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Progressnotes Year in Review: 2015

School-based telehealth
Telepresenter Lynn Floyd (left) assists school nurses such as Jamie Webb (right, back) of Kingstree High School with telehealth sessions and case management.

Changing Young Lives

Nurse practitioner Kelli Garber MSN, APRN, PPCNP-BC, vividly remembers her first telehealth patient from Williamsburg County—a young girl with asthma who had begun to sit out recess, fearing a bout of wheezing, and who was always sleepy in class. Further investigation revealed that the girl’s physician had moved away and her medications were running out. Once Garber prescribed the needed medications, the girl’s condition began to improve, and she now sleeps through the night and plays at recess. “You have changed her life,” the girl’s grandmother told Garber. “We didn’t know she could be this healthy.” 

Many parents in impoverished, predominantly African American Williamsburg County work minimum-wage jobs in Myrtle Beach, boarding a bus each day for the commute to work. Taking a sick child to the physician requires a day off work, which most parents cannot afford. There is no guarantee that a provider will be available given the shortage of primary care physicians in this rural county. Poor health translates to chronic absenteeism and a higher dropout rate. The vicious cycle repeats for another generation—poverty prevents proper health care, and poor health hampers students from graduating and breaking free of. poverty. 

Disrupting that cycle by empowering school nurses is the mission of the MUSC Center for Telehealth’s school-based telehealth program. “The school nurse knows all the families, the children, the needs,” says Garber. “Access to a provider through telehealth enables them to provide that next level of care. Without that access, they can recommend but barriers may keep families from following through.” 

“We need to put the care where the child is and that’s the school,” says Lynn Floyd, BSN, RN, CRRN, who was hired in 2015 as a telepresenter for the program after working more than 15 years as a school nurse in Williamsburg County. “I have witnessed that it helps kids get back to school quicker.” 

The school-based telehealth program was begun four years ago as a pilot study by MUSC Children’s Hospital pediatrician James T. McElligott, M.D., now Medical Director for Telehealth. Today, with the school district’s support, the program is in every school in Williamsburg County. Over the next 3 years, the program plans to expand to more schools in Sumter and Bamberg Counties and to add more schools along the I-95 corridor and potentially other sites across the state. The program places special emphasis on the care of asthma and trauma-related mental health issues, both of which have been implicated in poor graduation rates. 

Before telehealth, if a child with asthma experienced an exacerbation at school, the nurse had little choice but to send him or her home or to an emergency department. Garber and Floyd are developing a new asthma initiative to offer nurses more choices. Enrolled students will be given any needed prescriptions for controller and rescue medications. When they experience an episode of asthma, the school nurse or telepresenter will administer the medication and they can go back to class. For children or parents requiring more training on asthma management, Anita B. Shuler, RRT, AE-C, and Aimee Tripp Tiller, RN, A-EC, of MUSC Children’s Hospital will offer educational sessions. 

Michael A. de Arellano, Ph.D., Professor in the Department of Psychiatry and Behavioral Sciences, is directing the efforts to establish telemental health programs at selected schools and to adapt evidence-based protocols for the management of mental health in pediatric populations to a telehealth format. Regan Stewart, Ph.D., oversees the provision of services, with the support of Garber and school-based telehealth program manager Elana Wells, MPH. Telehealth is being used both to triage patients in need of mental health services and to conduct therapy. The telemental health program will be rolled out at D.P. Cooper Charter School in 2016. 

For more information, contact school-based telehealth program manager Elana Wells at navon@musc.edu.