Avera - Student Health Center

Overview

Avera, the health ministry of the Benedictine and Presentation Sisters, is a regional partnership of health professionals who share support services to maintain health care at more than 231 locations in eastern South Dakota and surrounding states. Avera has five regional centers: Avera St. Luke’s in Aberdeen, S.D.; Avera Queen of Peace in Mitchell, S.D.; Avera McKennan in Sioux Falls, S.D.; Avera Sacred Heart in Yankton, S.D.; and Avera Marshall in Marshall, Minn.

Until recently, South Dakota was one of only five states in the nation without school-based health centers. With a grant from the federal government, Avera established the first high school-level student health center in South Dakota. This two-year pilot program seeks to reduce emergency department (ED) utilization for non-emergent conditions by providing basic care at the school, and detecting and referring more difficult situations to primary care providers. The program was launched in fall 2008 at Washington High School, which has a student population of 2,175, a staff that is receptive to the project and space easily adapted for the service.

Washington High School was selected based on student population and health factors. A high percentage of its students are eligible for free or reduced meals — an indicator of possible health needs as a result of nutritional deficiencies and low economic status. In addition, there are 30 students with severe disabilities including physical, mental and learning disabilities. Further, 120 students are from 13 countries outside the United States and have the potential for wide disparities in health status, health needs and access to services. The student health center is open during school hours and is staffed by a certified nurse practitioner or physician assistant, under the supervision of Avera McGreevy Clinic.

Impact

In addition to measuring the program’s impact on ED use, the service will quantify reduction of absenteeism and parent time lost from work; impact on health education, nutrition, and dental and behavioral health; and management of chronic conditions such as diabetes and asthma.

By the beginning of April 2009, the student health center received nearly 400 visits. Early care provided at this time prevented the necessity of seven ED visits and 76 urgent-care visits. In addition, nearly 100 days of work were not missed by parents who would have had to take off work. Since the student health center opened in August 2008, it has also identified 17 students with new chronic illness and 13 students with no primary care provider.

Challenges/success factors

A short time period from grant notification until the beginning of the school year was a major challenge. However, the willingness of Washington High School, Avera McGreevy Clinic and Avera McKennan information technology to commit resources on short notice enabled the student health center to open and begin seeing students on the first day of the school year. Service delivery challenges for the student health center include the cultural diversity of the student population, the number of students with language challenges and the students with multiple disabilities. However, the availability of on-site health care enables the certified nurse practitioner to provide services and advocacy for students beyond the role of school nurses and keep the students in school. An ongoing challenge is the need for translator services, as a number of students needing care are classified as English Language Learner Immersion students.

Future direction/sustainability

Program leaders anticipate that the pilot program will be self-sustaining and thus continue after the two-year pilot. They are also looking into expanding the program to a second school. This will depend on the ability to use funds from the current grant, which may be feasible as third-party payers are making timely reimbursements.

Advice to others

Before implementing a program, you need at least a semester or other set period of time to work with the school, building relationships so everyone is working together. You also need to carefully plan the coordination of the student health center with the role of the school nurse. In addition to the important, pre-existing duties of the school nurse, close collaboration between the school nurse and the practitioner in the school health center is necessary to facilitate student access to the student health center. Finally, if possible, have a database created for statistical reporting. You can then collect any kind of data needed and show results. Having this data will also help with implementing future programming and obtaining future grants.

Contact: Deb Fischer-Clemens
Vice President, Avera Public Policy
Telephone: 605-322-4668
E-mail: deb.fischerclemens@avera.org