It’s already that time of year. For most pediatricians, back to school season is a barrage of well visits, school and sports forms, and early flu outreach. This year, however, there are plenty of questions surrounding how school, sports, and play will operate safely for kids and families. While answers to these questions may shift, pediatricians can prepare a host of options to make sure that kids’ health and education is accessible, equitable, and even fun.
Pandemic Practice: Drive-Thru Imms, Flu Clinics, and More
Pediatricians are getting creative to offer vital services and healthcare to families while keeping them safe and mitigating risk of infection as much as possible. While some have offered vaccinations in the parking lot or via a drive-thru, if you’re just getting started, here are some logistics to help.
Dr. Anwar of The Center for Advanced Pediatrics in Norwalk, CT working at the practice's drive-thru immunization. (Credit: Monica Jorge for The New York Times)
Keeping Vaccines Stored Safely
Keeping vaccines stored at the proper temperatures is all-important, lest they need to be discarded, which is a waste of your materials and money. Rather than attempting to move your fridge outside or attempt to transport individual vaccines from inside the practice to a patient waiting outside, some practices have elected to preserve the cold chain by storing vaccines in coolers, making sure they’re consistently checking an internal minimum/maximum temperature reading (a digital thermometer can work for this).
When considering materials to use in storing vaccines, the first choice is always a vaccine fridge. If this isn’t possible, you should use a hard-sided cooler with passive cooling from water bottles -- not a soft-sided cooler. The use of a “dorm” style refrigerator is also not recommended. According to the CDC’s Vaccine Handling Toolkit, vaccines can be transported using frozen water bottles to maintain the recommended temperature of 4-5 degrees Celsius.
Preparing for a Flu Clinic
Flu vaccines remain important for protecting the health of your patients and this year they are also crucial in reducing the burden on hospitals and urgent cares as the COVID-19 pandemic continues. As practices who have offered flu clinics in the past will know, clinics are a great way to reach many kids at once, and the difficulties mainly lie in logistics. Logistics during the pandemic-era are not dissimilar.
Some PCC clients such as The Center for Advanced Pediatrics in Norwalk and Darien, Connecticut have been hosting drive-thru immunizations and flu clinics for over 18 years; they were featured offering these services in The New York Times in April 2020. Their system is simple -- the parents drive up, the patient offers an arm, receives a vaccination, and the car is sent off to finalize paperwork.
Flu clinics really can be that simple with the right preparation! A successful flu clinic will need:
- Awareness campaign via email, social media, signage prior to the event
- A way for patients to register -- this allows for an accurate vaccine order
- Location for the event that allows for the flow of patients, safe distancing, and safe transport of vaccines
- Proper materials, from signs to tables, tents, coolers, and PPE.
- Pro tip: Some practices use stickers to confirm which vaccine and method (mist or shot) the patient receives; this sticker is transferred from the patient to the paperwork upon completion of the visit.
The CDC has a list of recommendations to keep patients and staff safe at satellite, temporary, or off-site flu clinics. Your practice may consider holding a clinic where risk is most mitigated -- this could be outside, at an alternate location, or in the office.
During a clinic, surfaces, equipment, and hands should be sanitized properly between each patient. Signs, announcements, flyers, and signals may help guide traffic and expectations for any wait times, as well as allow families to prepare for the visit while they wait. Post-vaccination, there should be a post-check area, for example, a sectioned-off parking space, in which to examine the patient before they leave. The CDC cautions that this goes especially for patients who are driving, whether adolescent patients or if you offer flu vaccines to parents and guardians.
Educational Changes: What to Look Out For
In attempts to balance in-person learning with safety measures to protect staff and students, schools across the country are proposing plans largely based on local needs and resources. Plans may include resuming in-person learning, remote learning, or a combination of the two. For pediatricians, it will be important to understand the benefits and risks associated with each model in order to best counsel patients and families to make the best choices for their child’s health, well being, and educational goals.
In-person schooling raises hopes and fears for families this year. In-person schooling is largely seen as more effective academically, and has benefits for kids who need more direct oversight and guidance, such as those with disabilities. However, while children are less likely to contract COVID-19 (with increasing risk for older kids and teens) the role of kids as carriers to adults is less clear. Therefore, social distancing and other safety restrictions may limit the number of kids who are able to attend school in person. Kids with disabilities and younger children stand to benefit the most.
Remote schooling is arguably the safest option for children in regards to restricting the spread of infection, but represents a huge struggle for both kids and parents. Lack of access to reliable internet or devices, lack of motivation and oversight, and lack of social connections during learning make remote learning difficult for many families. Kids in primarily remote learning environments may experience more emotional breakdowns and stress -- they may also be prone to injuries while playing unsupervised, as many occurrences this summer reflect. Remote work may be the best for immuno-compromised children, however, as well as older students who have more of a chance to contract COVID-19.
Pods and microschools are a recent phenomenon that aim to reduce a child’s exposure to peers to about 4 other students in a “pod,” taught by a hired teacher, a parent, or another supervising adult. Benefits include reduced exposure to others, opportunities for socialization, and options for parents to balance work and their child’s schooling. But while this strategy can be effective when executed correctly, critics are concerned that the expense of “microschools” or hiring a professional is prohibitive to many families, and that thorough safety measures are still required for complete success in preventing spread. Families attempting these methods may benefit from a discussion covering hand-washing, sanitization, safe distancing, and contact tracing.
Planning and Re-Planning
Because each school system and each student within the system will have different plans, needs, and resources, the takeaway for pediatricians is not to attempt to recommend any schooling option in particular, but rather to evaluate with families the options available that make the most sense for the health and success of the patients, which will be different in every case, even between siblings.
Questions to facilitate this conversation with families include:
- Did the patient participate in remote learning in the spring? If so, was it successful? What could make it better/more successful?
- Is anyone at home considered high risk?
- What is your first choice of schooling option? Your second choice? Is there a schooling option you wish you could do but cannot?
- Are you comfortable with the precautions your child’s school is taking? Is the patient comfortable with them?
- What would prompt you to need to change your plans?
Physicians should also prepare for -- and prepare families for -- revisiting schooling options if the first try doesn’t pan out the way everyone hoped. A student who did well with remote learning in the spring may struggle in the fall, or vice versa. It will be a stressful and tumultuous time for many families, but the support of their pediatrician during the adjustment period will be a valuable comfort and resource as the community moves forward together.
Well Visits + Patient Recall
We’ve mentioned before that patient recall, well visits, and vaccinations are crucial for your practice to focus on as school approaches. Recall and well visits are important indicators of health and maintain a child’s vaccination schedule -- they are also important to help your practice’s bottom line, especially if you took a financial hit during the first wave of the pandemic.
As well as keeping patients physically healthy, well visits offer a chance to check in with a child on their emotional health before a school-related issue occurs. Physicians can ask how they foresee the school year going, whether they have concerns for themselves or their loved ones, and offer resources for help.
Recall visits enable you to check on both complex care patients and revisit management plans for patients, especially as the shape and scope of their school year remains uncertain. For example, patients with asthma, diabetes, or an otherwise compromised immune system may benefit from counseling on safe practices around groups of peers, symptoms to look out for, and plans to turn to if they or their parents don’t feel safe with in-person learning -- for strategies, see the section on educational changes above.
Now is also a great time to revisit care plans for patients with behavioral needs or disabilities -- they may need extra support as their routines change from isolation to school or a combination of remote and in-person learning. Kids with autism may benefit from a slow, measured introduction to face masks, according to the nonprofit Autism New Jersey. The Child Mind Institute also has a great list of resources for parents on coping skills, managing anxiety and depression, and talking about feelings.
The changes in school and work routines are stressful and emotional adjustments for many families, and as a practice you may already be considering how you can be there to help kids get the support they need. If you’re considering behavioral health at your office, you’ll want to learn about all your options before committing. Learn about consulting, coordinating, and hiring the right specialist for your office with the ebook Integrated Behavioral Health: A Guide to Expanding Access. You can download the ebook and start your plan now by clicking below.