Stakeholders discussed initiatives aiming to help students access needed healthcare services in schools at the 2024 Michigan State of Reform Health Policy Conference last month.
Amy Zaagman, executive director at the Michigan Council for Maternal and Child Health, said 40 percent of school-aged children and adolescents have at least one chronic health condition.
“Children are dealing with these things every day, whether it’s asthma (or) obesity, and there’s been a rise in the need to deal with behavioral health conditions,” Zaagman said. “Those are things that affect their ability to learn (and) achieve at school. And we know they spend most of their waking hours when they’re school-aged at school.”
Evilia Jankowski, state school nurse consultant at the Michigan Department of Education (MDE), said approximately three kids in every Michigan classroom have asthma, while about two kids in every classroom have some sort of food allergy. More than one in 400 Michigan students have diabetes, she said.
“One in six kids has (had) some sort of seizure in their lifetime,” Jankowski said. “We need to be as prepared as possible to support those kids in school. If you’re that student, how could you be in school learning if you’re afraid your condition is going to take a downward turn?”
School nurses are distributing a lot more medications than they ever have in school settings, Jankowski said.
“So we’re training unlicensed people to administer medication. We have to help them be comfortable doing that, and do it in a safe manner. Unfortunately in Michigan, we don’t have a nurse in every school building. We now have more school nurses than ever. I have about 800 I communicate with on a monthly basis. But that’s not good enough.”
— Jankowski
Taggert Doll, section manager of Child and Adolescent Health Services at the Michigan Department of Health and Human Services (DHHS), discussed DHHS’ Child and Adolescent Health Center Program (CAHC). Centers promote the health of children, adolescents, and their families by providing important primary, preventative, and early intervention healthcare services.
“These programs provide a varying degree of care—mental health (and) physical health—together in a school or near school property,” Doll said. “The point is to reduce that barrier of care. Services can be done on school property.”
The CAHC model consists of three main programs—Child and Adolescent Health Centers, the School Wellness Program, and Expanding, Enhancing Emotional Health—and full clinical sites are open five days a week. DHHS funds hospital organizations to work with schools to deliver CAHC services. Henry Ford Hospital works with Detroit schools to deliver services, for example.
“They partner with Detroit schools to run a Henry Ford clinic in the school. We’re (at) around 250 (CAHC schools) now. It started in urban areas (like) Detroit, Flint, Lansing, Muskegon, (and) Saginaw. (They) were some of our first sites. But a lot of our recent expansion has been in rural areas.”
— Doll
Scott Hutchins, school behavioral health unit supervisor at the MDE, noted that Michigan amended its Medicaid state plan in 2018, which allows more students to access healthcare services in schools.
“We can bill Medicaid for certain eligible services for our students,” Hutchins said. “Up until 2018, that was only for students with an individualized educational program or an individual family service plan. You might know that as special education. When special education students get services in school, we can get Medicaid reimbursement for that. We amended our Medicaid State Plan so now any student that receives an eligible service in school from a certified provider (can get a reimbursement).”
Natalie Kasiborski, assistant professor at Michigan State University, noted that family influence is also important in improving student health.
“As a clinician, we know students are going to have better outcomes if their family is engaged in their care,” Kasiborski said.