Princess Health and Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture. Princessiccia

Princess Health and Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture. Princessiccia

child obesity children children's health exercise health rankings nutrition school lunch school nurses schools youth

Gusty 08:38 Add Comment

By Melissa Patrick

Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)

Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. �We recognize that. We saw that in our kids,� Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.�And if we don�t change something now, we�re going to be going to the funeral home for kids a lot younger.�

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

�The coalition came together [according to] Aristotle�s thinking, that the whole is greater than the sum of its parts,� Brewington told KET. �We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you�re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we�ve been able to do some great things.�

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition�s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Caf� to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

�It�s about accessibility,� Brewington said. �It�s about the kid who has a cough and needs to see a doctor, but the parent can�t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

�When you�re attempting to change a culture, and change the way people live, that�s a very long process,� Little said. �And it has to be something that�s consistent, that�s ongoing, and it has to be a message that children hear everywhere they go in the community.�

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

�What makes me feel good about it is that I know there�s a real need here,� Speck told KET. �There�s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we�re making an improvement.�

Princess Health and Pediatricians' national group calls for at least one nurse in every school; Ky.'s schools have a long way to go to meet that goal. Princessiccia

Princess Health and Pediatricians' national group calls for at least one nurse in every school; Ky.'s schools have a long way to go to meet that goal. Princessiccia

children's health pediatrics school nurses state budget youth

Gusty 17:21 Add Comment

By Melissa Patrick
Kentucky Health News

Kentucky's high schools fall far short of new recommendations by the American Academy of Pediatrics that call for every school in the United States to have at least one nurse on site.

Only 42.2 percent of Kentucky's high schools have a full-time nurse, 37.4 percent have a part-time nurse and 20.4 percent do not have one at all, according to research led by Teena Darnell, assistant professor of nursing at Bellarmine University.

"School nurses improve school attendance and decrease the dropout rate which leads to better academic outcomes. . . . Most importantly, they help keep the nearly 680,000 children attending public school in Kentucky safe, healthy and ready to learn," Eva Stone and Mary Burch said in an e-mail to Kentucky Health News.

Stone, an advanced-practice registered nurse, is the director of student support services for Lincoln County Schools. Burch is the health coordinator for Erlanger-Elsmere Schools.

The pediatrics academy's policy statement, published in its journal Pediatrics, replaces a previous recommendation that districts have one nurse for every 750 healthy students, and one for every 225 students who need daily professional nursing assistance.

"The use of a ratio for workload determination in school nursing is inadequate to fill the increasingly complex health needs of students," says the policy statement.

School nurses today monitor more children with special needs, help with medical management in areas such as attention-deficit/hyperactivity disorder, diabetes, life-threatening allergies, asthma and seizures and also provide immunizations, work on obesity prevention efforts and provide substance abuse assessments, among other things, says the statement.

As school nurses have been eliminated from school budgets, school-based health centers, which provide health care to students through a public-private partnership, have become popular. This model allows schools to bill private insurance or Medicaid for services to offset some of the costs.

Most recently, the Carter County Board of Education unanimously approved a one-year contract with Kings Daughters Medical Center of Ashland to provide its school health services, Joe Lewis reports for the Grayson Journal Times. The hospital will provide a nurse practitioner who will rotate throughout the district's schools.

That doesn't comply with the new guidelines to have one nurse in every school, but the program plans to use telemedicine to keep the nurse practitioner connected to the schools throughout the day.

"Unfortunately, Kentucky has no requirement to have a registered nurse in every school," Stone and Burch write. "Every school needs a nurse. What we see in the schools is a reflection of the health of the community. Kentucky is missing an incredible opportunity to not only keep children safe at school but also to implement a system of improving long term health in the commonwealth."

Princess Health and In-school health clinics not only meet the health-care needs of students and staff, but also their families.Princessiccia

Princess Health and In-school health clinics not only meet the health-care needs of students and staff, but also their families.Princessiccia

children children's health school nurses schools

Gusty 07:21 Add Comment

School-based health clinics in Kentucky could become a trend,  especially as the state searches for solutions to meet the health care needs of schools as budgets for school nurses continue to be slashed.

Southern Kentucky has Cumberland Family Medical, based in Burkesville, which has clinics at the five schools in Russell County and a deal to do likewise with the four in adjoining Adair County.

Western Kentucky has three such clinics, with two more likely to open next year, Genevieve Postlethwait reports for The Paducah Sun. 

The clinics are at McCracken County's Reidland Middle School, Lone Oak Elementary School, and Paducah's Morgan Elementary. Next school year a full-time clinic will open in McCracken County High School, hopefully followed by a clinic at McNabb Elementary.

These clinics exist as a partnership between Mercy Medical Associates and the local public school districts; the school districts supply the space, Mercy supplies and staff and the Lourdes Foundation helps with funding, Postlethwait reports.

An advanced practice registered nurse with Mercy Medical, Julie Higdon, said she has seen well over 30 patients at the Lone Oak clinic since it opened in mid-April. "That's not busy by ER standards," she said, "but that's busy for a little clinic that's just softly opened."

The clinics serve the entire "school family," from the students and their parents and siblings to the districts' teachers, staff and administrators, regardless of their ability to pay. "Their goal is to give the community the preventive, acute and critical health care it needs while reducing students' and teachers' time away from school, and parents' time away from work," Postlethwait writes.

"It's a big deal when you start talking about dollars and cents, too," Tennille Rushing, director of clinical operations for Mercy, told Postlethwait.  "Not only in the impact for the schools to have kids staying in the classroom and helping with attendance numbers, but for parents. If you only have a limited number of days that you can take off, and you have to take off half a day to go sit in a lobby somewhere with your child, you've missed a half day of pay."

These clinics will also help those without a primary-care provider, which are in short supply in the Paducah area. The Lone Oak clinic will remain open by appointment only this summer.

"I feel like these clinics really have the potential to meet a need for the community," Higdon told Postlethwait. "I feel like it has great potential to grow, I really do." (This story is behind a paywall.)

Princess Health andSouthern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year.Princessiccia

Princess Health andSouthern Kentucky physician expands his in-school clinics; already in Russell County, will be in Adair County next year.Princessiccia

children children's health health insurance school health school nurses schools youth

Gusty 07:03 Add Comment

Dr. Eric Loy
(Columbia Magazine photo)

An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.

Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.

Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.

�We have a chance to change the culture of health care in Kentucky,� Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."

"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.

School Supt. Alan Reed complimented the dedication and service of the county�s school nurses but said costs to employ them were �soaring,� Feese reports. Reed said of Loy's plan, �This is kind of a novel approach, and from all we�ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.�

Loy agreed, saying, �A lot of times that�s the barrier, that it�s hard [for parents] to miss work.�

School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he�s worked on in his time in the school system."

Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."

Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.

Princess Health and Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible.Princessiccia

Princess Health and Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible.Princessiccia

courts health insurance managed care Medicaid school health school nurses schools state government

Gusty 13:47 Add Comment

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. �Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,� Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. �It�s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,� Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had �sought a loophole� in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Princess Health and School nurses start getting scarcer, due to Medicaid problems.Princessiccia

Princess Health and School nurses start getting scarcer, due to Medicaid problems.Princessiccia

children's health county health departments health departments managed care Medicaid nurses school nurses schools

Gusty 11:36 Add Comment

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

�I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

Princess Health and School nurses in Fayette cut as public-health dollars shrink.Princessiccia

Princess Health and School nurses in Fayette cut as public-health dollars shrink.Princessiccia

children children's health education nurses public health school health school nurses

Gusty 11:51 Add Comment

Takirah Sleet, 7, and school nurse Michelle Marra assess her
lunch to manage Takirah's diabetes. (H-L photo by Pablo Alcala)

As public health and education dollars shrink, school nurses are caught in the middle. The Lexington-Fayette County Health Department is among those scaling back its school-nurse program due to cuts, even as "more students with greater medical needs are appearing in classrooms," reports Mary Meehan for the Lexington Herald-Leader.

The cuts and the need present a difficult scenario: "In order to be educated, a student has to be healthy. How do you make that happen?" asked Mary Burch, president of the Kentucky School Nurse Association.

Schools nurses are not mandated in Kentucky, and the way school districts address the issue varies widely. Some districts use a nurse consultant to train school staff. The National Association of School Nurses recommends one school nurse for every 750 students. With 40,000 students, Fayette County falls short of meeting that level of care. The Fayette County school board helps to increase funding to keep nurses in place. About $600,000 would need to be reallocated. (Read more)