By Dr. Dan Leikvold, Superintendent, Lead-Deadwood-School District, Lead, South Dakota
The Lead-Deadwood School District is a rural district located in the Northern Black Hills of western South Dakota. It has a K-12 population of around 710.  The tourism, gaming, and mining industries are the primary economic drivers in the Lead-Deadwood Community.
Although there are many outstanding opportunities for workers in the area, as with many school districts, we too have our share of challenges that are directly associated with the effects of poverty.  This includes behavioral issues, transiency, limited access to transportation, and a lack of affordable housing.  The free and reduced lunch rate in our district is around 50%.
Over the course of the last ten years, the school district has identified and worked with multiple local and regional agencies to address the needs of our children and families affected by poverty.  We realize we cannot be all things to all people, but we recognize the crucial connection between our children being happy, healthy, safe and supported and their ability to learn at school.
As part of this comprehensive approach, the school district entered into a partnership with Behavior Management Systems (BMS) in 2013 to bring a Family Pathways therapist from BMS to our schools/community full-time.  All of the children and adolescents with whom the therapists work must meet the severely and emotionally disturbed criteria as outlined by the Individuals with Disabilities Education Act (IDEA), and the program is open to anyone with this diagnosis whether or not they have an Individualized Education Program (IEP). This partnership has been a win-win opportunity for both parties and has benefited our children and families immensely.  Family Pathways is a fee-for-service program, so the direct costs to the school are minimal and include providing the therapist with an office and internet access, use of a copier, and parking.
After five years of a successful partnership in which we have been able to serve approximately 100 children and families onsite, we have identified another very important issue to address in order to have an even better program.  In conjunction with BMS, we will now be providing mental health services to the students in the Lead-Deadwood School District via telemedicine free of charge to students and families, as well as the school district, during the school day.
Telemedicine is the remote delivery of healthcare services, such as health assessments or consultations, over the telecommunications infrastructure. It allows healthcare providers to evaluate, diagnose and treat patients without the need for an in-person visit with the medical provider. TeleMed is the service provider BMS and the district use for the service.
The TeleMed program will alleviate barriers for families, so that medication and other therapies are consistent and maintained.  Many times, appointments are missed due to challenges with transportation facing students and families.  As a result, obtaining and maintaining adequate medication therapy is interrupted.  This new approach will alleviate that problem.
This is how it works.  A parent/guardian must be present at each appointment with BMS.  BMS will handle all release requirements prior to our students receiving services in our schools.  Before each BMS appointment, the School Nurse takes weight and blood pressure data for each student so the BMS provider has this information, but the District is not responsible for or charged for any portion of the services provided in the Lead-Deadwood School District.  We are responsible for providing a computer and technical support during the time of the TeleMed appointment with BMS.  Our students meet virtually with the BMS provider once per month or more if needed.
Students that receive free lunch will qualify for BMS services at no cost and there is a sliding scale rate for students that do not qualify.  We will make referrals to BMS based on school and parent communication, similar to what we currently do with BMS on-site counseling services.  BMS has contacted the Lead and Deadwood pharmacies and both are capable of receiving escripts.
Instead of taking a student out of school from three to four hours to an entire day, these virtual,  in-building appointments will take a maximum of 20 minutes to half an hour.  This will allow parents to come to the elementary school, eliminating the barriers of time, transportation hassles for parents and students, and loss of attendance.  We appreciate this partnership and are excited to be able to offer this new service to our children and families.

Dr. Leikvold is an Education Advisor to CHHCS for a RWJF-funded project to provide state and local stakeholders in the education and health sectors with tools they can use to develop a sustainable, cross-sector infrastructure to provide integrated supports for the healthy development and academic success of students.

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