Connecting medically fragile children with next-gen health care professionals


In Texas, Child Protective Services is divided into 11 regions with a nurse overseeing the cases of children considered “medically fragile.” These children are not being abused purposely but medically neglected because of family issues.

Natalie Bachynsky, assistant professor in the School of Nursing at the University of Texas Medical Branch at Galveston, recognized the opportunity to provide critical support to a vulnerable population while introducing them to students preparing as health professionals.

“I really enjoy service learning, taking students into the community where they learn clinical skills and resource management,” said Bachynsky. As health care takes more of a team approach, she sought out opportunities for teams comprised of students from different health disciplines.

She found it in the Family-based Safety Services program. CPS spends a year with a family helping them resolve issues and manage a child’s medical care.

Bachynsky received a grant for nearly $900,000 over three years from the Health Resources and Services Administration and developed IPAP, the Interprofessional Pediatric Advocacy Program. Working with CPS, student teams provide collaborative care to children and families in their homes.

The program is an elective course at UTMB for students in the School of Nursing and the School of Health Professions. Students from a number of disciplines, including nursing, occupational and physical therapy and physician assistants, train as a team before they are assigned to one family for the semester. In order to participate, the students also receive training from CPS.

“Many times the students are shocked at the living conditions,” said Bachynsky. “Their experience has been in the hospital where we give discharge instructions.” Students see first-hand what a family with limited resources faces in managing a complicated and chronic medical condition.

Some of the tech-savvy students also come up with imaginative new ways to resolve medical issues.

In one case, a 12-year-old boy was having trouble managing his diabetes and kept ending up in the emergency room. The student team found a cellphone app to help him and that simple move has kept him healthy and out of the ER. In another case, teen parents were preparing to leave the hospital with their newborn child who had a complicated heart condition. Those caring for the infant questioned whether the young parents had the skills required to care for their baby. The IPAP team realized the parents were simply overwhelmed so they had the mother tape the instructions for discharge care on her cell phone.

“They’ve been very creative about finding resources and coming up with solutions,” said Bachynsky.

Galveston is in Texas Region VI, which has 13 counties. “We can’t cover the whole area,” said Bachynsky, “so we’ve started going to other schools and universities to start this model for them.” IPAP is being used as a clinical experience for students in pediatric, community or specialty programs in nine other health care organizations.

To date, more than 260 students have helped 81 families in the region. Some of the students have enjoyed the experience so much that they have continued to volunteer with CPS.

What’s most rewarding to Bachynsky is how much the students have learned from the experience and each other. They develop a new appreciation and respect for their abilities and the team provides better care for the patient.

“When they go out as a team, they go into the same home and yet each discipline sees a different need,” said Bachynsky.