‘A real medical home’: Howard County expands school welfare centers to reach underserved and uninsured students

Doctor visits can be time-consuming for students, taking them away from the classroom for hours while they sit in traffic and waiting rooms. But at some Howard County public schools, a pediatrician is just a click away.

At the county’s 11 School Wellness Centers, students can receive on-site physical exams, screenings and, at eight of the locations, connect remotely with a local provider through a telemedicine appointment.

Using specialized electronic instruments at the centers, school nurses give pediatricians a look inside students’ ears, throats and noses to diagnose illness and prescribe treatment. Parents can even be connected to visits via a secure video link.

“I would say well over half of the [telemedicine] visits are easily treatable and the child can stay in school,” said Dr. R. Scott Strahlman, pediatrician at Columbia Medical Practice, which administers telehealth visits at no cost to students and their families. “The parent doesn’t have to leave home or work, the child doesn’t have to leave school, and proper medical care is provided.”

In addition to reducing missed class time, School Wellness Centers, which operate in partnership with the Howard County Health Department, aim to provide a medical home for uninsured students.

Last month, HCHD announced the expansion of services at School Wellness Centers with an $815,000 grant from the Maryland Department of Health, in an effort to further realize this mission. The county health department is using the funds to hire two new nurse practitioners and additional staff to bring on-site health care to the eight centers that previously offered telemedicine-only services.

With the expanded services, the more than 3,200 students enrolled in the centers will have access to comprehensive health care and chronic disease management to address issues ranging from ADHD to obesity.

“I think every child in Howard County should have the right to receive health care at school,” said Sharon Hobson, program administrator for the Howard Department of Health. “Whether or not they are insured, every child should be able to receive the health care they need in school to stay in class and learn.”

County and school officials hope the wellness centers will help address health care disparities in the HCPSS, where nearly a quarter of students are currently enrolled in the free lunch program and at discounted price.

“The original goal of this program was to reach the uninsured or underinsured populations in our schools,” said Kerrie Wagaman, director of health services for the county public schools. “We wanted to reach these families, thinking that the FARM rate would correlate with being uninsured, underinsured, or financially challenged in some way.”

The first five telemedicine-only sites launched in 2014 in Title I elementary schools, where at least 40% of students receive free or reduced-price meals. The virtual school-based program was the first of its kind in Maryland.

Hobson says the wellness centers came at a critical time because the health department saw a growing number of undocumented immigrant families whose uninsured children needed health services. The county’s only federally licensed health center in Chase Brexton in Colombia was overwhelmed with caseloads and children were missing school.

“[These students] come with a lot of needs and they are already behind academically,” Hobson explained. “In many cases, some don’t speak English. These children especially need to be in school and to learn.

With the help of a small grant from Howard County General Hospital, the health department contracted Strahlman’s Columbia medical practice to perform the free school-based telemedicine visits for uninsured students. No visit is charged unless the student sees their own private provider via the telemedicine platform.

“We provide these tours as a free public service to keep kids in school and to keep them healthy,” Strahlman said.

Although he has practiced medicine in the county since 1985, Strahlman says he was unaware of the extent of health care disparities among the student population until he began his partnership of telemedicine with the school system.

“I never really knew until I went to this program that there was this population of students who didn’t speak English, and their parents didn’t speak English and they didn’t have medical insurance,” said said Strahlman, whose fluency in Spanish allows him to connect with ESL families for visits. “Thanks to this, we are able to provide these students with a real medical home.”

With new funding from MDH, students at 11 School-Based Wellness Centers can receive acute care management, either through a nurse practitioner or through telemedicine services when a provider is out. site. These services have proven particularly helpful in addressing health care gaps in the wake of the pandemic, according to Wagaman.

“Nobody wanted to leave the house, nobody wanted to go to the doctor where the sick are,” she said. “We had a lot of catching up to do over the last year when schools reopened to get students vaccinated, to get students treated, to get students to do their physicals.”

While Bollman Bridge Elementary School and Patuxent Valley Middle School administered a total of nearly 600 on-site vaccinations of all types last year, the other wellness centers are still awaiting approval from the Maryland Vaccines for Children program to provide vaccines to students, according to Wagaman.

In addition to catching up, officials say the expanded wellness centers will help catch and manage chronic illnesses early, while enabling more regular care for students from all walks of life.

“The potential is there for these telemedicine visits to improve the quality of care for various chronic conditions,” Strahlman said, adding that the technology allows her to see how medications are affecting a child in real time during the school day. “We can track obesity, we can track mental health issues, we can track asthma without taking the child out of school.”

Hobson makes sure inhalers are included in centers’ budgets because the devices can stave off serious asthma attacks and spare uninsured families a costly trip to the emergency room.

Despite the challenges of the pandemic, she hopes school centers will prevent more students from slipping through cracks in coverage and hopes to see the model replicated across the country.

“It’s the perfect way to help kids because we’re there for them when they’re in school,” Hobson said. “Collaboration between local health departments and school systems is the best model for the needs of children, whether you have insurance or not.”