School Health Services Program 2015 Overview
+ 2 School Nurses: Leading the Way to a Healthier Generation Florida Association of School Nurses (FASN) 19 th Annual Conference February 2015 State Update Variety Pack Peggy Howland, RN, School Health Program Director Dianne Mennitt, DNP, RN, NCSN School Nurse Consultant
+ Objectives 3 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
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National Standardized School Health Services Data Set: Step Up and Be Counted! 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 Who Can Participate? ALL school nurses NASN and non-nasn members Private/parochial/charter schools 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 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! 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
+ 10 School Health Administrative Guidelines http://www.floridahealth.gov/programsand-services/childrens-health/schoolhealth/reports-information.html
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)
C e l e b r a t e! February 2-6, 2015 STUDENT SERVICES WEEK
Health Promotion Management of Student Health Conditions Screening Services S c h o o l N u Approximately 20% of the student population School-Entry in Florida Health report Exam the following health Compulsory conditions: Immunization Allergies Requirements (life threatening) + Health (non-life Education threatening) and Physical Asthma Education Cancer School/Community Wellness Activities Cystic Fibrosis r s e s Diabetes Health Screenings: Vision; Heart Conditions Hearing; Height, Weight and Kidney Disease Body Mass Index (BMI); Seizures and Epilepsy Communicable Disease Sickle Cell Disease School Health Fairs: Dental; Blood Pressure; Developmental; Mental Health School Psychologists School Counselors School Nurses School Social Workers Image Courtesy of Olyzel/Thinkstock
+ Guidelines- for the Care and Delegation of Care for Students with Diabetes in Florida Schools 16
+ Supporting Organizations 17 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
+ Supporting Organizations cont d. 18 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
+ Diabetes Guidelines Workgroup 19 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
+ Diabetes Guidelines Workgroup 20 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
+ Purpose of the Guidelines 21 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
+ Team Approach 22 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
+ Everyone Has an Important Role 23 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
+ What s New? 24 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
+ Introduction to the Guidelines Major Factors in Maintaining Health Legal Aspects to Consider Criteria for Safe Delegation Planning and Implementation Meeting Sections Guidelines for the Care and Delegation of Care for Students With Diabetes in Florida Schools Components of Individualized Health Care Plan Roles & Responsibilities Recommendations for Staff Education Disaster Preparedness Monitoring & Evaluation Appendices 25
+ Understanding the basics of diabetes management Maintaining optimal blood glucose control Assembling the school health team Contents Guidelines for the Care and Delegation of Care for Students With Diabetes in Florida Schools Training school personnel Implementing effective diabetes management: checking blood glucose, nutrition, physical activity, carbohydrate counting and insulin administration Recognizing and treating hypoglycemia and hyperglycemia 26
+ Healthcare Provider Principal School Nurse Unlicensed Assistive Personnel Highlights Roles & Responsibilities Guidelines for the Care and Delegation of Care for Students With Diabetes in Florida Schools 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 27
+ Diabetes Medical Management Plan Individualized Health Care Plan Emergency Care Plans for Hypoglycemia and Hyperglycemia Tools for Effective Diabetes Management Guidelines for the Care and Delegation of Care for Students With Diabetes in Florida Schools 28
+ Additional Resources Guidelines for the Care and Delegation of Care for Students With Diabetes in Florida Schools Appendices Glossary of Terms Sample Forms/Checklists School Food Service Guide and Carbohydrate Counting Sample Checklists Diabetes Medication Related Guidance Information References 29
HOLMES 3,249 BAY 26,129 More than 0.3% of the students are reported to have diabetes JACKSON 6,543 GULF 1,791 LIBERTY 1,398 GADSDE N 5,480 FRANKLIN 1,226 LEON 32,749 WAKULLA 4,737 TAYLOR 2,711 MADISON 2.398 HAMILTON 1,625 SUWANNEE 5,826 DIXIE 1,939 GILCHRIST 2,424 ALACHUA 27,321 LEVY 5,337 NASSAU 11,087 UNION 2,310 BRADFRD CLAY 3,003 34,996 CITRUS 14,735 BAKER 4,801 HERNADO 21,825 PASCO 66,857 MARION 41,363 HILLSBOROUGH 199,688 MANATEE 45,559 PUTNAM 10,746 LAKE 41,018 DUVAL 124,923 POLK 95,573 HARDEE 5,103 DESOTO 4,581 CHARLOTTE 15,804 LEE 85,675 ST JOHNS 33,135 FLAGLER 12,675 VOLUSIA 60,629 SEMINOLE 63,807 ORANGE 184,144 OSCEOLA 56,819 GLADES 1,508 HENDRY 6,761 INDIAN RIVER 17,753 ST LUCIE 38,898 MARTIN 18,282 PALM BEACH 179,542 COLLIER 43,700 BROWARD 257,736 DADE 347,224
+ 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 34 Integrated student supports (SS) are a school-based approach to promoting academic success by developing, securing, and coordinating supports for students academic and nonacademic barriers to achievement. School Psychologists School Counselors School Nurses School Social Workers
Each of the four student services professional disciplines Shares common areas of focus & common goals for all students and their families Contributes unique skills knowledge, experience, perspective to the collective work School Psychologists School Counselors School Nurses School Social Workers 35
Integrated Learning Supports Improve Health, Attendance, Academic & Career Outcomes! Physical, Social, & Emotional Health Attendance Family & Community Academic & Career School Psychologists School Counselors School Nurses School Social Workers
+ Federal Grants to Florida to Improve School Climate & Keep Students Safe 37 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
+ 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? 41 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
+ Education Records and PII 42 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.
+ Prior Written Consent Requirement 43 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.
+ 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 50 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.
+ 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? 53 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
+ Hot Topics Discussion 54 Epinephrine Legislation in Florida Immunization Issues Delegation Guidelines
+ 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 More than 1% of the students are reported to have severe allergies JACKSON 6,543 GULF 1,791 LIBERTY 1,398 GADSDE N 5,480 FRANKLIN 1,226 LEON 32,749 WAKULLA 4,737 TAYLOR 2,711 MADISON 2.398 HAMILTON 1,625 SUWANNEE 5,826 DIXIE 1,939 GILCHRIST 2,424 ALACHUA 27,321 LEVY 5,337 NASSAU 11,087 BAKER 4,801 UNION 2,310 BRADFRD CLAY 3,003 34,996 CITRUS 14,735 HERNADO 21,825 PASCO 66,857 MARION 41,363 HILLSBOROUGH 199,688 MANATEE 45,559 DUVAL 124,923 PUTNAM 10,746 LAKE 41,018 POLK 95,573 HARDEE 5,103 DESOTO 4,581 CHARLOTTE 15,804 LEE 85,675 ST JOHNS 33,135 FLAGLER 12,675 VOLUSIA 60,629 SEMINOLE 63,807 ORANGE 184,144 OSCEOLA 56,819 GLADES 1,508 HENDRY 6,761 INDIAN RIVER 17,753 ST LUCIE 38,898 MARTIN 18,282 PALM BEACH 179,542 COLLIER 43,700 BROWARD 257,736 DADE 347,224
+ 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 66 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-ofschool
+ Delegation Issues and Trends 67 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/childrenshealth/school-health/reports-information.html
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 noncomprehensive 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 School Health Services Program JACKSON 1309 GULF 597 2013-14 School RN to Student Ratio 2000-2999 3000-3999 4000 + LIBERTY 2796 FRANKLIN 1226 GADSDEN 1096 LEON 3484 WAKULLA 3336 TAYLOR 935 MADISON 2398 HAMILTON 1016 SUWANNEE 737 DIXIE 2394 GILCHRIST 3030 ALACHUA 683 LEVY 1866 NASSAU 1848 UNION 1155 BRADFRD CLAY 1001 816 CITRUS 2834 BAKER 686 HERNADO 2728 PASCO 1857 MARION 2236 HILLSBOROUGH 1939 MANATEE 1111 PUTNAM 1791 LAKE 3418 DUVAL 5255 POLK 3849 HARDEE 5103 DESOTO 4581 CHARLOTTE 3161 ST JOHNS 1274 FLAGLER 2305 VOLUSIA 5052 SEMINOLE 2900 ORANGE 3836 OSCEOLA 6110 GLADES 718 INDIAN RIVER 3945 ST LUCIE 3851 MARTIN 2374 LEE 2904 HENDRY 3073 PALM BEACH 827 COLLIER 1703 BROWARD 5005 DADE 3046
HOLMES 2166 BAY 2099 School Health Services Program JACKSON 1309 GULF 597 2013-14 School RN to Student Ratio 1000 LIBERTY 2796 FRANKLIN 1226 GADSDEN 1096 LEON 3484 WAKULLA 3336 TAYLOR 935 MADISON 2398 HAMILTON 1016 SUWANNEE 737 DIXIE 2394 GILCHRIST 3030 ALACHUA 683 LEVY 1866 NASSAU 1848 UNION 1155 BRADFRD CLAY 1001 816 CITRUS 2834 BAKER 686 HERNADO 2728 PASCO 1857 MARION 2236 HILLSBOROUGH 1939 MANATEE 1111 PUTNAM 1791 LAKE 3418 DUVAL 5255 POLK 3849 HARDEE 5103 DESOTO 4581 CHARLOTTE 3161 ST JOHNS 1274 FLAGLER 2305 VOLUSIA 5052 SEMINOLE 2900 ORANGE 3836 OSCEOLA 6110 GLADES 718 INDIAN RIVER 3945 ST LUCIE 3851 MARTIN 2374 LEE 2904 HENDRY 3073 PALM BEACH 827 COLLIER 1703 BROWARD 5005 DADE 3046
Florida s Students 2013-14 Elementary/Middle/High/Combined Level Schools (public and charter) Pre-K through 12 th 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 10.00% 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% Allergies Asthma ADD / ADHD Seizure Disorder Cardiac Psychiatric Diabetes Kidney Disease Sickle Cell Disease Bleeding Disorder Cancer Cystic Fibrosis All Other 0.00% 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
Comparison 2004 to 2014 Student Population 3,100,000 3,000,000 2,900,000 2,800,000 2,700,000 2,600,000 2,500,000 2,400,000 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 JACKSON BAY GADSDEN LEON LIBERTY WAKULLA GULF FRANKLIN TAYLOR MADISON HAMILTON SUWANNEE NASSAU DUVAL BAKER UNION BRADFRD CLAY ST JOHNS Overweight/Obese screening results(2013-14) DIXIE GILCHRIST LEVY ALACHUA PUTNAM MARION FLAGLER VOLUSIA CITRUS LAKE 40-49% of students screened are overweight or obese HERNADO PASCO HILLSBOROUGH MANATEE POLK HARDEE SEMINOLE ORANGE OSCEOLA INDIAN RIVER ST LUCIE 50% or more of students screened are overweight or obese DESOTO CHARLOTTE LEE GLADES HENDRY COLLIER MARTIN PALM BEACH BROWARD DADE
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 More than 4% of the students are reported to have ADD/ADHD JACKSON 6,543 GULF 1,791 LIBERTY 1,398 GADSDE N 5,480 FRANKLIN 1,226 LEON 32,749 WAKULLA 4,737 TAYLOR 2,711 MADISON 2.398 HAMILTON 1,625 SUWANNEE 5,826 DIXIE 1,939 GILCHRIST 2,424 ALACHUA 27,321 LEVY 5,337 NASSAU 11,087 UNION 2,310 BRADFRD CLAY 3,003 34,996 CITRUS 14,735 BAKER 4,801 HERNADO 21,825 PASCO 66,857 MARION 41,363 HILLSBOROUGH 199,688 MANATEE 45,559 PUTNAM 10,746 LAKE 41,018 DUVAL 124,923 POLK 95,573 HARDEE 5,103 DESOTO 4,581 CHARLOTTE 15,804 LEE 85,675 ST JOHNS 33,135 FLAGLER 12,675 VOLUSIA 60,629 SEMINOLE 63,807 ORANGE 184,144 OSCEOLA 56,819 GLADES 1,508 HENDRY 6,761 INDIAN RIVER 17,753 ST LUCIE 38,898 MARTIN 18,282 PALM BEACH 179,542 COLLIER 43,700 BROWARD 257,736 DADE 347,224
HOLMES 3,249 BAY 26,129 More than 7% of the students are reported to have asthma JACKSON 6,543 GULF 1,791 LIBERTY 1,398 GADSDE N 5,480 FRANKLIN 1,226 LEON 32,749 WAKULLA 4,737 TAYLOR 2,711 MADISON 2.398 DIXIE 1,939 HAMILTON 1,625 SUWANNEE 5,826 GILCHRIST 2,424 ALACHUA 27,321 LEVY 5,337 NASSAU 11,087 BAKER 4,801 UNION 2,310 BRADFRD CLAY 3,003 34,996 CITRUS 14,735 HERNADO 21,825 PASCO 66,857 MARION 41,363 HILLSBOROUGH 199,688 MANATEE 45,559 DUVAL 124,923 PUTNAM 10,746 LAKE 41,018 POLK 95,573 HARDEE 5,103 DESOTO 4,581 CHARLOTTE 15,804 LEE 85,675 ST JOHNS 33,135 FLAGLER 12,675 VOLUSIA 60,629 SEMINOLE 63,807 ORANGE 184,144 OSCEOLA 56,819 GLADES 1,508 HENDRY 6,761 INDIAN RIVER 17,753 ST LUCIE 38,898 MARTIN 18,282 PALM BEACH 179,542 COLLIER 43,700 BROWARD 257,736 DADE 347,224
+ Asthma Guidelines 95
HOLMES 3,249 BAY 26,129 More than 0.7% of the students are reported to have seizures JACKSON 6,543 GULF 1,791 LIBERTY 1,398 GADSDE N 5,480 FRANKLIN 1,226 LEON 32,749 WAKULLA 4,737 TAYLOR 2,711 MADISON 2.398 HAMILTON 1,625 SUWANNEE 5,826 DIXIE 1,939 GILCHRIST 2,424 ALACHUA 27,321 LEVY 5,337 NASSAU 11,087 BAKER 4,801 UNION 2,310 BRADFRD CLAY 3,003 34,996 CITRUS 14,735 HERNADO 21,825 PASCO 66,857 MARION 41,363 HILLSBOROUGH 199,688 MANATEE 45,559 DUVAL 124,923 PUTNAM 10,746 LAKE 41,018 POLK 95,573 HARDEE 5,103 DESOTO 4,581 CHARLOTTE 15,804 LEE 85,675 ST JOHNS 33,135 FLAGLER 12,675 VOLUSIA 60,629 SEMINOLE 63,807 ORANGE 184,144 OSCEOLA 56,819 GLADES 1,508 HENDRY 6,761 INDIAN RIVER 17,753 ST LUCIE 38,898 MARTIN 18,282 PALM BEACH 179,542 COLLIER 43,700 BROWARD 257,736 DADE 347,224
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 highrisk 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 Peggy.Howland@flhealth.gov
+ 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 dmennitt@usf.edu http://sss.usf.edu Contact Information Dianne Mennitt, DNP, RN, NCSN School Nurse Consultant