A Whole Person Approach to Kids Health Just Outside the Classroom / Public News Service

There is a strong connection between health and academic success, and some districts in Ohio are bringing wellness services into schools to meet kids where they are.

School-Based Health Centers help eliminate some barriers families face in accessing health care services such as transportation or lack of a medical home.

Jolene Joseph, CEO of the HealthCare Connection, which helped establish Mount Healthy’s new school-based health center, explained they help students with health-related issues such as treating colds, managing asthma, and dental problems. They also conduct mental and behavioral health screenings.

“We are looking at treating the whole individual from top to bottom and looking at social determinants of health,” Joseph pointed out. “Where are the struggles for youth? We oftentimes look at those from the perspective of the parent but not really looking at it from a child’s point of view.”

The Mount Healthy clinic was opened through a partnership with the district and Interact for Health. Gov. Mike DeWine recently awarded nearly $26 million to create 29 new School-Based Health Centers and expand services in 107 existing centers.

Recent data from the Centers for Disease Control and Prevention showed 44% of teens feel “persistent feelings of sadness and hopelessness,” up from 26% in 2009.

Joseph argued given the isolation youth experienced during the pandemic, the connection to mental health care through school-based-health centers is critical.

“This affords them the opportunity to really own their health and understand the importance of mental health,” Joseph asserted. “And reducing that stigma associated with seeking out support that you need.”

She added parental involvement is very important, along with an advisory community within the district to provide open communication and information for families.

“Parent engagement is equally important outside of the school-based health center or inside of the School-Based Health Center,” Joseph emphasized. “So that they’re in the know of their children’s health or challenges that their child might be experiencing.”

Interact for Health offers a learning group for stakeholders interested in setting up School-Based Health Centers. The Ohio Department of Education also developed a School-Based Health Care support toolkit.

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By Liz Carey for The Daily Yonder.
Broadcast version by Jonah Chester for Illinois News Connection reporting for The Daily Yonder-Public News Service Collaboration

For rural residents, just getting to the hospital during an illness can be a struggle.

A new trial of home-based hospital care may be a solution to that, officials think.

Called the Rural Home Hospital, Ariadne Labs developed the system to deliver home hospital principles to rural communities.

Mary Frances Barthel, M.D., chief quality and safety officer at Blessing Health System in Quincy, Illinois, runs the Rural Home Hospital program there. Covering a three-state area (Illinois, Missouri and Iowa), Blessing Health includes three hospitals, two physician groups, an accredited college of nursing and health sciences, and a network of medical specialty businesses. Barthel said the healthcare system provides services for about 100,000 people.

In February, Blessing Health started a three-year study of the home-based system. Based on a successful urban home hospital program at Brigham and Women’s Hospital in Boston, this trial will determine whether or not it can be applied to rural settings, Barthel said.

Just three patients have entered into the randomized study so far. Two of those patients were selected to stay in the hospital. One was selected to receive at-home care.

To enter into the program, a patient has to be admitted to the emergency department and then diagnosed with something that would normally require hospitalization to treat – like heart failure, chronic obstructive pulmonary disease, asthma, gout, chronic kidney disease, or diverticulitis. Once a patient has agreed to participate, they’re randomly selected to either stay in the hospital or be treated at home.

Those that are selected to be treated at home are discharged with a nurse who goes with them and sets up the necessary equipment in their house.

“They’re put on a monitor that gives us their vital statistics like blood pressure, blood oxygen… that information is available to me 24 hours a day, seven days a week,” Barthel said.

Patients are also connected to the doctor through telehealth visits. The nurse visits the patient in person twice a day, and Barthel checks in on them once a day via telehealth. Patients can also contact the nurse or doctor for telehealth visits if they have questions or concerns. In some cases, the monitor will connect with the doctor to alert them if things aren’t right.

“If there’s a change in their vital statistics, an alert will come across an app on my phone,” she said.

The system also alerts her if the monitoring equipment goes offline.

“We had an incident where the patient’s tablet went to sleep,” she said. “I got a notification on my phone and worked the patient through making sure the device didn’t turn off.”

The program frees up beds for more critically ill patients and ensures the patient can access the care.

“Transportation (to the hospital) is such an issue in rural areas, especially for our elderly patients,” Barthel said.

Research shows that home hospital programs tend to have higher patient satisfaction, lower readmission rates, and a reduced risk of getting hospital-acquired complications. Barthel said so far patients have reported that the program is beneficial.

“Patients reported getting up more and moving around more,” she said. “We also noticed they were more compliant with their medications and that they slept better.”

The program is not without its challenges, however. Barthel said some patients who were approached to join the study declined.

“They had an expectation that when they felt sick, that they were going to have people take care of them, and that they would be better when they left the hospital,” she said. “We are very careful about which patients we’re including. These patients did not want to go home to treat themselves.”

Another issue, she said, is internet access. The hospital has developed several strategies to ensure patients have a fast enough connection for a telehealth visit, including installing a new connection.

Another obstacle is staffing. Two in-home visits a day requires a significant amount of nursing capacity.

But advocates see the program as a way to reduce healthcare disparities for rural residents.

“Access to high-value acute care services in rural communities is a growing national problem,” David Levine, M.D., leader of Ariadne Lab’s RHH team, said. “A randomized controlled trial will help us examine how we can provide a high quality and safe patient experience affordably in a rural context.”

Blessing is one of only two American rural hospital systems to run the trial. The other, Appalachian Regional Healthcare (ARH), provides services for rural Eastern Kentucky and southern West Virginia.

Between now and the end of the study in 2025, Barthel said she hopes to sustain an average patient population of four, with new patients entering the program and ones who have recovered being released.

“Past the trial stage, we hope to be able to replicate the program with staff deployed in each of our hospitals,” she said. “Our goal is to have these services available from each of our facilities.”

Liz Carey wrote this article for The Daily Yonder.

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By Sky Chadde for The Midwest Center for Investigative Reporting via The Daily Yonder.
Broadcast version by Lily Bolhke for Missouri News Service/i>

The U.S. Department of Agriculture has food safety inspectors in every large meatpacking plant in the country. Just like the industry’s workers, the government’s inspectors entered the high-risk work spaces almost every day during the COVID-19 pandemic.

Sonny Perdue, USDA’s leader during the pandemic’s critical first year, made clear he saw no role for the agency in protecting workers. That mostly fell to the U.S. Department of Labor’s Occupational Safety and Health Administration.

Despite Perdue’s proclamations, however, the two agencies should have collaborated to ensure workers were safe from COVID-19 by leveraging USDA’s employees in plants to provide better oversight of the industry, the DOL’s Office of Inspector General concluded in a new report released Tuesday.

OSHA has been roundly criticized for failing to protect meatpacking workers from the coronavirus. In the pandemic’s first year, the agency doled out small fines to only a handful of plants, and it failed to inspect every plant where cases were publicly reported.

OSHA defended its approach in responses to the inspector general’s office. The head of OSHA under former President Donald Trump, Loren Sweatt, has told Investigate Midwest the agency was dedicated to protecting workers.

The agency entered the pandemic with its fewest number of inspectors in its history. At the same time, the number of workplaces it has to oversee has increased.

Still, according to the inspector general’s report, OSHA should have identified what federal agencies oversaw high-risk industries – including meatpacking – and provided training to on-the-ground employees in how to assist with worker safety.

“Without delivering the necessary outreach and training, OSHA could not leverage the observations of external federal agencies’ enforcement or oversight personnel active on job sites regarding potential safety and health hazards,” the report reads.

Fostering collaboration with the USDA’s Food Safety Inspection Service was “particularly important” given the risk at meatpacking plants, the report said. More than 400 meatpacking workers have died from COVID-19, according to Investigate Midwest tracking.

OSHA and FSIS had some history that made collaborating challenging, according to the report.

Before the pandemic, when FSIS inspectors would make a referral about potential worker safety violations to OSHA, OSHA would investigate FSIS, not the plant, according to the report. Because of this, FSIS inspectors were hesitant to refer possible violations.

OSHA said it “informally collaborated” with FSIS during the pandemic. Starting “early in 2020,” OSHA held weekly meetings with FSIS and other agencies where it “often” discussed the safety of meatpacking workers, the agency said in its response to the report.

OSHA “judged this effort to be far more fruitful than attempting to reach individual FSIS inspectors,” it said.

Sweatt didn’t reach out to FSIS’s head, Mindy Brashears, until mid-April 2020, weeks after the first reported COVID-19 case in a U.S. meatpacking plant and months after news of the contagious disease broke, according to emails obtained by Public Citizen.

“Is FSIS doing guidance for meat packers in the world of Covid-19?” Sweatt asked Brashears on April 11, 2020. “If so, is there anything OSHA can do to be of assistance?”

Brashears then emailed back, saying she’d like to see any guidance documents OSHA had.

“It’s shocking how much OSHA deferred to USDA” on worker safety during the pandemic, Adam Pulver, the attorney at Public Citizen who obtained the records, has said about the emails.

During the pandemic’s first year, COVID-19 deaths had been reported at 65 plants. OSHA didn’t inspect 26 of them, according to an investigation by USA TODAY and Investigate Midwest.

The trend has continued, according to OSHA’s responses to the report. Investigate Midwest has tracked nearly 500 plants with reported COVID-19 cases. Between March 2020 and March 2022, OSHA conducted 157 inspections related to COVID-19 in the meatpacking industry.

Sky Chadde wrote this article for The Midwest Center for Investigative Reporting via The Daily Yonder.

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Wisconsin has a 173-year-old abortion ban that hasn’t been enforced in decades. But if the U.S. Supreme Court strikes down the decision in Roe v. Wade, that law will trigger, criminalizing abortions in the state.

In a leaked draft opinion obtained by Politico, five of the court’s conservative justices described Roe’s reasoning as “exceptionally weak,” and said “the decision has had damaging consequences.”

State Sen. Kelda Roys, D-Madison, is the former executive director of NARAL Pro-Choice Wisconsin, a reproductive rights advocacy group. She said folks should plan for the court to follow through with the draft opinion.

“And if you don’t need an abortion yet, you should go to aidaccess.org and order an advanced prescription of abortion medication, so that it’s in your medicine cabinet even when abortion is illegal, and available for you or someone you love if they need it.”

The decision isn’t final and the justices could change their positions before a formal ruling is published, so abortion still is legal for the time being. Under Wisconsin’s dormant law, doctors who provide abortions could spend up to six years in prison and face a $10,000 fine. It makes a narrow exception in cases where abortions are provided to save the life of the mother.

Roys previously sponsored legislation to secure access to abortion in state law and repeal the pre-Civil War ban. However, the bill was blocked from a public committee hearing, stagnated for more than a year and died in March. Roys said Democrats have tried for years to enact similar bills, which have been blocked in the GOP-controlled Legislature.

“The Republicans have secured their majority through gerrymandering,” she said. “They don’t have to be accountable to people, they don’t have to do what the people want – and so, they’ve been able to ignore our efforts to try to repeal the criminal abortion ban.”

In a January national poll by the Marquette University Law School, nearly three-quarters of respondents indicated they were against overturning Roe v. Wade. While Democrats expressed stronger opposition to striking down the precedent, nearly half of the Republican respondents also opposed overturning Roe.

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