When a child has trouble breathing on their own or has such daunting developmental issues that a visit to the doctor’s office causes explosive outbursts, routine dental care or eye exams can be the last thing on parents’ minds.
On the other hand, parents of the children served at Mary Cariola Children’s Center may know their children need this type of care, but find it nearly impossible to get.
Staff at the center, which cares for and provides schooling for children with physical and developmental disabilities, have developed a series of partnerships with health care professionals to overcome these difficult scenarios. The result is bringing the health care to the children while they’re at the Cariola Center.
Anne Pawlowski, head nurse at the center, said she’s often had frantic calls from parents parked in the garage at the University of Rochester Medical Center, unable to get their kids out of the car. Even if they can get their child through the doors of the medical center, their behaviors might be upsetting to other patients waiting to be seen.
“Some families have not been able to be seen at the hospital,” Pawlowski said. Or, they make appointments and are unable to keep them. “Absenteeism at the hospital is very high.”
“Our kids are so complex,” said Sarah Watson, a social worker at Mary Cariola. She said it’s not unusual that when Cariola students are finally seen by a dentist, their records indicate the last – perhaps only – other instance of dental care was delivered in an operating room under anesthesia.
About three years ago, the staff started working out relationships with health care professionals who can bring their services to the children – either at the Al Sigl Center at Elmwood and South Avenues, or at the center’s other campus on East Henrietta Road. These special rounds will be offered at the Golisano Autism Center, too.
Through partnerships like this, Mary Cariola students can have their teeth cleaned, be seen for eye exams, have a followup visit with a nurse practitioner from the developmental and behavioral pediatric unit at URMC, get foot care from a podiatrist, and receive individual and family counseling from a dietician, all during their regular school day.
More children are getting the care they need; Watson said 200 children have visited the wheelchair-accessible SMILEmobile while it was at Cariola centers. Further, regular visits by the same health care professionals means the doctors, nurses and others are getting more adept at serving a special needs population.
“When I was in nursing school, I never saw the special needs population,” Pawlowski said. Only recently has the American Academy of Dentistry started to require training with that population for its members, Watson noted.
Dentistry had been the biggest unmet need among students at the center, Watson and Pawlowski agreed. Since the Smile Mobile began visiting, the staff introduced an oral care plan for the entire school. In some cases, Watson said, developmental or physical problems make brushing a child’s teeth difficult, while in other cases, the disability itself, such as the need for a feeding tube and the lack of regular chewing, creates its own challenges to oral care.
“The dentist goes into the classroom to develop a relationship,” Watson said. The dental professionals and staff work out plans for each student to help them care for their teeth independently, if possible, or advance them toward better care. The students are basically met where they are.
“We will brush kids’ teeth on the floor,” if necessary, Watson said. Or just let a student hold onto a toothbrush to become familiar with it, even if brushing isn’t possible yet. Parents can also get reports from or talk to the dentists directly after the visit.
Nurse practitioner Lorna Patanella visits the center twice a month to follow up on patients connected to the developmental and behavioral pediatric unit of Golisano Children’s Hospital.
“It reduces the out-of-school issues for families. It makes it much easier for kids to attend the appointment,” she said.
One of her visits might involve a social worker, physical therapist, occupational therapist and others, besides a parent. With both family and school staff present, Patanella said, “I get much clearer picture … It helps me to come up with better treatment plan.”
Developing such relationships with health care workers also makes for speedier return to school when a student has been hospitalized, Pawlowski said. She described a student who has a breathing condition that varies by body position. When the child was in the hospital, the staff was trying to find the best positions to situate the student so breathing was easier. Cariola staff, meanwhile, had already developed a positioning plan.
After that experience, the Cariola staff reached an agreement with hospital staff to be notified when a student goes into the hospital. The two-way exchange affects both the student’s stay as well as discharge plans.
“The goal is shorter hospital stays,” Pawlowski said. But she and Watson have other goals, too: offering a different clinic for the students every week. They’re working on replacing a visiting neurologist who moved away, and other specialties would be useful, too.