Olmsted County Public Health Services School Public Health Nurse Program Annual Report 2015-2016 School Year Creating a healthier community with school age youth and their families
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Olmsted County Public Health Services School Public Health Nurse Program Annual Report 2015-2016 School Year August 10, 2017 Olmsted County Public Health Services 2100 Campus Drive SE Rochester, MN 55904 Questions regarding this report or requests for full data tables can be directed to: Margene Gunderson, Associate Director Gunderson.Margene@co.olmsted.mn.us 507-328-7525 3
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TABLE OF CONTENTS Message from Associate Director. 6 Mission, Vision and Values... 7 Who are School Public Health Nurses?.... 8 History of School Public Health Nursing... 10 School Public Health Nurse Services.. 11 Collaboration.. 12 Advocacy and Referral.. 13 Health Promotion.... 14 How Much Do We Do?..... 15 Consultations.. 16 Support Groups.. 17 Teaching.. 18 Referral and Follow-up.... 19 Disease Surveillance... 20 School-Located Flu Clinics..... 21 Customer Service Survey. 22 Conclusions..... 24 Data Sources.. 25 Methodology.. 25 5
MESSAGE FROM ASSOCIATE DIRECTOR Olmsted County Public Health Services has a long history of partnering with schools, students, families and the community to advance the health and well-being of Olmsted County students. School public health nurses (PHNs) support child and adolescent growth and development by providing student-centered services that address specific needs through teaching, advocacy, health promotion, referral and follow up. They empower students and families to develop their highest level of wellness. School PHNs value health equity and focus on helping to improve social determinants of health at the individual, systems and community levels. School PHNs implement best practices, gather data on what is working at schools, and build upon this by expanding to other schools. They are community connectors who tirelessly focus on advancing student health through community engagement. They work with community partners to connect students, families and schools to available community resources. This is done by working collaboratively with community partners to leverage additional resources from hospitals, clinics, and other community organizations interested in improving the health of children, youth and families. On behalf of Olmsted County Public Health Services and the School PHN team, I am pleased to share this annual report of accomplishments and look forward to working toward improving conditions for Olmsted County students in the future. Sincerely yours, Margene Gunderson Associate Director Director of Nursing 6
VISION, MISSION & VALUES Mission Creating a healthier community with school age youth and their families Vision A healthy, vibrant and productive community Values Advocacy ~ Empowerment ~ Research-Guided Practice Prevention ~ Innovation ~ Diversity 7
WHO ARE SCHOOL PUBLIC HEALTH NURSES? Marty Alemán MAN, PHN Manager Janet Guderian BSN, PHN Mary Pat Jewison BSN, PHN, LSN Patrick Karls BSN, PHN Joan Kotschevar MS, PHN Jan Lueth BA, PHN Meagan Lechner BSN, PHN Cathy Manulik MS, PHN Cathy Miller MS PHN Glenna Noska BSN, PHN Renae Tapia BSN, PHN A school public health nurse (SPHN) is a licensed registered nurse with a public health nurse certification. School PHNs deliver essential public health services based on the core functions of public health assessment, policy development and assurance. 8
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HISTORY OF SCHOOL PUBLIC HEALTH NURSING IN OLMSTED COUNTY School Public Health Nurses (PHN) have had a long-term (75-80 years) relationship with public and private schools in Olmsted County, first in providing direct nursing services which transitioned in the past 20 years to a more population health approach for school-age youth. School PHNs provide free services, supported by tax levy, in over 65 school buildings in our county, including an adult literacy program. 1970s 1980s 1990s 2000s 2010s PHN s did all the different categories of work: home care new baby visits parent/child well child care chest clinic school nursing disease investigation community health education joint visits with social workers and police for child and adult protection assisted with community immunizations clinics, such as after 1978 flood and swine flu School PHNs worked only in school health: increasing numbers of medications treatments for students during school day care plans increasing immunization requirements Increasing amount of time spent with: medications care plans immunizations OCPHS worked with School District 535 to assess the need for more school nurse time and evaluated mission of PHN in the schools Services: private and charter schools (not 535): medications care plans immunizations start kindergarten records and care plans for 535 Services: charter and some private schools: medications care plans immunizations Today Focus on: advocacy health promotion teaching disease surveillance school-located flu clinics referral and follow-up 10
SCHOOL PHN SERVICES What services do school PHNs offer? Today s school public health nurses have a focus on several key areas of practice. It is difficult to stay within these activities because they are interlinked and school PHNs cannot do it all themselves, which is why collaboration is the center of all they do. How are school PHN services delivered? School public health nurses serve the needs of K-12 students by providing classroom education on important health topics, developing trusting relationships with students, supporting students experiencing adversity and connecting students and their families with community resources. 11
COLLABORATION 12 Stories from School PHNs: The school public health nurse group works with partners to provide additional services to the community schools in Rochester. The community schools are two elementary schools (Gage and Riverside) and a high school (Rochester Area Learning Center). The purpose of the community school is to organize school and community resources around student success. Our role in these schools extends to provide after-school and before-school education and enrichment for students and families. I have provided education at Fun/Fit Fridays where families bring their children and participate in physical activity together. At Riverside, we helped with a garden party where community partners came to the school and provided activities and education to students. At the Area Learning Center there is a food and hygiene closet where students can get everyday necessities that they cannot afford. Our role with the Community Schools is to collaborate with the community partners and the school to improve students health so they are able to learn. As the school public health nurse at Hawthorne Education Center, I learned that staff were concerned about the unhealthy eating habits of many of the adult learners, especially the immigrants and refugees, and the possible effects this was having with chronic disease development. I was asked to offer regular educational opportunities to the learners about making healthier eating choices at home, shopping and restaurants as well as accessing community resources for food support. I worked with school administration and teachers initially to plan classes on these topics and offered these classes to the learners during both regular classroom times and as extra presentations outside of class time. This became known as the Hawthorne Learner Garden Project. This is a collaboration with school administration, classroom teachers, volunteers, Rochester Alternative Learning Center garden staff, University of Minnesota Extension Service, the Supplemental Nutrition Assistance Program (SNAP) educator, and the Statewide Health Improvement Program (SHIP) grant staff to plan and sustain this project. The garden has grown from six pots to six raised beds where a variety of vegetables and herbs are grown. Presently, we give classes on healthy nutrition topics, using the garden as the focal point, from spring through fall to learners in the Preliterate to Level 2 English as a Second Language classes. I have seen the garden become a conversation piece for staff and learners where people stop to share past and current experiences with growing vegetables and teachers use the garden to help teach English speaking, reading and writing skills. While working at the high school that I cover, I became aware of work that Season s Hospice was doing to try to start a teen grief support group in the public schools but was having trouble making the connections needed. In my experiences at my school, there was a great need for such a group so I brought it up with other professionals at the high school. These social workers and counselors, as well as the principal, were very supportive and we were able to implement a seven-week program with students this year and have plans to continue this in the future.
ADVOCACY AND REFERRALS Stories from School PHNs: As the school public health nurse at Hawthorne, I work with many adult learners who have little or no knowledge of how to navigate our health care system and don t understand how to use their health insurance. A good example of my work happened recently with an adult refugee who had a recurrent tooth infection in her mouth where she had dental surgery done a few years ago in another country. The following case management occurred over a six-month period: I assisted the client with scheduling an appointment with a local dental safety net clinic. Antibiotics for a dental infection were prescribed and she was told she needed to see an oral surgeon. The client needed assistance to locate an oral surgeon so we called the Medical Assistance (MA) customer service (there are no oral surgeons in the area). The client returned to see me two months later with ongoing dental problems and more issues. I helped her address an outstanding bill from a private dentist and set up a payment plan. I helped her call for the list of oral surgeons who accepted MA. I assisted her to schedule an appointment with the nearest provider, who was in Minneapolis. I assisted her in filling out the health history form. I helped her go to a dental safety net clinic for treatment of a recurrent infection with antibiotics. I helped her understand a voice-mail message from the oral surgery clinic in Minneapolis, saying that they had reviewed her history. Because she received the surgery in another country, they wouldn t evaluate or treat work that had been done in another country. I consulted with the safety clinic manager who referred her to a local specialist who might possibly evaluate and treat her dental problem. I assisted the client in calling the specialist office over a six-week period to request an appointment. After six months, this client still hasn t gotten an appointment scheduled. I received a referral from a teacher about a high school student who was having hygiene issues. The teacher said that the student was wearing dirty clothes and had body odor for the past few weeks. In my experience, a hygiene referral is often the tip of the iceberg when it comes to what is really going on with a student and/or his family. I met with the student and instead of asking about his clothes or what was reported to me, I asked him how things were going at school and in his life. He told me that he had been living with friends and sleeping on their couch because his father (who was mentally ill) had kicked him out of the house after an argument. He was going to be moving to another friend s house soon but didn t have money to use the laundromat and felt awkward using his friend s shower. I referred him to the Students in Transition program, which provides assistance for students like him experiencing unstable housing or homelessness. The program was able to help him with referrals for medical care, food, housing, counseling, and even a way to use the school s shower and laundry facilities. 13
HEALTH PROMOTION Stories from School PHNs: As school public health nurses, we work with schools to promote a healthy environment. One area of concern for us is the extent that high sugar/high fat foods are present during the school day for celebrations and rewards. At the elementary level, our concern is with birthday treats: cupcakes piled high with frosting, candy, cookies and other sweet treats. Depending on class size, there could be birthday treats two to three times a week or sometimes twice in one day. As public health nurses we recognize the importance of recognizing birthdays and rewarding behavior. We advocate for nonfood rewards and celebrations. I had one school that was interested in not having birthday treats. The school had concerns about the financial cost of treats for low-income families, food allergy management and loss of instructional time related to distribution of the treats. They also agreed that most treats provided by families were poor examples of healthy food choices. As the school public health nurse, I helped the school define and implement a new school policy related to birthday celebrations. The change was announced in the spring of the school year and implemented the fall of the new school year. Results of this change: increased instructional time, the students ate more of their school lunch, students with food allergies and other health concerns that required dietary modification felt less social stigma and had less anxiety related to food at school. Maintenance staff reported that the classrooms were cleaner. Other schools adopted the policy the following year. 14
Olmsted County Public Health Services School Health 2015-2016 School Year Promotion Education 1,069 Classes Taught to 24,574 Students 656 One-on-One Consultations with Students 86 Facilitations/Groups to 614 Students Top 5 Subjects Nutrition Hand Washing/Personal Hygiene Health Promotion Safety Maturation/Puberty Top 5 Reasons for Consultations Health Promotion Community Resources Depression/Suicide Vision and Hearing Family Planning Top 5 Facilitations/Groups by Subject Health Promotion Parenting Nutrition Women s Issues Mental Health Referrals Out 237 Prepared by Olmsted County Public Health Services September 1, 2016
CONSULTATIONS During the 2015-2016 school year, School PHNs consulted one-on-one with 656 students. The top reasons for consultations were: 1. Health Promotion (229) 2. Community Resources (206) 3. Depression/Suicide (51) 4. Vision and Hearing (47) 5. Family Planning (42) 16
SUPPORT GROUPS During the 2015-2016 school year, School PHNs facilitated 86 groups with a total of 615 students in attendance. The top two subjects covered in the groups were 1. General health promotion (40 groups with 410 students) 2. Parenting (24 groups with 152 students) 17
TEACHING During the 2015-2016 school year, school PHNs taught 1,069 classes to 24,574 students with a variety of subjects being covered. The top five subjects were: 1. Nutrition (214 classes to 4,847 students) 2. Hand Washing/Personal Hygiene (187 classes to 3,370 students) 3. Health Promotion (123 classes to 1,945 students) 4. Safety (106 classes to 1,958 students) 5. Maturation/Puberty (84 classes to 2,269 students) 6. Dental Health (72 classes to 2,010 students) In the future, focus will also be on: Handwashing Bullying prevention Growth and development (puberty) Mental health topics Contraception 18
REFERRAL AND FOLLOW-UP During the 2015-2016 school year, school PHNs completed 2,543 screenings and 181 rescreenings. The majority of the screenings were for vision (46.5%) and hearing (26.1%). Of those screened, 237 were referred for further evaluation; 37% (88) were for vision screenings and 10% (23) for dental health. Top Student Referrals Made by School PHNs 37% Vision Screening 10% Dental Health 8% Depression/Suicide 8% Eye/Ear/Nose/Throat 8% Family Planning 7% General Health Promotion Other includes: general health promotion, depression/suicide, family planning, dental health, eye/ear/nose/throat, and school immunizations. 19
DISEASE SURVEILLANCE During the 2015-2016 school year, school PHNs played an important role in surveillance of communicable and infectious diseases in the school-age population. This included norovirus outbreaks, seasonal influenza and most notably, pertussis in the spring and summer of 2016. 20
SCHOOL-LOCATED FLU CLINICS The school-located flu clinics, started in 2009, are a collaboration between Mayo Clinic, Olmsted Medical Center, Olmsted County Public Health Services and Olmsted County Schools. The reach has increased from two schools in 2009 to 46 schools in 2016. In 2016, 6,294 students were vaccinated with an average of 30% of the student population participating. This program is part of Olmsted County s Community Health Improvement Plan which focuses on vaccine preventable diseases. 21
CUSTOMER SERVICE SURVEY In 2016, the school PHNs surveyed their customers (educators) two months, three times in the year. Customers completed questions about the most recent school PHN presentation and questions focused on how well they were treated, if school PHNs provided helpful and tailored information and if they learned anything from the presentations. The survey also offered an opportunity to provide suggestions for improvement and to suggest presentation topics. In total, 71 customers completed the survey. The majority (83%) of presentations were to elementary (K-5) students. Popular presentation topics included: nutrition, dental, and hand washing. WERE YOU TREATED WELL? Almost all customers completing the survey agreed/strongly agreed they and their students were treated well (99%). This is just short of the goal of 100% satisfaction. One customer mentioned, Went perfectly! Eloquent speaker, had the kids hooked the entire time. Other customer comments on SPHN staff included: Teachers and students were treated with respect Engaged all students with activities Always upbeat and empathetic Positive learning Very kind WAS THE PRESENTATION HELPFUL? The majority of the customers (97%) agreed that the information provided was helpful and tailored to their students. Student presentations were described as : Well done Appropriate Perfect topic for age group Engaging presentations Covered exactly what needed to Nice visuals DID YOU LEARN SOMETHING? Overall, 99% of school PHN customers reported that they and their students learned something new or important. Customers reported learning about a variety of different health topics including: Germs and hand washing Food groups Sugar amounts in beverages Portion control Contraceptives Responsibility Winter driving 22
Olmsted County Public Health Services School Public Health Nurses Division 83% of presentations were to elementary students (K-5) 99% agreed that they and their students were treated well 99% learned something new or important 97% agreed information was helpful & tailored to students
CONCLUSIONS Conclusions The School Public Health Nurse Program serves the population of families in Olmsted County schools. School PHN services focus on several key areas of practice: advocacy, health promotion, teaching, referral and follow-up, disease surveillance and school-located flu clinics. It is difficult to stay within these activities because they are interlinked and school PHNs cannot do it all themselves, which is why collaboration is the center of all they do. School PHN services are provided through classroom education on important health topics, developing trusting relationships with students, supporting students experiencing adversity and connecting students and their families with community resources. During the 2015-2016 school year, school PHNs taught 1,069 classes to 24,574 students on a variety of health topics. They conducted 656 one-on-one consultations with students and facilitated 86 support groups with a total of 614 students attending. They made 237 referrals to various community resources. School PHNs play an important role in surveillance of communicable and infectious diseases in the school-age population. seasonal influenza and most notably, pertussis in the spring and summer of 2016. This includes norovirus outbreaks, In 2016, the school-located flu clinics reached 46 schools, vaccinating 6,294 students. The majority of school PHN clients indicated they were treated well (99%), school PHN presentations were helpful and tailored to their students (97%); and they learned something (99%). Olmsted County Public Health Services is dedicated to providing quality School Public Health Nursing services and looks forward to continuing to partner with Olmsted County schools, students, families and the community to foster health and well-being for Olmsted County students into the future. HEALTHY STUDENTS ARE BETTER LEARNERS! 24
DATA SOURCES & METHODOLOGY Data Sources The data in this report was collected from PH-Doc, the electronic health record program used by OCPHS. Methodology Frequencies & Descriptive Statistics Frequencies (counts and percentages) were calculated for the number of clients, contacts, referrals and customer satisfaction associated with school public health nurse program areas. Trend Analysis Trend data is not available due to changing of documentation. 25