When a budget crisis in the late 1990s forced the Austin Independent School District (AISD) to look at cutting all school nurse and health positions in the district, local health care providers came together with district leadership to find a solution.
That solution was for AISD to partner with Dell Children’s, the pediatric center for Seton Family of Hospitals, to provide school nurses and health staff in AISD schools. “They understood that if you didn’t have school nurses, kids would be showing up in the emergency room,” says Sally Freeman, the director of the Children’s/Austin ISD Student Health Services program.
Initially, the entire program, including staff, was funded by the hospital, but the burden shifted back to the district within just a few years as the district got back on its feet financially. Today, the district pays for the full cost of the nurses’ and health staff’s salaries, while the hospital contributes about $650,000 worth of in-kind support, including human resources and legal services, management and oversight, and continuing education for the health staff.
The program includes both school nurses and health assistants. More than 75 school nurses, covering about four schools each, provide care to the district’s more than 80,000 students. “School nurses serve as a triage person,” Freeman says. “They help families to determine what level of care their child would need, whether that’s going to the hospital or waiting to see their pediatrician.”
From the start, Freeman says, the hospital kept detailed data on cost and outcomes, which allows the program to track its success. One of the focuses of the program has been to prevent hospitalization, especially when it comes to students dealing with complex medical conditions. “One of the things we’ve been able to do is help coordinate the specialist kinds of care that helps that child be healthy in the school setting,” Freeman says.
Another factor that allows this program to tailor itself is the model it uses to determine the needs of each school, called an acuity model. Every year, the program does an acuity analysis which looks at school enrollment; rates of free and reduced price lunch, which helps estimate insurance coverage and access; the number of illness or injury contacts for the previous year; and the number of students who received case management due to chronic conditions such as asthma and diabetes. All of those factors are weighted, and an analysis determines how many hours of a school nurse’s and a health assistant’s time a school might need.
This type of analysis is gaining traction in the school nursing world, Freeman says. “This allows us to address the needs of each school in a fair and equitable manner,” she says.
In addition to constantly evaluating the needs of each school, the program also responds to changing needs within the district as a whole. One issue that has come to the forefront in recent years is behavioral health. To respond to that concern, the program developed a pilot program that contracted licensed social workers to see students during the day. The school nurses act as a referral coordinator. The students with behavioral health issues who receive counseling have fewer discipline referrals and are more likely to pass their classes and move on to the next grade.
This amazing partnership is just one example of how a forward-thinking health system and a school district can partner together to ensure that students are getting the health care they need. Healthy Schools Campaign is working with the National Collaborative on Education and Health to catalyze partnerships like these across the country and ensure students have access to the health services they need to thrive.