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South Carolina-Upper Midlands Rural Health Network

The purpose of the Outreach Grant was to expand appropriate services for Network residents including children with diabetes and asthma.

Access to health care in the two County (Chester and Fairfield) Upper Midlands region is ranked among the lowest in the state of South Carolina. The purpose of the Outreach Grant was to expand appropriate services for Network residents including children with diabetes and asthma or at risk for developing it.

The primary goals of the grant were

  1. To strengthen the Network and its effectiveness in improving the system of health care in the Network region
  2. To reduce absenteeism of middle school students with the chronic conditions of asthma and diabetes
  3. To increase community knowledge of the risk factors for diabetes and asthma and how to manage them.

Asthma/Bronchitis is the leading cause of hospitalization for children under the age of 18 in the two Counties. Poverty, lack of education, high unemployment, unhealthy lifestyles and poor utilization of preventive health care all contribute to poor health status and strain the fragile rural health infrastructure.

The grant placed a middle school nurse in each County over a three year period and paid a declining portion of their salary each year. The School Districts agreed to continue the program after the three-year grant period barring any unforeseen or unavoidable problems. The program is on schedule to continue this fall.

The grant also helped to implement an electronic school health record system to help the school nurses effectively track and manage these students. In addition, we did yearly screenings (BMI, vision and hearing) on all of the students, which enabled us to look at and address the obesity problem. We were able to change the type of snacks sold in the school canteen and create a water drinking program, thus removing sodas from the vending machines.

Through another grant we were able to start an Exploring Healthy Lifestyles classes in all of the middle school in one County and started the Coordinated Approach To Children’s Health (CATCH) program in the other County.

Services offered

The primary target group was middle school students in Chester and Fairfield Counties, ages 11-15, with asthma and diabetes and how to manage them in order to keep them in school and in their classes. The secondary target group was the adult population who also have asthma and diabetes or who are at risk to develop the diseases.


Based on data from Health Office
  • Attitude and Behavior Surveys for Middle School students
  • Pre/Post knowledge testing from Exploring Healthy Lifestyles (EHL) classes
  • Measures of Academic Progress (MAP) scores from students in EHL versus non-EHL students

Outcomes: School Nurses educated, use of Health Office, more efficient use of time, data-all make schools better.


Staff turnover from initial group of participants: Middle School Principal, School Nurse, School District Superintendent, and class room teacher for Exploring Healthy Lifestyles classes. This was overcome by educating new staff and getting them on board with efforts.

Limited School District Information Resource Consultant (IRC) support-education of mission and importance of being committed to the project. This was overcome by meeting one on one with all participants and working directly with the IT and District staff.

Budget cuts in School District: limited travel. This was overcome by arranging school nurse workshops on Teacher Workdays, rotating sites between two Counties; offering workshops at no cost with continuing education credits and meal, in-kind support, partnership with agencies/companies to cover cost of meals/speaker honorarium, partner with other workshops (i.e. Asthma with Oral Health); other local grants, donation of door prizes (healthy foods) by local Bi-Lo Grocery Store.

School Nurse acceptance and use of computerized documentation, especially for nurses who were not use to using computer equipment. This was overcome by repeated face to face, hands on trainings and Administrative support and encouragement and finding School Nurses that became “champions” for project.

Our program can and has been a best practice model. It has worked in both Counties and was well-received. I think it is a program that can be replicated and we would be glad to share this information with other Networks. Our project has been presented at several national and state meetings with great interest.

Yes, the program will be sustainable. The Nurses hired through this grant program will be sustained by their respective school districts. When the grant was written, we asked the District Superintendents to sign a written commitment, pending any major budget disasters, to continue the program on their own. Although School Superintendents have changed every year or two, they have still honored the contract. Through this grant we provided declining funds over a three year period for a middle school nurse in each District.

Source Outreach Sourcebook, Vol.15, 2007-2010, Office of Rural Health Policy
Contact person Beverlyann V. Austin
Topics Children
States served South Carolina
Date added December 6, 2010

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RAC for your convenience. The programs described are not endorsed by RAC or by the Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.

Phone: 1-800-270-1898

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Funding for this project was supported by Grant Number U56RH05539 from the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the funder.