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School Health Services Program
2015 Overview
+ School Nurses:
Leading the Way to a
Healthier Generation
Peggy Howland, RN, School Health Program Director
Dianne Mennitt, DNP, RN, NCSN School Nurse Consultant
2
Florida Association of School Nurses (FASN)
19th Annual Conference
February 2015
State Update Variety Pack
+ Objectives
Understand the role of professional school nursing for the
delivery of health services in Florida schools
Apply the nursing process standards for the continuity of care
of school health services
Analyze current issues and trends for school nursing practice in
Florida
3
4
5
National Standardized School Health Services
Data Set:
Step Up and Be Counted!
SY 14-15 Data points • Chronic Conditions (diagnosed)
• Allergies (life-threatening)
• Asthma
• Diabetes (Type I and Type II)
• Seizures
• School Staffing (count)
• RN, LPN, Health Extenders
• Disposition (count)
• Health Office Visits
Purpose • School nurses collect same data the
same way across the country.
• National school nursing data set
• Describes the schools where we work,
the school community we care for, the
nature of our practice, and outcomes
of our care.
Process for SY 2014-15 • Collect at the local level (school to
district)
• District will report to the State
• State School Nurse Consultants or
Designated State Data Champion,
if no consultant
• States will report to national
• NASN/NASSNC database
• Results will be shared summer 2015
Learn More http://nasn.org/stepupbecounted • More information and definitions of data
points
• Collection template
• Archived webinars
• Articles discussing initiative
• Talking points
• Frequently asked questions
• Ask a question!
Who Can Participate? • ALL school nurses
• NASN and non-NASN members
• Private/parochial/charter schools
Participate! And invite your school nurse
colleagues to participate!
+ Joint Resolution
7
Data Collection
• Coding in HMS
• Data is used for legislative analysis
• Supports county in understanding
accountability for school health services
Data Collection
County School Health Programs are reviewed (pursuant to s. 381.0056, F.S.) using:
• Biennial School Health Services Plan
• Aggregate data coded into the Health Management System (HMS)
• Annual School Health Reports
• On-site visits and desk audits
• Review of revenue and expenditure Information
+
School Health
Administrative
Guidelines http://www.floridahealth.gov/programs-
and-services/childrens-health/school-
health/reports-information.html
10
Florida School Health
Administrative Guidelines
(FSHAG)
• Delivery of school health services
• Health screening
• Medication administration
• Students with chronic conditions
• Exceptional student education
• Individual health care plan
• Emergency planning and care
FSHAG Continued
• Communicable disease control
• Immunizations & school entry health exam
• Dental, nutritional, mental health and social services
• Students in transition
• Health education
• Program administration
• Legal considerations
Guidelines
• Guidelines for the Care and Delegation of Care for Students with Diabetes in Florida Schools (2015)
• Promoting Health and Academic Success Through Collaboration and Partnerships; A Guide for Florida's School Health Advisory Committees* - (2010)
• Guidelines for the Care and Delegation of Care for Students with Asthma in Florida Schools* - (2013)
• Emergency Guidelines for Schools 2011 Florida Edition*
• The Role of the Registered Nurse in the Delegation of Care in Florida Schools (rev. 2010)
• School Health Coding Manual (2014-15)
• State Requirements for Educational Facilities - (2012)
• State Requirements for Existing Educational Facilities - (2012)
STUDENT
SERVICES WEEK
February 2-6, 2015
C
e
l
e
b
r
a
t
e
!
Health
Promotion
Screening
Services
Management
of Student Health
Conditions
School Psychologists | School Counselors | School Nurses | School Social Workers
Approximately 20% of the student population in Florida report the following health conditions: Allergies (life threatening)
+ (non-life threatening) Asthma Cancer Cystic Fibrosis
Diabetes Heart Conditions Kidney Disease Seizures and Epilepsy Sickle Cell Disease
Health Screenings: Vision;
Hearing; Height, Weight and Body Mass Index (BMI); Communicable Disease
School Health Fairs: Dental; Blood Pressure; Developmental; Mental Health
Image Courtesy of Olyzel/Thinkstock
N
u
r
s
e
s
S c h o o l
School-Entry Health Exam
Compulsory Immunization
Requirements
Health Education and Physical
Education
School/Community Wellness Activities
+
Guidelines- for the Care and Delegation of Care for Students with Diabetes
in Florida Schools
16
+ Supporting Organizations
Academy of Nutrition and Dietics
American Academy of Pediatrics
American Alliance for Health, Physical Education, Recreation and Dance
American Association of Clinical Endocrinologists
American Association of Diabetes Educators
American Diabetes Association
American Medical Association
Barbara Davis Center for Childhood Diabetes
Centers for Disease Control and Prevention
Children with Diabetes
The Endocrine Society
Indian Health Service, Division of Diabetes Treatment and Prevention
17
+ Supporting Organizations cont’d.
Joslin Diabetes Center
Juvenile Diabetes Research Foundation International
National Association of Chronic Disease Directors Diabetes Council
National Association of Elementary School Principals
National Association of School Psychologists
National Association of Secondary School Principals
National Education Association Health Information Network
National Institute of Diabetes and Digestive and Kidney Diseases
Pediatric Endocrine Nursing Society
Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine
Society
U.S. Department of Education
18
+ Diabetes Guidelines Workgroup
Members
Anastasia Albanese-O’Neill, MSN, ARNP, CDE,
University of Florida
Kris-Tena Albers, ARNP, CNM Chief, Bureau of
Family Health Services, Florida Department of
Health (FDOH)
Debra Barber, RN
Registered Nursing Consultant, FDOH School
Health Program
Susan Bragonje, RN, Department of Health in
Brevard County
Anjeanette Carney, RN, Department of Health in
Brevard County
Shay Chapman, RN, BSN, MBA, Administrator
FDOH School Adolescent &
Reproductive Health
Nancy Cooper, RN, BSN, NCSN, Department of
Health in Leon County
Heather Diamond, M.Ed., Student Support
Services*/University of South Florida (USF), Florida
Department of Education, Bureau Exceptional
Education and Student Services (FDOE/BEESS)
Pamelia Hamilton, RN, BS, School Health
Coordinator, Department of Health in Brevard
County
Martha Hanna, RN, Health Services Coordinator,
Escambia County School District
Lori Hoopingarner, RN, Manatee County School
District
Peggy Howland, RN, Supervisor, FDOH School
Health Program
Paula Jameson, ARNP, Florida Center for Pediatric
Endocrinology, Florida Hospital for Children
Lisa Kern, RN, MSN, NCSN, Supervisor School
Health Services, Pasco County School District
19
+ Diabetes Guidelines Workgroup
Members cont’d.
Dianne Mennitt, DNP, PHCNS-BC, NCSN, AE-C,
Student Support Services*/USF
Rick Parks, MS, RDN, SNS, Dietitian, Florida
Department of Agriculture, Division of Food,
Nutrition and Wellness
Barbara Roufa, RN, NCSN
Roberta Stevens, RD, LD/N, CDE, Tallahassee
Memorial Hospital Diabetes Center
M.R. Street, MPH, FDOH Bureau of Chronic
Disease Prevention
Marsha Studdard, Media Publishing Specialist,
Student Support Services*/USF, FDOE/BEESS
Kelly N. White, PhD, FNP-BC, ARNP, Assistant
Professor, South University, College of Nursing and
Public Health
Barbara Williams, Staff Assistant, Student Support
Services*/USF, FDOE/BEESS
Leslie Wurster, MSW, MPA, School Health Liaison,
FDOH School Health Program
20
+ Purpose of the Guidelines
To educate school personnel about effective diabetes
management
To provide guidance for a team approach to ensure a
safe learning environment and equal access to
educational opportunities for students with diabetes.
To share a set of practices that enable schools to
ensure a safe learning environment for students with
diabetes
21
+ Team Approach
Effective diabetes management, using a team
approach, is critical for the following reasons:
For the immediate safety of students with diabetes
For the long-term health of students with diabetes
To ensure that students with diabetes are ready to
learn and have equal access to all educational
opportunities
To minimize the possibility that diabetes-related
emergencies will disrupt classroom activities
22
+ Everyone Has an Important Role
Everyone has a role to play in effective
diabetes management in the school setting:
School Nurse
Bus Drivers
Teachers
Administrators
School Food and Nutrition Staff
School Health Team
Students, Parents, and Families
23
+ What’s New?
The updated Guidelines includes:
Diabetes management strategies for children
with type 1 and type 2 diabetes
Updates on diabetes management and
medications
School Food Service Guide and resources on
carbohydrate counting in schools
A three-tiered approach to diabetes training for
school personnel
24
+
Sections
Introduction to the Guidelines
Major Factors in Maintaining Health
Legal Aspects to Consider
Criteria for Safe Delegation
Planning and Implementation Meeting
Components of Individualized Health
Care Plan
Roles & Responsibilities
Recommendations for Staff Education
Disaster Preparedness
Monitoring & Evaluation
Appendices
Guidelines for the Care and Delegation
of Care for Students With Diabetes in
Florida Schools
25
+
Contents
Understanding the basics of
diabetes management
Maintaining optimal blood
glucose control
Assembling the school health
team
Training school personnel
Implementing effective diabetes
management: checking blood
glucose, nutrition, physical
activity, carbohydrate counting
and insulin administration
Recognizing and treating
hypoglycemia and hyperglycemia
Guidelines for the Care and Delegation
of Care for Students With Diabetes in
Florida Schools
26
+
Highlights…
Healthcare Provider
Principal
School Nurse
Unlicensed Assistive Personnel
Teachers/Coaches and Before-and After-School Program Staff
School Counselor, Social Worker, Psychologist
School Food and Nutrition Staff
School Bus Drivers
Parents/Guardians
Student with diabetes
Roles & Responsibilities
Guidelines for the Care and Delegation
of Care for Students With Diabetes in
Florida Schools
27
+
Tools for Effective
Diabetes
Management
Diabetes Medical Management Plan
Individualized Health Care Plan
Emergency Care Plans for Hypoglycemia
and Hyperglycemia
Guidelines for the Care and Delegation
of Care for Students With Diabetes in
Florida Schools
28
+
Additional
Resources
Appendices
Glossary of Terms
Sample Forms/Checklists
School Food Service Guide and Carbohydrate Counting
Sample Checklists
Diabetes Medication
Related Guidance Information
References
Guidelines for the Care and Delegation
of Care for Students With Diabetes in
Florida Schools
29
HOLMES
3,249
BAY
26,129
JACKSON
6,543
GULF
1,791
LIBERTY
1,398
FRANKLIN
1,226
GADSDE
N
5,480 LEON
32,749
WAKULLA
4,737 TAYLOR
2,711
MADISON
2.398
HAMILTON
1,625
SUWANNEE
5,826
DIXIE
1,939
LEVY
5,337
GILCHRIST
2,424 ALACHUA
27,321
UNION
2,310 BRADFRD
3,003
NASSAU
11,087
MARION
41,363
CITRUS
14,735
HERNADO
21,825
PASCO
66,857
LAKE
41,018
PUTNAM
10,746
CLAY
34,996
BAKER
4,801
DUVAL
124,923
ST JOHNS
33,135
FLAGLER
12,675
VOLUSIA
60,629
SEMINOLE
63,807
ORANGE
184,144
OSCEOLA
56,819
POLK
95,573
HILLSBOROUGH
199,688
MANATEE
45,559 HARDEE
5,103
DESOTO
4,581
CHARLOTTE
15,804
LEE
85,675
GLADES
1,508
HENDRY
6,761
COLLIER
43,700
DADE
347,224
BROWARD
257,736
PALM BEACH
179,542
MARTIN
18,282
ST LUCIE
38,898
INDIAN
RIVER
17,753
More than 0.3% of the
students are reported
to have diabetes
+
School
Responsibilities
Under Federal
and State Laws
Section 504 of the Rehabilitation Act
Americans with Disabilities Act
(ADA)
Individuals with Disabilities
Education Act (IDEA)
Family Educational Rights and
Privacy Act (FERPA)
Nurse Practice Act
School Health Services Act
Section 1002.20, Florida Statutes
Rule 6A-6.0253, Florida
Administrative Code
31
+ Service Animal Guidelines
32
+ NASN Position Statement: Service
Animals in School (June 2014)
33
+ Integrated Student Services
Integrated student supports (SS) are a school-based approach
to promoting academic success by developing, securing, and
coordinating supports for students’ academic and non-
academic barriers to achievement.
34
School Psychologists | School Counselors | School Nurses | School Social Workers
35
Each of the four student services professional
disciplines…
Contributes unique skills
knowledge,
experience,
to the collective work
perspective
Shares common
areas of focus &
common goals
for all students
and their families
School Psychologists | School Counselors | School Nurses | School Social Workers
Integrated Learning Supports Improve
Health, Attendance, Academic & Career
Outcomes!
Physical, Social, &
Emotional Health
School Psychologists | School Counselors | School Nurses | School Social Workers
Attendance
Academic & Career
Family
&
Community
+ Federal Grants to Florida to Improve
School Climate & Keep Students Safe
Now is The Time – Advancing Wellness and Resilience in
Education (NITT-AWARE)
2014 School Climate Transformation (SCT) grants:
Florida SCT to Florida Department of Education
Florida School District Grantees: Broward, Duval, Nassau,
Hillsborough, & Polk
2014 Project Prevent Grantees: Sarasota, Hillsborough, &
Miami-Dade
37
+
Comments/Questions?
38
HIPAA and FERPA Compliance
Concerns During Public Health
Emergencies National Association of State School Nurse Consultants
January 25, 2015 Dale King, Director
Family Policy Compliance Office
U.S. Department of Education
Family Educational Rights and
Privacy Act (FERPA)
Statute: 20 U.S.C. § 1232g
Regulations: 34 CFR Part 99
Family Policy Compliance Office (FPCO) in
U.S. Department of Education administers
FERPA.
https://www.youtube.com/watch?v=nhlDkS8h
vMU&sns=em
40
+ What is FERPA?
Gives parents the right to access and
seek to amend their children’s education
records
Protects personally identifiable
information (PII) from education records
from unauthorized disclosure
Requires written consent before sharing
PII – unless an exception applies
Applies to educational agencies and
institutions that receive federal education
funds
41
+ Education Records and PII
“Education records” are records that are directly related to a
student; and maintained by an educational agency or institution
or by a party acting for the agency or institution.
“Personally Identifiable Information (PII)” includes such
information as student’s name, student’s parents or family,
social security number, student number, date and place of birth,
and other information that, alone or in combination, is linked or
linkable to a specific student that would allow a reasonable
person in the school community , who does not have personal
knowledge of the relevant circumstances, to identify the student
with reasonable certainty.
42
+ Prior Written Consent Requirement
Except for specific exceptions, a parent or eligible student shall
provide a signed and dated written consent before a school may
disclose education records. The consent must:
specify records that may be disclosed;
state purpose of disclosure; and
identify party or class of parties to whom disclosure
may be made.
43
+ Health or Safety
Emergencies Exception
What conditions apply to disclosure of
information in health or safety
emergencies?
Disclosure is necessary to protect the
health or safety of the student or others.
There is an articulable and significant
threat to the health or safety of a student
or other individuals.
Appropriate parties typically means local,
State, or federal law enforcement, trained
medical personnel, public health officials,
and parents.
Must be related to an actual, impending,
or imminent emergency.
44
+ Health or Safety Emergency
Exception, cont.
Must be articulable and significant threat.
School must make determination on case-by-case basis.
Department will not substitute its judgment if there is a
rational basis for decision to disclose under health or
safety emergency exception.
Limited to period of time of the emergency.
Must record pertinent information when it discloses PII.
45
+ Health or Safety Emergency
Exception, cont.
Typically public health officials and trained medical
personnel are among the types of appropriate parties to
whom information may be disclosed under FERPA’s health
or safety emergency provision.
For personally identifiable information from education
records to be disclosed to a public health department in a
non-emergency situation, unless there is another
exception to the consent requirement, FERPA requires that
parents and eligible students provide written consent.
46
+ Health or Safety Emergency
Exception, cont.
If the school determines that a health or safety emergency
exists, may it disclose without consent personally
identifiable information on students to the media?
No. FERPA only permits disclosures of personally identifiable
information from students’ education records under the health
or safety emergency provision to “appropriate parties” (such as
public health officials) whose knowledge of the information is
necessary to protect the health or safety of students or other
individuals in the school community. While the media may have
a role in alerting the community of an outbreak, they are not
“appropriate parties” under FERPA’s health or safety emergency
provision because they generally do not have a role in
protecting individual students or other individuals at the school.
47
+ Health Insurance Portability and
Accountability Act (HIPAA) Privacy
Rule
Establishes standards and imposes requirements to
protect the privacy of individually identifiable health
information.
Records that are subject to FERPA are not subject to the
HIPAA Privacy Rule (see page 82483, Federal Register, Vol.
65, No. 250, December 28, 2000)
Other HIPAA rules may apply.
48
+ HIPAA and K-12 Schools
In most cases, the HIPAA Privacy Rule does not apply to an elementary or secondary school because the school either:
(1) is not a HIPAA covered entity or
(2) is a HIPAA covered entity but maintains health information only on students in records that are by definition “education records” under FERPA and, therefore, is not subject to the HIPAA Privacy Rule
49
+
FERPA and Health Records
At the elementary or secondary school level, students’
immunization and other health records that are maintained by a
school district or individual school, including a school-operated
health clinic, that receives funds under any program
administered by the U.S. Department of Education are
“education records” subject to FERPA, including health and
medical records maintained by a school nurse who is employed
by or under contract with a school or school district.
50
+ Non School Employed Health Care
Provider
If a person or entity acting on behalf of a school
subject to FERPA, such as a school nurse that
provides services to students under contract with or
otherwise under the direct control of the school,
maintains student health records, these records are
education records under FERPA, just as they would
be if the school maintained the records directly. This
is the case regardless of whether the health care is
provided to students on school grounds or off-site.
As education records, the information is protected
under FERPA and not HIPAA.
51
+ Health Care Provider Disclosure to
School Nurse
The HIPAA Privacy Rule allows covered health care
providers to disclose protected health information about
students to school nurses, physicians, or other health care
providers for treatment purposes, without the
authorization of the student or student’s parent.
For example, a student’s primary care physician may
discuss the student’s medication and other health care
needs with a school nurse who will administer the
student’s medication and provide care to the student while
the student is at school.
52
+ Comments/Questions?
Joint Guidance on the Application of the Family Educational
Rights and Privacy Act (FERPA) And the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) To Student
Health Records
https://www.nasn.org/ToolsResources/DocumentationinSchool
Health/HIPAAandFERPA
53
+ Hot Topics Discussion
Epinephrine Legislation in Florida
Immunization Issues
Delegation Guidelines
54
+ Epinephrine Issues and Trends
The 2013 Florida Legislature amended sections 1002.20 &
1002.42, F.S. to allow public and private schools the OPTION to
purchase and maintain a supply of epinephrine auto-injectors
from a “wholesale distributor” licensed in Florida, as defined in
section 499.003, F.S.
HOLMES
3,249
BAY
26,129
JACKSON
6,543
GULF
1,791
LIBERTY
1,398
FRANKLIN
1,226
GADSDE
N
5,480 LEON
32,749
WAKULLA
4,737 TAYLOR
2,711
MADISON
2.398
HAMILTON
1,625
SUWANNEE
5,826
DIXIE
1,939
LEVY
5,337
GILCHRIST
2,424 ALACHUA
27,321
UNION
2,310 BRADFRD
3,003
NASSAU
11,087
MARION
41,363
CITRUS
14,735
HERNADO
21,825
PASCO
66,857
LAKE
41,018
PUTNAM
10,746
CLAY
34,996
BAKER
4,801
DUVAL
124,923
ST JOHNS
33,135
FLAGLER
12,675
VOLUSIA
60,629
SEMINOLE
63,807
ORANGE
184,144
OSCEOLA
56,819
POLK
95,573
HILLSBOROUGH
199,688
MANATEE
45,559 HARDEE
5,103
DESOTO
4,581
CHARLOTTE
15,804
LEE
85,675
GLADES
1,508
HENDRY
6,761
COLLIER
43,700
DADE
347,224
BROWARD
257,736
PALM BEACH
179,542
MARTIN
18,282
ST LUCIE
38,898
INDIAN
RIVER
17,753
More than 1% of the
students are reported
to have severe
allergies
+ 2013 Florida Epinephrine Legislation
Requires participating school districts and private schools to
adopt a protocol by a physician
Requires the school-supplied epinephrine auto-injectors to be
maintained in a locked location
Allows an authorized student to self-administer an auto-injector
that was purchased by the school
+ 2013 Florida Epinephrine Legislation
Requires training for school personnel to recognize when a
student is having an anaphylactic reaction
Allows trained school personnel to administer an epinephrine
auto-injector without parent authorization
Removes school employees’ liability arising from administration
of an epinephrine auto-injector and removes liability from the
physician who developed the epinephrine protocol
+ Position Statement
+ Tool Kit
+ School Nurses: Partnering to Prevent
& Respond to Anaphylaxis Video Series
+ Online Get Trained Program
+ Epinephrine Training Materials
+ 2013 Federal Legislation
Congress passed H.R. 2094: School Access to Emergency
Epinephrine Act that President Obama signed into law on
November 13, 2013
This federal law (Public Law No: 113-48) gives preference in
awarding certain federal grants to states that allow students to
self-administer medication for asthma and anaphylaxis that
includes civil liability protection for trained school personnel
who administer epinephrine to a student reasonably believed to
be having an anaphylactic reaction
+ National Guidelines for Anaphylaxis
+ Immunization Issues and Trends
Measles, http://www.cdc.gov/measles/cases-outbreaks.html
Centers for Disease Control & Prevention (CDC), NASN,
Families Fighting Flu, and the National Foundation for
Infectious Diseases School-located influenza clinic initiative at
http://www.preventchildhoodinfluenza.org/keep-flu-out-of-
school
66
+ Delegation Issues and Trends
Technical Assistance Guidelines: The Role of the Professional
School Nurse in the Delegation of Care for Students with
Diabetes in Florida Schools (2010)
http://www.floridahealth.gov/programs-and-services/childrens-
health/school-health/reports-information.html
67
Delegation of Care
Unlicensed Assistive Personnel (UAP) are permitted by s. 1006.062, F.S. to administer prescribed medication at school, provided appropriate training has taken place.
• Completion of skills checklist
• Return demonstration
• Periodic assessment of competency
• Documentation of above
Department of Health (DOH)
• School Health Services Act – s.381.0056, F.S. FDOH
and FDOE collaborate to supervise and monitor all 67 county
school health programs
• S. 402.3026, F.S. establishes Full Service Schools
• S. 381.0057, F.S. funds Comprehensive programs
• 64B9-14 F.A.C. Delegation to Unlicensed Assistive Personnel
• 64E-13.004 F.A.C. School Sanitation
• 64F-6.004 F.A.C. Meeting Emergency Health Needs
• 64J-1.023 F.A.C. Guidelines for AED in State owned or
leased facilities
Department of Education (DOE)
• 1002.20 F.S. K-12 Student Parent Rights
• 1003.22 F.S. School entry health examinations; immunization
against communicable diseases; exemptions; duties of DOH
• 1003.25 F.S. Procedures for maintenance and transfer of
student records
• 1006.165 F.S. Automated external defibrillator; user training
• 1006.062 F.S. Administration of medication and provision of
medical services by district school board personnel
Basic School Health Services
• Health appraisals, nursing & nutritional
assessments and health education
• Record reviews
• Screen for vision, hearing, scoliosis, and growth &
development
• Plan for emergency health services
• Parent & school staff consultations and
assessment, screen & consult for placement of
students in ESE programs
What is a
Comprehensive
School?
• Selected by the local Department of Health in collaboration with the local School District
• Health management to promote student health, decrease risk-taking behaviors and teen pregnancy
• Comprehensive schools are typically staffed by the local Department of Health
• Local leaders decide if abstinence, abstinence plus, teen outreach or similar programs are to be included in the services provided based on local objectives
Comprehensive
School Health
Services
• 502 Comprehensive Schools with 348,135 students
• 6,400,966 health services were provided to students in Comprehensive Schools, including:
• 398,681 Nursing Assessments
• 355,788 Complex Medical Procedures
• 769,655 Instances of Medication Administration
• 82,632 Preventive Dental Services
• 2,757 Social Work Interventions
Comprehensive School
Health Services Cont.
• 21,634 Health Education Classes Taught including:
• 1,871 Pregnancy Prevention Classes
• 1,301 STD Prevention Education Classes (Including HIV)
• 4,547 Violence Prevention Classes
• Comprehensive student birthrate was 6.73 per thousand compared to non-comprehensive student birthrate of 9.74 per thousand
Full Service School Health
• 66 counties
• Partnerships with community-based service
providers who donate in-kind services
• 368 Full Service Schools with 302,703 students
Estimated Value of In-Kind Donated Services
$14,870,234
Who Provides School Health
Services ?
• Registered Nurses, Licensed Practical Nurses,
Unlicensed Assistive Personnel
• Employed by:
– Local DOH
– School Districts
– Contracted providers
– Other community partners
RN Ratios
RN to Student Ratio 1 : 2,214
RN to School Ratio 1 : 3.02
RNs = 1,245
LPNs = 830
Health Aides/Techs = 1,249
Total = 3,324
HOLMES
2166
BAY
2099
JACKSON
1309
GULF
597
LIBERTY
2796
FRANKLIN
1226
GADSDEN
1096 LEON
3484
WAKULLA
3336
TAYLOR
935
MADISON
2398
HAMILTON
1016
SUWANNEE
737
DIXIE
2394
LEVY
1866
GILCHRIST
3030
ALACHUA
683
UNION
1155 BRADFRD
1001
NASSAU
1848
MARION
2236
CITRUS
2834
HERNADO
2728
PASCO
1857
LAKE
3418
PUTNAM
1791
CLAY
816
BAKER
686
DUVAL
5255
ST JOHNS
1274
FLAGLER
2305
VOLUSIA
5052
SEMINOLE
2900
ORANGE
3836
OSCEOLA
6110
POLK
3849
HILLSBOROUGH
1939
MANATEE
1111
HARDEE
5103
DESOTO
4581
CHARLOTTE
3161
LEE
2904
GLADES
718
HENDRY
3073
COLLIER
1703
DADE
3046
BROWARD
5005
PALM BEACH
827
MARTIN
2374
ST LUCIE
3851
INDIAN
RIVER
3945
School Health Services Program
2013-14 School RN to Student Ratio
2000-2999
3000-3999
4000 +
School Health Services Program
2013-14 School RN to Student Ratio
HOLMES
2166
BAY
2099
JACKSON
1309
GULF
597
LIBERTY
2796
FRANKLIN
1226
GADSDEN
1096 LEON
3484
WAKULLA
3336
TAYLOR
935
MADISON
2398
HAMILTON
1016
SUWANNEE
737
DIXIE
2394
LEVY
1866
GILCHRIST
3030
ALACHUA
683
UNION
1155 BRADFRD
1001
NASSAU
1848
MARION
2236
CITRUS
2834
HERNADO
2728
PASCO
1857
LAKE
3418
PUTNAM
1791
CLAY
816
BAKER
686
DUVAL
5255
ST JOHNS
1274
FLAGLER
2305
VOLUSIA
5052
SEMINOLE
2900
ORANGE
3836
OSCEOLA
6110
POLK
3849
HILLSBOROUGH
1939
MANATEE
1111
HARDEE
5103
DESOTO
4581
CHARLOTTE
3161
LEE
2904
GLADES
718
HENDRY
3073
COLLIER
1703
DADE
3046
BROWARD
5005
PALM BEACH
827
MARTIN
2374
ST LUCIE
3851
INDIAN
RIVER
3945
≤1000
Florida’s Students
2013-14
• Elementary/Middle/High/Combined
Level Schools (public and charter)
• Pre-K through 12th Grade Students
• % of Students Returning to Class
After Health Room Visits
3,612
2,651,421
93.53%
Reported Conditions
Total = 664,510
2013-14
• Allergies – Life Threatening
• Allergies – Non-Life Threatening
• Asthma
• ADD/ADHD
• Seizure Disorder
• Cardiac
• Psychiatric
30,668
203,063
186,975
93,407
18,444
13,652
16,632
Reported Conditions Cont.
2013-14
• Diabetes
• Kidney Disease
• Sickle Cell Disease
• Bleeding Disorder
• Cancer
• Cystic Fibrosis
• All Other
7,249
4,046
3,133
3,058
1,342
546
82,565
Comparison
2004 to 2014
Reported Conditions
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Allergies
Asthma
ADD / ADHD
Seizure Disorder
Cardiac
Psychiatric
Diabetes
Kidney Disease
Sickle Cell Disease
Bleeding Disorder
Cancer
Cystic Fibrosis
All Other
Comparison
2004 to 2014
Student Population
2,400,000
2,500,000
2,600,000
2,700,000
2,800,000
2,900,000
3,000,000
3,100,000
2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Student Population
Health Screenings
• Vision Screenings – K,1,3,6
• Hearing Screenings – K,1,6
• Scoliosis Screenings - 6
• Growth and Development/BMI – 1,3,6
Healthy Weight
HOLMES
BAY
JACKSON
GULF
LIBERTY
FRANKLIN
GADSDEN
LEON
WAKULLA TAYLOR
MADISON HAMILTON
SUWANNEE
DIXIE
LEVY
GILCHRIST ALACHUA
UNION
BRADFRD
NASSAU
MARION
CITRUS
HERNADO
PASCO
LAKE
PUTNAM
CLAY
BAKER DUVAL
ST JOHNS
FLAGLER
VOLUSIA
SEMINOLE
ORANGE
OSCEOLA POLK HILLSBOROUGH
MANATEE HARDEE
DESOTO
CHARLOTTE
LEE
GLADES
HENDRY
COLLIER
DADE
BROWARD
PALM BEACH
MARTIN
ST LUCIE
INDIAN
RIVER
Overweight/Obese
screening results(2013-14)
40-49% of students
screened are
overweight or obese
50% or more of
students screened are
overweight or obese
Estimated Health Room
Visits and Medication Doses
(based on FTE week counts)
Average Student Health Room Visits
Daily=78,346 Annual=14,102,316
Average Medication Doses Administered
Daily=26,651 Annual=4,437,180
Florida School Health
Services Program Staff
• Peggy Howland RN, Program Administrator
• 5 Liaisons
– Each liaison provides technical assistance and monitoring for
13-14 counties. Liaisons also manage contracts, collaborate
with groups working with children including: Chronic Disease,
Coordinated School Health Partnership, Public Health Dental
Program, Healthiest Weight and various workgroups who
provide guidelines to school nurses
• Lisa Ross provides administrative support for the team
Monitoring
School Health Services
• Schedule C Scope of Work
• School Health Services Program is responsible
for monitoring for both DOH and DOE
requirements
• Counties that contract all or a portion of their
school health services must monitor their
contracts
Monitoring Functions
• Begin at DOH Central Office with review of data
• Incorporates data from annual reports and the Health
Management System (HMS/HMC)
• Take place in individual schools
• Review of facilities, policies, health rooms, student
records
• Technical Assistance
• Review of School Health Advisory Council (SHAC)
efforts and community partners
Tools for Monitoring
• School Health Program Monitoring Tool
• Statewide Screening Reports run at intervals
(per Schedule C requirements)
• School Health Room Review
• Student Health Records Review
• County Three Year Worksheet (trending)
• School & Adolescent Health Summary
• Cash Balance Report
Medication Administration
s. 1006.062, F.S. (DOE)
References:
• 464 F.S. (Nurse Practice Act)
• 381.0056, F.S. (School Health Statute)
• Board of Nursing
HOLMES
3,249
BAY
26,129
JACKSON
6,543
GULF
1,791
LIBERTY
1,398
FRANKLIN
1,226
GADSDE
N
5,480 LEON
32,749
WAKULLA
4,737 TAYLOR
2,711
MADISON
2.398
HAMILTON
1,625
SUWANNEE
5,826
DIXIE
1,939
LEVY
5,337
GILCHRIST
2,424 ALACHUA
27,321
UNION
2,310 BRADFRD
3,003
NASSAU
11,087
MARION
41,363
CITRUS
14,735
HERNADO
21,825
PASCO
66,857
LAKE
41,018
PUTNAM
10,746
CLAY
34,996
BAKER
4,801
DUVAL
124,923
ST JOHNS
33,135
FLAGLER
12,675
VOLUSIA
60,629
SEMINOLE
63,807
ORANGE
184,144
OSCEOLA
56,819
POLK
95,573
HILLSBOROUGH
199,688
MANATEE
45,559 HARDEE
5,103
DESOTO
4,581
CHARLOTTE
15,804
LEE
85,675
GLADES
1,508
HENDRY
6,761
COLLIER
43,700
DADE
347,224
BROWARD
257,736
PALM BEACH
179,542
MARTIN
18,282
ST LUCIE
38,898
INDIAN
RIVER
17,753
More than 4% of the
students are reported
to have ADD/ADHD
HOLMES
3,249
BAY
26,129
JACKSON
6,543
GULF
1,791
LIBERTY
1,398
FRANKLIN
1,226
GADSDE
N
5,480 LEON
32,749
WAKULLA
4,737 TAYLOR
2,711
MADISON
2.398
HAMILTON
1,625
SUWANNEE
5,826
DIXIE
1,939
LEVY
5,337
GILCHRIST
2,424 ALACHUA
27,321
UNION
2,310 BRADFRD
3,003
NASSAU
11,087
MARION
41,363
CITRUS
14,735
HERNADO
21,825
PASCO
66,857
LAKE
41,018
PUTNAM
10,746
CLAY
34,996
BAKER
4,801
DUVAL
124,923
ST JOHNS
33,135
FLAGLER
12,675
VOLUSIA
60,629
SEMINOLE
63,807
ORANGE
184,144
OSCEOLA
56,819
POLK
95,573
HILLSBOROUGH
199,688
MANATEE
45,559 HARDEE
5,103
DESOTO
4,581
CHARLOTTE
15,804
LEE
85,675
GLADES
1,508
HENDRY
6,761
COLLIER
43,700
DADE
347,224
BROWARD
257,736
PALM BEACH
179,542
MARTIN
18,282
ST LUCIE
38,898
INDIAN
RIVER
17,753
More than 7% of the
students are reported
to have asthma
+ Asthma Guidelines
95
HOLMES
3,249
BAY
26,129
JACKSON
6,543
GULF
1,791
LIBERTY
1,398
FRANKLIN
1,226
GADSDE
N
5,480 LEON
32,749
WAKULLA
4,737 TAYLOR
2,711
MADISON
2.398
HAMILTON
1,625
SUWANNEE
5,826
DIXIE
1,939
LEVY
5,337
GILCHRIST
2,424 ALACHUA
27,321
UNION
2,310 BRADFRD
3,003
NASSAU
11,087
MARION
41,363
CITRUS
14,735
HERNADO
21,825
PASCO
66,857
LAKE
41,018
PUTNAM
10,746
CLAY
34,996
BAKER
4,801
DUVAL
124,923
ST JOHNS
33,135
FLAGLER
12,675
VOLUSIA
60,629
SEMINOLE
63,807
ORANGE
184,144
OSCEOLA
56,819
POLK
95,573
HILLSBOROUGH
199,688
MANATEE
45,559 HARDEE
5,103
DESOTO
4,581
CHARLOTTE
15,804
LEE
85,675
GLADES
1,508
HENDRY
6,761
COLLIER
43,700
DADE
347,224
BROWARD
257,736
PALM BEACH
179,542
MARTIN
18,282
ST LUCIE
38,898
INDIAN
RIVER
17,753
More than 0.7% of the
students are reported
to have seizures
Special Projects 2014-15 FY • FSU Immokalee = $300,000 to develop and
implement an Obesity Prevention Toolkit. • Keys AHEC - $250,000 to provide primary care
services to students at four sites in Monroe County Schools
• Teen Express - $50,000 to provide health care to uninsured children
• Florida’s Vision Quest - $1,250,000 for vision exams and glasses
• Florida Heiken-Miami Lighthouse - $1,000,000 for vision exams and glasses
Abstinence
Education
• $2,601,681 from Federal Department of Health
and Human Services, Office of Adolescent Health
(October 2010 – September 2015).
• School & Community Based Education Program
• Prevent & reduce the incidence of out-of-wedlock
pregnancies, STDs, and school drop-outs
• Funding September 2010 – August 2015
• 23 Counties/$67,103 per position per year
• Evidenced-based curriculum
• Weekly activities of 9-months
• Self-esteem, refusal skills, healthy behaviors,
community involvement, consequences of high-
risk behaviors
Contact Information
Peggy Deason Howland, RN Community Health Nursing Consultant School Health Services Program Administrator School, Adolescent, and Reproductive Health Section Bureau of Family Health Services Division of Community Health Promotion Florida Department of Health 4052 Bald Cypress Way, Bin A-13 Tallahassee, FL 32399-1721 Phone: 850-245-4496 [email protected]
+
Contact Information
Dianne Mennitt, DNP, RN, NCSN
School Nurse Consultant
101
Student Support Services Project
University of South Florida
Florida Department of Education
325 W. Gaines St., Suite 644
Tallahassee, FL 32399-0400
Phone: 850-245-7851
Fax: 850-245-7849
http://sss.usf.edu
