Center News!
September 15, 2020, Grapevine, Concord School-Linked Health Center
By: Kib Snow
Life here in rural America is special. The idea that we think of more than two cars approaching a four way-stop intersection at the same time to be a traffic jam has its foundation in our reality. With all of its benefits, country life also offers certain inconveniences. Among those is pediatric health care. When I was a youngster Concord was a completely different Community. We were blessed with a strong local economy. Almost everything that one would want to procure could be purchased locally. We had our own local health care system. Dr. Keefer was our M.D., Dr. McClees took care of our dental needs. We had a local Pharmacy, that also housed a Soda Fountain Bar.
In those days should we become ill at school our mothers would retrieve us and take us to see Dr. Keefer. That visit was often followed by a Root Beer Float with mom while we waited for the prescription to be filled. The Root Beer Float was nearly as therapeutic as the medication. That was then, today we have no local Doctors or Pharmacy and sadly no soda fountain. Mother’s as well as fathers have full time jobs outside of the home, leaving precious little time to devote to traditional household responsibilities. While todays health care systems have become more sophisticated, they have become increasingly inconvenient for those who live in the country to take advantage of.
Cindy Magness, Pediatric Nurse Practitioner is a product of the Concord Community, its welfare is something that is near and dear to her. She is also a person when she becomes aware of a problem will step up and work to find a solution. Aware of those inconveniences and their potential impact on the health of the children on our community she went to work. Cindy brought together members of our community, the school and area health care providers in a collaborative effort. The result was that the establishment of Concord-School-School Linked Health Center.
Their Goal is to provide equal access to health care to all children and families in western Jackson County. “Healthy Kids Learn Better!” The Center provides both physical and mental health services by licensed health care professional. The Center’s health care services are covered by most insurances and if a client isn’t covered, they will go out of the way to help them get coverage. No matter the circumstances no child who seeks and needs treatment will ever be turned away.
The Team is made up of Cindy Magness, CPNP-PC. Cindy received her MSN from Wayne State University and her Nurse Practitioner Certification from the Pediatric Certification Board. Raised in the village of Concord, she is an alumnus of Spring Arbor College and Jackson Community College. She still lives in Concord with her husband, they have three children and eight grandchildren.
Dr. Cary Wierenga, M.D. who grew up out on Sears Road, graduated from Wayne State University Medical School. She did her internship at Henry Ford Main in Detroit and her family residency in Marquette. Lisa Holdridge, MA LPC, is a Licensed Professional Counselor who is a new addition to the team, and who services are also available through the Center.
I have two Granddaughters that recently visited the Concord School-Linked Health Center. In short, they both found it to be a wonderful experience. They both, to quote their mother’s, fell in love with Cindy. One of them told me that it was the most comfortable experience they ever had getting a physical going to a Doctor. Cindy isn’t a Doctor of course but she certified to provide Pediatric Health Care Services. Dr. Wierenga is always available by phone for consultation and should a patient require services beyond the scope of the Concord-School Health Center, the patient can be immediately transferred into the Henry Ford Health Care System.
My Granddaughters mothers are both employed in very demanding professions. The convenience of being able to take them to the Center was invaluable to each of them. My one daughter while having been working at home for the passed several months. Normally has duties that require her attention across a large portion of the state. Should we ever return to a degree of near normalcy she will once again be on the road a lot. Even as things are right now, she is literally on the phone and, or the computer tied up in virtual meetings and administration. As part of the services parents can make arrangements on an individual bases for the Center to treat students without the parent being present. Much like the days of Dr. Keefer.
As far as I could tell the only improvement I would make to the services offered by the Concord School-Linked Health Center would be the installation of a Soda Fountain.
By: Kib Snow
Life here in rural America is special. The idea that we think of more than two cars approaching a four way-stop intersection at the same time to be a traffic jam has its foundation in our reality. With all of its benefits, country life also offers certain inconveniences. Among those is pediatric health care. When I was a youngster Concord was a completely different Community. We were blessed with a strong local economy. Almost everything that one would want to procure could be purchased locally. We had our own local health care system. Dr. Keefer was our M.D., Dr. McClees took care of our dental needs. We had a local Pharmacy, that also housed a Soda Fountain Bar.
In those days should we become ill at school our mothers would retrieve us and take us to see Dr. Keefer. That visit was often followed by a Root Beer Float with mom while we waited for the prescription to be filled. The Root Beer Float was nearly as therapeutic as the medication. That was then, today we have no local Doctors or Pharmacy and sadly no soda fountain. Mother’s as well as fathers have full time jobs outside of the home, leaving precious little time to devote to traditional household responsibilities. While todays health care systems have become more sophisticated, they have become increasingly inconvenient for those who live in the country to take advantage of.
Cindy Magness, Pediatric Nurse Practitioner is a product of the Concord Community, its welfare is something that is near and dear to her. She is also a person when she becomes aware of a problem will step up and work to find a solution. Aware of those inconveniences and their potential impact on the health of the children on our community she went to work. Cindy brought together members of our community, the school and area health care providers in a collaborative effort. The result was that the establishment of Concord-School-School Linked Health Center.
Their Goal is to provide equal access to health care to all children and families in western Jackson County. “Healthy Kids Learn Better!” The Center provides both physical and mental health services by licensed health care professional. The Center’s health care services are covered by most insurances and if a client isn’t covered, they will go out of the way to help them get coverage. No matter the circumstances no child who seeks and needs treatment will ever be turned away.
The Team is made up of Cindy Magness, CPNP-PC. Cindy received her MSN from Wayne State University and her Nurse Practitioner Certification from the Pediatric Certification Board. Raised in the village of Concord, she is an alumnus of Spring Arbor College and Jackson Community College. She still lives in Concord with her husband, they have three children and eight grandchildren.
Dr. Cary Wierenga, M.D. who grew up out on Sears Road, graduated from Wayne State University Medical School. She did her internship at Henry Ford Main in Detroit and her family residency in Marquette. Lisa Holdridge, MA LPC, is a Licensed Professional Counselor who is a new addition to the team, and who services are also available through the Center.
I have two Granddaughters that recently visited the Concord School-Linked Health Center. In short, they both found it to be a wonderful experience. They both, to quote their mother’s, fell in love with Cindy. One of them told me that it was the most comfortable experience they ever had getting a physical going to a Doctor. Cindy isn’t a Doctor of course but she certified to provide Pediatric Health Care Services. Dr. Wierenga is always available by phone for consultation and should a patient require services beyond the scope of the Concord-School Health Center, the patient can be immediately transferred into the Henry Ford Health Care System.
My Granddaughters mothers are both employed in very demanding professions. The convenience of being able to take them to the Center was invaluable to each of them. My one daughter while having been working at home for the passed several months. Normally has duties that require her attention across a large portion of the state. Should we ever return to a degree of near normalcy she will once again be on the road a lot. Even as things are right now, she is literally on the phone and, or the computer tied up in virtual meetings and administration. As part of the services parents can make arrangements on an individual bases for the Center to treat students without the parent being present. Much like the days of Dr. Keefer.
As far as I could tell the only improvement I would make to the services offered by the Concord School-Linked Health Center would be the installation of a Soda Fountain.
Safe return to school: Part 2August 19, 2020
Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, Ann Taub MS, CPNP, Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN
Relevant Topics
As fall approaches, one of the biggest questions is: Can children return to school and be in classroom environments that assure health and well-being for all? Here's how practitioners can help.
Over the past 20 years, pediatric and family nurse practitioners (PNPs & FNPs) have been providing primary health care services to children whose lives are often challenged by the social determinants of health (SDOH).1 COVID-19 has adversely impacted the health and well-being of grandparents, parents and close relatives of these children, with an overwhelming number of their relatives succumbing to COVID-19. In the last week of April 2020, the emergence of a new disorder, Multisystem Inflammatory Syndrome in Children (MIS-C)2 was identified in the United States (US) and the United Kingdom, and disproportionately affects children in these vulnerable, multi-ethnic, minority communities.3 Thus, because COVID-19 has demonstrated how adversely it can affect children, critical decisions must be made on the topic of safe ‘return to school.’
The practice of school nursing began in the United States on October 1, 1902, when Lina Rogers, the first school nurse, was hired to reduce absenteeism by intervening with students and families regarding healthcare needs related to communicable diseases.4 One hundred and eighteen years later, in the midst of the COVID-19 pandemic, school nurses still play a critical role in the totality of the management of health, including the prevention and control of transmission of this novel COVID-19 virus for all who return to school, not only the children. Today, school nurses are not limited to the care of children in vulnerable communities. School nurses have leadership roles overseeing the healthcare needs of children and school personnel in schools throughout the United States. The COVID-19 pandemic brings to the forefront the need for legislation that requires every school, throughout the US, to employ an on-site registered nurse (RN). In 2016, the American Academy of Pediatrics recommended that schools have at least one registered available in each school to meet the health needs of the children.5
During the 2015-2016 school year, 52 % of public schools had a full time school nurse. Three-quarters or 82% of the schools had a at least one full time or one part time school nurse.5 Thus, school districts that do not have, at a minimum, a RN to oversee the day-to-day healthcare assessments of each child and school personnel will be at a disadvantage over schools that have a nurse to assess the children and staff for COVID-19 risks and make determine appropriate interventions.6 Preparation for return of to school for children with chonic illnesses, (eg, asthma, diabetes mellitus, congenital heart disorders) and children from vulnerable communities adversely affected by the social determinants of health (SDOH) will require NPs in School Based Health Centers (SBHCs) to work alongside school nurses to ensure the health, well-being and safety of both students and school personnel. Nurse practitioners are educationally prepared to critically analyze local COVID-19 data and to share and discuss the analysis with key administrators and school nurses. Shared decision making is a key component in the process of protecting the health of each individual and the entire school community. Nurse practitioners are also prepared to educate school nurses, all personnel, parents and children on the COVID-19 virus, including the most common presenting COVID-19 symptoms and MIS-C, as well as all of the safety precautions that must be in place prior to reopening schools.2 Nurse practitioners and school nurses are integral to the safe reopening of schools.
Children at increased risk for COVID-19 complications
Extrapolating data for the adult population for children who are chronically ill children, in particular, those with asthma, diabetes mellitus type 1 and 2, heart disease, kidney disease or sickle cell disease, immune compromised children, obese children and anecdotally, adolescents who practice risky behaviors, eg, vaping, or illicit drug use, are at-higher risk than the general pediatric population for complications from COVID-19. Plans for return to school must take into consideration whether the school environment can be designed as a safe environment for these high-risk children. Discussions with the entire team, including parents and older children, teachers, and school administrators must take place to decide on an individual basis whether the child/adolescent can safely return to school.
Update children’s immunizations and physical assessments
The CDC released data from the analysis of the Vaccine For Children (VFC) distribution of immunizations throughout the United States that revealed a significant decrease in the numbers of vaccines ordered by providers when comparing vaccines ordered from VFC during January 7, 2019 to April 21, 2019 to the numbers of vaccines ordered from Januaray 6, 2020 to Aprinl 19, 2020.5 Children aged 24 months and older, were most affected during the first 3-months of the COVID-19 pandemic during the time that parents followed the stay-at-home orders that were in place across the country.7 Now is the time for NPs and school nurses to be vigilant when reviewing immunization and physical exam records. Schools and children do not need the additional crisis of unimmunized or underimmunized children contracting a vaccine preventable disease (VPD) during the pandemic.8
Nurse practitioners can conduct telehealth and telemedicine visits which are suitable for assessing the child’s physical status for return to school.9 Nurse practitioners in SBHCs can perform a physical assessment once school is in session for children who receive their care in SBHCs. For children who need immunization updates, NPs may offer ‘drive-in parking lot immunization updates’ prior to school openings. Parents can visit local pharmacies that offer on-site immunization updates. Children seen in private pediatric offices or community clinics can contact their providers to be seen at their practices sites. Guidance and best practices for NPs and school nurses to support the safety of students and staff return to school is presented in the following tables.
Table 1
Table 2
Table 3
Table 4Discussion
Planning, assessing, reassessing, and evaluation of potential problems are all critical components of return to school policies that focus on the health and well-being of the children and school personnel. In the COVID-19 pandemic, school nurses should be considered essential personnel for each school.13 Nurse practitioners or school nurses are needed to oversee implementation of public health initiatives to maintain a safe school environment (See Safe return to school: Call to action part 1). These initiatives include masks for all children and school personnel, monitor screening results before child enters school, and monitoring COVID-19 test results of children and school personnel. Management of ill children should be a top priority of every NP and school nurse.
School nurses should work closely with local Departments of Health for contact tracing when a child’s test result is positive for COVID-19.12
Conclusions
Nurse practitioners and school nurses play a critical role in the assessment and management of the health care needs of all children and personnel in school systems. Every school, that does not currently have a school nurse as a member of their team, should consider employing a RN to provide the complex assessments that must be implemented to assure the safety of each person who enters the school. School nurses routinely assess school health records, as well as the immunization status and physical examinations of children and take appropriate actions when children are not in compliance with school regulations. School nurses will have even greatere responsibilities during this pandemic. School nurses will have an important role in monitoring best practices for clearing children/adolescents and school personnel to come to school each day. In addition, school nurses will be working with local Departments of Health in the assessment of possible exposures of children or families to COVID-19 with the critical role of prevention of the spread within the school community. The school nurse and NPs will also play a role in the implemnentation and evaluation of safety precautions necessary for personal hygiene, social distancing, and proper wearing of masks and eye protections. The entire medical community, including physicians, NPs, school nurses, and local departments of health are valuable members of the return to school team with the overall goal of health and safety for all children and school personnel.
Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, Ann Taub MS, CPNP, Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN
Relevant Topics
As fall approaches, one of the biggest questions is: Can children return to school and be in classroom environments that assure health and well-being for all? Here's how practitioners can help.
Over the past 20 years, pediatric and family nurse practitioners (PNPs & FNPs) have been providing primary health care services to children whose lives are often challenged by the social determinants of health (SDOH).1 COVID-19 has adversely impacted the health and well-being of grandparents, parents and close relatives of these children, with an overwhelming number of their relatives succumbing to COVID-19. In the last week of April 2020, the emergence of a new disorder, Multisystem Inflammatory Syndrome in Children (MIS-C)2 was identified in the United States (US) and the United Kingdom, and disproportionately affects children in these vulnerable, multi-ethnic, minority communities.3 Thus, because COVID-19 has demonstrated how adversely it can affect children, critical decisions must be made on the topic of safe ‘return to school.’
The practice of school nursing began in the United States on October 1, 1902, when Lina Rogers, the first school nurse, was hired to reduce absenteeism by intervening with students and families regarding healthcare needs related to communicable diseases.4 One hundred and eighteen years later, in the midst of the COVID-19 pandemic, school nurses still play a critical role in the totality of the management of health, including the prevention and control of transmission of this novel COVID-19 virus for all who return to school, not only the children. Today, school nurses are not limited to the care of children in vulnerable communities. School nurses have leadership roles overseeing the healthcare needs of children and school personnel in schools throughout the United States. The COVID-19 pandemic brings to the forefront the need for legislation that requires every school, throughout the US, to employ an on-site registered nurse (RN). In 2016, the American Academy of Pediatrics recommended that schools have at least one registered available in each school to meet the health needs of the children.5
During the 2015-2016 school year, 52 % of public schools had a full time school nurse. Three-quarters or 82% of the schools had a at least one full time or one part time school nurse.5 Thus, school districts that do not have, at a minimum, a RN to oversee the day-to-day healthcare assessments of each child and school personnel will be at a disadvantage over schools that have a nurse to assess the children and staff for COVID-19 risks and make determine appropriate interventions.6 Preparation for return of to school for children with chonic illnesses, (eg, asthma, diabetes mellitus, congenital heart disorders) and children from vulnerable communities adversely affected by the social determinants of health (SDOH) will require NPs in School Based Health Centers (SBHCs) to work alongside school nurses to ensure the health, well-being and safety of both students and school personnel. Nurse practitioners are educationally prepared to critically analyze local COVID-19 data and to share and discuss the analysis with key administrators and school nurses. Shared decision making is a key component in the process of protecting the health of each individual and the entire school community. Nurse practitioners are also prepared to educate school nurses, all personnel, parents and children on the COVID-19 virus, including the most common presenting COVID-19 symptoms and MIS-C, as well as all of the safety precautions that must be in place prior to reopening schools.2 Nurse practitioners and school nurses are integral to the safe reopening of schools.
Children at increased risk for COVID-19 complications
Extrapolating data for the adult population for children who are chronically ill children, in particular, those with asthma, diabetes mellitus type 1 and 2, heart disease, kidney disease or sickle cell disease, immune compromised children, obese children and anecdotally, adolescents who practice risky behaviors, eg, vaping, or illicit drug use, are at-higher risk than the general pediatric population for complications from COVID-19. Plans for return to school must take into consideration whether the school environment can be designed as a safe environment for these high-risk children. Discussions with the entire team, including parents and older children, teachers, and school administrators must take place to decide on an individual basis whether the child/adolescent can safely return to school.
Update children’s immunizations and physical assessments
The CDC released data from the analysis of the Vaccine For Children (VFC) distribution of immunizations throughout the United States that revealed a significant decrease in the numbers of vaccines ordered by providers when comparing vaccines ordered from VFC during January 7, 2019 to April 21, 2019 to the numbers of vaccines ordered from Januaray 6, 2020 to Aprinl 19, 2020.5 Children aged 24 months and older, were most affected during the first 3-months of the COVID-19 pandemic during the time that parents followed the stay-at-home orders that were in place across the country.7 Now is the time for NPs and school nurses to be vigilant when reviewing immunization and physical exam records. Schools and children do not need the additional crisis of unimmunized or underimmunized children contracting a vaccine preventable disease (VPD) during the pandemic.8
Nurse practitioners can conduct telehealth and telemedicine visits which are suitable for assessing the child’s physical status for return to school.9 Nurse practitioners in SBHCs can perform a physical assessment once school is in session for children who receive their care in SBHCs. For children who need immunization updates, NPs may offer ‘drive-in parking lot immunization updates’ prior to school openings. Parents can visit local pharmacies that offer on-site immunization updates. Children seen in private pediatric offices or community clinics can contact their providers to be seen at their practices sites. Guidance and best practices for NPs and school nurses to support the safety of students and staff return to school is presented in the following tables.
Table 1
Table 2
Table 3
Table 4Discussion
Planning, assessing, reassessing, and evaluation of potential problems are all critical components of return to school policies that focus on the health and well-being of the children and school personnel. In the COVID-19 pandemic, school nurses should be considered essential personnel for each school.13 Nurse practitioners or school nurses are needed to oversee implementation of public health initiatives to maintain a safe school environment (See Safe return to school: Call to action part 1). These initiatives include masks for all children and school personnel, monitor screening results before child enters school, and monitoring COVID-19 test results of children and school personnel. Management of ill children should be a top priority of every NP and school nurse.
School nurses should work closely with local Departments of Health for contact tracing when a child’s test result is positive for COVID-19.12
Conclusions
Nurse practitioners and school nurses play a critical role in the assessment and management of the health care needs of all children and personnel in school systems. Every school, that does not currently have a school nurse as a member of their team, should consider employing a RN to provide the complex assessments that must be implemented to assure the safety of each person who enters the school. School nurses routinely assess school health records, as well as the immunization status and physical examinations of children and take appropriate actions when children are not in compliance with school regulations. School nurses will have even greatere responsibilities during this pandemic. School nurses will have an important role in monitoring best practices for clearing children/adolescents and school personnel to come to school each day. In addition, school nurses will be working with local Departments of Health in the assessment of possible exposures of children or families to COVID-19 with the critical role of prevention of the spread within the school community. The school nurse and NPs will also play a role in the implemnentation and evaluation of safety precautions necessary for personal hygiene, social distancing, and proper wearing of masks and eye protections. The entire medical community, including physicians, NPs, school nurses, and local departments of health are valuable members of the return to school team with the overall goal of health and safety for all children and school personnel.