Vine School Health Center in Knoxville
It’s been a long journey from the first day of operation back in 1996. The Vine School Health Center was then just a curtained alcove near the bathroom in the teachers’ lounge. Privacy and space were at a premium but at long last the low income children who attended school there had access to primary care and health prevention through a partnership among the University of Tennessee College of Nursing, Knox County Schools and the Knox County Health Department.
Fast forward to 2015 where I find a large facility with four exam rooms, a health screening room for vision and hearing, lab, nurse station, registration area, large waiting room, medication room, offices for the nurse practitioners, social worker and education specialist, and a telehealth room. There is a conference room and a staff break area as well, which are put to good use as various health professions students rotate through the site over the course of the academic year. The current partnership is between the UT College of Nursing and Knox County Schools; any child in Knox County can access the health and wellness services offered here.
Today this nurse managed school health center cares for about 1500 unique patients, all under age 19. The clinic will have over 3000 patient visits during the year. Children are seen for ailments such colds, flu, asthma and minor injuries. The clinic providers also perform hundreds of school and sports physicals each year. Most children are on Medicaid but there are also privately insured children and there are children who have no insurance at all. The faculty nurse practitioners and the front desk alert the social worker when a child is uninsured so that all effort can be made to help parents access any insurance programs for which they are eligible. When no coverage is available such as when the child’s parents are foreign graduate students at UT, the health center uses a sliding fee scale based on income. The parents pay cash and/or work out a payment plan; some families’ incomes are so low that they are charged nothing at all. No child is turned away regardless of ability to pay for care.
One of the most unique aspects of this site is its telehealth program. Using specialized equipment, a nurse practitioner at the Vine School site can examine and diagnose many common childhood conditions remotely at 11 school sites across Knox County. In each of these schools the local school nurse–an RN, not a nurse practitioner–uses telehealth equipment such as a computer with video capability and a specialized stethescope that transmits breath sounds back to the Vine School site where a nurse practitioner listens to the lung sounds or heart sounds over the internet while observing the child and the RN. By using these technologies, the Vine School Health Center is able to extend its reach across the county from a single location.
There have been challenges in growing this creative and vital service. It is still necessary to send some children to Nashville for specialist care at Vanderbilt, three hours away. The child’s lack of insurance or the lack of specialist providers in the Knoxville Medicaid networks force families to travel for care. This situation causes delays in treatment and places added burdens on the family and on the clinic to make the arrangements and help families follow through.
Nan Gaylord, PhD, PNP has been a driving force behind the school health center since the beginning. Growth and expansion requires funding and Dr. Gaylord has been relentless in seeking and obtaining federal, state and local funding for the past 19 years. Her vision is infectious and her colleagues at the UT College of Nursing are firmly committed to the mission of this place: To serve those students who have limited access to healthcare and improve the overall health and wellness of Knox County school children. As their brochure states more succinctly, “Healthy students are students ready to learn.” Vine School Health Center has successfully integrated health, wellness and learning into the lives of this special population providing the foundation for a better life.