Clinic Provides Medical Home For Children With Disabilities

Enjoying a good rapport with her patient, nurse practitioner Sallie Prugh examines ten-year-old Jessica Stroman during an appointment at the Palmetto Children's Clinic.

“While the concept of a medical home is a relatively new one, it’s an important one for children with special needs,” said Dr. James Stallworth, an associate professor in the Department of Pediatrics of the USC School of Medicine, and Medical Director of the Palmetto Children’s Clinic. Now in its tenth year, the clinic serves children from low-in-come homes with a complexity of medical issues, including cerebral palsy, Down’s syndrome, and autism. Before the School of Medicine partnered with DHEC and what was then Richland Memorial Hospital to provide the services, such children frequently ended up in the emergency room for routine problems. Not only did these visits pose a costly and inefficient use of medical services, but the children’s ongoing comprehensive needs couldn’t properly be addressed in an ER setting.

Whether a troublesome rash or a well-child exam is on the day’s agenda, office visits at the Palmetto Children’s Clinic are geared toward each child’s particular set of circumstances. “Development may be different in these children in that a three-year-old could just be learning to walk or a seven-year-old receives much of his nutrition from a formula given through a tube in the stomach,” explained nurse practitioner Sallie Prugh, who provides the majority of the patient care. Dr. Stallworth added, “Many factors have to be taken into account, and these kids require a whole lot more time and attention.”

Prugh provides that time and attention in abundance, bolstered by RN Gloria Speed, the medical supervision of Dr. Stallworth and four other pediatric faculty members, and 24-hour coverage provided by pediatric residents. This can mean anything from coordinating appointments with various specialists to explaining the side effects of medications to just lending a listening ear. “A lot of the families’ concerns are day-to-day problems with paying rent and having enough food for the family. Sometimes the needs of the disabled child have to compete with the basic issues of survival,” Sallie said. 

Over the years Prugh has had the opportunity to follow patients like ten-year-old Jessica Stroman through their childhood. Jessica and her six-year-old brother, Joshua, both have sickle cell anemia. “Miss Sallie treats my kids as if they were hers,” said Columbia resident Carol Stroman. “She will sit down and say, ‘Mom, this is what I am looking at from a medical point of view. Now I want your point of view.'"

Prugh and Dr. Stallworth’s hope is that ongoing parent education and a stable health care environment will guide their young patients into a healthier future. “We’re seeing some of these kids living a whole lot longer, and we want to be sure to transition them into adult care,” Dr. Stallworth said. Prugh added her observations, “I watch with amazement how much families learn. After coming to us confused and worried, I see how confident they become. I hope that through it all I have made a bit of a difference,” she said.

Stroman will attest to that difference. “After being poked and prodded so much in their little lives, my kids don’t like the word doctor. But when I tell them that we are going to see Miss Sallie they beat me to the door, saying, ‘Mom, aren’t you ready yet?’”

Reprinted from Connections newsletter, August 2004

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