Feasibility of School-Based Telehealth in Rural California

1. Feasibility of School-Based Telehealth in Rural California December 2, 2008

2. Project Overview • Partnership among UC Davis, The Children’s Partnership, and California School Health Centers Association • Goals • Assess the feasibility of school-based telehealth in rural areas of California • Create a plan for implementing and sustaining school-based telehealth • Fresno and Plumas counties

3. Objectives • Identify health/mental health care needs of children • Identify current capacity, existing assets, and resources to meet needs • Identify role of telehealth to meet needs • Identify receptivity to providing telehealth in schools (for Plumas, receptivity to school-based health care) • Identify key community partners and identify their roles in implementing school-based services • Develop plan for implementing school-based telehealth

4. Key Questions • How does the delivery of services using telehealth technology differ in school districts with school health centers versus without such clinic infrastructure? • What are the specific conditions necessary to support the application of telehealth in schools?

5. Partners • Collaboration is key to success • Critical to have local partners lead activities and bring on additional local partners • Successful local/state-based collaboration - Plumas Sierra Institute for Community and Environment · Plumas Unified School District · Plumas County Public Health · Plumas County Mental Health · Local Health Districts · UC Davis · California School Health Centers Association · The Children’s Partnership · Northern Sierra Rural Health Network · California School Nurses Organization

6. Activities: Plumas County • Core project team formed (May 2008) • Sierra Institute for Community and Environment • Northern Sierra Regional Health Network • UC Davis • California School Health Centers Association • The Children’s Partnership • Meetings with community stakeholders (July 2008) • Focus groups (September 2008) • Elementary School: parents; teachers, nurses, and staff • High School: Parents; students; teachers, nurses, and staff • Parents of children with special health care needs (district wide) • Development of plan

7. Assessment Questions • Health and mental health care needs of children and adolescents? • Language and cultural needs? • Current capacity to meet these needs? • Who are the key stakeholders? • Receptivity to/interest in to providing additional health services in the schools? Via telehealth? • Potential challenges and concerns? • What are the technology capacity and needs?

8. Findings: Needs • Behavioral health care needs (training for teachers, school staff to identify children with behavior health issues; limited assessments; lack of expertise to provide interventions) • Health education needs (nutrition, healthy lifestyles, sex education, using the health care system, other) • Nurses are stretched thin -- 2.25 RNs for 3000 students across large geographic area • No pediatricians in Plumas County • One community does not have a hospital

9. Findings: Needs • Lack of specialists (families drive hundreds of miles for specialty care for their children) • Transportation within community, especially in bad weather • Getting an accurate diagnosis, especially for CSHCN • Dental health services • Lack of Latino/Native American providers • Need better coordination of currently available services • Lack of health insurance

10. A number of community resources in Plumas County; though not being effectively utilized because of lack of coordination, limited outreach, or distance Schools as hubs for all types of community services and appropriate place to address health care needs of Plumas children, families, community members Every school has telehealth equipment; school nurses and other staff are experienced in using it Health providers using telehealth Enthusiasm for project Findings: Community Assets

11. Enthusiasm for school-based telehealth Interest in being a part of designing/implementing project School principals and district staff supportive Youth excited about helping to implement program through designing project, outreach, other activities Providers expressed interest in finding ways to use telehealth to better coordinate care for school children County public health department engaged in integrating this project with its programs Findings: Community Interest

12. Concerns and Cautions • Program must not place additional burdens on school nurses or other school staff • Implement one program and do it well, rather than try to implement too many activities • Make sure program is sustainable • Parents need to be involved • Must get buy-in from all levels of school district • Don’t ‘outsource’; use local services before going out of county

13. Pilot behavioral health intervention: Training for school staff to identify children with behaviors impacting school performance Teachers, nurses, primary care providers trained in evidence-based assessment tools Subspecialty consultation Small grant from UC Davis Develop grant proposals Strong collaboration Build in sustainability, including strategies for reimbursement Develop replicable model Next Steps in Plumas

14. Next Steps in Fresno • How does having existing school-based health centers change the conditions needed to support a telehealth project? • How do the questions, challenges differ? • Similar assessment questions

15. The Children’s Partnership www.childrenspartnership.org Jenny Kattlove (310) 270-7167 jkattlove@childrenspartnership.org