School-Based Telehealth Improves Outcomes and Equity

School-Based Telehealth Improves Outcomes and Equity

For low-income schools in North Carolina, a health system’s telehealth services are much more than a convenience.

Christina Green is in the middle of bathing her elderly mother when she gets a call from her daughter’s school. “Kaleesi is having an asthma attack,” she is told. “We need you to get here as soon as possible.”

Christina is forced to pull her mother out of the tub, sit her on the bed and dash out the door, worrying about both loved ones in unsafe situations.

For a long time, events like these were all too common.

Kaleesi is a fourth grader with Hashimoto’s Disease, asthma, and chronic migraines. As a result, she often misses classes for rest, doctor’s appointments, and medication administration. Since the introduction of school-based telehealth at Bessemer Elementary School in Greensboro, North Carolina, Kaleesi no longer has to leave school early or miss a day entirely.

Cone Health, which includes Cone Health Women’s & Children’s Center at Moses Cone Hospital, is rolling out telehealth services across 51 Title I schools in the Guilford County system. They have nine sites open and have completed 300 televisits.

How it works

Acting as an on-site clinic, the telehealth center is equipped with a telepresenter — a trained certified medical assistant (CMA) or licensed practical nurse (LPN) – who acts as a bridge between student, provider, and parent. The telepresenter has a direct tie to Cone Health doctors, can consult about medications, and can facilitate a virtual visit with a doctor and a student’s parent. State-of-the-art technology, like an electronic stethoscope, allows both doctor and parent to see medical issues up close, despite being miles away.

Both Cone Health and Guilford County Schools (GCS) believe that placing clinics inside schools could have a significant impact on combating learning loss.

“This partnership arose out of listening and understanding what the school system needs. It’s a great opportunity to make a difference in children's lives,” says Cone Health CEO Mary Jo Cagle, MD.

Meeting a host of needs

One problem telehealth services solve is students having to leave school and parents having to leave work when a child feels ill. In the school-based clinics, telepresenters are authorized to give the student medication. In most cases, students are given the care they need and sent back to class. Within its first year at Bessemer, the telehealth clinic saw 300 patients — 240 of which were able to return to their classrooms following their visits, improving educational outcomes.

“I absolutely see the difference in our school community,” says Jonathan Brooks, principal. “Our students are healthier. They attend school more regularly. They have increased confidence.”

John Jenkins, MD, medical director of school-based care at Cone Health, believes the impacts of telehealth run even deeper. “In the current state, our families are going to the emergency room for routine care. We have analyzed our emergency room use and we see that low severity visits are occurring on a routine basis by these families,” Jenkins says.

Part of the reason for that is many parents can only seek care in the evenings due to their jobs, which means they end up in the emergency department at Cone Health.

Patterns like this represent an equity issue in both health and education, according to Jenkins. Students attending Title I elementary schools may not have access to the same financial, educational, or medical resources as other youth, forcing them to miss school often with few safety nets to catch them when they fall behind.

Jenkins, a former high school teacher, came up with the idea of placing telehealth clinics in Guilford County’s public schools after seeing other areas use this model successfully. Cone Health has made its partnership with GCS unique by leading with Title I elementary schools, a designation indicating that at least 52% of the families in a given school are low-income. Chronic absenteeism — defined as missing 10% of instructional time or more — is common among these schools. Absenteeism can be connected to a host of issues, including low grades and low graduation rates among students, as well as increased financial issues as parents are forced to leave work to care for sick children.

Cone Health’s larger vision is to expand school-based telehealth with even more support options, specifically, mental health access and care options for teachers and staff members. Ultimately, the mission is to make the whole school, and by extension the whole community, healthier.

An earlier version of this article was published by Cone Health Philanthropy.

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