When the School Nurse Is on a Screen Instead of in an Office

Some schools are using telemedicine to provide health care to students in underserved districts. But few think it’s a cure for their ailments.

A nurse examines a little girl's throat
A school nurse in rural Texas uses a camera to show a doctor in Houston a student's throat.
AP Images
When one thinks about a school health clinic, the image that comes to mind is likely that of a single harried nurse working in a dingy room with dated equipment. But school health centers have been undergoing something of a makeover in recent years, expanding in size and scope. In part, these changes reflect the impact of the $200 million allocated by the Affordable Care Act for school-based health centers. But they also are related to a broader push to focus on the social determinants of health.

In Oregon, where school health advocates have been particularly proactive for the past two decades, the state increased its share of funding for local school clinics from $1.3 million in 2002 to $6.8 million in 2014. “We emphasize that school-based health centers are part of the social safety net, and the number of kids that are in school are the number of kids who have access to health care,” says Sarah Knipper, a school health economist at the Oregon Health Authority.

Across the country, there is still a lot of unmet need for health services in public schools: More than half don’t have even a single full-time nurse. That’s one reason that school-based health centers have been a breeding ground for experimentation in the brave new world of telemedicine.

Underserved rural areas present a special opportunity for telehealth efforts. Before going to medical school, Steve North worked for Teach for America in rural North Carolina, and he was struck by just how much health impacts a child’s ability to come to school and thrive. Now, as medical director of the North Carolina-based Center for Rural Health Innovation, he’s overseen a telehealth program that in six years has grown to 33 schools in the state. In three rural counties, every school now has access to telehealth options. Some urban school districts also have been testing the waters. In the Bronx, where there are 23 school-based health centers but just one school child psychiatrist, telehealth has been used for psychiatric medication management appointments.

But few in the school health community see telehealth as a fix-all for underserved areas, particularly when it comes to preventive care. “My greatest fear is we’re going to buy this equipment and think it’s a replacement for a school nurse,” says John Schlitt, president of the School-Based Health Alliance. “You can do some great things with acute care and mental health, but it’s not a primary care tool.”

North agrees, adding that he’s been getting phone calls from venture capitalists looking to cash in on the innovative technology of telehealth. “Whenever I explain that telehealth must be integrated care focused on the whole child -- care that ultimately helps them reach educational achievement -- that typically ends the conversation.”

That focus on the whole child -- including family and neighborhood factors seen as determinants of health -- is one reason some school clinics have opened their doors to the outside community. North says this marks a changing attitude around school health clinics, which historically haven’t been brought into conversations around healthier communities. North sees school clinics ultimately fitting into a broader “patient-centered community care” model. School clinics, he says, “should be a resource, not a competitor.”  

Mattie covers all things health for Governing.

Special Projects
Sponsored Stories
GHD identified four themes critical for municipalities to address to reach net-zero by 2050. Will you be ready?
As more state and local jurisdictions have placed a priority on creating sustainable and resilient communities, many have set strong targets to reduce the energy use and greenhouse gases (GHGs) associated with commercial and residential buildings.
As more people get vaccinated and states begin to roll back some of the restrictions put in place due to the COVID-19 pandemic — schools, agencies and workplaces are working on a plan on how to safely return to normal.
The solutions will be a permanent part of government even after the pandemic is over.
See simple ways agencies can improve the citizen engagement experience and make online work environments safer without busting the budget.
Whether your agency is already a well-oiled DevOps machine, or whether you’re just in the beginning stages of adopting a new software development methodology, one thing is certain: The security of your product is a top-of-mind concern.
The World Economic Forum predicts that by 2022, over half of the workforce will require significant reskilling or upskilling to do their jobs—and this data was published prior to the pandemic.
Part math problem and part unrealized social impact, recycling is at a tipping point. While there are critical system improvements to be made, in the end, success depends on millions of small decisions and actions by people.
Government legal professionals are finding Lexis+ Litigation Analytics from LexisNexis valuable for understanding a judge’s behavior and courtroom trends, knowing other attorneys’ track records, and ensuring success in civil litigation cases.