01-13 Letcher County clinics

01-13 Letcher County clinics

Kentucky School Advocate

Kentucky School Advocate

Hands-on approach
Letcher County schools serve as health clinics

By Madelynn Coldiron
Staff Writer

The bug that had given Spanish teacher Brenda Quillen laryngitis the week before was now settling into her lungs. But rather than miss all or part of a day’s work to go to the doctor, she popped into the health clinic at Letcher County Central High, where she teaches.
“I’ve been fighting this for a week,” she said. Having the clinic at school “is really handy, and I’ve known Larissa since she was a little girl.”

PHOTO: Sixth-grader Caleb Cook gets his physical examination to play on Whitesburg Middle School basketball team from physician assistant Matt Holbrook.

Nurse practitioner Larissa Bailey staffs the clinic on a rotating basis with physician assistant Matt Holbrook – both are Letcher County natives and graduates of the school district. Holbrook is an employee and Bailey a contractor for Mountain Comprehensive Health Corp., which operates clinics in each of the system’s 10 schools.
Holbrook, meanwhile, was having a typical time at West Whitesburg Elementary, where in less than an hour, he had seen a student who complained of blurry vision, one with a stomachache, another whose arm hurt where she had received a shot and two boys there for their basketball team physical.

“Our main goal is we wanted to be able to take care of kids at school,” said Dr. Van Breeding, director of clinical affairs for Mountain Comprehensive Health Corp. Under the unique arrangement, each school is considered a Mountain Comp clinic site. He said the clinics, which opened at the start of this school year, see a total of about 500 patients per month.

“It has been one of the best things we’ve ever done,” Letcher County Schools Superintendent Anna Craft said.

The clinics cost the school district nothing, except for having to provide the space in each school. The company is paid through Medicaid, private insurance or directly from the patient on a sliding scale based on income.  Mountain Comp, as a federally qualified health center, receives federal funding for treating indigent patients.

The arrangement also encompasses the school district’s own two nurses, who work mainly at the high school, and local health department nurses who work in the elementary and middle schools. The nurses provide an informal triage system at the clinics, deciding which cases they can handle and which need to be seen by Holbrook or Bailey. The health department and the health care company also kicked in some of their own grant money to help equip the clinics.

The idea for the school clinics came from Holbrook, who worked in Mountain Comp’s pediatrics department and was getting more and more phone calls from school nurses asking for help – a prescription, for example, for the children they were seeing in school.

“I wanted to take the burden off the parents,” Holbrook said. “I wanted to give the convenience to the parents of having care here instead of having to go sit in the clinic all day long.”

Robbie Delph, whose son, Jordan, saw Bailey at the high school clinic, said the service goes beyond convenience.

“For one, he’s not going to have to miss as much school. And also that way we know he’s getting the care he needs right when he needs it,” he said.

“A lot of these children we’re getting to see in these school-based clinics would not have access to care otherwise,” Bailey said. Their parents may lack insurance, money, transportation or all of the above.
Parents with jobs don’t have to miss work to take their kids to the doctor, and children and staff don’t have to miss school for the same reason. They can go to their school clinic and any medicine Bailey or Holbrook prescribe can be picked up later. Craft said student attendance in the first months of school was up nearly a full point from the same period a year ago, and staff attendance similarly rose. Improved attendance benefits students academically and benefits the district financially, said school board Chairman Will Smith.

“It’s a win-win-win for everybody and a big win for our attendance – it keeps the kids in school and the money flowing,” he said.

Letcher County Central High School Principal Stephen Boggs said his school had the highest regional attendance for its size in the High Attendance Day competition in September – which he attributes to the clinics.

“That was a shock,” he said. “We have had much improved attendance and I would imagine we have much healthier children.”

From a medical standpoint, contagious diseases can be diagnosed early, checking the spread. “This has really opened the door for those kids to be seen earlier in their illness so they’re not sick for three or four days before they’re treated – they’re being treated the first day of their illness,” Breeding said.

Clinic staff also can recognize more easily and earlier when a virus is spreading, he added, “and get those kids home and out of the general population so it doesn’t spread to all the other students.”

Once the federal and state approvals were given for the clinics, school officials faced a different kind of paperwork: the lengthy permission forms parents had to sign to allow their children to be treated at school.

Family resource centers held open houses for staff to help parents with the forms and even visited homes of families who had not turned them in, Craft said. Holbrook said the district is working on condensing the forms.

The actual medical records generated at the clinics remain on Mountain Comp’s computer system; no health records are kept at the schools.

After just weeks of operation, the high school’s clinic in a school office was deemed too small for the traffic and a waiting area and three-bed clinic were created from a former home economics space. “It’s nicer than most of the ERs in central Kentucky,” Breeding said.

Future expansions?
Expansion may not stop there. Craft and Holbrook would like to provide care for parents, perhaps for a few hours in the evenings on designated days since, under normal circumstances, care cannot be provided during school hours. 

The health care company is hiring another nurse practitioner, which Holbrook said will provide more continuity and coverage and address the demand.

“We’ve been busy from day one,” he said. “The only complaint we’ve had is parents say, ‘I want you to be at my school more often.’” Many parents have accepted the system so well that they will call or send notes asking that the school clinics see their child.

“A lot of what we see are parent requests,” Bailey said.
Craft also would like to see an arrangement whereby children could receive mental health services beyond what is now offered. Some school counselor positions have been eliminated for financial reasons but the need is greater than ever, she said.

Mountain Comp, meanwhile, is talking with other interested school districts in the area it serves.

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