Establishing A School-Based Health Center For An Underserved Community In Vermont: Collaboration Between Pediatric Residents, School Nurse, And The Community.

Abstract

Program Goals School-Based Health Centers (SBHCs) provide a cost-effective way to reduce healthcaredisparities of underserved populations (AmJPrevMed,2016), and provide a way to advocate for children'shealth, an essential skill for pediatricians to learn This advocacy project, led by a pediatric resident and aschool nurse, established a SBHC in Winooski, VT, a town with a diverse underserved population of 7500 TheWinooski School District serves 691 elementary through high school students, who speak 18 languages, and98% 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 toaddress these barriers, modeled after similar nearby SBHCs To establish the SBHC, the resident and nurseassembled a multidisciplinary team, recruited physicians, secured grants, and engaged leaders from theschool, 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, andpromote student wellness Evaluation Now in its third year, the SBHC is open twice weekly, staffed by apediatrician or physician's assistant Services include acute visits, follow-ups, chronic and behavioral conditionmanagement, and basic laboratory tests and procedures Students are referred to PCPs for well care, and acoordinator assists with data collection and PCP communication A community advisory council informs SBHCoperations To fund services, the school donates space, providers bill for services, healthcare organizationsdonate 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 acutecomplaints (70-77%) Although 41-50% of visits result in prescriptions, labs, imaging, or procedures, moststudents stay in school after visits (Figure 2) Students who are overdue for well visits (10-20 yearly) arescheduled with their PCP Discussion This project highlights successful collaboration between a pediatricresident, 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 recruitspatients, a collaborative local culture that facilitates partnerships between stakeholders in the health andeducation sectors, and access to initial grant funding The SBHC is now sustainable: it is nancially viable without further grants;leadership is transitioning to a rst-year resident;and data demonstrates an ongoingneed for the SBHC Next steps include increasing patient recruitment and adolescent outreach, engagingstakeholders 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