.”

Medical care at school

Kids who become ill at school can be seen by an off-site Levine Children’s Health provider via a “telepresenter,” a certified medical assistant trained to use specialized diagnostic tools.

A school nurse, secretary, or staff member first obtains parental consent for the virtual visit and for the child’s medical insurance to be billed. Next, the school staff summon the telepresenter to campus.

Telepresenters use specialized equipment to listen to the child’s heart and lungs and take high-resolution images of the eyes, mouth, and ears. They can also test for flu, strep throat, COVID, and conduct a urinalysis. Conditions seen by school-based medical providers most frequently include:

  • Allergies.
  • Ear pain.
  • Fever.
  • Headache.
  • Pink eye.
  • Rash.
  • Sore throat.
  • Stomachache.
  • Urinary tract infections.

The child — and often parents — use a technology-enabled tablet to speak with the off-site pediatrician or advanced practice nurse, and the telepresenter sends the provider the diagnostic information. If the provider diagnoses the child with a contagious condition, the school’s staff ask a parent or guardian to pick up the child. The provider can also send medications to the family’s pharmacy.

Teletherapy at school

The program’s goal is getting kids into treatment sooner and avoiding emergent conditions, said Donnie Mitchem, LPA, director of outpatient behavioral health services for Atrium Health.

Students can access care at school without having to drive long distances that require them to miss school. Additionally, Mitchem said students in rural counties often had to wait six months for appointments with a mental health care provider. Now, they wait no more than 10 days for an initial appointment with the school-based program.

The program is offered to middle and high school students. When it’s time for a scheduled therapy session, students go to a vacant office or classroom and use a tablet to connect with their therapist. Family members and interpreters can join the calls as needed.

“We find that it works well. It’s a platform they’re very familiar with, and it’s easy to use,” Mitchem said.

In 2023, some 1,500 students received teletherapy services at school. The program prioritizes historically underserved communities, with 70% of patients identifying as Black, Hispanic, or American Indian/Alaska Native and 63% reporting financial barriers to access, such as being uninsured or Medicaid-insured.

Mitchem cited a 10% increase in family therapy sessions since the program’s inception as an unexpected benefit.

“I think we used to say things like, ‘Oh the parent doesn't want to participate,’ when really a parent wants to participate. They just couldn’t without fear of losing their job,” she said. “Now, the parent doesn't have to miss work. They can participate in their therapy session during their lunch break. This program really equips parents to better advocate and care for their kids.”

Looking ahead

Atrium Health is piloting a program in one school district to identify students’ social needs and connect at-risk families with resources. Students are screened during telehealth or teletherapy services and the results entered into the electronic health record. The student’s risk is assessed, and when necessary, the student’s family is referred to a community health worker or a nurse navigator.

“They focus on time sensitive support needs and the most vulnerable patients and their families,” Cody said. “They also walk alongside families as they navigate the health system and serve as a connection point for community resources.”

Keys to success

  • Partner with community groups that provide similar services.
  • Seek funding from grants, community foundations, and insurance reimbursement.
  • Explore resources available from the National Consortium of Telehealth Resource Centers.
  • Enlist schools’ help to advertise the program to families.

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