A Team Approach to Delivery of EPSDT Services in the Pittsburgh, Pennsylvania, Schools
Nativio, Donna G., Allison, Virginia L., Turk, Hattie H., Ballou, Geneva, Dubinion, Diane, Monahan, Nancy K., Tall, Nancy L., Tobin, Patricia, Journal of School Health
Early and periodic, screening, diagnosis, and treatment (EPSDT) was created to address the health care needs of poor and underserved children from birth to age 21. This program was mandated in 1967 by amending the Social Security Act and strengthened in 1989 when funding was provided for comprehensive diagnostic and treatment services for Medicaid-eligible children. The program is financed by a state-federal government partnership.
Despite the documented beneficial effects of this free program,[2,3] many eligible children are not being served. A substantial number of this group attend school. Typically, when children reach school age, a decline occurs in the frequency of health care visits. Explanations for the decline include the popular notion that school-age children are well and thus do not need health visits, and the lack of third party payment for health promotion and preventive services. Further, with the exception of emergency rooms, health care facilities are open during the same hours that children are in school and parents are at work. This fact forces them to miss one to attend the other. Also, the EPSDT program is underused because parents do not know it exists.
EPSDT services generally have been delivered in health departments, hospital clinics, physician offices, and in at least one academic nursing center in which nurse practitioners (NPs) provided the service. This project combining the benefits of EPSDT and in-school delivery of health services by school nurse practitioners (SNPs) addressed both cost and access issues. It also addresses one of the three broad goals of Healthy People 2000: achieving access to preventive services. In addition, the project provided the opportunity to champion the health promotion and care delivery skills of nurse practitioners to families, school officials, and the community at large.
The overarching program goal was improving the health of school-age children. Under the direction of two of the authors, the Program Manager for School Health Services in the Pittsburgh (Pa.) Public Schools, and a consultant from the University of Pittsburgh School of Nursing, a task force was convened. Other volunteer participants included school nurses and nurse practitioners, a health aide, a dental hygienist, a school physician, and the director of the management corporation under contract by the state to administer the EPSDT program. Although the program did substitute for some state-mandated school physicals, it represented additional work for the staff who volunteered since the routine tasks of first aid and responding to ill children and teacher concerns continued. The necessary administrative permissions were secured and the following objectives were set:
* To increase the percentage of EPSDT-eligible children being screened.
* To offer EPSDT services to all in the target population whether eligible or not.
* To provide a profile of health status and health care needs of the targeted population including specific health education needs.
* To generate funds through EPSDT reimbursement to support and improve the school health program.
* To fully use the skills and talents of existing personnel.
* To test a team approach to health screening.
The set of services to be provided were defined and included health history; physical examination; height and weight, dental, vision, and hearing screens; blood pressure; assessment of behavior and development; targeted health education; and a plan for follow-up of problems identified. Laboratory tests included dipstick urinalysis, hemoglobin or hematocrit, lead and cholesterol levels, screening for group A beta hemolytic streptococcal pharyngitis when indicated by physical examination or history, immunizations, and tuberculin skin testing as needed. All services except cholesterol and pharyngitis screens are mandated in the EPSDT program. …