Flagship Program Provides a Model for Early Clinical Exposure, Service to Community

History

For nearly a quarter of a century, a large-scale health screening program, now known as Score 1 for Health®, has served elementary school children in the urban core of the Kansas City metropolitan area. This program, sponsored by Kansas City University of Medicine and Biosciences (KCU), illustrates the unique role a medical school can play in improving the health of the community it serves.

The program began in 1993, when a local nurse set out to assess if the health needs of school children were being met. She completed a community needs assessment of the neighborhood surrounding the former Park Lane Medical Center and discovered that a significant number of children enrolled in local elementary schools had unmet health needs. Following this discovery, the nurse implemented a program aimed at performing health assessments on children enrolled in two elementary schools near Park Lane. During the first year of the program, 240 school children from the area included in the initial needs assessment survey received free health screenings.

Following these early strides, the program began to experience significant growth. By 1996, it had grown to include nine schools in the Raytown School District, necessitating the addition of a second nurse. This was also the year in which Dr. Bob Ricci, chief of staff at Park Lane Medical Center and dean of the University of Health Sciences (UHS) — now KCU — saw an opportunity to involve second-year medical students from UHS. He incorporated the medical students into the program by having them perform the physical assessment portion of the health screening. By this time, the program had formed partnerships with local nursing schools and the University of Missouri-Kansas City (UMKC) School of Dentistry, leading to increased manpower, the provision of additional services and further growth.

Community support for the program began early on, when it caught the attention of former Kansas City Chief, Deron Cherry. Through the generosity of the Deron Cherry Foundation, proceeds from the Deron Cherry Celebrity Invitational golf tournament began to help support Score 1 for Health. His association with the program also led to grants from other NFL Charities for the purpose of supporting Score 1.

By 1999, 3,700 children in 13 schools were being served annually by Score 1 for Health. In 2000, as a result of Park Lane Medical Center’s closure, UHS absorbed Score 1 for Health, adopting a formal mission of “serving the underserved.” In 2001, with strengthened support from the University and a grant from the Kauffman Foundation, the program more than doubled in size. This growth included a new partnership with the Kansas City Missouri Public Schools, adding eight schools in 2001 alone. In 2005, the program expanded across the state line to include schools from USD 500, a large urban school district in Kansas City, Kansas. By 2007, nearly 13,000 children were being served by the program, and a follow-up component was developed to reach out to parents in the days following the health screenings to answer any questions regarding screening results.

The years following 2008 have been years of growth in terms of grant funding, continued outreach, service to the community, staff, and technology. Additionally, the program has been able to provide valuable and unique information back to the community and to community leaders regarding the health status of children living within the program’s boundaries. The Score 1 for Health program is a unique and special program that is now deeply engrained in the culture of KCU and the community in both academic and community service sectors.

Score 1 for Health’s CHAMPS program, which pairs KCU students with local families to provide healthy lifestyle coaching, celebrates a successful cohort.

How the Program Works

The program would not exist if it were not for a supportive University, a supportive community and an incredibly dedicated Score 1 team.

Nearly all of the elementary schools participating in the Score 1 program have a very high percentage of students enrolled in the free/reduced school lunch program, and the families of these students face more challenges than most in terms of finances, transportation and equitable access to health care. The elementary school nurses (when there is one) and the principals at these schools are instrumental in engaging the teachers and families in Score 1 and making the value of the program known. Prior to a screening day, all children participating in the program must have a consent signed by their parent or guardian. While it is made clear to the family that the Score 1 screening is not meant to take the place of well-child visits, teachers report that Score 1 provides the only medical assessment some of their students receive.

Today, the Score 1 team is led by a group of full-time registered nurses in the roles of director, school/community outreach coordinator and screening coordinator. Also included on the team are an office coordinator, registered dietician, community health worker, program coordinator, data entry specialist and data entry clerk, and 10 PRN nurses who help on screening days. A pediatrician (a member of the clinical faculty) serves as the medical director of the program. On screening days, nursing students from area nursing schools and dental students join the medical students at screening sites. Members of the KCU clinical faculty, along with several community physicians, serve as supervisors for the medical students. Nursing instructors and the Score 1 nurses supervise the nursing students, and the dental students receive supervision from the faculty of the UMKC School of Dentistry.

On approximately eight afternoons scattered throughout the first and early part of the second semester, the approximately 250 second-year medical students at KCU board buses and are transported to elementary schools throughout the urban core and close suburbs of both Kansas City, Missouri, and Kansas City, Kansas. They are met at the schools by the nursing students, dental students, Score 1 team and supervising faculty. There are approximately 45 elementary schools that participate in the program, with between four and six schools visited on each screening day. The nursing students measure and weigh all the students, calculate the BMI and screen everyone’s vision. The medical students obtain a blood pressure reading and perform a modesty-protecting physical exam. Finally, the dental students along with some of the medical students screen everyone for tooth decay and other dental issues. Kindergarten classes through fifth or sixth grade participate and all findings are documented, with positive findings confirmed by a supervisor. If it is determined a child needs to see his/her physician, a note is sent home with the student that includes the findings and the recommendations of the screener.

After the day of the screening, the Score 1 team goes to work. A letter is generated and sent to the parents with height, weight, BMI, results of the vision screen, and findings of the physical exam and dental screening. This letter contains educational information about BMI, what it is and what it means. If students have failed vision screens or have abnormal blood pressure measurements, a Score 1 nurse will return to the school to repeat the screen and make appropriate notifications and arrangements. The last step is a phone call to the families of screening participants several days after the event to answer any questions they may have about the Score 1 letter. Again, if follow-up with a physician was recommended, they are encouraged to seek appropriate care. If they do not identify a primary care provider, recommendations are given. If the school has a nurse, he/she is made aware of any findings needing further attention and becomes an important liaison in the effort to communicate with and educate the family.

Score 1 collaborates with many community organizations and has developed several programs and services in response to the needs identified by families. For example, finding adequate and affordable support to combat obesity is a need many parents of obese children have reported. Score 1 designed the CHAMPS program, currently grant-funded by a local community health foundation, to help meet this need. In this program, medical students are first trained by a pediatrician and a dietitian. These medical students are then matched, one-to-one, with a child and his/her parents to provide education and coaching for healthy lifestyle modifications. The program is free, flexible for families, and provides a rich opportunity for medical students to actively engage with the community. They learn how to assess and counsel children and parents from culturally diverse and mostly low-income households, educating them on how modification of lifestyle and changes in behavior can have a positive impact on health.

Why Score 1 for Health?

The benefits of Score 1 for Health are multifaceted. First and foremost, it benefits the children of the community in several ways. Because schools that participate in Score 1 serve families and neighborhoods in which the social determinants of health could be described as poor to fair¹, for some children it provides an interface with the health care system they might not otherwise experience. On screening days, it is not unusual for the screeners to identify a physical finding needing further evaluation, a dental condition requiring dental care, or a social situation needing further investigation.

For example, consistent with published literature on the childhood obesity epidemic and its disproportionate effect on children in an urban-core setting, 40 percent of the children screened by Score 1 are found to be overweight or obese upon calculation of their BMI.² Score 1 provides the opportunity to educate the families about the BMI, what it means, and how obesity increases the risk of hypertension, Type 2 Diabetes and heart disease. Dental caries can be a cause of school absence, poor nutrition and pain in children. Oral health exams performed on screening days demonstrate untreated dental caries in 27 percent of the children whose families are then instructed to seek dental care for their child. If a child fails his/her vision screen on the first attempt, it is repeated at a later date. On average, 19 percent of children whose vision is screened are referred to a vision care specialist. The goal of the Score 1 program (and the desired result) is to connect families to health care services and promote good health in children, helping them reach their full potential.

Score 1 for Health screenings give the elementary school children an opportunity to interact for a short time with a diverse group of young, energetic medical students and nursing students. This interaction occurs in a safe, familiar and non-threatening environment. Although these children are not yet likely planning their future careers, exposure to health professions students could plant the seed of interest in a health care career that, if nurtured, would grow as years pass.³ The medical and nursing students can often be heard asking their young elementary school counterparts, “What do you want to be when you grow-up?” Hopefully Score 1 is inspiring at least a few who will become the health care professionals of the future.

Score 1 for Health is also beneficial to the medical students at KCU. Score 1 gives them the unique opportunity to see a community from the vantage point of those who actually live there. It provides a real-world lesson on the impact that social determinants can have on the health of children and families, and it serves to remind the students of the immense challenges many families face on a daily basis. This program provides extensive experience in how to approach, examine and communicate with pediatric patients. This pre-clinical pediatric experience is unique among medical schools in the US and helps prepare KCU students for their third-year pediatric clerkships. Moreover, Score 1 provides an opportunity for medical students to see themselves as part of a team-based approach to care, highlighting the importance of professionalism. Having medical, nursing and dental students working together to accomplish these screenings provides an educational opportunity for valuable inter-professional interaction and inter-professional coordination and cooperation.

Score 1 provides an early clinical experience for medical students, and while it involves children and is particularly inspiring to those interested in pediatrics or family medicine, the experience is beneficial to all of the health professions students. The nursing, dental and medical students are an essential and valuable part of the entire Score 1 effort. Unlike most early clinical experiences in which students merely observe and listen, students at Score 1 weigh, measure, obtain vital signs and examine the children and then document their findings. There is great value to the work they do, and their contribution is vital to the overall goals of the program. Their efforts impact both the children being screened and Score 1 for Health as a whole. The feeling of being a contributing member of a medical team has been shown to combat the “burnout” sometimes experienced by health care learners, and it helps bring meaning to the extraordinarily hard work of medical school.⁴

KCU is proud of Score 1 for Health, as it is a very unique program in both the academic and community sectors. Currently, scholarly efforts are underway to more objectively assess the benefits of this program for the children screened, the collaborating schools and the professional students involved in the screenings. It is hoped that Score 1 for Health will become a model for other academic institutions and communities wishing to develop their own large-scale childhood health screening programs.

Biography

Ray Newman, MD, MSMA member since 2016, is Medical Director for Score 1; Anne VanGarsse, MD, MSMA member since 2013, is Assistant Dean, Clinical Affairs; and Annette Campbell, RN, is Director, Score 1 For Health; all are with the Kansas City University of Medicine and Biosciences.

Contact: RNewman@kcumb.edu