A number of FirstHealth services for children are good examples of the power of thinking outside the box. They are novel and innovative responses to children with all sorts of health problems and needs.

By creatively addressing those needs, FirstHealth helps improve children’s health and prevent more serious problems in the future. The Foundation of FirstHealth and its special funds for children’s services support many of the programs.

The Children’s CARE Fund in Moore County addresses many of the dental and school health needs, and the FirstHealth Montgomery Foundation has supported the school health and dental programs in Montgomery County.

Dental care for kids
In the mid-1990s, school health nurses identified dental care as the number one unmet need of local children. FirstHealth responded by setting up clinics to provide dental care for the children of low-income families who did not have a regular dentist. The FirstHealth Dental Care Center in Southern Pines opened in 1998 and operates full time, often six days a week. Since then, dental centers that operate on a part-time schedule have been established in Troy and Raeford. Together, the three centers average about 1,000 patient visits a month.

“When we first opened, we saw so many kids with really serious dental problems because they hadn’t had any dental care,” says Sharon Nicholson Harrell, DDS, MPH, director of the Dental Care Centers. “There is still a big need for restorative care such as fillings and extractions, but that is leveling off. Last year, many of the kids who came for their six-month check-up didn’t have to return for a procedure.”

Slightly more than half of the Dental Care Centers’ patients are between 6 and 12. About 25 percent are under 6.

“We love seeing young kids,” Dr. Harrell says. “We look at their teeth to see if there are any problems, but it’s more of an educational appointment for the parents. We try to help the parents learn good dental health habits so the kids don’t have problems later on. The kids keep it exciting and fun for us, and we do everything we can to make them comfortable.”

Each exam/treatment room has a TV set tuned to Nickelodeon or some other kids’ channel.

“It’s amazing the effect it has when kids come into the room and see ‘SpongeBob’ on the screen,” Dr. Harrell says. “They’re immediately more relaxed.”

The Dental Care Center in Southern Pines recently expanded from four exam/treatment rooms to six. FirstHealth and grants from the North Carolina Department of Health and Human Services and the Kate B. Reynolds Charitable Trust funded the additions.

Each of the three centers is regarded as a model for addressing the needs of traditionally underserved children.

“More and more dental clinics are springing up across the state to serve this population, and they often look to us as a resource,” Dr. Harrell says. “We like having them visit and seek our advice.”

Every summer and fall, dental students from the University of North Carolina at Chapel Hill rotate through the Dental Care Centers to learn and improve their clinical skills. For many of them, it is a real eye-opening experience.

“They find out that not everybody has a phone and that some people have to depend on others to bring them in for their appointment,” says Dr. Harrell. “We hope that, having had this experience, the students will be more aware of the challenges that underserved kids and adults face, so that when they go into practice on their own, they might be more open to taking patients who receive Medicaid.”

FirstHealth has a program specifically for girls 11 to 16 whose size and weight jeopardize not only their physical health but also their psychological and emotional well-being. Called FirstFit, the program consists of two group therapy and exercise sessions every week for five weeks.

Therapy for overweight girls When you are a teenager, the one thing you want more than anything else is to fit in. So imagine what it’s like to be a teenage girl who is 50 or 100 pounds or more overweight. Nothing looks good on you. You don’t have many friends. You’re slow and clumsy in P.E. And some of the other kids stare and make hurtful remarks when you walk by. FirstHealth has a program specifically for girls 11 to 16 whose size and weight jeopardize not only their physical health but also their psychological and emotional well-being. Called FirstFit, the program consists of two group therapy and exercise sessions every week for five weeks. A registered dietitian teaches the girls about good nutrition and healthy food choices. An exercise physiologist gets them moving and working up a sweat. Liz Watson, MSN, R.N., C.S., a clinical specialist with FirstHealth Behavioral Services, directs the program and provides cognitive behavioral therapy that focuses on the relationship between thoughts and behaviors.

“While they are involved in the physical activity, I ask them to be aware of what they are thinking and how they are feeling about the exercise,” Watson says. “Then I ask them to think about how that is affecting what they are putting into the exercise and how they feel after exercising.

“A lot of times, they come in after school feeling irritable and cranky. After exercising, they realize their mood has improved. We know that exercise can help with depression.”

Studies also have found a relationship between obesity and depression, particularly in girls. When people are depressed, they are more likely to sit around watching television instead of going out to take a walk or shoot baskets, and they often find comfort in food.

“They tend to eat whether they are hungry or not,” Watson says. “We try to get the kids to tune in to their stomachs and be aware of what hunger feels like. We want them to eat moderate amounts, just to the point where they are satisfied, not stuffed.”

The parents of participating girls are required to attend at least four of the 10 FirstFit sessions, because their understanding and support is critical, Watson says.

“We look at family dynamics and communications, and the girls learn to express their thoughts and feelings rather than internalize them,” she says.

When the girls start the program, Watson has them rate their willingness and readiness to make the lifestyle changes needed to address their weight problem and improve their self-esteem.

“We don’t expect to see any weight change during the five-week program, because losing weight should be slow and gradual,” she says. “But about 90 percent of the girls move forward at least one step in their readiness to change.”

While there is a fee to participate in the FirstFit program, the Moore Regional Hospital Foundation provides scholarships for those who are unable to pay.

Kids ACT
Difficult problems call for creative solutions. For children and adolescents in Richmond County who are at high risk for various health problems, part of the solution is an innovative FirstHealth program called Kids ACT. The program helps the county’s most at-risk kids by providing home visits, customized health education and assistance in obtaining such resources as prescription medications, transportation to medical appointments and health insurance.

Kids who are considered at risk range from premature infants to morbidly obese teenagers. They include children with developmental problems, diabetes, asthma, high blood pressure and other chronic conditions who lack adequate health care.

To help address their needs, FirstHealth has established an assessment committee led by local physicians to study local health care data, identify gaps in current health care resources for at-risk kids and recommend ways to close those gaps.

FirstHealth also has collaborated with the Richmond County Healthy Carolinians Partnership to help identify community resources and health education and service needs. Two nurse case managers help the local physicians achieve these goals.

Kids ACT has developed a guide to services and agencies in Richmond County that focus on children’s needs.

Health care at school
FirstHealth operates two Schoolbased Health Centers in Montgomery County—at East Montgomery and West Montgomery middle schools. A nurse and a nurse practitioner at each center provide health care for students during the school day.

Members of FirstHealth’s Regional Services staff visit the School-based Health Centers several times a week to offer fitness and nutrition counseling. After students are referred by the nurse practitioner, a nutritionist talks with them about their eating habits and works with them to develop a weightcontrol plan. Behavioral Health Care of the Carolinas also provides mental health services several times each week.

Although the health centers are located at the two middle schools, any student in the Montgomery County school system can be seen with parental consent. Two cars purchased with funds provided by the FirstHealth Montgomery Foundation enable health center staff members to transport students between schools and sometimes to medical appointments. “Transportation is a big problem for a number of people in our county, and parents sometimes can’t get their children to the medical attention they need,” says Kerry Hensley, president of FirstHealth Montgomery Memorial Hospital. “The School-based Health Centers help solve this problem.”

Family Nurse Practitioner Joleen Moore examines a student at one of the School-based Health Centers in Montgomery County.

Kids in Crisis
Most of the time, school nurses see kids with cuts and scrapes, coughs and colds, but they also see much more serious problems that aren’t being addressed. In many cases, that’s because the child’s parents can’t afford the needed care or they aren’t aware of resources in the community that could help.

FirstHealth’s Kids in Crisis program provides funds that school nurses in Moore and Montgomery counties can use to get children the care they need. Recent examples of Kids in Crisis assistance involved a child with abscessed tonsils, a learning disabled student who was found to be deaf, a disruptive secondgrader who needed extended-release medication and a seventh-grade student with a severely infected finger.

The FirstHealth Montgomery Foundation supports the Kids in Crisis program in Montgomery County. In Moore County, the Children’s CARE Fund of the Moore Regional Hospital Foundation supports Kids in Crisis. The Children’s CARE Fund also supports the FirstHealth Dental Care Centers, the Clarke Neonatal Intensive Care Unit at FirstHealth Moore Regional Hospital and other FirstHealth services for children.

School nurses use Kids in Crisis funds primarily to address immediate health-related needs and to avert emergency situations.

“They can intervene quickly, before the child has to go to the emergency room or before long-term resources can be found,” says Phyllis Magnuson, manager of FirstHealth’s School Health Program.

“For example, if a diabetic child needs an insulin pump and no other resources are immediately available, the nurses can use Kids in Crisis funds for that. They can use the funds for medicines, glasses, behavioral specialists, even a warm winter coat—whatever is needed to help individual children and keep them in school.”

Dr. Sharon Harrell: Giving back to kids
Dr. Sharon Nicholson Harrell	Sharon Nicholson Harrell, DDS, attributes her special rapport with her patients to her own childhood dental experiences.
As a child growing up in Rockingham, Sharon Nicholson Harrell, DDS, MPH, now admits, she was “not a happy dental patient.” Even though she had a “wonderful dentist,” she was still afraid. She became interested in dentistry as a career when she was in high school and got braces on her teeth. She was fascinated by all the instruments and decided she wanted to be an orthodontist. While she was in dental school at the University of North Carolina at Chapel Hill, however, Dr. Harrell found that she enjoyed the variety of general dentistry. She also developed an interest in administration and public health. After a few years, she went back to UNC for a master’s degree in public health. “That’s how I came to be in the arena I’m in now,” she says of her role as director of the FirstHealth Dental Care Centers. “I really felt I wanted to give back to the community. I wanted to provide care for kids who might not otherwise get that care.” Dr. Harrell has a special rapport with her patients and attributes much of that bond to her own childhood dental experiences. “Since I understand what it’s like to be afraid, it’s easy for me to empathize with anxious patients and make them feel comfortable,” she says.