1. our Students, Staff, and Community
Partnership to Improve the Health of
our Students, Staff, and Community

2. We would like to share how our school district formed a partnership with a local health care system to improve the health of our students, staff, and community.

3. The Carl Junction School District is in the southwest corner of the state. You can see from the map on the left that our school district expands out several counties from our city limits, encompassing approximately 120 square miles. District enrollment is approximately 3400 students. Our districts free/reduced rate is 37-38%. Our students meet the averages across the state when it comes to special health care needs, approx. 10% with asthma, 2% with ADHD, 1% with life threatening allergies, etc.

4. Process from beginning through implementation
School nurses performed a community needs assessment prior to attending Johnson & Johnson School Health Leadership Academy May/June/July ‘13
School nurses discussed idea with superintendent August ’13
Approval given by School Board to proceed with process Sept ’13
School Health Advisory Council formed Sept ’13
SHAC members toured other SBHC’s in area, researched SBHC’s nation wide, Fall ‘13
In 2013, a health needs assessment was performed by our school district RN’s. At the time of our assessment, we documented a disproportionate number of school nurse visits , over 31,000 in one year. We have 3400 students in our district. There were barriers to health care. We had zero health care providers or clinics in our town and lacked public transportation. MDHSS identified the SW region of MO as having a significantly higher rate of no health care coverage, and HRSA identified our area as underserved in the medical and dental providers category. The main health care hub in our area is Joplin which had just experienced the devastation of a tornado, wiping out many local health care facilities and providers. Our nursing team identified that improving access to health care was a high priority and would be best addressed at the community, district employee, and student level. We discussed our ideas with our superintendent, Dr. Philip Cook in August of Dr. Cook recognized the need as well, and strongly supported us. We were given approval by our school board to proceed with the process of identifying a solution the following month. We formed a School Health Advisory Council and toured SBHC’s in the area and also researched them nationwide.

5. A subcommittee was formed from the SHAC to create a RFP, Dec ’13
RFP was approved by School Board February ‘14 and published
Freeman Health System responded to the RFP in a creative way that was a good “fit” for our school district
After School Board approval, Freeman was selected to provide their comprehensive school-based or school-linked health program to students, and staff.
Partnership began in August ‘14
A subcommittee of our school health advisory council was formed to create a request for proposal in December of The RFP was approved in February of Freeman Health System, one of two local hospitals in Joplin, responded to the RFP in a creative way that was a good fit for our school district and its specific needs. Our partnership began in August of 2014.

6. Comprehensive School-Based Health Program Includes:
Local primary care by a NP at Carl Junction Family Medicine Clinic
Direct Tele-health connection between school nurses and CJFMC
Priority scheduling for all Carl Junction students and staff
Mental health services for all through Ozark Center Clinic located adjacent to CJFMC
Transportation for students to and from CJ schools and CJFMC
Dental health services resource as needed
Health and wellness education and resource center
These are the services Freeman Health System offered to our school district. A local primary care nurse practitioner, telehealth access via Ipad between each school nurse and the nurse practitioner at the clinic, priority scheduling for all CJ students and staff, mental health services, transportation for students to and from school and the clinics, a dental health resource, and a health and wellness resource center. All of this for minimal costs to our district.

7. The school linked medical clinic is 2 blocks from our elementary campus, and 5 blocks from our JH/HS campus. Freeman Health System completely funds the clinic and accepts private insurance, Medicaid, and self pay from our students/staff. Our school district is not involved in the collection of pay for services in any way. It is included in our agreement that students will not be denied services based on inability to pay. In those circumstances the Freeman office staff work with the family. The health clinic includes a waiting area, 4 exam rooms, lab, very standard for a typical doctor office set up. Staff for the clinic includes a receptionist, medical office assistant, and a nurse practitioner. The clinic staff are Freeman employees.

8. This is a picture of a sign located inside the clinic, stating that CJR1 students and staff have priority scheduling at the clinic. Our school nurses have a priority number we can call the clinic office to notify them that we are sending a student or staff member to the clinic. This works out great for parents, when they pick up a sick child from school, they can take them to the clinic to be seen quickly, and also for staff. Many staff members choose to be seen for ailments during their planning time. This decreases loss of time from school and in many cases students and staff return to school sooner after illness. For example, without this service many staff would have to take a half day or full day depending on appointment time to be seen. Another example would be a student being seen in the early morning would be able to start a round of antibiotics quickly and return to school the next day.

9. The Ozark Center provides mental health services for children ages 18 and under. It is staffed with a receptionist and a licensed therapist. We have several scheduled mental health appointments for students each day that require transportation.

10. The Freeman van was gifted to our district
The Freeman van was gifted to our district. Our school district is responsible for providing staff to transport students, and all upkeep costs of the vehicle. With parental consent we are able to quickly and easily transport students to and from their medical or mental health appointments.

11. This picture is of both clinics side by side on Main St
This picture is of both clinics side by side on Main St. of our small town. Our school linked health model allows services to be accessible to students, school staff, and the community.

12. This is our staff wellness room that Freeman, our partnering health system, renovated from a unused locker room area. This was provided as a part of our partnership agreement to promote staff wellness. Freeman provides a part-time wellness liaison that works at our schools promoting student and staff wellness. Our district is responsible for maintenance of the wellness room and has supplied the fitness equipment. Staff is able to utilize the wellness room 24/7 via key card for security.

13. Positive results observed – after 6 months
Improved attendance for students who are seen with priority scheduling and are able to return the same day
Fewer staff absences
Positive feedback from parents regarding immunization accessibility

14. After 3 years – Staff Survey – November 2016
65% staff reports they or family member have utilized services
66% felt like the clinic accommodated their planning times
61% felt like the service helped reduce total time away from work
96% felt like services have helped improve access to health care and mental health services
Based on Survey Monkey survey to staff 11/2016

15. Student and Staff Attendance Data - Because students and staff are absent for a variety of reasons, and due to the confidential nature of illness reporting, we found it difficult to track absences based on illness only through our SIS. These are the student attendance rates for our district over the past four years which are all over 95%.

16. Remaining Challenges/ Plans for the Future
Collecting data for sustainability
Networking with other school health clinics (Freeman and others)
Preventative/restorative dental care
Parent support
Local primary care provider support
Better use of telehealth services
5 year re-evaluation of contract with Freeman in 2019
Remaining challenges and plans for the future include finding ways to collect data to provide sustainability, incorporate networking between school health clinics in our area, secure a preventative/restorative dental program, increase parent and local pcp support, and improve telehealth services.
Challenges related to parent support were present at start up, and although many have diffused, it is still an obstacle. Some responses from parents include “the school should not be involved in healthcare”, and “my child’s health is not the schools business.”
At start up, some local primary care providers didn’t understand the purpose of the clinic and told their patients they would drop them from care if they were seen at the clinic. It was apparent they saw the clinic as trying to take their patients, or competition. It seems that has eased now, are other providers view it as more of an urgent care type facility. Patience and time has resolved many of the issues we had initially. Also, having staff in the clinics that are vested in the community and a good fit for our community. Their bedside manner and phone etiquette has gone a long way in resolving initial fears. Continued close communication is the key to making are keeping this partnership a good fit for our students and staff.
Networking meetings between school nurses and clinic staff of other school linked partnerships in our area are being scheduled soon. We will have a 5 year re-evaluation of services with Freeman in 2019.