IRHA Program Spotlight: Indiana Rural Schools Clinic Network
by Luke Wortley
Welcome to the first installment in a series of posts that will highlight some of the various programs that help to support rural citizens across the state of Indiana. The goal behind these posts is to explore and share the story of how these programs came to be, what needs we’re trying to address, and how they align with the mission of the IRHA.
For this inaugural post in the series, we’ll be taking a look at the Indiana Rural Schools Clinic Network (IRSCN – pronounced “ER-SKIN”).
At a glance:
- Mission: Improve the health and well-being of rural Indiana residents, particularly children 18 years and younger by developing a rural school-based clinic network by providing access to primary care school health clinics in rural Indiana and increasing rural access to telehealth services.
- Purpose: To provide access to primary and behavioral care school-based health clinics in rural Indiana and increase rural access to telehealth services.
- Membership: 15 schools in various stages of implementation across the state. To apply, click here.
A Brief History
The initial impetus behind developing a program for school health bubbled to the surface during a series of strategic planning meetings conducted in 2015. The IRHA at that point had been awarded a Network Planning Grant from the Health Resources and Services Administration (HRSA), which allowed an entire year to build infrastructure, conduct needs assessments, and foster collaborative partnerships. Eventually the project came to rest on two main pillars: 1) implementation of telehealth (more on that in a second) equipment and training, and 2) building relationships locally among community members.
This year of planning quickly turned to the first steps of creating a formal network in four school systems due to funding from a Rural Health Network Development Grant: Elwood Schools, Southwestern Jefferson, Crothersville, and Scott County District 1. Each school system had its own unique set of demographics and challenges, as well as its own interdisciplinary coalition of healthcare providers, school administrators, managed care entities, and IT providers. The first school-based telehealth clinic launched at Elwood Intermediate School in September 2016. The other three school systems in Southern Indiana launched at the beginning of the second semester, in January 2017 with plans to add more during the 2017-2018 academic year.
What Is Telehealth, and How Does It Work?
Telehealth is the use of technology to deliver healthcare, health information, or health education at a distance. By using high-definition, secure videoconferencing software, a school nurse can communicate with a licensed physician or other healthcare provider to examine, diagnose, and recommend treatment for a student on-site as though they were in the doctor’s office. Think of it like a virtual checkup without a parent having to take a half day to take their child across county lines to the nearest clinic or potentially queue up at the end of a forever-long waiting list for a routine diagnosis.
Telehealth equipment includes a full exam camera, telemedicine-enabled stethoscopes and otoscopes, and videoconference software. The provider examines the patient through high-definition visual and audio equipment with the assistance of the school nurse/personnel and is able to identify a treatment plan and prescribe medication if needed. Parental consent must be obtained beforehand, and parents/guardians are always invited to participate in the appointment if available. Follow-up notes are sent to the child’s primary care provider for their records and further coordination of care. Fees are billed directly to insurance providers (consent form must be on file), similar to how services would be billed in a doctor’s office.
Why Does All This Matter?
Any cursory glance at the first page of results on Google will yield dire headlines concerning the physician shortage throughout Indiana, and indeed, the nation. Nearly one-third of Indiana counties are designated as Health Professional Shortage Areas (HPSAs) for Primary Care, and rural counties are disproportionately impacted by these shortages. A map provided by the Indiana State Department of Health highlighting these counties can be found here. While this phenomenon is not unique to Indiana, the problem is very real and complex, and it has potentially disastrous impacts on families throughout the rural school systems in our state.
I had a brief chat with Program Director, Hayley Ready, and she agrees that the single biggest need for students is access to quality care. Without adequate physician coverage in a given community, having a telehealth clinic that can connect a student remotely to an available provider is one of the most tangible impacts IRSCN can have on a child’s health and indeed the health of a community. But, of course, just having the ability to use telehealth equipment isn’t a panacea; you still have to build trust and put in the work to build the relationships necessary to keep that avenue of healthcare delivery open and reachable.
Hayley went on to say, “IRSCN helps strengthen the school system and the surrounding community by encouraging partnerships. By connecting local providers to the students in the school, providers are able to meet patients where they are, and students are able to receive convenient, quality care. Providing access to healthcare at the school also provides another opportunity for schools to serve families and build deeper relationships with those in the community.” Indeed, one of the truly remarkable benefits of IRSCN in these communities has been connecting families to local resources outside of just the school-based telehealth clinic. For instance, in several communities, families who were unaware of how to enroll into insurance plans are now covered thanks to IRSCN partners.
What’s the Future of IRSCN?
Later on in my conversation with Hayley, I asked her what the future might look like for programs like IRSCN. She’s presented at several major conference across the nation, and the program has been embraced with wild enthusiasm, especially given the implications for potentially offering behavioral health consultations in HPSAs for Mental Health Providers – yet another sore spot for health-conscious Hoosiers, as Indiana ranks 48th overall in mental health services per Mental Health America.
Several new school systems are slated to be launched next academic year, and according to Hayley, “I think that we will continue to see telehealth expand across the state and nation whether at schools, hospitals, or even from home. I think programs like IRSCN which can help alleviate the cost burden are wonderful for schools and hospitals on the forefront of the expansion. IRSCN members also have the benefit of sharing experiences with other members across the state to learn best practices and lessons learned.”
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