Finding a pediatrician or behavioral-health specialist is a time-consuming endeavor for parents in rural Jones County, N.C.
With only one private pediatric practice and few local organizations offering mental- and behavioral health services for the county’s nearly 1,700 children, parents often wait long hours to see a medical professional when they finally snag an appointment.
That’s why the telehealth program in the Jones County public schools has been such a game changer for the district’s 1,110 students and 215 employees. They now can visit with health-care professionals via a secure remote connection for minor medical conditions such as sore throats and ear infections, nutrition counseling, and mental health issues—all without leaving their school buildings.
The initiative, the brainchild of Superintendent Ben Thigpen, is the first of its kind in this agricultural community, about 100 miles southeast of Raleigh. It launched at a fortuitous time in 2021—amid the global COVID-19 pandemic, which has severely disrupted school systems and catapulted students’ mental health and social-emotional well-being to the top of district leaders’ minds.
Remarkably, Thigpen got the program up and running just one year after arriving at the five-school district in January 2020. To him, the initiative simply made sense.
“You learn that [a] student’s academic outcome is affected by a lot of different things, including their health,” Thigpen said. “And school is where they all come together. It’s where we serve them.”
Luckily, Thigpen, 58, didn’t have to start from scratch; he’d overseen the start of a similar school-based telehealth program in the Duplin County district, in nearby Kenansville, where he worked as an assistant superintendent before moving to Jones County.
The inspiration came from a trip he took with the district’s nurses in 2016 to the far western part of the state to learn more about the work of Steve North, the founder of the Center for Rural Health Innovation’s Health-e-Schools. A teacher-turned-physician, North started the school-based telemedicine program after seeing his former students struggle academically because they lacked access to adequate medical care.
Thigpen left the meeting impressed and optimistic about offering telehealth on school campuses, but without funding, the Duplin County district couldn’t move forward.
That changed later that year, when East Carolina University’s Brody School of Medicine received a $1.2 million grant from the U.S. Department of Health and Human Services to start the Healthier Lives at School and Beyond school-based telemedicine project. The program aims to leverage telehealth to improve and expand access to mental health services, primary medical care, and nutrition education and counseling to students and staff members in rural eastern North Carolina.
“The bottom line is this: Healthy children make better students,” said Jill Jennings, the coordinator of the Healthier Lives at School and Beyond grant at East Carolina University’s Family Medicine Center. “The project addresses critical rural health needs and has great potential to impact at-risk minority children while also improving the health and wellness of the local workforce.”
Additionally, Duplin’s high childhood poverty rate—34 percent compared to 21 percent statewide, according to 2021 U.S. census data—puts its children at an overall disadvantage.
Those conditions were not lost on Thigpen, his colleagues say.
“I think he has a real vision for the relationship between health and academic performance,” said Doyle Cummings, the co-director of the Research Core for the ECU Health Disparities Research Center. “He understands that at a level I think many administrators don’t, because he came up through the ranks in a community where kids don’t have access to good, quality health care.”
The program intentionally started small, in just three of Duplin County’s schools (it now spans all 12 traditional schools). The impact was clear early on. Participating schools saw fewer student and staff absences and disruptions for working parents, many of whom previously had to travel long distances and miss work to take their children to the doctor.
Thigpen leaned into his relationship with East Carolina University once he got to Jones County, a community whose demographics and dearth of medical professionals are similar to Duplin’s. Many of the residents in both areas work in low-paying agricultural jobs, with few perks. An estimated 37 percent of Jones County residents younger than 18 live in poverty, according to census data. Many also are uninsured, making them likely to miss annual check-ups and routine screenings, said Adrian Smith, a public-health education specialist in Jones County’s health department.
But it wasn’t just data that drove Thigpen; he also knew firsthand how hard it was to find pediatric medical care locally.
“As a parent myself, if I want to take my child to the doctor, I was looking at at least a half day to do that,” he said. “It’s not like a major city where I can take off and be there in 15 or 20 minutes and be seen. Even if I go to see my local family doctor, I’m going to wait two or three hours.”
Pandemic-related school closures meant the initiative got off to a slow start, but the district is already seeing positive effects.
To date, well over a thousand medical visits via telehealth have been recorded for students and staff in Duplin and Jones counties.
The majority of visits have been for behavioral-health reasons, such as anxiety and depression; others were for acute minor medical concerns like ear pain and flu symptoms. Additionally, there have been more than 500 nutrition-counseling sessions, mainly in small groups, to educate students on healthy eating and other positive habits, such as the importance of regular physical activity and its connection to better health.
School nurses and telehealth providers coordinate follow-up visits when necessary.
District officials also report diminished classroom disruptions and better academic performance among students who have participated in regular behavioral-therapy sessions and overall improvements in student-absenteeism rates.
Sue Ellen Cottle, the lead nurse in Duplin County, credits Thigpen with the initiative’s success.
“His dedication to the program and to securing health services for all students and staff is clearly a representation of his commitment to education and compassion for the well-being of all students and staff,” she said.
Telehealth has been a godsend for students like Cesar Marquez-Morillo, a senior whose family immigrated from Venezuela three years ago.
Cesar developed severe anxiety during the pandemic, so much so that when school reopened, he couldn’t bring himself to enter the cafeteria at lunchtime.
“I wanted to talk to someone,” he said. “My mom wanted me to get therapy but didn’t know how.”
He found help at school, where twice this school year he has sat down with the school nurse in front of a computer monitor and met online with a therapist, who talked to him about his problems and shared techniques to relieve his anxiety.
“Now I go to the cafeteria,” Cesar said. “I can go to other spots at school with no problem.”
Thigpen grew up in Duplin County, where he started his education career as a teacher and spent the next 12 years.
Though he had a family connection to education—his father taught business education in neighboring Onslow County schools for 30 years—Thigpen didn’t always see himself following in his father’s footsteps.
But his dream of becoming a wildlife officer after college was cut short because of his poor eyesight. While Thigpen was figuring out his next steps, the principal of East Duplin High School, Thigpen’s alma mater, called to inquire whether he was interested in a five-month stint as a substitute for a teacher on maternity leave.
Thigpen said yes. His response, he acknowledged, may have been because of his upbringing.
His father, who raised Thigpen and his two siblings after their mother’s death when Thigpen was 16, was also a self-taught farmer. And Thigpen recalls his father poring over manuals and books on anything he needed to learn, from carpentry to raising Black Angus cows.
“He was undaunted and just felt like he was well equipped to do whatever he needed to do,” Thigpen said.
So, Thigpen became a substitute teacher with no training. By the time he left Duplin, he had earned master’s and doctorate degrees in education and had taught English, coached football and baseball, and served as an administrator.
Thigpen’s current and former colleagues describe him as a public servant who is acutely aware of the negative and layered consequences of the lack of health-care access, and they say he’s resolved to find solutions.
“He knows we can’t just target academics, that we have to take care of the whole child,” said Danielle Bryan, the director of exceptional children and student services in Jones County schools.
Along with the big-picture vision needed to initiate a program like school-based telehealth, Thigpen has been persistent in seeing it through, his colleagues say.
He “has been pivotal at every turn,” Jennings said. “He’s offered his support in every way we could have possibly needed—helped with extended funding, promoted the services among families. He’s just been a tremendous support.”
Recent natural disasters have created additional health hurdles in the area, which was battered by Hurricanes Matthew in 2016 and Florence in 2018. The latter caused the Trent River to overflow. Hundreds of homes were destroyed. Schools were shuttered for weeks. Two years later, the COVID-19 pandemic struck.
In the face of such challenges, Thigpen’s promise to meeting his students’ and community’s long-term needs remains unwavering.
“The parents expect us to take care of their kids,” he said. “They put a lot of trust in us, and we try to make sure we honor that.”
As Thigpen reflects on the telemedicine program, he considers its impact from both an immediate, individual perspective, as well as its longer-term, big-picture potential.
“For some kids, it’s just there, and they rarely need it,” he said. “But for those who need it, it’s really critical and it turns things around for them. I think, five years down the road, we’ll look back and say: We really did a great thing by doing that.”
A version of this article appeared in the February 16, 2022 edition of Education Week as A Telehealth Program Brings Mental and Medical Health Care To a Rural District