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By Taylor Knopf

Starting this fall, Duplin County students can visit the school nurse’s office to see a primary care doctor, a behavioral health specialist, a dentist or a dietician.

East Carolina University is teaming up with the county school system on a grant project to bring telemedicine into the schools.

Not only will the telemedicine service help kids see a doctor when they are sick, but ECU staff will use the technology to conduct screenings to prevent chronic problems such as obesity, diabetes and cardiovascular disease. ECU providers will also conduct mental health screenings for issues such as anxiety or depression.

Kristina Simeonsson, primary investigator on the Duplin County Schools project and assistant professor in Pediatrics and Public Health at the ECU Brody School of Medicine. She says the Duplin school nurses really know their kids well and can use that knowledge to help them get access to services, especially mental health and other specialty services not available in many rural counties. Photo credit: Taylor Knopf

ECU plans to offer similar services to school staff to increase “worksite wellness.”

The school nurse’s office is now more than just a place a kid is sent when they throw up or just don’t feel good. It’s becoming a place where kids can get real help.

How it works

A cart with a screen set up in the school nurse’s office is equipped with a stethoscope, otoscope, and a dental and general camera to look at the skin or in the back of throats.

For example, the nurse holds the stethoscope to a student’s chest, the doctor sees the child on the screen, and, with special headphones, he can hear the child’s heartbeat. With the other devices, the image the nurse sees of the inner ear or teeth shows up live on the screen in the physician’s office.

ECU received a four-year grant from the U.S. Health Resources & Services Administration for the telemedicine project. The first year consisted of setting up the equipment and training the staff at ECU and in Duplin County. The second year starts this fall when everything will be put into action.

Duplin County Schools fit well as a project partner because it already has a telemedicine relationship for acute care with Goshen Medical Center, said Kristina Simeonsson, primary investigator on the project and assistant professor in Pediatrics and Public Health at the ECU Brody School of Medicine.

She added that the school system has shown enthusiasm for the project. There are 13 nurses, one for each school.

“The nurses were trained on all this and they are just fantastic,” Simeonsson said. “They are excited about the program and already know their kids so well.”

The student screenings can be an important piece in preventing chronic diseases such as diabetes.

Duplin County Schools lead nurse Sue Ellen Cottle demonstrates how the telemedicine gadgets work for ECU dietician Jill Jennings. Video by Taylor Knopf

Jill Jennings, an ECU registered dietitian, will conduct the nutrition consults with the Duplin County students.

“The nurse would be there with the student and we would discuss the various issues that led to the referral to begin with,” Jennings said. “It might be an overweight student that needs some weight loss guidance or healthy eating guidance.”

A way to increase attendance

Telemedicine is growing in use and popularity across the United States, especially as a way to improve access to health care in rural areas. With more insurance companies, including Medicaid in many states, reimbursing for telemedicine visits, the technology is spreading.

In the western part of the state, schools in Yancey, McDowell and Mitchell counties are already using telemedicine.

Simeonsson said the drive to the doctor’s office and the wait time for an appointment, especially for mental health, are the two biggest deterrents to accessing care for many folks in rural areas.

The hope is that more children in Duplin County receive that care without leaving the school and without parents missing work for appointments, Simeonsson said. Goshen Medical Center will make slots available to see kids remotely.

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“We hope that this will get students seen faster, especially with acute illnesses like strep throat, ears, rashes, simple things like that,” said Duplin County Schools lead nurse Sue Ellen Cottle.

She hopes it will also help expand access to mental health providers. Students showing signs of anxiety, depression or attention deficit disorder can visit the school’s social worker or counselor’s office and have a virtual visit with a mental health provider.

Simeonsson said her team at ECU is looking at mental health visits as a way to combat bullying in schools as well.

“We’ve thought about kids that get in trouble at school, instead of automatic referral to principal, could they be referred to behavioral health session?” she said.

This option may appeal to parents, she added, especially if their student is about to be suspended.

Parents will be kept in the loop on all telemedicine visits. Before the new school year begins, there will be a meeting for parents to learn about the new program and letters will be sent out with consent forms for parents to sign.

Every time a child goes in for a telemedicine visit, the parents will be called. Cottle said the parents are welcome to join the visit in person or through a phone call if they can’t leave work.

“We hope that it increases students’ attendance, ” Cottle said. “They can’t learn if they are not here. So we want to keep them in school as much as can.

“We have a lot of parents that work in our school system. So if we call a parent to pick up a student, we have a staff member absent and a student absent,” Cottle added.

Sustainability

All technology requires upgrades and replacements at some point. The grant will end in three years and Simeonsson believes the telemedicine sick visits have a good chance of continuing.

“I think the acute care visits are going to pay for themselves because [providers] will file insurance,” she said. “Telemedicine is being looked at as something that can be reimbursed like an office visit. The Goshen Medical Center will probably realize this is worthwhile and keep doing it.”

“From our end — with behavioral health and nutrition counseling and work site wellness — we are hoping that if we can bill for it, ECU will say ‘This is a good thing. Let’s get a contract.’”

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...

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