For years, Vermont schools and pediatricians were trying to support the same children and families, often with overlapping goals and challenges. But they struggled to do so together, even though they wanted to.
“We heard similar hopes and frustrations from both sides,” said Heidi Schumacher, MD, a pediatrician at Golisano Children’s Hospital at UVM Health and faculty leader at the Vermont Child Health Improvement Program (VCHIP) at the University of Vermont.
Most clinicians believed school-related issues were within their scope of practice, yet fewer than half reported having standardized procedures to support partnerships with schools. Clinicians and school staff alike cited inconsistent communication pathways, difficulty obtaining consent to share information, and limited opportunities to build relationships and address problems together.
A statewide quality improvement project led by VCHIP set out to solve those problems and bridge the gap.
“We said, ‘We hear that you want to partner, and we’re going to design a project that’s going to make it easier for you to do that effectively,’” Schumacher said.
The result is a blueprint for building effective, collaborative hospital-school partnerships.
The project
Using the Institute for Healthcare Improvement’s Breakthrough Series Collaborative model and its Model for Improvement, VCHIP brought together pediatric and family medicine practices, school partners, and children’s hospital clinicians.
“As with all VCHIP projects, we designed it to shoulder with community partners,” Schumacher said. “Our children’s hospital faculty brings their expertise, but we also leverage the expertise of our community partners, community practices, schools, and state government colleagues.”
The collaborative established four statewide aims:
- Increase documentation of consent allowing practices to communicate with schools
- Increase sharing of visit summaries or health information with schools
- Create regular systems-level meetings between practices and school partners
- Improve participants’ perceptions of communication quality and care coordination
Participating practices attended a learning session, collected baseline data, tested changes through Plan-Do-Study-Act cycles, and joined monthly collaborative meetings where they reviewed performance data and learned from peers.
“Quality improvement can be hard, but ultimately it makes things easier,” said Christine Pellegrino, project director and quality improvement associate at VCHIP.
Each meeting included topic-specific learning, practice spotlights, and breakout discussions so teams could talk through what was working and where they were stuck. Practices that were not formally collecting data could still listen and learn.
A multidisciplinary planning team, including clinicians from Golisano Children’s Hospital at UVM Health, guided the work based on School Friendly Health Systems principles.
While practices worked toward common goals, each team adapted changes to fit its own workflows and community needs. Practices received coaching from VCHIP quality improvement specialists that integrated the collaborative’s data and lessons.
“All quality improvement is local,” Pellegrino said. “Every practice was figuring out what worked in their setting.”
Practical solutions to common problems
In one way or another, everyone expressed struggles with communication. Medical staff were not always confident about when information could be shared, consent forms were difficult to find, or families did not understand why schools and providers needed permission to exchange information.
Teams tested a range of solutions:
- Embedding consent documentation into EHR workflows
- Creating electronic release forms families could complete online
- Developing educational materials that explained how school-health communication benefits children
- Systematizing the secure sharing of records with school partners after visits
- Organizing regular huddles between practice and school teams to discuss workflows, communication opportunities, policy questions or needs
Some practices found that parents were highly supportive of communication between schools and health care providers once they understood how the information would be used. Teams began incorporating those conversations into routine visits rather than waiting until a specific issue arose.
As solutions were implemented, teams encountered further barriers. Even when information could be shared, practices often did not know who to contact.
One participating practice created a master directory of school contacts that included names, phone numbers, email addresses, fax numbers, and preferred communication methods. The directory was later shared with other practices in the region.
The monthly collaborative calls allowed teams to learn from one another while adapting ideas to their own communities. What worked in one practice rarely transferred exactly as written to another. Practices modified approaches to fit their staffing models, school relationships, and existing workflows.
Over time, participants reported that communication became easier because relationships already existed before a problem needed to be solved.
New opportunities emerged
As practices strengthened connections with schools, the work expanded beyond the project’s original focus.
Some teams began paying closer attention to absenteeism and discussing attendance during clinical visits. Others identified opportunities for deeper partnerships around student health and well-being.
One primary care site affiliated with Golisano Children’s Hospital at UVM Health began exploring a school-based health center pilot with a local district. Project leaders also started exploring how the work could extend into specialty care and how technology could support more seamless information sharing.
For Schumacher, those developments reflect the natural connection between health and education.
“We know healthy students are better learners, and we know students who do well in school tend to have better long-term health outcomes,” she said. “The more we can work together around the same kids, the more we can help them succeed.”
