P0160 - Establishing a School-Based Health Center for an underserved community in Vermont: collaboration between pediatric residents, school nurse, and the community.

Program Goals

School-Based Health Centers (SBHCs) provide a cost-effective way to reduce healthcare disparities of underserved populations (AmJPrevMed,2016), and provide a way to advocate for children’s health, an essential skill for pediatricians to learn.
This advocacy project, led by a pediatric resident and a school nurse, established a SBHC in Winooski, VT, a town with a diverse underserved population of 7500. The Winooski School District serves 691 elementary through high school students, who speak 18 languages, and 98% of whom qualify for Free and Reduced Lunch. Although most students have a primary care provider (PCP), families face multiple barriers to accessing care. The idea of opening a part-time SBHC was conceived to address these barriers, modeled after similar nearby SBHCs.
To establish the SBHC, the resident and nurse assembled a multidisciplinary team, recruited physicians, secured grants, and engaged leaders from the school, healthcare organizations, health department, and the community. Within 12 months, the SBHC opened, with the mission to increase students’ access to quality healthcare, reduce healthcare disparities, and promote student wellness.

Evaluation

Now in its third year, the SBHC is open twice weekly, staffed by a pediatrician or physician’s assistant. Services include acute visits, follow-ups, chronic and behavioral condition management, and basic laboratory tests and procedures. Students are referred to PCPs for well care, and a coordinator assists with data collection and PCP communication. A community advisory council informs SBHC operations. To fund services, the school donates space, providers bill for services, healthcare organizations donate supplies, and grants funded initial equipment.
Utilization of the SBHC has been increasing (Figure 1). Almost all (95%) of SBHC users are covered by Medicaid. Most visits are scheduled (70-94%) and are for acute complaints (70-77%). Although 41-50% of visits result in prescriptions, labs, imaging, or procedures, most students stay in school after visits (Figure 2). Students who are overdue for well visits (10-20 yearly) are scheduled with their PCP.

Discussion

This project highlights successful collaboration between a pediatric resident, school nurse, and the community to establish a SBHC. Multiple factors contributed to initial success, including a strong school nurse advocate who contributes in-kind planning time and effectively recruits patients, a collaborative local culture that facilitates partnerships between stakeholders in the health and education sectors, and access to initial grant funding.
The SBHC is now sustainable: it is financially viable without further grants; leadership is transitioning to a first-year resident; and data demonstrates an ongoing need for the SBHC. Next steps include increasing patient recruitment and adolescent outreach, engaging stakeholders to adapt operations to the COVID-19 pandemic, and gathering data on SBHC impact on health and educational outcomes. We hope this work inspires trainees and school staff to promote school health within their communities.