Working with Schools

Schools do not generally consider themselves to be in the business of providing healthcare services. They are educating children.

Concerns frequently heard from schools (school boards, superintendents, principals)
“We cannot accept liability for medical services.”
“Our school cannot afford to spend money on services unrelated to education.”
“No one on the staff has time to spend on telehealth.”

These are all valid concerns and it is helpful to anticipate them before they are said.

Contracts
A Memorandum of Understanding or Contract or Service Agreement should be in place before services begin. It should include these basic sections and can be as simple or as complicated as your legal teams require.

• Scope of services to provided and by whom.
• Liability.
• Who is eligible to use the service (students, non-student siblings, faculty/staff, parents, neighbors, etc.)
• How costs will be covered and for how long
• In Kind support to be provided by Schools (IT support, private space, school nurse’s time, marketing support, etc.)

Examples: There are two examples attached here:

• MUSC School-Based Health Services Agreement
• Addendum to MUSC School Based Health Services Agreement for Telehealth Services

Note that these are only examples and should not be used by any entity without review by their own legal support.

Enrollment or Registration Forms
A tenent of school-based healthcare is that minors needs to be consented into care *before* they need care. To reduce the need for parents/guardians to travel to the school, they should complete the registration forms in advance.

Best Practices: Consider sending forms to families along with all other annual forms whenever that is. In some programs, the schools retain the paper forms and in others they are collected and maintained by the service provider. Multiple methods of completing the forms are recommended: paper, PDF attachment, fully electronic (mobile-friendly). Request insurance information at the time of enrollment, understanding that it will need to be updated/verified at time of service. If possible, make enrollment valid for entire tenure of a student in the school district, not just for one calendar year.

Relationships
Two different groups in a community will have something to say about a new school-based telehealth program. Parents and Doctors.

Parents: Smooth your way with a formal Community Needs Assessment. Hold information session about the service; send home materials that explain it. Present to Parent organizations and attend Back to School events.

Doctors: To be more specific, local primary care providers, who often resist a school-based program because of some of the following concerns: They do not understand the role of telehealth (they may think that the school nurse is making a telephone call to request antibiotics.) They have read an article about poor antibiotic stewardship via telehealth and fear over-prescribing in their patient population. They may fear losing patient volumes.

Best Practice: Announce and Explain the school-based telehealth program to local providers at the start and periodically over time. Always send the encounter note to the Primary Care Provider as identified by your patient or their family. Invite PCPs to collaborate on patient care when practical.

Workflows
Naturally the exact process of referral, scheduling, providing care and follwoing up will be different for every program. Here is one example of a workflow, color-coded by who is responsible — the School Nurse/Presenter, the Provider, the Back Office.