February 28, 2003

VUSN-run clinics need funds to remain open; health of disadvantaged children in jeopardy

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Vanderbilt’s Patti Scott, MSN, checks the temperature of a patient at the Fall-Hamilton Elementary School clinic. Scott has been the nurse practitioner at the school clinic for eight years. (photo by Dana Johnson)

VUSN-run clinics need funds to remain open; health of disadvantaged children in jeopardy

Two of the three Jane McEvoy School-Based Health Centers, run by Vanderbilt University School of Nursing’s Faculty Practice, could soon close unless additional funding is raised.

Funding for the center at Fall-Hamilton Elementary School was supported by the Bureau of Maternal Child Health, and in past years the center at Stratton Elementary School received partial funding from the Memorial Foundation, a local health care conversion foundation. But the money from both of those funds will be gone by the end of this school year.

Fortunately, funding for Park Avenue Elementary School’s clinic, generated from a separate grant, will last for three more years.

Clare Sullivan, MSN, a nurse practitioner working at Stratton Elementary School, says $100,000 is needed to keep the clinics functioning at their current level with part-time nurse practitioners. But she says they would like to find an additional $15,000 to provide support for fund-raising and grant proposals to pay for basic office supplies like a fax machine, and to buy educational videos for children with chronic illnesses like asthma and diabetes.

“We’ve never really gone out and solicited funds for our program, outside of or within the Vanderbilt community. So we are beginning a fund-raising campaign. We do have the support of Metro schools, but we should probably go back and ask them, ‘could you do more?’” Sullivan said.

She says each year the fate of the school-based health centers hangs in the balance. “Each year there’s a different reason why grants are not available.” But she adds that she’s hopeful someone will come forward to help keep the centers open. “There’s a growing recognition for the need of this type of work.”

All three school-based centers serve neighborhoods with a high need for practical, easily accessible health care for both children and families.

Vanderbilt’s nurse practitioners provide preventive medicine, health education and promotion, as well as manage chronic illnesses. Many children use the nurse practitioners at the school-based centers as their primary care provider.

Bonnie Pilon, DSN, senior associate dean for Practice Management, says the need is great. “These kids who have no other provider, or have their asthma or diabetes managed while they’re at school by the nurse practitioners are in jeopardy,” she said.

Patti Scott, MSN, has been working as the nurse practitioner in the school-based center at Fall-Hamilton Elementary School for eight years. She says she’s watched the children grow during that time, and can’t imagine what will happen if she can’t continue her work at the school.

“I don’t know what would happen to these kids. I feel terrible,” Scott said. “I see about 20 kids a day, some the school nurse can deal with, but about half really need NP help. Some would be able to go to the Vine Hill Clinic, some wouldn’t. I don’t know where they would go.”

Each registered nurse working as the school nurse at the three centers is paid for by Metro Schools, and will continue working for each school regardless of the fate of the nurse practitioners. But Scott says the clinics could not serve primary care needs without a nurse practitioner.

“An RN alone can only follow doctor’s orders. They can’t treat an ear infection, strep throat, pneumonia, or other illnesses. They can’t write prescriptions,” Scott said.

Sullivan says though the RN will still provide general school nurse services at her school clinic, Metro funding doesn’t provide for full-time RN care at Stratton.

“She is at the school 20 hours a week, and that’s a lot more than any other school,” Sullivan said.

Scott says VUSN’s school-based centers have been operating on very little money for a long time. She says services are often provided without reimbursement.

“We can only bill for a tiny percent of what we see,” she said. Because TennCare status has changed for many families, some don’t even know whether they are insured when they seek care for a sick child at the school-based center.

“A lot of the children are now uninsured, because TennCare has dropped off. So a lot of times they have to pay out of pocket,” Scott said. She says the number of children with primary care needs has increased since TennCare has ended for many children.

Sullivan says research shows 50,000 children have been cut from TennCare rolls, and data shows less than 20 percent of Tennessee’s private pediatricians, the lowest figures in any state, are accepting new TennCare patients. She says children who are uninsured are more likely to delay getting care and suffer from chronic conditions that go unrecognized and untreated.

Scott says children with unmet health needs have a very difficult time focusing on their schoolwork. “Kids have to be healthy to learn. You can’t educate a kid that’s sick, hungry, and stressed. And the best means to get children healthy and learning is to have a school-based health center.”

Scott says school-based health centers also help cut back on the amount of time parents have to take off from work to address needs of a sick child, making it easier on parents struggling to hold down jobs.

Jim Shmerling, executive director and CEO of Vanderbilt Children’s Hospital, and advocate for school-based health programs hopes funds can be raised. “An integral part of our mission is advocacy and programs that keep children healthy and not in the hospital are worthy of support.”

The school health program is named after the late Jane McEvoy, a VUMC faculty member who died from stomach cancer in September 2001 at the age of 39. Jane is survived by her husband, Dr. Joseph Gigante, assistant professor of Pediatrics and clinical assistant professor of Nursing at Vanderbilt, and their two daughters.

Scott says it would be sad to see Jane’s legacy come to an end. “That’s part of our mission, to help carry on her work here. She loved this, the kids loved her. This was her clinical practice,” Scott said.