Interprofessional Practice at the Vine School Health Center: A School-Based Nurse-Managed Clinic
Background & Goal
Many school-age children lack access to quality health care and other essential services to meet their needs and support their physical, mental, and behavioral health. Dr. Nan Gaylord, PhD, RN, CPNP-PC, PMHS, FAANP, FAAN, has been providing comprehensive care to the children of Knox County, TN since 1995 through her innovative model, Interprofessional Practice at the Vine School Health Center: A School-Based Nurse-Managed Clinic. The Vine School is the physical site of the Vine School Health Center (VSHC), a Title 1 school where 100% of the students qualify for free lunch and, according to the 2010 census, the median household income for the zip code is $9,721. Locating the health center within the school ensures this vulnerable population is provided convenient access to quality care and follow-up visits. In addition to providing care for the students attending the Vine School, VSHC also provides care to anyone from 0 to 21 years of age who will be, or is, a student in the county. There are ten additional schools served by the Vine School Health Center, through either direct health care or telehealth services, and all of these schools are Title 1 schools with at least 75% of the students qualifying for free lunch.
When the VSHC opened in 1995, its primary focus was providing quality primary physical healthcare by APRNs, nurses, and student nurses within the school facility. In 2011, recognizing that many of its students had unmet social, academic, and mental health care needs, the VSHC expanded to an interprofessional practice to meet these needs through a three year Nurse Education, Practice, Quality and Retention (NEPQR) Program grant. The expansion of services also enabled the center to assist families with issues including food resources, housing, clothing, insurance, financial support for rent and utilities, as well as individual and family therapy. The VSHC also expanded its delivery method to include telehealth services to ten additional schools in Knox County with a HRSA School-Based Health Center Capital Program. With only 7% of the 2315 school-based health centers in the country utilizing telehealth, the VSHC became a model of innovation for healthcare solutions through nurse-designed and nurse-managed care. In addition to the availability of telehealth services on weekdays between 8:00 a.m. and 4:30 p.m., a nurse practitioner is on-site at each of the schools at least ½ day/week to provide Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) exams and follow-up on telehealth visits.
Evidence of Success
During a three month period in the 2016-2017 academic year, a total of 130 patient satisfaction surveys on the VSHC services were collected with an overall care rating score of 4.67 out of 5. In these surveys, 77% of the patients reported that VSHC was their primary care provider. Of the 33 parents utilizing VSHC’s telehealthcare services in April of 2016, 100% reported being satisfied with the care received. Similarly, the 75 patients in ongoing mental health therapy in 2016/2017 reported a patient satisfaction rating of 4.9 out of 5. In addition to the quality of care provided by VSHC, the increased access to care is evidenced by the 1110 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) exams, 1896 immunizations, 4455 physical health visits, and 1796 mental health clinic visits within the 2016/2017 academic year. With acute care concerns (typically 2500 plus an academic year) frequently addressed with a visit to the emergency room for $300 more than the standard cost of care at VSHC for the same diagnosis, the health care system realizes a cost savings of $375,000 if even half of these 2500 patients receive care at VSHC instead of the emergency room. In the April 2016 survey completed by the 33 VSHC telehealth patients, 28.5 percent of the parents reported they would have taken their child to the emergency room for care had the VSHC telehealth service not been available – equating to a savings of $1800 for just that one month in April