students

Rural areas are not the only places for which health care access is a challenge.

In urban areas like Wilmington, North Carolina, access is also an issue, especially for teens and young adults in underserved populations who face barriers like transportation, location, and insurance coverage. Jill Boesel, the Development and Outcomes Director at WHAT, or Wilmington Health Access for Teens, has been a part of closing the gap and bringing health care closer to where teens and young adults are.

WHAT is a community-based nonprofit health care organization that focuses on improving health care access and integrated care for adolescents and young adults between the ages of 11 and 24 in the Wilmington area.

WHAT opened its first school-based health center in 1999 and currently runs centers in three of the four local public high schools in Wilmington. The centers are located on the high school campus, open to students as walk-ins or by appointment. The centers are staffed with multidisciplinary teams that include a primary provider, mental health counselor, and registered dietician at each site.

School-based health centers have several advantages from their location. In addition to overcoming the barriers mentioned above (transportation, geography and insurance coverage), WHAT minimize lost class time for students, as students are able to simply walk down the hall to their appointment. WHAT also minimizes lost work time for parents. Parental participation in appointments is strongly encouraged, but rather than a parent having to pick their child up, take them to the doctor and back to school, parents can simply come to the school for the appointment and then return to work.

In addition to offering health care services to students in the form of one-on-one appointments, WHAT also provides the entire school with ongoing education about the health care needs of students, and WHAT providers work closely with school counselors, social workers, faculty and administration to improve the overall health of students.

Along with the school-based clinics, WHAT also runs a centrally located facility that offers adolescents and young adults, ages 11-24, access to primary care, mental health, nutrition and prevention services. Three-quarters of the population served by WHAT clinics are either publicly insured or uninsured, which provides a fair share of challenges for the clinics, especially in the rapidly shifting health care environment in the country and in this state.

Jill Boesel came to the Wilmington area and to WHAT in 2007, and her primary role focuses on seeking and securing public and private grants and managing current grants. She is also a member of the organization’s leadership team, and believes that the key to her work is communicating very effectively the advantages of having a school-based health center situated conveniently on campus for students and parents.

“The most cherished aspect of my job is having the ongoing opportunity to develop relationships with so many incredibly talented, energetic and committed people—both within and outside of Wilmington—who are working relentlessly to pave the way for a better tomorrow here in North Carolina, despite the often seemingly insurmountable challenges we face in health care today,” Boesel says.

She points out that WHAT is focused on “whole person care”, where the traditionally separated areas of primary care, mental health care, nutrition, and other areas occur within a connected network. This enables the provider in each area to be aware of what is going on in other areas and proactive in connecting the dots when appropriate to give the patient the best overall care possible. By having different types of providers serving patients in a team-based approach in the same location, integrated care works naturally and improves the patient experience and outcome.

Boesel is a current Bernstein Fellow, and her project is very fitting with the true integrity of the Bernstein Fellowship program and the mission of Jim Bernstein: ensuring access to health care for the populations that are most vulnerable in our state. She is exploring how WHAT as an organization can improve the use of data for population health and patient engagement, within the context of an integrated school-based healthcare setting.

Boesel says: “My fellowship has afforded me the unique opportunity to connect with others doing similar work throughout other regions of the state, including my “fellow Fellows” and many others.”

Most students in North Carolina have just started another year of school, another year of learning with teachers, friends, homeroom, and physical education classes.

For students in rural areas, good healthcare is not always easy to access. Many parents work full-time, and it can take up to an hour (or, in some places, longer) to get to the nearest hospital or doctor’s office. This often makes finding the time to take your kids to the doctor, for a routine check-up or a seemingly small health issue, so difficult for parents that many don’t do it. Consequently, many students don’t receive medical attention they might need.

That’s why school-based telemedicine programs – where students have videoconference appointments from right inside their school building with doctors who are in other locations – are spreading across the country and showing successful outcomes. One such program is right here in the western part of North Carolina.

MY Health-e-Schools is a program started in 2011 by Dr. Steve North, a family physician who saw the need for better healthcare access for students in Mitchell and Yancey counties in western North Carolina.

How does a telemedicine program like MY Health-e-Schools work? At the beginning of each year parents can sign consent forms enrolling students in MY Health-e-Schools, which allows students to be seen during the school day by remotely located nurse practitioners or physicians. Parents or teachers can refer students, or the students themselves can make an appointment to be seen for anything from a cold to potential symptoms of ADHD.

Many things can be done at that appointment, which is conducted via high-definition videoconferencing using specially equipped stethoscopes and cameras. This allows a centrally located health-care provider to examine students at multiple schools without traveling, and therefore allowing more students to be seen across a large area. When more complex processes like lab work or further tests are needed, the provider refers the student to the closest hospital or specialist.

MY Health-e-Schools providers can address issues ranging from the common earache, stomachache or cold, to chronic disease management, medication management, check-ups, sports physicals, adolescent medicine, and even telepsychology and tele-behavioral health.

North first became interested in school-based health systems while working for Teach For America in Edgecombe county before attending medical school at UNC-Chapel Hill. Steve then moved to Rochester, NY for his residency and a fellowship in adolescent medicine, during which time he learned from the school-based health centers there.

North relocated back to North Carolina in 2006, and in 2007 became a Bernstein Fellow. During this time, he continued researching and seeking to better understand telemedicine systems and began developing the idea of a school-based telemedicine program in western North Carolina. He received initial grant funding from the Kate B. Reynolds Foundation and the Community Foundation of Western NC, and several other sources that matched funds in the following years.

With these funds, a pilot program was begun in 2011, serving three schools in Mitchell and Yancey counties. By the second year, the program was expanded to 10 schools in the two counties and, by the third year, to 14 schools, which meant that all the schools in the two counties without their own health center had access to a primary care provider through MY Health-e-Schools.

This year MY Health-e-Schools is expanding into schools in McDowell County, and the program now allows over 8,000 students in 21 schools in the three counties to have access to trained medical providers during the school day without leaving their school building.

MY Health-e-Schools also recently received the 2014 American Telemedicine Association’s President’s Award for Health Delivery Quality and Innovation, showing that, even in only its 4th year of operation, the program is still growing and has the opportunity ahead to better health-care access for rural communities in North Carolina.

In the meantime, MY Health-e-Schools is working to improve health care in the community, one student at a time. North talks about the program’s impact with stories, including one of an eight-year-old student with high blood pressure who was seen at an appointment through the program. During the appointment the provider referred him to his primary care physician and to get labs done, during which time they discovered that the student had post-streptococcal glomerulonephritis (GN), a kidney disorder that can occur after a routine strep infection. Without the initial appointment with the MY Health-e-Schools provider, the disorder might have gone undetected for much longer and become much more severe.

North attributes the success of MY Health-e-Schools to being able to do a lot without a lot of resources, with tremendous community support.

MY Health-e-Schools is now the largest program part of North’s nonprofit organization, the Center for Rural Health Innovation. For more information on MY Health-e-Schools, visit their website.

Special Note: The N.C. Foundation for Advanced Health Programs is pleased to announce Dr. Steve North will be joining its Board of Directors in 2015.

Bernstein Fellow Spotlight: Jill Boesel Works with Wilmington Health Access for Teens