Keeping Kids in Class – Combating Chronic Absenteeism Through School-Based Telehealth
Cone Health & Guilford Education Alliance – School-Based Telehealth Initiative
Summary
The Cone Health School-Based Telehealth initiative, a strategic partnership with Guilford County Schools, and Guilford Education Alliance, impacts chronic absenteeism in high-poverty schools by providing medical services that children would otherwise leave school to receive. The program works closely with public health nursing and school staff to increase the health and wellbeing of students. By placing full-time Certified Medical Assistants (CMAs) equipped with advanced diagnostic technology in 34 schools, including 10 High Point elementary schools, the program connects students with virtual medical care, rapid strep, covid and flu testing, and newly integrated behavioral health. Children receive needed care in place and, in most cases, can return to the classroom the same day.
Highlights
- Strategic Collaboration: Driven by a “Better Together” philosophy, Cone Health and Guilford County Schools have developed a deep collaboration aligning medical care and educational outcomes.
- High Utilization: Dedicated on-site Certified Medical Assistants facilitated thousands of encounters, providing basic first aid services to all students, and comprehensive health evaluations and treatment to those who consent to telehealth services.
- Measurable Impact: Early findings show that the initiative has successfully reduced unnecessary early dismissals and low-acuity emergency room visits. The initiative is partnering with research institutions to rigorously quantify its impact on academic performance and long-term community health.
Funding
In 2023, the Foundation for a Healthy High Point awarded $250,000 to Guilford Education Alliance to support a three-year pilot of telehealth services in eight high-poverty High Point elementary schools. In 2024, the School-Based Telehealth program’s budget in Guilford County was just under $2 million including $400,000 in direct support from Cone Health.
The Foundation for a Healthy High Point works with partners to transform conditions that impact health and well-being of Greater High Point residents by investing in and engaging the community to address upstream social influences on health.
In 2025, the program’s budget grew to $2.7 million with Cone Health providing $780,000 in direct support. Other philanthropic organizations supporting the initiative include The Duke Endowment, Armfield Foundation, Reich Family Foundation, and others.
Background
The School-Based Telehealth project is a collaborative partnership between Cone Health, Guilford County Schools (GCS), and Guilford Education Alliance (GEA). Headquartered in Greensboro, Cone Health is a private, nonprofit health system providing healthcare services through a network of over 150 hospitals, outpatient clinics, and specialized care centers, including MedCenter High Point in High Point. Guilford County Schools (GCS) is one of the largest public-school districts in North Carolina, serving approximately 67,000 students across more than 120 schools in the Greensboro and High Point areas. To help support the school district, Guilford Education Alliance (GEA) operates as an independent nonprofit organization that mobilizes community resources, funding, and advocacy. GEA entered into a strategic alliance to merge with shift_ed in November 2025.
In 2021, Cone Health, Guilford County Schools, and Guilford Education Alliance partnered to establish the School-Based Telehealth program. The program established telehealth clinics to provide students in high-poverty schools with on-demand virtual medical care within their schools, helping to reduce chronic absenteeism and improve educational outcomes. Nationally, while telehealth began being integrated into school clinics in the mid-2010s, the COVID-19 pandemic forced a rapid expansion of telehealth options to ensure continuity of care. Since 2020, many states, including North Carolina, have expanded Medicaid reimbursements policies to cover telehealth services in schools, thus accelerating and sustaining their implementation.
Need
The Guilford County School district struggles with chronic absenteeism, particularly within high-poverty schools. While the causes are complex, one factor is the district’s shortage of school nurses. On average, there is one school nurse for every two Guilford County schools. When a nurse is not on-site, students experiencing acute minor health issues may be sent home, often along with their siblings. Consequently, the lack of full-time coverage in health offices increases unnecessary early dismissals and absentee rates.
Additionally, school nurses provide crucial healthcare services in high-poverty schools where roughly 20% of students manage chronic conditions. Ultimately, the shortage of school nurses disproportionately affects low-income families who rely heavily on school-based services for their children’s basic medical needs.
Project Description
The Cone Health and Guilford County Schools telehealth initiative is designed to expand healthcare access when school nurses are unavailable, ensuring students receive timely care and remain in class. Partner schools were selected based on a combination of high need and operational readiness. Some candidate schools were not selected for participation due to a lack of physical space for a telehealth clinic, particularly in old school buildings.
The core of the model centers on placing a full-time Certified Medical Assistant (CMA), with access to telehealth support, in each participating school. Arriving before the school day begins and staying through the afternoon, the CMA serves as a consistent medical presence. For all students, regardless of whether families have consented to receive services from Cone Health, CMAs are able to provide “delegated services.” This includes services such as basic first aid for common minor issues, such as paper cuts or skinned knees, or providing hydration.
For students with active parental consent, the program utilizes advanced telehealth technology. CMAs perform physical examinations with digital equipment to look into ears, eyes, and throats, and to listen to heart and lung sounds. This technology enables a remote healthcare provider to assess and diagnose health needs with accuracy comparable to traditional, in-person clinical visits.
CMAs receive specialized training on Cone Health’s electronic health record system and the “Tidal Care” technology, which enables them to conduct on-demand virtual examinations in conjunction with remote healthcare providers. The exams include the use of high-definition cameras and AI enhanced digital stethoscopes. The technology allows remote providers to distinguish between similarly presenting respiratory or other illnesses. Because providers can assess patients and prescribe treatments virtually, CMAs are authorized to dispense eight commonly prescribed medications stocked on-site. Furthermore, in February 2026, the program expanded to include point-of-care testing in High Point schools, enabling the rapid detection and diagnosis of illnesses such as COVID-19, strep, and influenza A and B.
“I was in a school this week… and this young child said. ‘I come in here, and I get on Zoom… and they take care of me, and they make me feel better.’ So, to me, the lesson is the next generation believing that the school and the health system want to take care of them and make them feel better.”
Michelle Schneider,
Chief Philanthropy Officer, Cone Health
Support from The Duke Endowment and Cone Health launched the implementation of behavioral health support in two High Point schools in March 2026. Behavioral health support utilizes a facilitator model rather than CMAs. Community health workers travel between schools to conduct scheduled therapeutic interventions, collaborating closely with school social workers to address underlying social determinants of health that contribute to student trauma and may result in behavioral issues presenting at school.
The initiative actively works to build trust and collaboration between established school nurses and newly integrated CMAs. This team-building effort included an inaugural joint retreat in the fall of 2025. Professional relationships have grown as school nurses and CMAs work alongside one other within the schools.
Results
As of February 2026, the School-Based Telehealth initiative operates telehealth clinics in 34 high-poverty Guilford County schools. This includes 10 High Point elementary schools: Fairview, Kirkman Park, Montlieu Academy of Technology, Northwood, Oak Hill, Oak View, Parkview Village, Shadybrook, Triangle Lake Montessori, and Union Hill.
The secret to the program’s success, according to initiative leaders, is the full-time presence of the CMA, who builds relationships with students and staff, offering reassurance and delegated services even to unconsented students. Dedicated CMAs facilitated nearly 2,500 telehealth clinic visits during the 2024-25 school year and a total of 1,077 visits in High Point elementary schools during the fall of 2025. At Bessemer Elementary School in Greensboro, the original pilot site, CMAs host 12 to 14 daily visits, with 4 to 5 escalating to virtual providers.
Family consent rates for telehealth treatment across the district reached 45% in the first year. While lower than the program’s goal, there are several challenges to gaining consent including financial concerns and immigration-related distrust. To combat fears of financial burden, the program emphasizes scholarship options for students ineligible for insurance. Through targeted school outreach, such as translated materials, bilingual CMAs, and support from principals, higher consent rates are being achieved in the early adopter schools.
The primary goal of the School-Based Telehealth program is to reduce chronic absenteeism by treating acute illnesses on-site and preventing unnecessary early dismissals. Anecdotally, principals report improved attendance and academic performance and note that parents value the service. According to one school principal, when attendance zones shifted, parents applied to stay in Bessemer’s attendance zone, in part because they had school telehealth. Additionally, regional data found a decline in low-acuity ER visits (ESN 4s and 5s) for children aged 4–12 residing in the attendance zones of the participating schools.
To move beyond anecdotal evidence, the program is partnering with the Value Institute for Virtual Excellence (VIVE) and the Sheps Center at UNC Chapel Hill to analyze utilization and health outcomes. New reporting methods will distinguish between the consented students and active service utilizers to measure the program’s specific impacts on attendance and behavior. Additionally, the program is collecting data to determine if telehealth has an impact on third grade reading and math scores. Preliminary data from the second year of the initiative found that consented students improved their math scores by 0.3 points, while students without consent saw a decline of 0.4 points on their math scores during the 2023-24 year.
“I think the power of collaboration has been the key to the success of our School-Based Telehealth program. Everyone has a very intentional focus on the impact this program can provide in supporting student’s success in school. That has always been the driving force; having healthy children who can remain in school and be successful.”
Dr. Kimberly Steinke,
Chief Officer for Exceptional Children and Student Services, Guilford County Schools
Lessons Learned
In reports submitted to the Foundation and interviews for this report, Cone Health, Guilford County Schools, and Guilford Education Alliance staff shared that:
- Collaboration is key. Initiative leaders stated the most significant lesson they’ve learned is the power of deep collaboration between large institutions with a shared goal and commitment to being flexible. The relationship between Cone Health and Guilford County Schools requires constant communication and shared objectives. The partners emphasize a “Better Together” philosophy, ensuring that medical and educational objectives are aligned, specifically linking health interventions to school attendance and academic metrics such as third grade reading scores.
- Funder diversity contributes to a robust program. Another key lesson learned is that it takes a diversity of funders and high levels of collaboration to support such a complex initiative. Some funders focused on the community, some on the telehealth component, and others focused on educational outcomes. Support from the Foundation for a Healthy High Point launched the initiative in High Point elementary schools, leveraging additional dollars and bringing more funders to the table to support High Point families and schools.
- Adaptation and flexibility lead to success. The team adopted a “learner’s mindset,” acknowledging that prototypes are messy and require frequent adaptation. Initially, the rollout plan was based strictly on a list of Title I schools. The team learned this was flawed and shifted to prioritizing schools that demonstrated a strong principal buy-in, cultural readiness, and available physical space, resulting in a more effective launch.
- Recruiting Certified Medical Assistants requires innovation. The program introduced sign-on bonuses and training through Cone Health’s CMA Academy to attract new CMAs and also has expanded the role to EMTs. The partnership between the school nurses and the CMAs has been strengthened through joint retreats and clear protocols, allowing them to “tag team” during outbreaks of illness to build trust and respect.
- Addressing social determinants will increase future impact. The behavioral health component has highlighted that many barriers to attendance are rooted in social determinants. For example, the team utilized a “social determinants fund” to purchase new shoes for a student whose anxiety and refusal to attend school stemmed from bullying regarding his worn-out footwear. This flexibility allows the program to address root causes that standard medical reimbursement would not cover.
What’s next?
Sustainability remains a complex challenge. In addition to seeking additional philanthropic investments, the initiative is exploring new streams of funding, including billing Medicaid for behavioral health services in addition to physical medicine which is already in place. Cone Health views this as an investment in value-based care. They are focusing on prevention and early intervention to reduce long-term costs, even if the current fee-for-service models do not fully reimburse for the care they provide.
“At Fairview Elementary, Cone Health’s School-Based Telehealth clinic program has become an essential part of how we care for our scholars. Quick access to healthcare right here at school means fewer absences, more time in class, and stronger academic growth. Families love and appreciate the convenience, flexibility, and peace of mind the program provides. Parents can even call ahead to request that their child be seen through Telehealth, ensuring timely care and helping scholars return to learning within minutes. Teachers also appreciate the quick response to scholar health needs, which allows instruction to continue smoothly.
Our Telehealth representative, Ms. Tina, has built strong, trusting relationships with our families. She knows our scholars by name, understands their needs, and helps identify and mitigate potential health concerns before they become larger issues. Parents have shared how reassuring it is to know that, even while they’re at work, their child’s health is being cared for with compassion and professionalism.
Together, we’re supporting the whole child, academically, physically, and emotionally. It’s one of the most meaningful partnerships we’ve established to ensure our scholars can be present, healthy, and ready to learn every day.”Fanisha Love
Principal, Fairview Elementary School