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Comfort and caring: The School Nurse Program

FirstHealth employee Deana Kearns has experienced first hand how important the School Nurse Program is in providing highquality care for students in Moore County. Her son, Josh, was diagnosed with type 1 diabetes as he was entering eighth grade.

“He was diagnosed one week before school started and, of course, his football tryouts started right away,” says Kearns, a registered nurse who works as an assistant director in Clinical Practice at Moore Regional Hospital. “We worked closely with the school nurse, the coaches and our physicians to ensure that he could safely practice and play while we worked out his medical plan.”

Type 1 diabetes usually occurs in children, attacking their body’s insulin-producing cells and making them dependent on insulin injections for the rest of their life. Treatment involves a balance of food, insulin and exercise. During the school year, Josh would often deal with extreme fatigue caused by low blood sugar during the night, as well as frequent doctor visits that would interrupt classes.

FirstHealth administers Moore County’s School Health Program in a contracted partnership with Moore County Schools and the North Carolina Department of Health and Human Services. Seven school nurses provide care, case management and intervention to more than 12,000 students and 1,600 faculty and staff across the county. “It is comforting to know that there is someone at school to handle the emergencies that often occur with children with diabetes,” Kearns says. The nurses at Josh’s middle school and high school also set up meetings between Josh’s family and his teachers to explain the specifics of what Josh needed and helped educate the teachers about the disease and its treatment.

“The advocacy by the school nurses has been very important,” Kearns says. “They recognize the challenges that children with diabetes face and provide them with support and encouragement. It is very important to have someone at school who understands the illness and can interpret or explain the needs of the child.”

Changing behaviors and knowledge at the School Health Centers

Developed to increase access to care for students in areas with low access, the FirstHealth Montgomery County School Health Centers now serve many students with no health insurance. FirstHealth partners with Montgomery County Schools to provide the program.

Students who would otherwise end up in the Emergency Room visit the centers at East and West Montgomery Middle schools for everything from well-child check-ups and immunizations to treatments for sore throats and earaches, to mental health counseling, nutrition services and more.

“We have actually purchased hearing aids for a child with money from our Kids in Crisis fund provided by the FirstHealth Montgomery Foundation,” says Regina Smith, FNP, the nurse practitioner who practices at and manages the School Health Centers.

Recently, because of the rampant increase in childhood obesity and the diseases (such as type 2 diabetes) that accompany it, the centers got involved in changing the behavioral and nutritional habits of a group of third-graders at Page Street Elementary School. “We worked with school nurses to obtain body mass index data on all of the students in Montgomery County, and about halfway through the process, we identified Page Street third-graders as our most obese students at that time,” Smith says.

(Thirty-nine percent were obese, and 16 percent were overweight.)

Smith worked with registered dietitian Joanne Rinker and Christina Turbeville, the certified cafeteria manager at Montgomery Memorial Hospital, to develop a four-week intervention for the thirdgraders in which the nutritionist presented a program on healthy eating and being physically active. At the end of the four weeks, the children’s BMIs were tested again.

“We had a 1 percent decrease in obesity, which is great for just four weeks,” Smith says.

The third-graders were also tested about their knowledge on such things as how many minutes a day they need to be physically active and how many fruits and vegetables they should eat every day. “On the post-intervention test, there was a huge increase in the number of correct answers,” Smith says. “It was successful because of the gain in knowledge about good nutrition and healthy behaviors.”

According to Smith, there was a very good reason for the healthy eating/physical activity program. “This is one generation whose parents might outlive their children because of the epidemic of childhood obesity,” she says. “Our goal was to really make a difference so that some of those behaviors and knowledge will stay with them for the rest of their lives.”

Dental Care Centers put healthy smiles on young faces

When Nicanor Sanchez was just 8 years old, an awful toothache and swollen face sent him to the new FirstHealth Dental Care Center in Southern Pines. Now a young adult, he is grateful for the program that not only relieved his condition but also taught him about the importance of good dental health.

“I don’t remember all of the details about that first visit,” he says. “My face hurt, and I was scared. They needed to take out several of my teeth, because they were rotting.”

In 1998, stories like Nicanor’s were all too common in the FirstHealth service area. Many children didn’t go to the dentist until they had a painful emergency. Within 10 years, the FirstHealth Dental Care Centers—there are now three—had put smiles on the faces of more than 19,000 children.

During the program’s first year, nearly 70 percent of the youngsters who were treated had either never had dental care or hadn’t been treated in more than 12 months.

With original funding from The Duke Endowment, Kate B. Reynolds Charitable Trust and FirstHealth’s Community Benefit Fund, the Dental Care Centers were created to provide comprehensive dental services for Medicaid and Health Choice recipients and uninsured or underinsured individuals (ages 0 to 18) meeting financial guidelines.

In centers now located in Southern Pines, Troy and Raeford, three full-time dentists provide routine dental care, promote disease prevention, encourage early detection and intervention, and ensure care for children with dental emergencies. During Fiscal Year 2007, that translated into more then $2.5 million in care.

Private donations to the Foundation of FirstHealth now support services, and a special Kids in Crisis fund assists with more extensive dental needs that are beyond the scope of the general dentistry services offered at the Centers. Smart Start funds targeting children ages 0 to 5 have been available since 1999.

When they are able, families without Medicaid or Health Choice coverage share a portion of the cost of care.

“Hopefully, the time we spend with each family will help make sure our message is passed along not only that day, but also to future generations,” says program director Sharon Nicholson Harrell, DDS. “When you reach out to a child, you have the chance to affect not only that individual, but everyone he or she connects with throughout life.”

Growing young minds with CIS FirstSchool Garden

It may have been the vegetables that grew and thrived in the Communities in Schools (CIS) FirstSchool Garden, but it was the children at Aberdeen Elementary who really blossomed.

“The thing that strikes me most is that children have an incredible desire to learn about the world around them,” says Kathy Byron, former chair of the FirstHealth Moore Regional Hospital Auxiliary, which helped fund the Communities In Schools FirstSchool Garden along with the Blue Cross and Blue Shield of North Carolina Foundation.

That desire for hands-on learning was fulfilled with the development of the CIS FirstSchool Garden and Fitness Trail, a community health initiative to increase activity levels of children and teachers at the school. Byron, a former registered nurse, Master Gardener volunteer and CIS board chair, was asked to design a healthy eating program delivered via hands-on experience in an organic garden.

Third-, fourth- and fifth-graders at Aberdeen Elementary—a school with about 75 percent free and reduced lunch participation— learned how to plant and compost, fed fish in a small pond, and made and ate such delicacies as lettuce roll-ups and kale and walnut pesto. “We went from kids who said, ‘I’m not getting dirty,’ to being up to their elbows in dirt,” Byron says. “It was a real back-to-basics connection, and they loved it.”

The children were engaged and involved during their weekly time in the garden, and there were very few behavior problems. Byron says one of the most amazing things to watch was how children who had been identified as having learning challenges and needing self-contained classrooms—small, highly structured learning environments—truly thrived when they went outside into the garden where there was no containment.

One of those fourth-graders became a well-versed spokesperson for the CIS FirstSchool Garden after Byron trained him and several other students to be hosts and hostesses when the mayor and other guests, including U.S. Congressman Howard Coble, came to visit.

“This little boy did an incredible job,” Byron says. “He took people around, and they loved talking to him. He was very knowledgeable about all of it and was an incredible voice of the garden.”

The pilot CIS FirstSchool Garden program at Aberdeen Elementary School has now expanded to four additional schools and is being integrated into the curriculum. “The children get so much out of it, and they are so willing and excited about being involved in the garden.” Byron says. “They have an insatiable desire for knowledge, and they walk away with so much.”

Safe Kids Mid-Carolinas: A model for other rural areas

Every year in North Carolina, around 200 children die from accidental injuries. Another 45,000 visit doctors because of accidents.

Safe Kids North Carolina has a mission of reducing and preventing accidental childhood injuries for ages birth through 14. “We work primarily with child passenger safety, bike and pedestrian safety, water safety, playground safety, falls prevention, poisoning prevention, ATV safety, choking and strangulation prevention, fire and burns, and firearms safety,” says Kelly Ransdell, state Safe Kids director.

The organization has a total of 36 coalitions that serve children, parents and caregivers in 58 counties.

FirstHealth of the Carolinas is the lead agency for the Safe Kids Mid-Carolinas coalition, which includes five counties: Richmond, Montgomery, Moore, Scotland and Hoke. Amy Hamilton, the coalition coordinator and outreach manager for FirstHealth Community Health Services in Richmond County, works with local contacts to provide injury prevention activities throughout the fivecounty region.

For example, “Bucklebear” is an educational tool to teach preschoolers and school-age children the importance of always buckling up, wearing bike helmets and pedestrian safety. There is also an eight-minute video demonstration on ATV safety.

“Safe Kids Mid-Carolinas is one of the largest coalitions in the state,” Ransdell says, “and is a model for our rural areas that do not have the infrastructure to support a one-county coalition.”

Calling all kids

Richmond Memorial Hospital purchasing analyst Myra Sanford has been a Kids’ Day volunteer for at least six years. She enjoys helping with the program that mixes fun activities with health screenings because of the children she sees—some of them from one year to the next.

“I love kids anyway,” she says. “I love to see their faces and the different things they can do.”

Once the dispenser of cotton candy, Sanford now distributes fruit smoothies at Kids’ Day. The change presented something of a challenge at first—the kids preferred the sugary cotton candy to the healthy beverage. Now Sanford not only makes and distributes the icy fruit and yogurt treats, but also encourages the children to try them. She also shares the easy recipes with their parents.

It’s been a dozen years since Richmond Memorial Hospital introduced Kids’ Day to its community. The program is now a muchanticipated annual event that has attracted as many as 500 children and parents.

Kids’ Day began as an offshoot of Wellness Screening Day, a program that has been a mainstay of the hospital’s community outreach effort for more than 20 years.

“We mix a multitude of basic children’s health checks with fun and games,” says RMH President John Jackson.

In addition to a variety of medical screenings, the emphasis of Kids’ Day is on prevention and safety. Everything from immunizations to safe play, bicycle safety, car seat safety, and even a hand-washing game is included in the line-up.

Amy Hamilton of FirstHealth Community Health Services has seen the event evolve and change. “It has grown noticeably,” she says, “and it runs more smoothly each time we put it on.”

Hamilton credits the cooperation of outside organizations in making Kids’ Day the success that it has become. “They make a big event even larger and more meaningful, and we appreciate the help of our outside community partners,” she says.

Services offered during the 2008 Kids’ Day included asthma screenings and information, body mass index assessments, hearing screenings, immunizations, lead screenings and blood pressure checks. Fun activities over the years have included visits from K-9 Officer Robby, Smokey Bear and Sparky the Fire Dog, and ambulance and fire truck tours.

Thanks to the support of the FirstHealth Richmond Memorial Hospital Foundation, most of the activities are free. “It’s truly a community event, and we look forward to sharing with Richmond County families,” says Hamilton.

Teddy Bear Fairs/Affairs

The two little boys watched wide-eyed as a nurse at FirstHealth Moore Regional Hospital used a teddy bear to demonstrate what it’s like to get stitches. One little guy even tentatively touched the weblike sutures on the stuffed patient as his first-grade teacher looked on, just as interested.

The youngsters were participating in a program that is held annually at Moore Regional and Montgomery Memorial hospitals to introduce each community’s first-graders to various health care services.

At Moore Regional, these programs are called Teddy Bear Fairs; at Montgomery Memorial, they’re Teddy Bear Affairs. Both offer children a brief glimpse into the mysteries of a hospital visit.

Moore Regional’s program attracts more than 1,000 public, private and home-schooled children every spring. It’s a chance to explore a variety of health-related topics—imaging, laboratory services, stitches and injections, dental care, patient transport and vital signs—in a fun, and non-threatening, learning experience.

Montgomery Memorial’s program takes place each spring during National Hospital Week and is hosted by the hospital’s PAVE Club. The event reaches about 400 children from public and private schools, and promotes safety and accident prevention as well as hospital services.