Healthy Me – Healthy SC launches bold plans for expansion

The COVID-19 pandemic has laid bare the vast disparities in access to health care that exist across the U.S., with rural areas and minority communities having less access and, often, worse outcomes.

But even before the pandemic made this issue so uncomfortably clear, two South Carolina institutions had teamed up to improve health care access and inequities in rural and underserved areas across the state. Now they plan to broaden their efforts to reach more South Carolinians.

The Medical University of South Carolina and Clemson University joined forces to create Healthy Me – Healthy SC in 2019, following successful pilot programs in Anderson, Barnwell and Williamsburg counties. The program’s original focus was on infant mortality, childhood obesity, cancer prevention and pain management.

The idea is to build upon the reach of Clemson University’s Cooperative Extension Service to bring MUSC and Clemson’s clinical and faculty expertise to the people of the state. Extension, which has an office in every county in the state, is perhaps best known for its agricultural programs. However, its Health and Nutrition Extension Team has agents in 12 counties.

“Our work combines the clinical excellence of MUSC with the land grant mission of Clemson University. It’s a powerful combination that seeks to reach all corners of our state.”

David Sudduth, executive director

HMHSC became a partnership program that would build upon the extension model and place dedicated HMHSC agents in designated counties to serve as the direct link between the two universities and the various communities.

When the COVID-19 pandemic descended on South Carolina, HMHSC quickly pivoted to create mobile testing locations in rural and underserved areas while simultaneously transitioning its traditional programming to a virtual format.

Now, as the end of the pandemic appears to be in sight, HMHSC has new leaders who are infusing the program with fresh energy and enthusiasm and expanding its reach even further.

“Our work combines the clinical excellence of MUSC with the land grant mission of Clemson University. It’s a powerful combination that seeks to reach all corners of our state,” said David Sudduth, executive director of HMHSC.

“There was already great work occurring within the HMHSC umbrella. We brought all of the different subprograms together and underwent a strategic planning process, specifically focused on expansion,” said Kapri Kreps Rhodes, manager of HMHSC, who explained that HMHSC will be adding new programs and expanding into new counties.

Leadoff agents Shanna Sykes in Anderson, Paris Mebane in Williamsburg and Amber Wilson in Barnwell will be joined by new regional HMHSC agents in Lancaster, Darlington and Florence counties, expanding the program’s reach into the Pee Dee. Allendale will get a dedicated HMHSC agent and Anderson will get an additional agent.

“Extension is excited about the expansion of the HMHSC partnership. Adding extension agents in the Pee Dee region with support from HMHSC will help us reach more people and improve the health outcomes of the state,” said Michelle Parisi, Ph.D., Health and Nutrition Program team director at Clemson University.

COVID testing

Pandemics weren’t part of the plan when HMHSC launched in 2019. But in 2020, it quickly became apparent that underprivileged and under-resourced areas needed access to COVID-19 testing.

 

MUSC allocated some of its federal COVID-relief funding to create a mobile COVID-19 testing team within Clemson Rural Health, a statewide health service delivery and prevention framework operated by Clemson’s College of Behavioral, Social and Health Sciences. The funds also supported Extension efforts to find community partners in rural areas to host testing sites. Moving forward, the testing team will be offering vaccines.

“The success of the COVID testing clinics is validation of the partnership between Clemson University and Medical University of South Carolina. The working relationships we have established with churches, civic organizations and other state agencies will continue to be beneficial as Healthy Me, Healthy SC moves forward with health improvement projects. We fully expect the work done over the past year on this project will provide ongoing community benefits,” said Rhonda Matthews, assistant Extension program team director.

The Clemson Rural Health COVID-19 testing team includes paramedics, emergency medical technicians and nurses who travel throughout the Upstate and Midlands to support rural and underserved at-risk communities with COVID-19 testing, regardless of weather or other conditions. The team is regularly praised by the communities for their efficiency and professional operations, said Marvina Jones, program manager for rural health and community development at Clemson.

School wellness

As part of its focus on children’s health, HMHSC will expand the School-Based Wellness Initiative developed by the MUSC Boeing Center for Children’s Wellness. The center currently works with 18 school districts across the state to promote a healthy learning environment, offering schools a menu of strategies through the School Wellness Checklist in areas like nutrition, physical activity and social-emotional learning from which the schools can select the activities that make sense for their students and staff.

All of the strategies included in the initiative are grounded in research and meant to help schools build and sustain a culture of wellness.

This year, HMHSC agents in three counties are working collaboratively with the MUSC Boeing Center to support five school districts in implementing this initiative.

 

Kristi Martin, a school nurse in Anderson County’s Mt. Lebanon Elementary, praised the initiative for the support it provides to teachers and staff and the emphasis it places on healthy habits during the pandemic.

“The School Wellness Checklist has really been able to capture the picture of how much our teachers are doing on a daily basis to promote health and wellness in the classroom, at lunch, recess and during the after-school events,” she said.

Some of those checklist items that schools can implement include creating a water drinking campaign, conducting fresh fruit and veggies taste tests or building a school garden.

“As a school nurse, I hear children proudly tell me that they are drinking a lot of water and have personal water bottles of their own. It has become a fashion statement to have your own water bottle decorated with stickers.

“Wear your mask, but don't forget to drink from your water bottle,” Martin added.

Cancer screening/HPV vaccination

Cancer screening and preventive care are important parts of the HMHSC mission. In partnership with MUSC Hollings Cancer Center, a new large mobile unit will bring breast and cervical cancer screenings to underserved areas.

The goal is to visit all Lowcountry and Pee Dee counties during fiscal year 2022, which begins on July 1.

According to American Cancer Society guidelines, women over the age of 40 should have annual mammograms, and adult women should have cervical cancer screenings every three to five years, depending on age.

In addition, a small mobile unit will offer HPV vaccinations. The vaccine can prevent six types of HPV-related cancers, and Hollings has prioritized HPV vaccination as one of its top cancer prevention initiatives. Two doses of the HPV vaccine are recommended for all boys and girls, first at age 11 and then at age 12.

Breastfeeding support / Mother’s Milk Bank

Agent Amber Wilson will continue working on all of the HMHSC Extension programs in Barnwell while taking on a new statewide breastfeeding support coordination role.

According to the Centers for Disease Control and Prevention, babies in rural areas, Black babies and babies receiving aid from the Special Supplemental Nutrition Program for Women, Infants and Children are all less likely to be breastfed. But those moms and babies are missing out on the health and emotional benefits.

“It's so beneficial,” said Wilson, a certified lactation counselor. “A lot of times, we talk about how it benefits baby, but it benefits the baby, the mom, the family and society. It really can contribute to a healthier mom and baby, short-term and long-term.”

But breastfeeding doesn’t always come easily, and women in rural areas often don’t have access to the resources to help them continue breastfeeding.

Thelma Albany was one of those mothers. She was having trouble producing enough milk for her son, Teigan, born in October 2019.

“She was always there for me. I could call or text when I was having difficulty, and she would always help. She taught me how to power pump and gave me advice on calorie intake, and my milk supply increased dramatically,” Albany said.

Now, more mothers will be able to access the program. The pandemic forced the program to go virtual, which allows it to reach more people. Wilson plans to offer general breastfeeding classes twice a month as well as classes on specific topics like milk supply, pumping and storage, returning to work and common challenges.

Working with MUSC’S Center for Telehealth, the groundwork is being laid for future collaborations to help more women across the state, to include pre- and postpartum breastfeeding and mental health support.

 

HMHSC is also working with the Mother’s Milk Bank of South Carolina, headquartered at MUSC Children’s Health, to expand the number of milk depots in the state.

Women with excess milk supply can donate the milk to the Mother’s Milk Bank. It’s collected at the depots, then sent to MUSC Children’s Health where it’s pasteurized. From there, the milk is sent to hospitals across the state for premature and hospitalized babies whose mothers can’t breastfeed.

HMHSC will fund a second pasteurizing machine this year and expand the number of milk depots in the state to help more mothers.

Pain rehabilitation

MUSC’s Pain Rehabilitation Program is directed toward patients experiencing chronic pain. This three-week, evidence-based program aims to help people sidelined by pain to resume normal activities, decrease reliance on medication and learn stress management techniques.

The program incorporates cognitive behavioral therapy and physical and occupational therapy, and it complements other state initiatives that aim to treat patients who have already progressed to opioid addiction. There is an unmet need for this at-risk pain population, which will increase as opioid prescribing decreases across the state. Over 450 patients representing 45 of South Carolina’s 46 counties have been served by this program to date.

The program has expanded to include a virtual skills group for patients and will be piloting a telehealth model of its three-week program, improving access for those who live far from Charleston.

Regional health fairs

One of the new initiatives planned for fiscal year 2022 is regional health fairs. The idea is to model the fairs on the MUSC Health CARES Clinic initiative in St. Stephen, in rural Berkeley County.

The student-run CARES Clinic brings basic preventive care, like flu shots, blood pressure readings and blood sugar tests, to the community, along with fresh produce donated by the Lowcountry Food Bank. The students typically schedule the clinics to coincide with community events like high school football games.

“By combining health screenings and free medical care, nutrition counseling and distributions of fresh produce, this program has effectively connected the role of nutritious food to health while simultaneously making inroads into addressing food insecurity in this rural town,” said Anita Ramsetty, M.D., an associate professor in the MUSC College of Medicine and medical director of CARES.

HMHSC plans to replicate this model in three other locations across the state.

Innovation grant

Also new this year are innovation grants designed to solicit ideas to improve the implementation, reach or scale of HMHSC programs.

HMHSC will fund up to two grants of up to $50,000 each for ideas that help the partnership to improve health care access and reduce inequities in rural or underserved communities.

The application period has already opened and will close April 19. 

Chronic disease education

One in three South Carolinians has been diagnosed with high blood pressure, according to the S.C. Department of Health and Environmental Control. And South Carolina is in the top 10 states in the nation for rates of adults with diabetes. And according to DHEC, only half of adults diagnosed with diabetes have taken a class on how to manage their condition.

Chronic disease education / self-management is a main pillar of the HMHSC expansion plan and something that both Clemson and MUSC have focused on.

“One thing we’ve identified through program pilot testing is the need for health and social resource navigation in rural counties,” Parisi said. Agents help participants connect to food pantries, transportation services for doctor’s appointments and housing assistance.

One of the reasons it’s so important to have an agent in each county, rather than centralized at Clemson or MUSC, is because they can build relationships at the local level and fill the gap between the health care system and social needs that can influence a person’s health, she said.