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Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole, and I invite you to listen as we delve more into the Pediatric Asthma Symposium From a Teacher's Perspective and the Mobile Clinic For Care Outside Four Walls. Joining me is Kelly Parker. She's a Nurse Manager with the Mobile Health Services at the Carle Foundation Hospital. Kelly, thank you so much for being with us today. So, tell us a little bit about the Carle Mobile Health Services and how has this mobile clinic improved care delivery for students? What is it? What do you do?

Kelly Parker, MSN, RN, CLC (Guest): Hi, everyone. Thanks so much for having me today. I'm happy to be a part of this podcast symposium. So, the Mobile Health Clinic and our Mobile Health Services at Carle is a full service walk in clinic, truly for anyone in the community that is seeking out healthcare. We really work to break down the barriers of access. We really try to bring high quality health care out beyond the brick and mortar buildings. And we truly come into neighborhoods where access is lacking, or they're very far away from clinics or hospitals. And we truly just bring our high quality providers, nursing staff, social work teams. We bring them outside of our walls, into the communities, right to people's homes and into their neighborhoods. And like I said, we are a full service, so we provide wellness care, medication reviews, physicals and immunizations. We provide care from wellness checks of infants all the way up to geriatrics of grandmas and grandpas.

So, we truly try to be full service, full access walk in, so you don't have to plan around anything. You just come to us and we can take care of whatever you're looking for.

Host: What a marvelous initiative this is. How helpful for the community. So, how does it work for patients and their families? You said they can walk up. Tell us a little bit about some of the nuts and bolts and is cost an issue?

Kelly: We really try to make sure that cost is never a barrier because having insurance or not having insurance should never impede somebody from obtaining high quality healthcare. We all deserve good healthcare. So, that's why we do have a social work person that works on the bus. So we have, again, anybody can come, they can walk right on the bus. You don't have to be a Carle patient. We don't make you go back to a Carle provider. We work with whatever healthcare organization that you currently use. But whatever you're needing, if it's a physical, if it's a medication update, if it's even just hey, can you check my blood pressure or my blood glucose?

We get you registered within our Carle Medical Record System, and then you're able to see the nurse and then you see the provider, if you need help cause we are a billable service, but if there is issues with billing or you don't have any insurance, our social work team have multiple options to ensure that patients and families do not have any out of pocket costs. That's what we work to make sure happens.

Host: That's amazing. What great work you're doing Kelly. So, as we're talking about the Pediatric Asthma Symposium and this Teacher's Perspective and listeners may not be sure of really what that entails. So, why don't you start by telling us a little bit about bi-directional consents, how they're improving care and communication between students, families, and healthcare providers. Because I think that is what we're really getting at here.

Kelly: Yeah. So, we developed this bi-directional consent in 2019. We came into operation in 2018 in August and we were seeing a lot of you know, students from the school districts. And we really wanna make sure that our services are partnered with all sorts of community entities, the schools being a really big part of that. We want to be an option for students to come and seek healthcare. Either we can get them back into school that day, or we can say, hey, you know what? We need to get you back home, but we tried it. We develop this bi-directional consent that the parents are able to sign that then we give to the school district that that way we can interchangeably, send these students back and forth.

A family liaison, a school nurse, anybody can bring the student out to our mobile clinic. We make sure we have the bi-directional consent on file. And then the parents can even kind of just list out what they're okay with and what they're not okay with. You know, are you okay with us doing a strep test? Are you okay with us doing an assessment to see if this child needs to come home, or if they need to go back to school? Not that we don't still call the parents, we always call the families, right? We never want a parent to feel like that this consent is taking over them being notified that their child is sick. That does not take the place of that. But what we're able to do is if a patient does have a positive strep test or we develop an asthma action plan, we can then share that information back to the school. And this bi-directional consent helps us to share information with the school nurses or the school staff that helps keep these kids' care consistent.

We don't want the school to have an asthma action plan that got developed a year ago. They don't have the updated one and this child's care has changed. And then they're not providing the correct care or they're not providing the correct medications or the correct treatment plans according to what the new thing is. So, if a kid has a bi-directional consent and we develop a treatment plan for their asthma, we can forward that directly to the school. And that way again, especially with asthma and any, really any chronic disease, they should have consistency in their treatment plans, consistency in their care. And that's where this bi-directional consent helps us to share information to where everybody that's caring for this child is on the same page and doing the same kind of care.

Host: So important. So, how can teachers be prepared to care for students with asthma? Can you help us with an action plan or to recognize signs and symptoms? How do you work with the teachers specifically? Because they're obviously the first line of defense right there in the class with kids. And in this COVID time, it can be a little confusing. So tell us where that communication with teachers comes in and how you work with them.

Kelly: So, we really work closely with the school medical staff first and foremost, the nursing staff, the district nurses. And we really make sure that they specifically obviously know signs and symptoms of what they're looking for. And then we really rely on those district nurses, because again, there's unit four, which is our, you know, Champagne and district 116 for Urbana; they're so large, there are so many teachers that it would be very difficult for us to meet with each individual teacher. So the Carle Health Services really works with those district nurses and all of the individual school nurses to make sure that they then provide whatever information that they can down to the teachers or down to the teachers aides, the secretarial staff, right?

Because there's so many different people that are those first line of defenses, even the lunchroom folks, right? Because if the kid starts having some issues in the lunch room, everybody needs to be able to jump in and help. And obviously the first sign and symptom is shortness of breath. A lot of times kids can tell you pretty quickly. They recognize when they may be going to start having some shortness of breath, some symptoms, coughing, shortness of breath is, some of those very first signs that we try to make sure that, hey, we need to get this kid over to the office where the school nurse is, because then, they can pull up this kid's action plan and say, okay, he's got a rescue inhaler or this kid needs to have a nebulizer. The action plans kind of give from very mild symptoms to moderate symptoms all the way up to severe symptoms where we might need to call for help, right? Like we might need to call the ambulance. So, we break it down into what these symptoms look like for each kid.

So, that every action plan is individualized per patient. Because again, if you and I both had asthma, our symptoms might vary. Our symptoms might be different, but that's going to lead to more severe complications. So, every kid that gets that asthma action plan has an individualized plan of care. That's when they can pull that action plan out and they know what they need to do for those kids in those situations. So, recognizing those early symptoms, which again it's not always that high pitched wheezing. You hear that, but that's more of a moderate symptom. Those early symptoms, that shortness of breath, that coughing, a kid just maybe even leaning over at his desk, that shows that he's struggling for air and we need to get this child some help.

Host: So much coordination between providers, but it sounds like it's so efficiently run. So Kelly, are there any factors unique to your region? You discussed the sheer size of it. So, the scope and are there factors which could improve the care of students with asthma in schools? What would you like to see happen as this initiative progresses and the services are expanded? Tell us what you'd like to see happen.

Kelly: So obviously the Asthma Specialty Clinic that we have just launched in July, it's fairly new. So my hope is as we're really just now starting to have those direct conversations with the school district to make sure that they're aware of our Asthma Specialty Clinic, because we're truly bringing out the experts in Pediatric Pulmonology or Respiratory Care and asthma. So we bring these specialized doctors out to our clinic and we want that communication. And we want that streamlining of patients. We want these schools to be able to call us directly and say, hey, I have a student for you. Hey, I've got a patient that needs that the asthma doctor.

And they just immediately schedule them with us in real time. That's honestly the next step. And then again, I would love to start bringing our Mobile Clinic or these Specialty Clinics to the individual schools, but with our schools being so large, it's hard to pick which school to go to, but that's where having those direct relationships and that streamlined communication with the school districts; if they have a kid that is missing school because of asthma or it's constantly having to come to get asthma treatment in the office, maybe we need to re-look at this kid's plan and see what we need to do. So hey, get them into the Asthma Clinic and let's look at how we can get this kid more stabilized to where his whole life isn't effected so drastically by missing school or just missing classes or not being able to participate in extracurricular activities because of his asthma diagnosis. So again, I think just having that streamlined two way communication, even by phone, by email, whatever that is, is the first step in getting these kids better stabilized and better cared for to where their lives are not so impacted by this chronic illness.

Host: As we wrap up, what else would you like to mention for the listeners in this episode, on the Pediatric Asthma Symposium, From That Teacher's Perspective and the Mobile Care Clinic For Care Outside the Four Walls?

Kelly: We do have the Specialty Asthma Clinic, which is again, we hope to have these kind of specialty care clinics for all sorts of chronic illnesses. Asthma was just kind of the first one that popped up because it is so prevalent in our community, but the Mobile Clinic truly is trying to be that full service, full scope of direct access to quality care. And I really just want everybody to know that we are here for the entire community. We have these Specialty Asthma Clinics, but we're out five days a week that anybody can come to our clinics that are needing any kind of acute care, chronic disease management, or even just needs that social worker. Our social work team also does social determinants of health, where we assess a patient's transportation ability, their housing stability, their food insecurity. And we really make sure that we try to fill all of those gaps because just coming to us doesn't fill in the need. There's all of these things on a social level or on their home level that is also going to impact their health care. So, we really try to provide that holistic approach. That includes again, food, housing, utilities, transportation, safety and mental health. And we really try to be that all encompassing clinic that looks at everything, or it looks at a disease or an illness from an entire holistic approach.

Because that way we can help to decrease that stress and decrease that anxiety, that then they can focus more on how to take care of themselves. And so again, I encourage anybody to reach out to me with any questions or if they have any ideas on how to make this bigger, to make this better, of what they'd like to see us do next, because we really want to be the bridge to getting these kids, adults, everybody, the care that they need.

Host: And you are, and I can hear the passion for what you're doing in your voice, Kelly. What a great, great job you're doing. And thank you for joining us today and really telling us all about this. That concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com for more information, or you can visit carle.org to get connected with one of our providers. Thanks so much for listening. I'm Melanie Cole.