This issue of the NCMJ discusses factors that influence the well-being of residents in rural communities in North Carolina. These include factors related to health care, such as physician recruitment and retention, the effects of hospital closures, and the need for behavioral health services, and factors beyond the health care sphere, such as child care, health behaviors, economic development, and access to health services.
Physicians Providing Leadership for Rural Communities
Goldsboro Pediatrics provides community leadership by targeting adverse child outcomes such as unplanned pregnancy, chronic mental health disorders, tobacco addiction, child abuse or neglect, school failure or drop out, obesity, and type 2 diabetes. Physicians can address long-term child outcomes during office visits, but we need to collaborate with other groups to assure success. We must provide leadership and form coalitions with like-minded professionals in the community in order to effectively improve child outcomes.
I was on our school board from 1983 to 1991, during which time the issue of student pregnancy became a prominent concern. During that period, the school board hired a health educator, and I served as her supervisor; through this relationship, she became linked with our practice. Pregnancy rates were cut in half after 1 full year of this program.
Today our practice oversees the Wayne Initiative for School Health (WISH), a private, nonprofit corporation that operates 6 school-based health centers in schools with at-risk students. The centers utilize our practice’s electronic health record, and enrollees receive services at Goldsboro Pediatrics whenever schools are closed. Pregnancy rates are significantly lower in the WISH schools.
Chronic Mental Health Disorders
Private-sector mental health professionals provide over 5,000 consultations per year in the WISH centers. We have implemented a program in an elementary school that allows at-risk children identified by the school nurse and social worker to receive mental health services onsite from a private-sector mental health professional. We hope to later duplicate this model in other elementary schools. There are 2 mental health professionals at Goldsboro Pediatrics, and the practice arranges telemedicine consultations with the Department of Child Psychiatry at East Carolina University if a patient needs a child psychiatrist.
Goldsboro Pediatrics participated in an American Academy of Pediatrics program—called Pediatric Research in the Office Setting—to develop a system for educating patients and their families about the dangers of tobacco addiction and for linking smokers with QuitlineNC. To continue this valuable program, the practice is collaborating with Prevention Partners.
Child Abuse and Neglect
In the early 1990s, research began to show that intensive home visiting can reduce early child abuse and neglect. Through a strong partnership with our local Head Start agency, we established Wayne County First Steps, a Healthy Families America intensive home visiting program. Currently, we are in the process of converting to the Nurse Family Partnership model for intensive home visiting.
School Failure and Drop Out
For the past decade, Goldsboro Pediatrics has raised about $40,000 per year to participate in Reach Out and Read, an early literacy program wherein primary care providers give new books to patients aged 6 months to 5 years at all well-child visits. According to 2013 data from the Annie E. Casey Foundation, 66% of 4th-grade students nationally are not reading proficiently . We met with the administration of our public schools to discuss school readiness. We learned that, despite our Reach Out and Read effort, far too many children enter kindergarten unprepared to learn to read; thus, our community needs to do more to improve the language skills of preschool children. We therefore organized a steering committee of partners—including Smart Start, Head Start, the local health department, the local hospital, public schools, the mayor’s office, the public housing authority, the public library system, the Cooperative Extension Service, and Seymour Johnson Air Force Base—and conducted a community forum. Our goal is to work with this coalition to improve the school readiness of kindergarten students.
Childhood Obesity and Type 2 Diabetes
Goldsboro Pediatrics partnered with the health department and Family YMCA to obtain grant funding for the CHANGE for Children program (Commitment to Healthy Attitudes in Nutrition, Growth, and Education). Scholarships are available for youth living in poverty. Enrollees attend wellness sessions at the Family YMCA 2 nights per week for 10 weeks; during these sessions, a dietitian, a fitness expert, and a health professional teach children healthy exercise and eating habits. Goldsboro Pediatrics also joined GoWayneGo, a countywide effort to improve wellness that is being spearheaded by the county commissioner, the local hospital, and the local health department. Our practice is also starting a quality improvement program administered by the American Academy of Pediatrics to improve the outcomes of overweight and obese children.
Goldsboro Pediatrics is a true medical home for the children in our catchment area, and we are integrated with our state’s Medicaid model, Community Care of North Carolina (CCNC). Today Goldsboro Pediatrics operates 4 offices where 17 pediatricians, 7 nurse practitioners, 1 physician assistant, 2 mental health professionals, 1 certified lactation consultant, and 2 CCNC care coordinators provide comprehensive health services for pediatric patients. Our practice continues to provide leadership for our community to ensure that more of our children grow up to be responsible, happy, economically independent adults.
Potential conflicts of interest. D.T.T. is an employee of Goldsboro Pediatrics.
1. Kids Count Data Center. Fourth Grade Reading Achievement Levels. Annie E. Casey Foundation website. http://datacenter.kidscount.org/data/tables/5116-fourth-grade-reading-achievement-levels?loc=1&loct=1#detailed/1/any/false/36,867,38,18,16/1185,1186,1187,1188/11560. Accessed December 7, 2014.
David T. Tayloe Jr, MD, FAAP president, Goldsboro Pediatrics, Goldsboro, North Carolina.
Address correspondence to Dr. David T. Tayloe Jr, 2706 Medical Office Pl, Goldsboro, NC 27534 (firstname.lastname@example.org).