Since 2006, Healthcare & Education Alliance of Louisiana (HEAL) has helped schools secure more than $400 million in Federal Medicaid funds to support inschool healthcare and health equity, officials said in an August press release.
HEAL partners with schools to successfully access federal Medicaid dollars that are currently being untapped by most Louisiana schools. These schools may not know the funds exist or might not have the information, staffing and resources to apply for these critically need funds.
Dr. Deborah Palmer, lead psychologist with HEAL, works in the Central City area of New Orleans where generational poverty is common and healthcare limited. As lead psychologist, she has worked in multidisciplinary team settings, assisting those with autism, depression, anxiety, ADHD and trauma. She follows the Whole School, Whole Community, Whole Child model developed by the Center for Disease Control and Prevention.
The Health & Education Alliance’s mission is to eliminate the health and educational disparities for children who live in poverty in Louisiana. HEAL works directly with students, families, and schools to ensure students are healthy and academically successful, note officials.
“HEAL continues to work in New Orleans charter schools as well as several districts across Louisiana,” Dr. Palmer explained. “We continue to help schools effectively screen for and provide appropriate treatment for both physical and mental health concerns. I’m spending more of my time these days providing professional development regarding appropriate behavior plans for students with emotional dysregulation, professional development regarding Medicaid implementation, and compliance checks for healthcare documentation requirements,” she said.
“I find this type of work incredibly rewarding,” she previously explained to the Times, “as we are addressing student challenges in the environment in which they spend a majority of their time.” In addition, she noted that helping educators learn more about behavioral interventions supports them not only with a single student, but with all their students.
“The multidisciplinary nature of our project ensures that we are addressing the whole child, and not just an isolated symptom of a larger issue,” Dr. Palmer said. “The integration of mental health services into the school setting makes so much sense in terms of access to services, but also in maximizing student outcomes.”
Dr. Palmer provides classroom observations so she can identify a student’s triggers and behaviors, as well as teacher related behaviors and strategies. She also provides behavior management strategies, small group interventions for social skills, emotional literacy, emotional regulation, grief, and anger management, for example. She provides, “a clinical psychology ‘lens’ in meetings addressing students’ with challenging behavior to ensure that real mental health issues aren’t missed or misrepresented,” she noted.
Results from a three-year pilot cohort study between 2014 to 2017 showed that schools that partnered with HEAL had seen a school-wide grade point increase of 25% on average during the three-year study with growth as much as 60% among high-risk children. During the study, HEAL reached 90,784 children in Louisiana and also saw a 25% reduction in failed vision screenings.
According to officials, HEAL is the only organization known to provide a system for schools to address all aspects of childhood health in school. HEAL also teaches schools how to fund the Coordinated Care for the Whole Child™ model permanently and sustainably as part of every school year.
Why is this approach so important to Louisiana? “Students spend a good portion of their day in school and receiving healthcare services at school can save time and travel for the family,” explained Dr. Palmer. “Also, the services in school are in addition to the services they can receive via traditional outpatient services––they can receive both!” she said.
“Funding for these services via Medicaid means the student/family does not have to pay for the services; and the free care ruling means that students that do not have Medicaid are also eligible to receive services in the school setting. Medicaid funding for school based services continues to be underutilized in the state of Louisiana.”
According to the press release, this matters for three important reasons:
• One in four school-age children has a vision disorder that could go undiagnosed without access to regular screenings, according to the American Optometric Association.
• Undiagnosed hearing loss leads to speech delays and is the primary cause of misdiagnosed learning or behavioral disorders.
• More students are behind on regular healthcare checkups due to the Covid-19 lockdown.
“Louisiana schools are essentially leaving free money on the table,” said Connie Bellone, RN SHSC CCRN-K CCHC, Chief Executive Officer for HEAL. “Our goal is to use these funds to get a nurse in every building and a therapist in every school in our state, with a priority on lower- income communities where inschool healthcare is even more critical to the wellbeing of our students.”
HEAL also works with schools to create access to on-site nurses and critical health screenings including mental health, vision, hearing and dental.
“Not being able to see a smartboard or hear a teacher are obvious barriers to a child’s education,” added Bellone, “but we also need to address mental health and undiagnosed chronic illnesses that prevent Louisiana students from reaching their full potential – especially in low-income communities and communities of color. By addressing these health barriers, we can give children a chance to break the cycle of poverty and receive an education.”
One of the success stories from their webpage tells the story: Three boys, aged 16 but still in the 8th grade, had been labeled “emotionally disturbed” and were spending their school days in isolation due to disruptive behavior in the classroom. All three boys were legally deaf.
When the faculty of their school was informed, suddenly everything made sense. The boys weren’t refusing instructions—they weren’t hearing them. They weren’t intending to disrupt the classroom—they just weren’t aware that they were speaking or acting at inappropriate times because they couldn’t hear what was happening. Worse yet, these boys didn’t know they couldn’t hear. They just knew they were always in trouble, but they didn’t know why.
All three boys received interventions for their deafness. Two received hearing aids, and the other received a cochlear implant. They are now close to being on level for their age and were saved from an eventuality that is unthinkable.
“HEAL was instrumental in changing the Louisiana Medicaid State Plan to cover more students,” said Dr. Palmer. “Previously only students with an IEP would be eligible for Medicaid reimbursement. With the change in the state plan, any student with Medicaid coverage and a medically necessary plan of care would be eligible for reimbursement,” she said.
“HEAL continues to work with LDH to update the fee schedule to appropriately reflect the services provided in schools. HEAL is working with the Children’s Cabinet to address the challenges schools face in appropriately documenting healthcare services. It is HEAL’s belief that if there was a Universal Documentation system available to all schools; then students wouldn’t miss out on their services if they had to change schools,” Dr. Palmer explained.
According to the HEAL website, “Children from low-income households face the greatest challenges to completing school and achieving long-term success. You can teach a child only so much when that child is hungry, hurting, not sleeping at night, or simply can’t see or hear well. Experts agree that health and academic achievement are inextricably linked. The CDC agrees that providing health services in schools, both mental and physical, plays a critical role in helping children achieve academically.”
The HEAL program has three essential components. Health screenings, student support teams, and program sustainability. The approach is The Coordinated Care for The Whole Child™ Program. By bridging the gap between education leaders and health professionals, our program ensures comprehensive care for every child in our partner schools.
Jared Frank at HEAL partner Morris Jeff Community School, has seen the difference on-site healthcare can make in the lives of students. “We are grateful for the work of HEAL with our school. With improved and increased access to on-site health care, we’ve seen a dramatic improvement in academic and socialemotional outcomes for our students. They feel better and have better access to health resources which allow them to thrive.”
HEAL officials point out, “It’s important for parents to understand that these are additional health services provided by schools and do NOT count against a student’s individual Medicaid benefit limits. HEAL partners with schools statewide to expand school healthcare services at no additional cost to families.”
HEAL has served 87 schools, districts, and education centers in Louisiana and reached 21% of those students. And 29 local education agencies in Louisiana have obtained Medicaid provider status thanks to HEAL. Since its founding in 2006, HEAL has served more than 147,000 children from early education through K-12. HEAL has performed 100,437 preventative health screenings in schools in Louisiana.
The movement is gaining momentum. According to the HEAL website, on May 10, 2023, Nevada Congresswoman Dina Titus reintroduced her Nurses for Under-Resourced Schools Everywhere Act, legislation that would help public elementary and secondary schools hire registered nurses by creating a grant program at the U.S. Department of Education. According to the National Association of School Nurses, only 39.3% of schools employ full-time school nurses, even though the Centers for Disease Control and Prevention has said that more than 40% of school- aged children and adolescents have at least one chronic health condition. “This legislation would help provide resources for schools to invest in public health and make sure our students have the support they need to thrive,” said Rep. Titus.