School districts across the country are partnering with local health systems and telehealth companies to give students access to primary and chronic care services, along with much-needed behavioral and mental health services.
Healthcare has become a vital resource in schools, alongside the familiar staples of reading, writing, and arithmetic. But schools are moving beyond delivering care through a school nurse or staff member with rudimentary medical training. They're using telehealth and digital health tools to give students and staff on-demand access to healthcare providers, offering everything from primary care to chronic care management and behavioral health services.
Providing telehealth to a school or school district can be complex, often because of the costs involved. Schools don't have a lot of money to spend on healthcare, so they rely on grants, federal and state appropriations, or partnerships with local health systems or telehealth companies.
The benefits are numerous. Access to telehealth in the school can reduce both staff and student absenteeism, improve morale and even boost test scores, while also improving clinical outcomes. In many rural and underserved communities, a school's telehealth program may be the only care provider-for students whose families can't afford or travel to any other healthcare services.
In South Dakota, Avel eCare, a telehealth company spun off from Avera Health, is providing virtual care services to students living with Type 1 diabetes in roughly 100 schools in several states. The program was launched as a demonstration project by Avera Health, the Juvenile Diabetes Research Foundation, and the Helmsley Charitable Trust.
Sheila Freed, RN, BSN, NCSN, Avel eCare's school health director and a nurse with some 20 years of experience, says many rural schools don't have a nurse on hand, don't have the money to hire one and wouldn't be able to find one even if they had the funding.
"There's a huge gap there that someone has to fill," she says. "Some nurses are driving from school to school, maybe 60 to 100 miles a day, and they're spending more time behind a windshield than with a student."
Providing the technology for a virtual visit isn't that complicated. A small room is needed for privacy, and many programs use a PC or laptop to establish an audio-visual connection with a care provider. The Avel eCare program uses a telemedicine device developed by Tyto Care to capture vital signs and other biometrics during the virtual visit.
Freed says the Avel eCare program operates as a hub-and-spoke telemedicine network, with the care provider at one location offering services to a number of schools. The program will train someone at each school on how to use the technology.
"We set up the whole program so that teachers can relax," she says.
That idea extends beyond teachers. With a telehealth program in place, Freed says, providers can not only boost care management for students, but be a resource for school staff and even the student's family, helping everyone within the child's orbit to improve their understanding of diabetes and how to help someone living with the chronic condition.
"Type 1 diabetes doesn't end when the school day is over," she says.
And while the program was set up to focus on students living with diabetes, Freed says they'll treat a variety of health issues. One of the long-term goals of the demonstration project, she says, is to prove the feasibility of a telehealth program for addressing almost any health issue in rural and remote schools where access to care is limited.
Avera Health, the sprawling, 300+ site health system based in South Dakota, is supporting the project through its research branch. As of late last year, the program included schools in the Dakotas, Minnesota, Montana, Nebraska, and even Maine, where Avel eCare providers had to learn about the brown-tail moth rash and tick-borne illnesses to treat students, with other states showing interest as well.
"Health systems should pay more attention to these programs," Freed says. "It's a wonderful match for value-based care. Sometimes there's a bit of a disconnect between school system and local health systems, and these programs can bridge that gap."
While some school districts are partnering with health systems for school-based telehealth programs, others turn to telehealth companies like Hazel Health, a San Francisco-based organization launched in 2015 and now working with thousands of schools across the country.
In Los Angeles, city and state organizations are using telehealth to address the dire need for access to behavioral health services in schools. According to the California Master Plan for Kids' Public Health, more than 284,000 school-aged children are dealing with major depression, and two-thirds aren't receiving treatment.
The Los Angeles County Office of Education, partnering with the LA Care Health Plan, Health Net, and the Los Angeles County Department of Mental Health to make free telemental health services available to more than 1.3 million students in kindergarten through grade 12. With $24 million in funding from the health plans and the Department of Health Care Services' Student Behavioral Health Incentive Program, for the next two years, the partnership has contracted with Hazel Health, which expanded its platform to include telemental health services in 2021.
"We continue to see the devastating impact the pandemic has had on our children's mental well-being. This crisis has called us to collective action," Los Angeles County Superintendent of Schools Debra Duardo said in a Los Angeles Daily News story earlier this week. "As a mental health professional, I am keenly aware that partnerships and collaboration across sectors are necessary to meet our children's needs. We must remove barriers to access and continue our efforts to destigmatize help-seeking around mental health. We must also recognize that physical and mental health is crucial to teaching and learning."
Much of the need for behavioral and mental health services has been driven by the pandemic, which disrupted school-based programs and cut off students from familiar healthcare resources. The Centers for Disease Control and Prevention says more than a third of high school students reported mental health issues in 2022, and according to a School Pulse Panel survey used by the US Department of Education's National Center for Education Studies, more than two-thirds of the nation's schools have increased access to mental health services to address that problem.
“I think people should always ask for help,” SaRiya Parker, an 8th-grade student at Benjamin O. Davis Middle School in Compton, told the Los Angeles Daily News. “If you’re suffering in silence it’s like that drowning feeling when you get in the water and can’t get out. Coming to a school psychologist for help is a good way to get out of the water.”
“There's a huge gap there that someone has to fill. Some nurses are driving from school to school, maybe 60 to 100 miles a day, and they're spending more time behind a windshield than with a student.”
— Sheila Freed, RN, BSN, NCSN, school health director, Avel eCare.
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.
Many schools across the country lack adequate access to healthcare services for their students, often relying on a school nurse, a district nurse who covers several schools, or staff members with special training.
To improve access to care for both students and staff, school districts are partnering with local health systems and telehealth providers on programs that enable virtual access to care providers througn a telemedicine portal.
Many schools are using these resources to address a surge in behavioral and mental health problems brought on by the pandemic.