How Embedding Health Access and Nurses in Schools Improves Health in Grand Rapids, Michigan


For more than 20 years, Grand Rapids Public Schools (GRPS) has partnered with Spectrum Health to improve educational and health outcomes for their students through Spectrum’s School Health Program. Started in 1995, the School Health Program will be expanded to its 14th additional school districts in 2017.

The GRPS Model

The GRPS program utilizes school health teams comprised of registered nurses (RNs), licensed practical nurses (LPNs), and health aides to provide direct services to students in 48 schools. GRPS’ branch of the School Health Program currently employs 34 RNs, 11 LPNs, and 34 health aides and operates four full-service school-based health centers.

In the GRPS model, school teams operate under the supervision of a school nurse whose primary responsibility is oversight of health care delivery to students during the school day. The district has established policies and procedures to describe how care is to be delivered by the team under the supervision of the Registered Nurse. The nurse may delegate care to other school staff.

School nurse responsibilities include: identification of students who have health conditions; developing a plan for care during the school day; training and oversight of staff for safe delivery of medications and treatments; providing services that cannot be delegated; establishing medical response teams to respond to emergencies; telephone triage and support; surveillance and reporting of communicable diseases; connecting students to medical, dental, and mental health care through referrals; promoting health; health education; health screenings and follow up; and assisting students in obtaining immunizations.

GRPS uses funds from a variety of sources to support their school nurses including:

  • the district budget;
  • their local intermediate school district;
  • the State Department of Education—including grants and 31A funds (for students deemed at high risk); and
  • Spectrum Health.

The full-time equivalent (FTE) for the nurses for each school is adjusted based on the health needs of the student population and the availability of funds. Even though some funding for school nurses is still provided through Title I, GRPS has largely moved to alternative funding streams due to cumbersome reporting requirements.

While RNs serve as the cornerstones in the model, GRPS also braids together funding streams from both public and private entities to allow for reimbursement and service provision under a variety of health delivery models beyond the traditional school nurse reimbursement model. Coordinating funds and services across the spectrum of health providers and sources enables GRPS to provide services outside of the traditional school nurse model—such as dental services.

GRPS has also partnered with Cherry Health Services a local Federally Qualified Health Center (FQHC) to deliver health services in their school-based health centers and through a traveling dental program. Because these services are provided through an FQHC, they are eligible for Medicaid reimbursement and receive the FQHC enhanced reimbursement rate.

While data systems and privacy concerns have hindered data sharing and integration in the past, GRPS is actively moving towards linking education and health data under one system. The new data system is built upon the district’s student record system and has the potential to more easily link school health metrics to attendance and academic data. These system improvements are crucial steps to helping Spectrum Health and GRPS track and accomplish both its short-term goals to improve attendance and reduce chronic absenteeism and its long-term goals to improve graduation rates, workplace readiness and college entry.

Consultative RN Hub Model

In more rural districts, Spectrum Health has developed a consultative RN hub model for service delivery. Nurses are able to serve students utilizing telemedicine through its MedNow program—reducing travel time for school nurses and costs for the district. The Regional program will serve 13 districts in 2017 with 14 RN and two LPN.


The partnership between Spectrum Health and the school districts have produced significant improvements in important school health indicators. Key accomplishments from FY 2015 included:

  • 97 percent of students at participating schools met current immunization requirements to attend school;
  • 98 percent of problems identified were resolved on-site by the school health care team;
  • 195,092 visits occurred to the school health office; and
  • 28,864 students were served across 7 school districts.


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