P2.080: “Just in Time” School Health Assessments: Removing Barriers to Care by Leveraging Partnerships in Pitt County

Purpose/Objectives: Many states, including North Carolina, require health assessments for school-age children entering public school for the first time to identify health barriers to learning (HBLs). Despite the potential to identify children affected by HBLs through these assessments, rigid annual deadlines for assessment completion have created significant bottlenecks at clinics before the start of school in August, putting students without an assessment at risk for suspension. We created a sustainable, community-engaged solution for completing health assessments at the beginning of each academic year.

Design/Methods: ECU Health Medical Center (ECUHMC) Pediatrics in Greenville, NC, piloted a quality improvement initiative at the Pitt County Health Department (PCHD) in partnership with Pitt County Schools and School Health Services at ECUHMC to provide school health assessments for children at risk of suspension. School personnel identified students without health assessments at the start of the school year and offered appointments during the last week of September at the PCHD to complete them. Appointments included a medical history, a physical exam, and a vision and hearing screening. Immunization records were reviewed, and students needing vaccines for school received them at the appointment. Students with medical conditions requiring medication at school or action plans (e.g., asthma or diabetes) also had the necessary paperwork completed. The interprofessional team included public health nurses, school nurses, pediatric asthma team members, child life specialists, faculty and resident physicians, and medical students. Data collected on students included demographics, past medical history, insurance coverage, primary care provider (PCP), immunization status, and social barriers to care.

Results: PCHD served 124 out of 400 students at risk of suspension during the two-day event; there were 123 charts available for review. The ages of the students ranged from 3 to 17 years, and all were residents of Pitt County. Of these students, 57% identified as Black or African American, 32% as White or Caucasian, and 11% as other; 23% identified as Hispanic or Latino. Among children seen during these assessments, 65% did not have an established PCP, and 41% lacked insurance. 10% of children were referred to the asthma action team on-site, and 51% received vaccinations needed for school. Twenty-three students self-reported barriers to healthcare, including housing instability and low income.

Conclusion/Discussion: This project showed that implementing school health assessment clinic days at PCHD during the first month of the school year decreased the risk of suspension for students with barriers to healthcare. Removing barriers to obtaining school health assessments requires a collaborative, dynamic, interprofessional team and a well-organized workflow. Future Plan-Do-Study-Act cycles following complete data analysis may include adding more clinic sessions, implementing a prescreening process to improve efficiency, and establishing a workflow for transferring health assessments from clinics to schools.