This post first appeared on the REL West blog and is posted here with permission.
The adage that healthy students make better learners is backed by evidence. A growing body of research shows that healthy students are more likely than their classmates with health-related problems to attend school regularly, to achieve at grade level, and to graduate on time. A number of organizations, including the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the U.S. Department of Education, confirm what teachers routinely observe in their classrooms — that unmet student health needs can impede student motivation and learning.
Finding ways to help schools deliver health care to children and youth makes good sense. In non-COVID times, more than 50 million students can be reached weekdays at school sites across the country. Bringing services directly to them at school can reduce barriers to health care, such as cost, lack of transportation, and concerns about students missing class time or parents missing work in order to attend an appointment.
Yet schools have not typically been set up with the onsite resources or expertise needed to offer comprehensive health care to their students. Fewer than half of U.S. public schools have a full-time nurse and even fewer have a bricks-and-mortar clinic.
And just a few years ago, it was practically inconceivable that doctors, nurses, or counselors could conduct evaluations, diagnoses, and treatment remotely while students remained at school.
Health Care From Afar
Now, with breakthroughs in telecommunications technology transforming what’s possible, school-based telehealth — also referred to as telemedicine — can offer students nearly instant access to primary and urgent health care, chronic disease management, mental and behavioral health services, and access to medication, all through virtual medical appointments. With the potential for videoconferencing and other interactive tools, it’s possible for all students, including those in groups that have traditionally been underserved, to receive multi-specialty health care from a distance — while they are at school and their attending health care professionals are engaging with them from afar.
Hazel Health is one of a small but growing number of telehealth providers nationally that focus on schools. Serving districts across the western states, from California’s rural Central Valley to some of the nation’s largest urban school systems, it provides a virtual school-based health clinic, integrating services into the district’s broader multi-tiered student support system. REL West recently studied a district that used Hazel Health to better understand which students used telehealth services and if receiving the services kept them in school.
Typically, at schools offering telehealth services, a student who is sick or injured, or whose teacher is concerned about their physical or mental health — and whose parents have given permission — can have a virtual appointment with a medical professional almost immediately. In the case of Hazel Health, after activating an app that links the student to a doctor or nurse in under five minutes, a trained member of the school staff uses data-transmitting equipment from a medical cart, such as a computer-connected pulse oximeter and blood pressure monitor, to collect and transmit student health information to the attending provider. The provider analyzes the data and engages with the student as they would in an office appointment. Beyond conducting a virtual examination and supervising treatment, telehealth staff often also educate students and families about ongoing care needs and how to enroll in Medicaid, and they make connections with local health care providers to establish a “medical home” where the students can receive continuity of care in their own community.
REL West Study Shows Telehealth Optimizes the Amount of Learning Time
REL West researchers examined the first two years of the implementation of telehealth in one small elementary school district, just prior to the outbreak of the COVID-19 pandemic. The study found that for this district, providing telehealth has helped optimize the amount of learning time for students who might otherwise have been sent home or stayed home for a doctor’s appointment. In 94 percent of the cases, after visiting telehealth doctors or nurses, students were able to return to class for another three hours, on average.
Districts, like the one in the REL West study, appear to be motivated to adopt or expand virtual school health services to promote health equity and prevent student absences. Educators see firsthand how the lack of health care — along with other social determinants of health, such as poverty and exposure to trauma — affects learning outcomes, and are turning to telehealth to find ways to keep students coming to school. Regular attendance is critical to student success and health-related absenteeism is a key reason students fall behind academically. When students are sick, hungry, or struggling emotionally, they are more likely to miss school and, with it, the opportunity to learn.
Making Differences Big and Small
Ensuring that students are healthy and ready to learn every day is a weighty effort. Sometimes student health care needs are clear and relatively straightforward, as when a child needs prescription glasses in order to read more easily or needs a working asthma inhaler. Other times, school-based telemedicine providers encounter problems that are more complex and even life-threatening.
Big or small, all health care needs must be addressed — even if it turns out that students’ physical symptoms might actually indicate something other than a medical problem. Hazel Health staff explained that virtual doctors and nurses need to be adept at recognizing when medical intervention is not the solution for resolving a student’s symptoms. These telehealth providers must be what one staffer described as “especially thoughtful about unpacking the storylines” that might link a student’s stomach ache not to some kind of an intestinal bug, but to the fear and tension related to being bullied, or, even, to being hungry. In such instances, these providers can recommend other kinds of intervention, linking with other school-based support.
The pandemic has laid bare some of the most glaring vulnerabilities in our communities, including health inequities and student achievement gaps. School-based telehealth can help address these persistent challenges. As one Hazel Health staff reflects, “the more ways in which we can support children, the more likely we are to change the trajectory of their lives.”