From Asthma to Marijuana: What s New in School Health

Transcription

1 From Asthma to Marijuana: What s New in School Health Jessica Gerdes, RN Principal Consultant, Health Issues Special Education Directors Conference Wednesday, August 1, 2018 Whole Child Whole School Whole Community

2 ISBE Vision & Mission Vision: Illinois is a state of whole, healthy children nested in whole, healthy systems supporting communities wherein all people are socially and economically secure. Mission: Provide leadership and resources to achieve excellence across all Illinois districts by engaging legislators, school administrators, teachers, students, parents, families, and other stakeholders in formulating and advocating for policies that enhance education, empower districts, and ensure equitable outcomes for all students. Whole Child Whole School Whole Community

3 ISBE Goals Goals: Every child in each public school system in the State of Illinois deserves to attend a system wherein All kindergartners are assessed for readiness. Ninety percent or more of third-grade students are reading at or above grade level. Ninety percent or more of fifth-grade students meet or exceed expectations in mathematics. Ninety percent or more of ninth-grade students are on track to graduate with their cohort. Ninety percent or more of students graduate from high school ready for college and career. All students are supported by highly prepared and effective teachers and school leaders. Every school offers a safe and healthy learning environment for all students. Whole Child Whole School Whole Community

4 Today s Objectives 4 o Participants will be able to: o Consider strategies written in law, rule and guidance, that lead toward achieving the Illinois State Board of Education (ISBE) goal. Every school offers a safe and healthy learning environment for all students. o Describe the most recent changes in school health law in Illinois and related rule. o Explore how utilizing services of a variety of school health professionals within a structured model may save dollars and increase effectiveness in school health service delivery.

5 Child at Center Healthy Safe Engaged Supported Challenged Information from: ASCD.org

6 Community Resources Community Partners Extension of safe environment Inclusivity Available Health Services Social Service Agency Stakeholders Information from: ASCD.org

7 Mental Health HB 4658 requires training of licensed school staff and administrators at least every two years on current best practices regarding identification of and recommended courses of action for student mental health issues HB 4658 also requires a school board to adopt and implement a policy on how to recognize mental health issues Passed and sent to the Governor on June 21

8 Pending legislation -- HB 4658: Mental health awareness policy and training HB 4908: Adds 9 th graders to the grades at which a student must present evidence of a completed dental examination (or waiver) SB 3015: Stock albuterol for use as needed SB 2889: Stock epinephrine in pre-filled syringes SB 2654: Notify parents about influenza vaccine HB 4870: Medical Cannabis

9 Medicinal Marijuana: P.A Compassionate Use of Medical Cannabis Act Allows use for under age 18 Rules are under IDPH jurisdiction Presence on school grounds or on school transportation is prohibited. AAP statement on use in children - contraindicated Remains Schedule I, Controlled Substances Act, FDA - no medicinal value ISBE guidance - Medications tab:

10 Medical Marijuana Currently, by court order, only one district and one student within that district are permitted to have medicinal marijuana on school grounds. HB 4870 would allow a student s designated caregiver to give the drug while on campus (to Governor 6/22/18).

11 Cannabidiol Legally, same restrictions as marijuana and medicinal marijuana by definition since it comes from the same plant, the cannabis plant. The U.S. Food and Drug Administration in July approved the first cannabis-derived drug, but it cannot be sold until the Drug Enforcement Administration changes how it classifies the specific compound used. The drug, Epidiolex, is found to treat about 5% of forms of childhood epilepsy and contains the compound cannabidiol (CBD). Though CBD comes from cannabis, it has low risk of causing anyone to get high; it does not contain the compound THC, which produces the high. But because it comes from cannabis and cannabis overall is classified as a Schedule I drug with no currently accepted medical use and a high potential for abuse, pharmaceutical companies are not allowed to sell it unless the DEA reclassifies CBD.

12 Illinois Law and Administrative Rules: Health Services School Code: Chapter 122, Sec b (medications) School code: Sec the teachers institutes shall include instruction on prevalent student chronic health conditions. ISBE rule 1.530: Health Services (policy and procedures relative to injury or sudden illness of students and staff) ISBE rule 1.760: Standards for Student Support Personnel (sections b-h, school nurse) ISBE rule : Personnel required to be qualified (nursing interventions) ISBE rule : Medical review: performance of health evaluation for student for IEP

13 Medications ISBE s guidance recommends that - all medications given or taken at school be approved by U.S. Food and Drug Administration (FDA). all medications, whether purchased with subscription or without subscription, have both medical provider and parental authorization. For example, HB 4216: Sunscreen - would have allowed students to carry and selfadminister sunscreen and if unable to apply themselves, school volunteers apply without either parental or medical authorization. Did not get out of committee

14 Medications Revised Illinois Nurse Practice Act (P.A ) effective January 1, 2018, allows a registered nurse (R.N.) discretion in delegating medication administration to a non-nurse, non-health care licensed personnel in community settings ISBE issued new medication guidance document in May 2018 ISBE proposed rules on delegation of medications in schools this past winter. Public comment period has ended, awaits board action.

15 Highlights of Medication Guidance Refers to School Code: (105 ILCS 5/ b) (from Ch. 122, par b), Sec b: Administering medication. Authorizes schools: To provide for the administration of medication to students. It shall be the policy of the State of Illinois that the administration of medication to students during regular school hours and during school-related activities should be discouraged unless absolutely necessary for the critical health and well-being of the student. Under no circumstances shall teachers or other nonadministrative school employees, except certified school nurses and non-certificated registered professional nurses, be required to administer medication to students. This Section shall not prohibit a school district from adopting guidelines for selfadministration of medication by students. This Section shall not prohibit any school employee from providing emergency assistance to students. (Source: P.A , eff )

16 Highlights of ISBE Medication Guidance All drugs, purchased OTC or by prescription, are treated the same. Essential oils and other natural remedies should not be allowed unless Ordered by appropriate medical prescriber. Listed by the FDA as a treatment for the condition stated by the prescriber. RN and LPN and administrators authorized to administer medications by state law. Non-nurse permitted to administer emergency medications if trained and has volunteered. Upon rule action by either ISBE or IDFPR rule, RN may delegate to non-nurse.

17 Changes to State s Nurse Practice Act P.A Expands potential for delegation of nursing care in community settings (i.e., schools, nursing homes). Delegatee may not re-delegate. Administration and Registered Nurse should review staffing patterns and areas for potential delegation of care. RN maintains right to refuse to delegate, stop, or rescind a previously authorized delegation. Consistent with School Code: The duty to provide registered professional nursing practices, as defined in Section of the Nurse Practice Act, shall not be included among the functions assigned to any school district personnel not covered by the job description required for school nurses (ISBE 23 IAC Standards for School Support Personnel Services) Consistent with ISBE rule IAC

18 Medications In addition to student specific medications, schools may (are not required to) maintain: stock drugs limited to: Epinephrine for severe allergic reactions Naloxone for overdose to an opioid drug Reports on use are available on ISBE website, medications. SB 3015: albuterol (quick acting bronchodilator for severe asthma); passed and sent to Governor June 22 Potentially on the horizon: glucagon for severe hypoglycemia for students with diabetes

19 Epinephrine: Student Specific or Stock Dose Student Specific Student may self-carry and self-administer. May be first time and student needs assistance. Student always needs reassurance. Student always needs 911. No report required to ISBE Should not be used on another student or person Stock dose Allows schools to stock one or more doses for use as needed. Law and ISBE rules require specific training and protocol. Allows drug to be given to any person not previously known to have severe allergy and/or not previously given a prescription for epinephrine Requires a report to ISBE within three days of the administration Student always needs 911. Whole Child Whole School Whole Community

20 20 Opioid Antagonist: Narcan or Naloxone Law - P.A Antidote for opiates, both legal and illegal forms Authorizes (but does not require) the administration of opioid antagonist by school nurses or trained personnel to "any person (who) the school nurse or trained personnel in good faith believes is having an opioid overdose" ISBE Rule includes requirements of both of epinephrine and naloxone. Report required to ISBE upon use

21 ISBE Forms for Reporting Administration of Undesignated Epinephrine and Opioid Antagonist 21 Form Epinephrine Form 34-20a Opioid Antagonist Forms at

22 22 Diagnosed Chronic Health Conditions, * 6% asthma 59, % life threatening allergy 15, ,875 Students counted 0.2% Type 1 Diabetes 2, % seizure disorder 9, % Type 2 Diabetes 1,486 *Sample of school nurses reporting

23 Discussion on Top Student Chronic Health Conditions Based on frequency, severity, potential for serious health consequences, personnel and costs dedicated to care of students with these conditions: Diabetes Seizures Severe allergies Asthma

24 Diabetes The most serious short-term condition requires a source of sugar, not insulin. If a district determines need to have a non-nurse assigned to a student with diabetes (Delegated Diabetic Care Aide), staff member must be trained initially by a Certified Diabetic Educator (CDE) or MD with expertise in diabetes. Online training can be part but not all of that aide s training. School R.N. may provide additional training and should be involved in any changes to medical order. Whole Child Whole School Whole Community

25 25 Care of Students with Diabetes Act In any school enrolling a student with diabetes, school staff are to be trained on general signs and symptoms and emergency care of a student with diabetes Authorizes a DCA (delegated care aide) to provide care that is usually in the domain of a nurse Training for the specific student is to be individualized, according to the student s DMMP, with parent and student Initial instruction by CDE or MD School nurse oversight is inferred Staff must really volunteer, not be required to accept assignment as DCA Requires a 504 plan

26 Seizures Many seizures are virtually unnoticeable. Most seizures do not progress beyond a minute or two. Seizures lasting longer or accompanied by change in color or respirations may require administration of medication. Students who have history of seizures needing medication are often accompanied by a nurse (RN or LPN); 1:1 nurse is an accommodation that may be made after careful review of the risks. Medical cannabis has been effective in some with seizures to reduce frequency and/or length. Whole Child Whole School Whole Community

27 Students with Food Allergies Substitutions must be made to the regular meal for any child with a disability related to food if: A licensed physician completes the Physician s Statement for Food Substitutions. The statement includes the child s disability, explanation as to how the disability restricts the child s diet, the major life activity affected by the disability, and foods/beverages to be omitted and foods/beverages to be substituted. Without the physician statement, substitution may but is not required to be made.

28 Other Food Modifications Students with disabilities needing food modification not related to allergy For children with disabilities only requiring modifications in food texture, such as chopped, ground, pureed, a licensed physician's written instructions indicating the appropriate texture is recommended, but not required.

29 Allergy Awareness, Prevention, and Treatment Food Allergy Guidelines Food Allergy Prevention Plan Environmental awareness of other allergens: latex, insects, medications Self-carry, self-administration of epinephrine auto injectors Availability of stock epinephrine for those not yet diagnosed with allergies

30 30 Asthma Law P.A requires each district and school (including charter and nonpublic) to request Asthma Action Plan from parent Required ISBE to develop a model asthma emergency response protocol (on ISBE website) Required each district and school to adopt a similar protocol by January 1, 2017 Requires school staff to be trained at least every 2 years on asthma (resources on ISBE website)

31 Asthma Students with asthma are allowed by state law to selfcarry and self-administer their emergency medications (inhaler with a quick-acting dilator of their airway). Pending Governor s action, schools may be allowed to stock albuterol (the airway dilator medication); If student does not get better with a second use of inhaler or symptoms are severe, call 911. Whole Child Whole School Whole Community

32 32 Erin s Law (P.A ) Erin, one who was victimized by child sexual abuse, is an advocate for early learning related to child sexual abuse awareness by children. Law amends School Code and the Critical Health Problems and Comprehensive Health Education Act (105 ILCS 110/3). All public schools must implement an age-appropriate child sexual abuse prevention and awareness program with students in grades pre-kindergarten through grade 12. Limited research available on the effects of specific curricula; ISBE has chosen not to promote any specific prevention curriculum, but refers to non-profit associations that recommend core components.

33 Ann Marie s Law: Youth Suicide Awareness and Prevention Public Act : Schools beginning must review/revise existing suicide prevention and awareness policy, or create one A youth suicide awareness and prevention policy is required pursuant to 105 ILCS 5/ , amended by Public Act ISBE created a task force from a variety of stakeholders to develop a model policy that schools may use and provide resources and recommendations. Model Suicide Prevention Policy Available to All Districts in Illinois The Illinois State Board of Education and the Illinois Association of School Boards (IASB) collaborated on a model policy available to all school districts in Illinois. To request a copy, please IASB to Brian Zumpf (bzumpf@iasb.com) with the subject line: Suicide Awareness and Prevention Policy Request. For more information, please visit

34 Exceptions to Emergency Treatment Do Not Resuscitate (DNR) and similar orders DNR is most common layperson term. Physician Orders for Life Sustaining Treatment (POLST) is a current term. If a student has a POLST or similar order, school or district IEP or 504 team should be convened. Follow the orders to the letter; a recent lawsuit found a district at fault for saving the life of a student with DNR order due to costs involved. Whole Child Whole School Whole Community

35 Evaluation for Special Education - Health 35 IDEA requirement to rule out medical issues (among others) prior to determining student to have a learning disability Components of Medical Review (MR) (IAC ) : Parts 1-4: assessment and data collection Part 5: recommendations, goals, evaluation 23 IAC Section 1.610: All professional employees shall be properly licensed as required Personnel qualified to perform Medical Review Parts 1-4: RN with PEL, with designation; RN with at least bachelor s degree; APRN; MD Part 5: RN with PEL endorsement or IEP designated RN No other personnel qualified or permitted to perform MR

36 Special Education Directors Needing Nurses to Complete Health Evaluations (modified from Superintendent Weekly Message dated June 12, 2018) Health assessments and recommendations for health-related goals for students with Individuals Education Programs (IEPs) must be provided by a Registered Nurse (RN) with an ISBE-issued Professional Educator License (PEL) endorsed in school nursing (as written in School Code). The PEL (formerly known as CSN) is the legally defined and required School Code credential for school nurses performing any job duties that include student academic evaluations. Many RNs have completed coursework and internships leading to the PEL, but some districts have tried and been unable to hire a qualified school nurse. Such districts may apply to ISBE to hire and train a non-pel RN and remain in compliance with special education evaluation rules if they follow these steps: Encourage, require, and/or support an existing staff RN with at least a bachelor s degree to enter into an approved school nurse certification program offered by an Illinois university. [DePaul University] Lewis University and the University of Illinois-Chicago currently have approved programs. [Each] of those programs offer extensive distance learning options, and most nurses would be able to complete the program within 12 months. If time is of the essence, you may apply to ISBE to have an RN obtain an IEP designation through two other options, but only after a district submits prerequisite documents to ISBE that verify a search for a fully qualified RN (PEL with school nurse endorsement) has been made: An ISBE-sponsored IEP course is available through Illinois Virtual Schools. Next school year, the course will be offered once, in as many sections as needed, in a six-week course that runs Jan. 16 through Feb. 26. An RN may opt out of the ISBE-sponsored IEP course and directly take the school nurse content test #[236], which is available from the Illinois Licensure Testing System (ILTS). The test option remains available through the ILTS system year-round, [beginning 9/3/18]. It may be helpful in some districts to restructure the job duties of personnel in the nursing services department. A nurse with a bachelor s degree who does not hold either the PEL or IEP designation may still perform 80 percent of the five components of IEP health evaluations as identified in 23 IAC (a) - Medical Review. Hiring an RN who already holds the IEP designation does not remove the requirement upon the district to first seek a PEL school nurse and apply to ISBE to utilize the new hire who holds only an IEP designation. Since the rule creating the IEP designation credential was instituted in the fall of 2013, 802 RNs obtained the IEP designation through additional coursework and 45 by testing out. During this same time period, 208 RNs have obtained the PEL license with the school nurse endorsement. It is important to note that fully qualified RNs (PEL with school nurse endorsement) are entitled, according to the School Code, to the same benefits and compensation as teachers. More information is available by contacting Jessica Gerdes at jgerdes@isbe.net or Rebecca Doran RDORAN@isbe.net or by reviewing information regarding the required credentials.

37 Medical Review Evaluation for Special Education 381 RNs have completed the course 80 spring summer fall winter spring RNs have indicated completed test option Classes scheduled through Spring 2016 Significant of July 1, 2016 Components of medical review Qualifications of persons to conduct medical review Role of RN on IEP teams Form on which to document designation for IEP for non-isbe school nurses coming soon

38 IAC Special Education Rule A school district or special education cooperative that does not have a person qualified to perform all five components of a Medical Review and needs one, must engage in an effort to recruit and hire a registered nurse who holds the PEL endorsement in school nursing. Active engagement can be demonstrated by a position posting that is publicized in a way that would demonstrate effort to recruit a qualified candidate. The posting for a positon that requires the PEL endorsement must meet the requirements of the School Code (105 ILCS 5/21B-25), which stipulates that the holder of such an endorsement is entitled to all of the rights and privileges granted holders of any other Professional Educator License, including teacher benefits, compensation, and working conditions.

39 Required Documents 39 Six required documents a district/cooperative submits to ISBE for review and approval: 1. The position posting as advertised 2. The results of such recruitment 3. Letter from the public school district or special education cooperative administrator indicating that the RN s duties will include providing educational evaluation and instructional judgment for students being evaluated or reevaluated for special education services 4. Cover letter from the RN, including degree(s) (at least a bachelor s degree in nursing, education, or related field) 5. Copy of current RN licensure 6. Proof of current employment (pay stub) or notice of hire (contract, board minutes) by the district or special education cooperative, or agency contracted.

40 Role of RN on IEP Team Evaluation: Part of a group (IEP team, PPS team, etc.) that conducts a complete and individualized assessment Review the obvious. Then dig deeply for overlooked health impact of health and other issues, whether or not medically diagnosed. Planning: Address all of a students needs in the PLAAFP. Assign specific services and minutes. Review qualifications and level of credentials of persons to provide any identified services. Write student goals related to health and academics. Write nursing goals in IHP or nursing care plan. Evaluate plan: Monitor outcomes, student goal achievements, nursing goals. Adapted from Avoiding Substantive Errors in Individualized Education Program Development October 2016

41 School Nurse Role in Reducing Absences School nurses can have a positive influence on school attendance. Health counseling on when a child is well enough to attend school. Observe for signs/symptoms of physical abuse (child is kept home to hide injuries). Observe for signs/symptoms of neglect (call in sick for lack of clean clothing, adequate winter wear). Assist with access to resources for health care (practitioners and funding). Monitor and review absences excused for illness or injury. Promote good health through education and resources: flu immunization clinics, hygiene and infection control (handwashing), and health fairs. Develop Individual Health Plan for students with chronic health conditions. Refer to 504 team or IEP team as relevant. Look for signs/symptoms that another family member s health is the real reason for the student health related excuse. Bring dental clinics and immunization clinics to school (mobile medical vans).

42 Chronic School Absences Chronic absences addressed by P.A , Illinois Attendance Commission Chronic absenteeism a student success indicator in Illinois state plan for Every Student Succeeds Act (ESSA) Defined as 10% or more of unexcused and excused absences in the prior academic year* Health has been cited as the number one reason for absences in early childhood Data indicates that the most excused absences are for treatable illnesses, particularly oral health and asthma Data supports the perception that physical health and academic achievement are correlated *excludes medically certified home/hospital instruction or death of family member Report.pdf#search=attendance%20commission%20report

43 43 IDEA s Other Health Impairment (OHI): The Health Qualifier By their very nature, other health impairments involve medical care and medical concerns. The list of acute or chronic health conditions in the definition of other health impairment is not exhaustive, but rather provides examples of problems that students have that could make them eligible for special education and related services under that category. (71 Fed. Reg. at 46550) Avoid using OHI as a catch-all for students who do not fit or qualify for services. Qualified Registered Nurse (RN) should be involved in - the initial health evaluation and re-evaluations developing the present levels of functional performance the treatment plan the educational plan Consider also evaluating and reporting on health strengths.

44 Transition Plans 44 Federal law requires transition plans by age 16 years, but states can provide at younger age; Illinois requires that transition plans be in effect on or before a student turns 14 ½ years of age. Goals and services in the area of independent living skills are required (in addition to postsecondary goals and services in areas of training, education and employment). Resource: Got Transition, Center for Health Care Transition Improvement, a cooperative agreement between the U.S. Maternal and Child Health Bureau and the National Alliance to Advance Adolescent Health For students with IEPs and health needs, consider a nurse-written transition service and health goal written for the student, encouraging independence. Examples: define his or her condition using medically accurate terms; list/spell or speak names of daily medications; practice health-related self-care, such as personal hygiene, medical treatments, refill of prescriptions (demonstrated and evaluated by RN).

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46 State Law on Student Health 46 Required for Entry to School: Immunizations Vision examination (at kindergarten entry or at any first entry to an Illinois school) Dental examination (entry to kindergarten, second and sixth grades); HB 4908 adds 9 th grade; passed and sent to the Governor June 15 Physical examination (entry to school and 6 th and 9 th grades)

47 Waivers for Health Requirements Available waivers: Medical reason (written by medical doctor) On schedule (first in series; waiting period for boosters) Religious Objection (on state required form with medical counseling affirmed) Physician Statement of Immunity the only exemption reviewed by IDPH medical director with written parent permission Meets requirements for homeless status (school must work to remove the barriers to obtaining, but waiver is not forever Foster children (Department of Children and Family Services placement) are not considered homeless in and of foster status Unless the student holds a valid waiver: Exclusion for noncompliance (October 15 or earlier)

48 Student Vaccinations Compliance / enforcement measures IWAS report - due by November 15, based on district compliance date (October 15 or earlier, not both) By December 1 of each year, schools must make publicly available the immunization data they are required to submit to the ISBE (P.A ) ISBE and Regional Offices of Education perform monitoring visits ISBE data and statistics website includes compliance, noncompliance, and not reporting, schools School Code: Local school authorities shall monitor immunization schedules to assure their completion.

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50 Child Health Examination Lead: screening (non-invasive): kindergarten entry, ages six and under Lead testing (blood draw): kindergarten entry ages 6 and under if screening is positive for potential exposure Levels of lead exposure near children's homes has a direct, causal effect on the likelihood they'll be suspended from school, according to the review of data on 120,000 students, cited in a report from Rochester, NY. Social-emotional screening Rules to be developed and implemented by IDPH New form will not be available before fall 2019 Schools should not be undertaking their own screening based on this law without state rules or guidance

51 State Law - Staff 51 o o o Employment physical Tb testing of new school staff in all facilities with preschool-age children (under the age of five). Test performed within 7 days of employment If there is medical documentation of a skin test done within past 12 months, it does not need to be repeated. Rules found in Public Health Code (only referred to in School Code) Vaccines for all employees of licensed child care facilities caring for children ages 6 and under and recommended for all: o MMR vaccine (two doses, or proof of immunity to measles, mumps and rubella) o Tdap vaccine (one dose)

52 Student and Staff Privacy FERPA for students Exceptions for serious and imminent threats to health and safety Required release related to vaccine compliance HIPAA for staff: Definition of HIPAA covered entity Release of information related to outbreaks of communicable disease

53 53 Eliminate Disease Preserve FERPA Mandate upon health care providers on reportable diseases Centers for Disease Control and Prevention (CDC) regulations to state health departments State health departments to health care providers Downloadable posters produced by Illinois Department of Public Health (IDPH) No names, initials, or other identification may be released outside of school without written parental release, with few exceptions. Diseases required to be reported immediately (e.g., within three hours) or within three days are exempt from FERPA requirement for written parental permission based on public health emergency clause (by agreement between ISBE and IDPH).

54 54 Required Health Training for School District Personnel P.A , P.A , P.A , P.A require staff training on: Signs of mental illness and suicidal behavior (grades seven through 12, staff - frequency not specified) Domestic violence, sexual violence, and needs of pregnant/parenting youth (every two years) Anaphylactic reactions and management (at least every two years) Psychotropic medications Model district suicide prevention policy Instruction on prevalent student chronic health conditions Americans with Disabilities Act Federal and state OSHA laws (blood-borne pathogen) Signs and symptoms of and emergency protocol for asthma District emergency procedure to be followed in cases of injury to, or sudden illness of, students and/or staff (23 IAC 1.530) o Registered nurse may be utilized for staff training; canned training does not always meet the full requirements of law or rule

55 Keeping Staff Healthy Maintain your own good health through good nutrition and physical activity. Stay up to date on immunizations, including annual flu vaccine. Have a friendly attitude, but stay an arm s length away from student hair or respirations. Wash hands frequently; use hand sanitizers or wipes on equipment handled by students. Whole Child Whole School Whole Community

56 Keeping Staff Healthy Follow universal precautions Assume everyone has a disease you don t want. Wear gloves for handling blood and other body fluids (if available). Use a facial barrier when administering breaths in CPR. Protect yourself from needle stick. Remove gloves in manner that does not violate the whole point! Whole Child Whole School Whole Community

57 57 How Can Schools Better Utilize a School Health Services Team? Nurse Practice Act, and other medical/health care acts, refer to non-licensed health care providers assisting in the health care team ISBE 23 IAC 1.760(h): The duty to provide registered professional nursing practices, as defined in Section of the Nurse Practice Act, shall not be included among the functions assigned to any school district personnel not covered by the job description required for school nurses. ISBE 23 IAC (k): Clarification of Nurse Practice Act nursing activities as practiced in Illinois schools

58 State Funding: Evidence-Based (EB) Funding Model Eliminates some line items such as specific special education personnel reimbursement line items and specific reimbursement for home/hospital bound instruction. IEP still drives the services to be provided, including health services. Funding ratio includes funding for certified school nurse (RN with PEL) at 1:750 students

59 Evidence-Based Funding School Nurse Adequacy Target Core Investments Cost Factors Page 5 of this overview : resentation_overview.pdf#search=ebf

60 60 ISBE Classifications of Health Services Staff School Nurse (definition in school code and in EBF model) RN with PEL and school nurse endorsement, aka CSN (Certified School Nurse) Non-Certified Health Aide (NHA) - licensed by the Illinois Department of Financial and Professional Regulation as an RN or LPN, but without ISBE PEL endorsement in school nursing NHA includes the RN with only the designation for IEP privileges. Individual student aide: non-nurse, non-instructional support Paraprofessional educator: a staff member holding paraprofessional educator license Parapro who is not an RN or LPN may not perform nursing activities NHA (RN or LPN) who does not hold parapro license may not perform duties of a paraprofessional (instructional assistance). Consider utilizing NHA with para license to increase cost-efficiency.

61 Suggestions for Cost Efficiency 61 Utilize the RN with PEL for functions that require PEL and for which the certification training prepared them: IEP work (medical/health evaluation, IEP goals/evaluation) Policy development Program evaluation Instruction (staff in-service, student instruction, as permitted) Supervision of other health service staff Utilize RN without PEL for other direct nurse functions: Creating Individual Health Plans 504 plans Direct nursing care For bachelor s prepared RNs, 80 percent of IEP evaluation and plans

62 Suggestions for Cost Efficiency, cont. 62 Utilize the LPN for direct care of 1:1 care under delegation and oversight of Registered Nurse. Utilize the LPN as second office nurse in large schools or campuses, in close proximity to RN. Utilize a nurse aide or individual student aide for minor first aid or one-to-one aide for student not needing nursing care that requires license. Utilize adult or student volunteers with attention to FERPA and infection control (filing, ordering supplies, checking equipment, mailings, research). Small districts may combine with neighboring districts or co-op for direction and consultation services of at least one RN/PEL

63 The Allowable Tasks of the CNA Includes Personal Care Tasks, Such As: 63 Meal preparation Meal set-up Oral feeding Oral care Nail care Basic hygiene Bathing Dressing Toileting Changing bed linens Ambulation assistance Catheter: changing of bags and charting amounts Ostomy care: empty, clean, change appliance Turn and position Charting activities and outcomes Recreation activities Obtaining vital signs: temperature pulse blood pressure weight

64 64 Reimbursement for School Nursing Services: Really? Really!

65 Potential for More Federal/State Reimbursement for Health Services Medicaid free care rule letter and follow-up National meeting convened by Trust for America s Health and Healthy Schools Campaign Centers for Medicare and Medicaid (CMS) and Illinois Healthcare and Family Services NAME National Alliance for Medicaid in Education (conference October 2018, Baltimore)

66 Questions

67 Next Up Social Hour

68 Contact Information Becky Doran (Springfield office) Jessica Gerdes (Chicago office)

69 References and Resources 69 In addition to ISBE resources and the School Code, these resources were used in preparation of this session: American Academy of Pediatrics, Council on School Health. (2004). School Health Policy and Practice (6 th Ed.) Elk Grove Village., IL: American Academy of Pediatrics. American Academy of Pediatrics, National Association of School Nurses. (2011). The Scope and Standards of Practice for School Nursing. American Academy of Pediatrics, Council on School Health and Committee on Infectious Diseases. (2015). Pediatrics, 135(5). Resha, C., & Taliaferro, V. (2017). Legal Resource for School Health Services. SchoolNurse.com Illinois Department of Financial and Professional Regulation, accessed at Illinois General Assembly,