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Community health centers have to get creative to care for children during the pandemic's school closures
December 05, 2020
When Worcester Public Schools were closed this fall because
of the coronavirus pandemic, the health-minded decision not only kept students
out of the classroom – it also took away a key way for community health
providers to reach students easily while they’re already in school.
With schools closed in Worcester and many other communities,
the city’s two federally qualified health centers – Edward M. Kennedy Community
Health Center and the Family Health Center of Worcester – have been scrambling
to make sure they can still reach students in need in other ways. Kids who used
to pop into an office for a quick visit between classes, during gym or lunch,
or at other convenient times, now have to be reached in other ways.
“Access has always been the reason we’re there,” said Susana
Rodriguez, the Family Health Center’s school-based health centers director.
In many cases, the nurse practitioners or others who staff
such school-based centers have been spending much of the pandemic calling
students at home to either simply check in on how they’re doing or to set up
times to stop by clinics. In normal times, locations in schools are a major
part of both community health centers’ operations: Kennedy has six, including
five in Worcester and one in Framingham, and Family Health Center has eight,
including seven in Worcester and a dental program in Webster.
“We all have concerns that trusted adults who were in kids’
lives, either teachers or nurse practitioners, are not in those kids’ lives
anymore,” said Abigail Mathews, Kennedy's assistant medical director, who
oversees its school programs. “There’s no remote stand-in for that.”
Technological and other hurdles
Going remote for health care is easier in some specialties
than others.
Across health care – not only in pediatrics or school-based
centers – medical professionals have said talk therapy, for example, lends
itself well to telehealth, because a therapist can still see someone’s facial
expressions or hear their emotion without needing to be in the same room.
Specialists who would need to check vital signs or draw blood for a test have
had more difficulty.
The challenges are more complex for school-based health
centers, whose staff complement existing school nurses and can sometimes serve
as a student’s de facto primary care provider.
Schools provide the health centers with names and contact
information for children, but Worcester Public Schools has had challenges
ensuring enough students have computers and reliable internet access at home –
the same hurdles health providers can sometimes struggle with.
A phone call can be an easy way to get in touch, but
sometimes cell phones are shared between people, or numbers are changed often.
Students at home aren’t always the easiest to reach, especially if they’re
already working to balance school work and a day-to-day life without friends
and classmates they may still be getting used to.
Seeing students in person isn’t possible in school, and
because of virus concerns isn’t always advisable elsewhere either, leading to
fewer visits to the health centers’ main clinics and even fewer home visits. If
students have to make their way to a clinic, such as for a physical or vaccine,
they often have to rely on transportation from a parent or guardian, something that’s
not always a sure thing.
Health providers often screen for substance abuse or
behavioral health challenges, too. One question providers often ask is whether a
student is safe at home – a question more delicate if asked when the student is
at home, and one now made in the context of a student who is likely spending
far more time at home than normal.
“I’ll ask if they can talk privately,” Mathews said. “I
haven’t had a lot of pushback with that. I think everyone’s family is juggling
space. So it can be a matter of having a private space to have a conversation.”
That extra time at home can lead to potential depression and
anxiety for students who would normally look forward to seeing friends in
school or having after-school activities. The school-based centers have
traditionally been more often used by new immigrants, who might not have had a
chance to establish a relationship with a primary care doctor yet, leaving
already at-risk groups even more vulnerable.
“We’ve often been the first stop for kids who are new to
come into this country,” Mathews said.
Working in a new reality
When the pandemic forced schools to go remote in the spring,
staff at Kennedy and the Family Health Center began going through lists of
students to find when they last had a physical or vaccination, or who might
need particular outreach. Once Worcester Public Schools decided to do remote
learning this fall, health staff got updated enrollment lists and started going
through and marking which students needed to be contacted.
The Family Health Center has been working to keep going some
group activities, including one called Lunch Bunches, where students would
bring their lunch to smaller gatherings to chat about how to stay healthy and
have good nutritional habits. Today, those gatherings take place remotely, and
the conversations can revolve around what they miss doing because of the
pandemic or what they’re looking forward to most once it’s over.
Another initiative, the Positive Directions program for
students at risk of dropping out, has moved online with academic, social and
emotional support for students. The program typically includes a summer program
when students are about to enter high school, and continues intensively through
the school year. But regular meetings online have worked well, said Rodriguez,
the director of school programs for the Family Health Center.
For others, the Family Health Center has adjusted its hours
to allow for later afternoon and early evening hours for students to stop by
for check-ups or vaccines. Health providers who’d normally see students only at
their own school center are now available to work with students anywhere,
helping the center more quickly respond to students’ needs.
Providers and administrators at both community health
centers said those partnerships are vital – including with public school
systems, the Boys & Girls Club, the YMCA and others that may be seeing more
of students than they used to or playing a different role in their lives. At
Kennedy, a program normally providing menstrual products for girls at school
has instead been routed through a community partner, Girls Inc.
The Family Health Center might not be seen as so trustworthy
a partner if not for its relationship with school systems and primary care and
other medical offices, said Valerie Pietry, the center’s chief medical officer.
“That connection is so important,” Pietry said.
Courtney Pelley, Kennedy’s vice president for strategic
partnerships, said she’s been impressed by how well such partners have worked
more closely together during the pandemic to make sure kids’ needs are still
being met despite the health crisis.
“That’s one of the reasons I’m most proud to live in and
work in the city,” Pelley said. “It’s because it’s so collaborative.”
Grant Welker
Worcester Business Journal
2020 News