A Partnership Can Solve Anything School Health Collaboration in Worcester During the Covid-19 Pandem

Beverly Nazarian, MD

June 2020: three mOnths IntO the COVID-19 shutdown. Worcester Public Schools (WPS) were fully remote. The district had worked hard to equip students with laptops and Wi-Fi hot spots so they could access learning, but there were challenges. As the school year ended, those of us involved with school health were already starting to plan for school return in the fall. Around this time, the American Academy of Pediatrics (AAP) released interim guidance recommending return to school with in-person learning. Unfortunately, this release coincided with COVID-19 starting to surge in other parts of the nation as well as with fear and misinformation starting to spread in the news and social media.

As medical professionals we recognized that, although we too were learning about COVID-19, our district would require up-to-date accurate medical information to be able to make informed decisions about school reopening. With this in mind, a group of us reached out to Superintendent Maureen Binienda, offering to be a resource to the district for COVID-19 reentry planning. Shortly after, we convened the first meeting of the “Worcester Public School (WPS) Reentry Pediatrician Q & A group.” Participants included the superintendent and members of her team, the WPS nursing director and nurse leaders, and our physician group including the medical director of Worcester Department of Public Health (DPH), the WPS school physician, the president of the Massachusetts Chapter of the American Academy of Pediatrics (MCAAP), a pediatric infectious disease specialist and additional primary care pediatricians.

Our weekly virtual meetings initially focused on what we physicians were seeing in our clinics and hospitals, and fielding questions about masking, testing, or social distancing. As we began to understand each other’s perspectives and to develop trust, what started as a physician Q & A evolved into a true collaboration where we shared updates and solved problems together. Over time, our group expanded to include other key partners such as the WPS manager of social emotional learning and representatives from school-based health centers.

Remote learnIing Challenges:

The pediatricians in our group were advocates for return to school and in-person learning. We shared concerns about the impact of remote learning on our patients: rising obesity, worsening sleep issues, increasing anxiety, depression, and eating disorders. We described challenges for families: lack of daycare meant that single parents had to leave kids at home with remote learning supervised by older school-aged siblings or by grandparents struggling to navigate technology. Inadequate housing meant multiple children had to log on and learn remotely in the same crowded room.

As much as everyone wanted students back in school, our WPS partners taught us why this wasn’t simple. We learned from them about barriers to reopening, many of which were unique to large urban districts.

One barrier was transportation. Distancing requirements dictated that each school bus could transport only a fraction of the usual number of students. Existing buses already made multiple runs, and there were no extra buses, nor were there additional bus drivers. Unlike districts with more resources, many WPS families didn’t have cars or the option of driving their children to school. There was simply no way to transport all the students.

With small classrooms and a plan for six-foot distancing, only limited numbers of students could be allowed in each classroom. Older, poorly ventilated buildings proved another barrier that delayed reopening. While some Worcester schools were newer, larger, or better ventilated, WPS didn’t have the option of opening schools for some students and not others.

Nationally, urban school districts like Worcester were more likely to be fully remote than suburban or rural districts, and to have more students living in poverty. Urban districts also often have greater numbers of English language learners and students receiving special education services. These students with the highest needs often had greater difficulty learning remotely, amplifying existing disparities.

Meeting the needs of the Worcester Community

Although our district had unique challenges, WPS nurses, staff, and administration worked creatively to address them and to meet the needs of students, families, and the community.

Dr. Debra McGovern, WPS Nursing Director, shared that when buildings closed, school nurses adapted to serve the community. Early in the shutdown, they depleted their nursing offices and donated medical equipment, PPE, and cleaning supplies to shelters and the DCU field hospital. Many became contact tracing experts or staffed the afterhours COVID-19 call line, while others worked in temporary shelters set up in schools.

School nurses also worked at WPS food drop off sites, and created hygiene packs and toiletry bags for students, often purchasing supplies on their own. They ran flu vaccine clinics and later COVID-19 vaccine clinics at every school. They set up Google classrooms instead of nursing offices, and proactively reached out to students with chronic health issues.

To keep families updated, WPS administration hosted multiple online public forums to share information and answer questions from parents and students. WPS also created technology cafes to help families troubleshoot computer issues. All WPS students received pandemic EBT cards, improving food access for families dependent on school meals. In collaboration with the Family Health Center of Worcester, WPS offered access to COVID19 testing at school for symptomatic children and staff. Concerned about student mental health, WPS implemented daily socio-emotional check-ins. If a student didn’t respond, school adjustment counselors would reach out, or even visit the home.

The Value of Collaboration:

Our collaboration allowed groups that hadn’t worked closely together in the past to learn from each other. It particularly strengthened the relationship between school nursing and educational leadership. Having everyone at the table allowed nurses to be proactive with issues rather than reactive. One nurse leader described our meetings as, “The best way to get the info dispersed and the easiest way to get it resolved. We were able to get answers and solutions very quickly compared to where we would have been without this.” This proved especially important at a time with a rapid influx of new information regarding the pandemic, as well as frequent updates to DESE and DPH guidelines.

All participants gained an appreciation for the perspectives and challenges of others that they wouldn’t have had otherwise: “.... once we collaborated, we could see what their constraints were, they could see what our constraints were, and we were able to readily fix a lot.”

Almost two years have passed since our first meeting and our group continues to meet once to twice monthly. Reflecting on our success, Superintendent Binienda noted, “A partnership can solve anything. I would never have imagined that all of us would have been together on one committee working on public health and school safety. It is a model that we shouldn’t let go of.... because we know that there is nothing stronger than working with public health and school systems to make sure that everyone stays healthy. It’s key.”

Our collaboration has been a silver lining amid the COVID-19 pandemic, and we hope it will continue. While COVID-19 is not gone, we have vaccines and a lot more knowledge. WPS students have been back in school all year and are making gains. Going forward we’d like to build upon the relationships we have created, shifting our focus from COVID-19 to other priorities such the mental health of our students, and the need to address disparities and improve child health equity in our community.

Special thanks to Maureen Binienda, Dr. Debra McGovern, Kate Perry, MSN, RN, Nicole Kazarian, MSN, RN, and Drs. Lloyd Fisher, Christina Hermos, Mary Beth Miotto, Lynda Young, and Mike Hirsh, and to all the participants in our WPS Reentry Group! +

Beverly Nazarian, MD

Associate Professor, Department of Pediatrics, UMass Chan Medical School School Physician Consultant, Worcester Public Schools Beverly.nazarian@umassmemorial.org