From providing mobile units that serve as practically full-service primary-care offices on wheels to staffing school nursing services, healthcare providers have for years worked with schools and districts in various ways to care for students.
Reaching children at school made sense. It offered easy access and helped providers check in with children where they consistently were.
Until the pandemic sent them home.
“How do we help families connect if one of the largest connection points is severed?” said Dr. Claudia Hoyen, director of infection control for UH Rainbow and co-director for University Hospitals. “And how do we make it easy for people to get in to see us?”
As partners for healthcare in schools, health systems had to find creative ways to continue reaching students where they could. They often stepped into an expert adviser role as schools figured out how best to implement federal and state safety protocols and work toward returning children to classrooms.
“Definitely, the pandemic threw a wrench in a lot of our plans for 2020,” said Dr. Roopa Thakur, a pediatrician and medical director of Cleveland Clinic Children’s school-based healthcare program.
More than ever, the past year has shown how health and education go hand in hand and provided an opportunity to deepen the relationships between the two fields, said Katie Davis, director of the Center for Health Outreach, Access and Prevention at MetroHealth’s Institute for H.O.P.E.
"The more that we partner together and support each other with bringing the health experts to the field and the education experts to the field, we really can impact the whole child and that community so that these students can be successful," she said. "I'm just hopeful that we continue to deepen the relationships that were already there that have gotten stronger this past year."
Among the more than 200 schools that Akron Children's Hospital partners with to provide school health programming, many have been operating in some sort of hybrid model, necessitating flexibility and adjustments to tailor services to the needs of different student populations, said Michele Wilmoth, director of school health at Akron Children's.
For some schools, the hospital worked to reach out to children with chronic illnesses to make sure they're managing their asthma or diabetes; at others, their work focused on contact tracing. The hospital led most of the schools' COVID screening processes. And in many cases, Akron Children's served as an expert partner to help schools come up with health and safety protocols that met government guidelines.
One of the biggest things to come out of COVID-19, Wilmoth said, is these close partnerships with school administrators as they worked together in ways they never had before.
Debra J. Foulk, executive director of business affairs at Akron Public Schools, agreed that the pandemic helped to deepen relationships with health providers. The school system works with various providers, including Akron Children's. She considers the district "very fortunate" to have connections to medical professionals it can call when needed.
The past year has highlighted the benefit of schools working with providers to increase positive outcomes for students, said Meredith Sitko, school health director at PSI, a Twinsburg-based school support services provider that works with schools statewide, with a concentration in Northeast Ohio.
Without students in schools, the school health team at PSI shifted initially to helping support school administrators however they could, helping with communication and education for students and families. As PSI navigated the pandemic alongside schools, they partnered to ensure safety protocols for summer programs and then for reopening schools. Building walkthroughs helped them determine what needed to be modified to ensure safety. This included anything from the education setup (distancing, spacing, traffic flow), to proper HVAC filters, to rethinking how to run in-school health clinics, separating symptomatic students from those who need to receive medication for disease management, like diabetes, Sitko said.
The past year has forced providers to think differently about how to engage with schools and students and to find creative new ways to partner on children's health, said Hoyen of University Hospitals, which provides medical oversight for PSI's services.
Beyond individual care of children, there are opportunities past the pandemic to deepen population health and public health efforts through partnerships with schools, she said.
"How can we partner with schools as a health system to enable them to be able to be more successful, especially during this time where there were just so many questions and so many unknowns?" Hoyen said.
Though PSI has helped guide schools on different health needs in the past, this overarching advisory and consulting role was much broader than it had ever done before, she said.
Sitko said she "absolutely" believes that this new consulting and advisory role will be beneficial well beyond COVID. The opportunities for how to continue this are "really endless," she said.
PSI experienced a 35% increase in new or expanded services from June to December last year due to the health concerns from the pandemic, according to the provider.
"The benefits are clear," Sitko said. "There's so much more to going to school and being at school than simply the learning that takes place there. ... School health is more a part of that than I think people realized, and this year really did highlight that."
Going forward, providers are thinking through ways to more deeply integrate telehealth into school care. For instance, the Clinic is in discussions with districts to set up spaces inside schools to connect students to providers via telehealth, though no commitments have been made as the current priority is working through reopening, Thakur said.
Like many providers, Davis of MetroHealth thinks telehealth is here to stay. It had been used previously in school-based health centers, especially in rural areas, but the pandemic accelerated its use.
Also top of mind for providers is how they can support the mental healthcare needs of students who have struggled to varying degrees through the pandemic.
Thakur said that just in her practice, she's seeing mental health needs "escalate very quickly," with concerns about anxiety, depression and loneliness around COVID-19, as well as anxiety about returning to school.
"We know that a lot of kids are flying under the radar as well, until things get bad enough that parents reach out to their (primary care physician)," she said.
Wilmoth, of Akron Children's, said she and other providers are focused on getting kids reconnected with preventive and well care.
"We're doing well visits and immunizations, trying to get kids back connected," she said. "There was such a gap for such a long time where we were all isolated, where kids were not seeking care in their traditional primary practice office. We're able to do some of that work right in the schools where we partner."
MetroHealth is examining how to use school health to support families and ensure students are ready to learn and have access to care after a year when immunizations and well child visits decreased across the country.
"I think, actually, COVID is going to make maybe school-based health centers a little bit larger of a partner than they were in the past," Davis said, noting Ohio has seen growth in such programs in the past decade. "I think now is the time to even leverage those partnerships even more. ... How do we all bring our best skill sets to the table to really support the whole child?"