pennsylvania department of health division of school health school health update 2008
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PENNSYLVANIA DEPARTMENT of HEALTHDivision of School Health
SCHOOL HEALTH UPDATE
2008
Presented by
Beth Anne Bahn and
Rosemary Danchick-MoyerState School Health
Consultants
March 30, 2008
DIVISION OF SCHOOL HEALTH Jon Dale, Director
Beth Anne Bahn, State School Health Consultant
Rosemary Danchick-Moyer, State School Health Consultant
Stephanie Weigle, Administrative Officer
Bill Barbour, STEPS School Health Coordinator
Valerie Morgan, Administrative Support
Six Regional School Health Consultants
District Office Program Staff
Diabetes Cardiovascular Injury Prevention Chronic Disease Tobacco Prevention Maternal Child Health Special Needs Health
Care Public Health
Educator
HIV STD Communicable
Disease Environmental Health Sanitarians Tuberculosis Immunization EMS Program
Specialist
Regional School Health Consultants
NW - Linda Deeter 724-662-6068 [email protected]
NC - Andrea Dale 570-327-3400 [email protected]
NE – Lois Elick 570-826-2062 [email protected]
SW - Cindy Thomas 412-565-5101 [email protected]
SC – Linda Katherman [email protected]
SE - Sue Templin 610-378-4352 [email protected]@state.pa.us
Health District No. of School Districts
No. of Full Time School Nurses**
No. of Part Time School Nurses**
No. of IUs No. of Counties
North Central 46 102 7 4* 12
North East 59 264 7 4 10
North West 70 174 10 5* 13
South Central 76 241 10 5* 13
South East 109 830 84 8* 8
South West 140 438 16 8* 11
Totals 500 2049 134 29 67
** Data from 05-06 reports
* Includes duplicates
School Health Consultant Caseload
School Immunization Requirements
School Immunization RequirementsNOW:
School Immunization RequirementsPROPOSED:
http://www.pabulletin.com/secure/data/vol38/38-6/217.html
For New School Enterers in Kindergarten or First Grade
School Immunization Requirements
NOW: PROPOSED:
• 4 doses tetanus (DTaP, DT, Td)(1 dose on or after 4 years
old)• 4 doses diphtheria (DTaP, DT, Td)
(1 dose on or after 4 years old)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity
(vaccine or history of disease)
• 4 doses tetanus (DTaP, DT, Td)(1 dose on or after 4 years
old)• 4 doses diphtheria (DTaP, DT, Td)
(1 dose on or after 4 years old)
• 3 doses polio• 2 doses measles (MMR)• 2 doses mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity
(vaccine or history of disease)
• varicella immunity (vaccine or history of disease) 2 doses phased in by year 2010/2011
For Attendance In All Grades
School Immunization Requirements
NOW: PROPOSED:
• 3 doses tetanus (DTaP, DT, Td)• 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)
• 4 doses tetanus (DTaP, DT, Td)• 4 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 2 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or
history of disease) 2 doses phased in by year 2010/2011
For Entering 7th Grade
School Immunization Requirements
NOW: PROPOSED:
• 3 doses tetanus (DTaP, DT, Td) • 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity
(vaccine or history of disease)
• 3 doses tetanus (DTaP, DT, Td) • 3 doses diphtheria (DTaP, DT, Td)• 1 dose tetanus/diphtheria/acellular pertussis • 3 doses polio• 2 doses measles (MMR)• 2 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or history of disease) 2 doses phased in by year 2010/2011•1 dose meningococcal conjugate
Additional Proposed Changes to School Immunization Regulations
Grace Period - A vaccine dose administered within the 4-day period prior to the minimum age for the vaccination or prior to the end of the minimum interval between doses shall be considered to be a valid dose of the vaccine.
Additional Proposed Changes to School Immunization Regulations
Attendance at child care group setting located in a public, private or vocational school or in an intermediate unit or a prekindergarten program, early intervention program or private academic preschools is conditional upon satisfaction of the immunization requirements in 27.77, unless the child is 5 years of age or older.
Attendance of a child 5 years of age or older at a child care group setting is conditional upon the immunization requirements in 23.83 (School Health regulations)
OLD WAY:
All Schools Self Report Aggregate Counts (Department Form) # of students attending by grade level
# of students attending by grade-level completely immunized
# of students attending school by grade level classified as medical exemptions
# of students attending school by grade-level classified as religious exemptions
# of students provisionally admitted
# of students denied admission with inability to qualify for provisional enrollment
Reporting Requirements
Schools will self report (Department Form) # of students attending in a specific grade level or age group
# of vaccine dose(s) of every enrolled student in grade level or age group (as requested on reporting form)
May request information for only 1 or 2 grades or age levels
Will continue to request same information for exemptions, provisional enrollments and denied admissions
Reporting RequirementsPROPOSED:
School Immunizatio
n Law Report (SILR)
Statewide Immunization Information Registry (SIIS)
Began in 1996 Used primarily by hospitals, state
health clinics Now marketing to private providers No cost to enter immunizations or
view data “View only” access for school nurses
Benefits of Statewide Information Immunization System (SIIS)
Prevents extra and unnecessary doses of vaccines- decreasing costs
More accurate immunization records for those enrolled in the system
Access by State Health Clinics, Providers and Schools to accurate and complete vaccine administration records
Statewide Information Immunization System (SIIS)
To enroll for view-only access: Go to
www.health.state.pa.us/pasiis Click on Provider enrollment Complete the application and fax or
mail it to the Department
“No Child Left Behind” and Immunization Exclusion
There is no evidence found in “No Child Left Behind” that would prevent excluding students for inadequate immunizations.
This was determined after discussions with the PA Department of Health, Division of Immunizations and Legal Counsel; the PA Department of Education; NCLB Compliance Office and Legal Counsel; and the US Dept. of Education Compliance Office
Pre-K Counts Grant Programhttp://www.pde.state.pa.us/early_childhood/cwp/view.asp?A=316&Q=125765
Established by Dept. of Education Provide high quality pre-K
education for 3 and 4 yr. olds Free to families Focus on children at risk of
academic failure Approximately 300 early learning
programs participating
Pre-K Counts Grant Program
Immunizations: Follow 27.77 regulations,
Immunization requirements for children in child care group settings. Have up to 60 days to provide immunizations http://www.pacode.com/secure/data/028/chapter27/s27.77.html
Reimbursement May not count these students under
K4 ADMs on Annual Health Report
Pre-K (K4) Programs
Immunizations: Follow 27.77 regulations,
Immunization requirements for children in child care group settings. Have up to 60 days to provide immunizations http://www.pacode.com/secure/data/028/chapter27/s27.77.html
Pre-K (K4) Programs
Integral part of the school program Students counted in ADMs for
reimbursement Required to have physical and dental
examinations Required to have mandated screens
(vision, hearing, growth) Required to have nursing services
TB Testing of Students
PA Public School Code of 1949 Section 14-1402. Health services
(a) Each child of school age shall be given… (4) tests for tuberculosis under medical supervision…
(f) The Secretary of Health, upon petition of the school board…,may modify for individual school districts the school health services program specified in this section.
TB Testing of School Staff
PA Public School Code of 1949 Section 14-1418. Medical
examinations of teachers and other persons
(b) Each teacher, any other school employe and any person providing services for school children under contract shall be given tests for tuberculosis…
TB Testing
485 out of 501 school districts in PA have asked for modifications of their routine TB testing of students
New school employees when hired and volunteers are still required to have a TB test
TB Report to Dept. of Health
Historically, schools have been submitting a “School Tuberculin Testing Report” (form H516.488) to the Department on an annual basis.
Provided aggregate data on students and staff that had been tested or sent for follow-up testing during the previous year.
TB Report to Dept. of Health
The Department has determined that this aggregate data is no longer useful as a surveillance tool
Effective immediately, it is no longer necessary to submit the School Tuberculin Testing Report.
PE and Dental Modifications
Districts may request modifications to accept mandated physical exams up to one year prior to the year they are required
School Board must vote to make the modification; then the district sends a letter to DOH, Division of School Health, providing notice of the board decision
SHARRS School Health Annual Reimbursement Request System
Common Errors on Health Exams, Screens & Select Services
ERROR: Entering the number of CONTACTS under Students Requiring Skilled Nursing.
CORRECT:Should be the number of INDIVIDUAL students, not the number of contacts.
Health Exams, Screens, &
Select Services
(cont.)
Common Errors on Health Exams, Screens & Select
Services (cont’d)
ERROR: Counting only 6th grade for Scoliosis screenings when mandated for Grades 6 & 7.
CORRECT:If a student had his/her scoliosis screening done by a private provider during the 6th grade physical, it gets counted.
Health Exams, Screens, &
Select Services
(cont.)
The sum of A, B & C do not match #13 and 14.
Common Errors on Health Exams, Screens & Select
Services (cont’d)
ERROR: Number 13 & 14, respectively, match the sum of the at-risk categories A, B, and C
CORRECT:13 and 14 – Should be the total number of students screened with BMI-for-age percentile A, B, and C: Total number of students in each
of the at-risk categories Students in healthy ranges are automatically
calculated by the computer
These 3 numbers
must match
Common Errors on Health Exams, Screens & Select
Services (cont’d)
ERROR: Nature, Time and Location of Injury categories don’t match
CORRECT:Nature, Time and Location of Injury categories have the same total
The numbers in the Other,
Doses by Individual or
Standing Order, should
be low. These fields should only
include medications that do NOT fall into the
other nine (9) categories.
Data Entry Errors
Small errors in data make large errors in percentages.
When data is widely variable it is not considered to be valid.
Data Entry Errors Everyone needs to keep their tally sheet,
no matter how you keep track of your numbers. (BMI for age percentile groups; diabetics, procedures, etc.)
When you have collected your numbers you should calculate your percentages. (i.e. What percentage of your student population is obese? What percentage of your student population has a diagnosis of asthma? etc.
School Districts Providing Services for Private/Non-Public Schools
If the Private/Non-Public school asks for school health services the Public school must provide these services.
28 PA Code § 23.51. Children to be provided nursing services. A child in private, parochial and public schools shall be provided with school nurse services in the school which the child attends.
School Districts Providing Services for Private/Non-Public Schools
SERVICE K or 1 2 3 4 5 6 7 8 9 10 11 12Special
Education
Medical Examination X X X As Needed
Dental Examination X X X As Needed
Growth Screen X X X X X X X X X X X X X
Vision Screen X X X X X X X X X X X X X
Hearing Screen X X X X X As Needed
Scoliosis Screen X X
Tuberculin Test (unless approved todiscontinue)
X X Age Appropriate
School Nurse Services X X X X X X X X X X X X X
Maintenance ofHealth Record
X X X X X X X X X X X X X
ImmunizationAssessment
X X X X X X X X X X X X X
School Districts Providing Services for Private/Non-Public Schools
Provide school nurse services
Review of health care needs including IHPs and emergency plans as needed
School Districts Reporting Data for Private/Non-Public Schools
If the school district is providing school health services to private/non-public ADMs included on Annual Health Report Also include data for:
Health exams, screens and select services Chronic diseases Serious School Injuries Medication Administration
Transfer of Health Records 24 P.S. Section 14-1409. Confidentiality,
transference and removal of health records
“… the district or school wherein the child is newly enrolled shall request and the district or school where the child previously attended shall surrender the health record of the child.”
“…shall not destroy a child’s health record for a period of at least two years after the child ceases to be enrolled,…”
Maintenance of Health Records
Pennsylvania Code, Section 23.55, Health Services
Maintenance of health records “Health records shall be maintained for each
child. These records shall be kept in the school building where the child attends school and shall be available to the school nurse at all times. Records shall be transferred with the child when he moves from one school to another or from one district to another.”
Proposed Amendments to Chapter 27 Regulations
Communicable and Non-Communicable Disease Regulations
DOH proposed revisions near completion
To be published in PA Bulletin for comment www.pabulletin.com
Medication Issues Do school nurses need a doctor’s
order to administer over-the-counter medications to students?
SBN regulation @ 49 PA Code § 21.14. Administration of drugs. (a) A licensed registered nurse may
administer a drug ordered for a patient in the dosage and manner prescribed.
Medication Issues
Who can administer tylenol?
Nurses can, when a licensed provider, authorized to prescribe, has written a prescription.
Dental Hygienists have no such authority.
Medication Issues
Securing medications? Is it necessary? “The Controlled Substance, Drug,
Device and Cosmetic Act” Act of 1972, P.L. 233, No. 64
Definition of practitioner’s includes nurses
Section 11. Professional Prescription, Administration, and Dispensing.
Section 12. Records of Distribution of Controlled Substances
Medication Issues
28 PA Code § 25.61. General provisions. (a) Persons maintaining stocks or
having controlled substances in production areas or on hand for distribution shall provide effective controls and procedures to guard against theft and diversion of the substances.
Medication Issues
28 Pa Code § 25.63. Security controls for practitioners and research personnel. (b) Controlled substances listed in
Schedules II, III, IV and V shall be stored in substantially constructed, securely locked cabinets.
Medication Issues
This is why we count narcotics with another nurse and sign off for the process in most health care facilities where nurses work.
Some accountability needs to be established in the school environment as well.
Medication Issues All medication in schools are personal
property for which the school nurse is responsible
All medications are substances that can be abused and may be injurious if not taken as ordered or if taken by someone other than the person for whom it has been ordered.
Recommendation: ALL medications should be stored in locked space.
Should have a method of accounting for access to these medications.
Delegation Administration of an Epipen in an
emergency by anyone trained to use one = emergency first aid and does not require professional nursing skill
The nurse may train an unlicensed person in how to respond using an Epipen. This Does Not = Delegation
Defining Delegation
In PA, professional nurse law does not provide for delegation of nursing functions to unlicensed individuals.
CSPG’s – Certification Staffing and Policy Guidelines
Located at PA Dept. of Education website @ www.pde.state.pa.us
In search box, type in CSPG # 80 - School Nurse 95 – Principal 101 - Paraprofessional
CSPG 95 - Principal
Certification Assignment: An educator holding a valid PA
certificate as a K12 Principal is qualified to perform the following:
Supervision and direction of certified and non-certified staff persons required for school operation exclusive of directing health services controlled by the Nurse Practice Act.
CSPG 101 - Paraprofessional
Utilization of Paraprofessional Staff #7. Paraprofessionals serving as
health room aides or other non-professional school district employees shall not be directed to engage in health-related activities reserved exclusively for licensed professionals and controlled by the Nurse Practice Act or other medically related laws.
Homeschooled Students
PA Public School Code of 1949, Section 1327.1 states these students must have: Evidence of Immunizations in
accordance with Article XIV 1303 (a) Evidence of Health and Medical
services required for students of the child’s age or grade level per Article XIV.
Homeschooled Students According to PDE’s Basic Education
Circular (BEC) on home schooled children, the school must have evidence of the immunizations and health and medical services.
According to the affadavit form available as part of the BEC, the affadavit is to include attached evidence.
Child Protection Law
School Nurses are mandated reporters
Who to call: Childline (1-800-932-0313) and local Child Protective Services
Child may be interviewed at school without parent notification
Documentation of suspected abuse
Child Abuse Reporting LawAct 179 of 2006
Reporting of child abuse committed by any person
Reporting is required by any person affiliated with an institution, etc, who has the child under it’s care
Verbal reports are made to Child Line and F/U with a written report
SCAN “The SCAN Program provides excellent
presentations and abundant resources. We need to get this clinical program out to all school nurses.” Barbara Zimmerman, DNSc, RN, Nurse Educator Chair, PASNAP Board of Directors
Suspect Child Abuse? Call 1-800-932-0313
STEPs [email protected]
http://www.stepstoahealthierluzernecounty.org/
http://www.stepstoahealthierfayettecounty.org/
http://www.tiogasteps.com/
Transition plan for Special Education Students
Should include a health component Transition Health Care Checklist is
available online: www.health.state.pa.us/transitionchecklist
Workshops and Trainings available through PaTTAN (PA Training and Technical Assistance Network) Online Registration: www.pattan.net
http://www.dsf.health.state.pa.us/health/cwp/view.asp?q=243876
Transition areas to Consider
Communication Transportation Financial & Legal Concerns HIPAA/ COBRA SSI/SSDI/Medicare/Medicaid/CHIP Health & Medication Insurance Assistive Technology
TransitionMedical Home Term defined by the American Academy of
Pediatrics (AAP) and The Academy of Family Physicians (PAFP)
An approach to providing comprehensive health services in a high-quality and cost-effective manner
Provides considerations for all adolescents, especially those with special needs, when transitioning from schools to adulthood
All-Hazard Planning for Schools Title 35, states that all public-funded
schools shall develop and implement emergency preparedness plans…
Subcommittee of PA Safe School Statewide Advisory Committee
PEMA, Dept. of Education, Dept. of Health, Attorney General’s Office, State Police, representatives from IUs and school districts
All-Hazard Planning for Schools Develop “all-hazards” toolkit to assist
schools in their planning efforts through general policy guidance and checklists for specific hazards
Follow National Incident Management Systems (NIMS) model
To be Introduced at Safe Schools Conference May 2008
Released to schools August 2008
Continuing EducationRequirement for RN’s
June 29, 2006 Act 58 of 2006 (SB 235) was signed into law.
Requires 30 hours of Board approved continuing education (CE) in each two year license period for Registered Nurses in Pennsylvania
PA State Board of Nursing is in the process of developing CE regulations for the Registered Nurses.
Continuing Ed. (cont)
Effective date of CE requirement has yet to be determined
PDE Certified School Nurses may use their Act 48 CEs to complete the RN licensure CE requirement
www.dos.state.pa.us/nurse
LMS – Learning Management System
School track has been added Now offers on-line courses for
school nurses and Act 48 hours through the Div. of School Health
58 hours available in 26 courses 665 school personnel signed up
LMS (cont.)
To become a registered user: www.health.state.pa.us
Send an email to [email protected] and provide your name, email address, phone number and job title or description
http://key.emsed.com/login.asp
Topics under LMS for CE Assessment I & II
Exam, Documentation, Clinical Decision Making
Bioterrorism & Infections SARS, MRSA, WMD
Management I & II Asthma, Seizure, N&V,
Allergic Reaction, D.M., Obesity, Hypoglycemia
Environmental Trauma Hypothermia, Animal
Bites
NIMS – National Incident Management System
The role of School Nurses in Wellness
Disaster Nursing Orthopedic Trauma Drug Abuse Trauma I & II Grant Writing Multi-Hazard Emergency
Planning for School Nurses
Training Disaster Preparedness Training for
School Nurses April 25, 2008- BLaST IU 17, Williamsport May 5, 2008- Safe School Conference,
Harrisburg June 19, 2008- Lincoln IU 12, New Oxford
PA Annual Safe Schools Conference May 5-7, 2008- Harrisburg
Training
Keystone Health Promotion Conference June 17-19, 2008- Lebanon Valley
College, Annville School Health Updates
April 29, 2008- Southcentral- Capitol Area IU, Summerdale
May 1, 2008- Southwest- PaTTAN Pittsburgh
School Nurse Induction Program PA Code- Ch. 49 Certification of
Professional Personnel, Section 49.16
http://www.pacode.com/secure/data/022/chapter49/s49.16.html
Plan for the induction of first year teachers… and educational specialists
Historically, geared only toward teachers
School Nurse Induction Program
Developed and piloted by York County School Nurses
Based on Charlotte Danielson’s model for teachers Enhancing Professional Practice: A
Framework for Teaching
School Nurse Induction Program Subjects Covered:
School Nursing Practice: Roles and Responsibilities
Medications, Immunizations & Special Education Issues
How to Begin: Preparing for Opening Day
Communicating with Families and School Personnel
Individualized Student Medical Plans of Care
School Nurse Induction Program
Subjects covered (cont.): State Reporting School Screening Programs Communicable Diseases Resources and Budgeting End of the Year Organization Legal Issues & Professional
Accountability
School Health Web page Data/reports from Annual Report Database Laws and Regulations Policies and Procedures Manuals, Guidelines and Forms Training opportunities, Grants and Funding Information on Current and Future Health
Issues What’s New
www.health.state.pa.us/schoolhealth
Resources Healthy Schools Campaign
www.healthyschoolscampaign.org Quick & Easy Guide to Green Cleaning in
Schools Quick & Easy Guide to School Wellness
Kids Health in the Classroom http://classroom.kidshealth.org/
National Health Information Center http://www.healthfinder.gov/library/nho/nho.asp#m4
Resources Parent Education & Advocacy
Leadership Center http://www.pealcenter.org/
Game On! The Ultimate Wellness Challenge http://actionforhealthykids.org/gotuwc/index
.php PSAHPERD- Minutes in Motion School
Challenge www.psahperd.org
Pennsylvania Advocates for Nutrition and Activity (PANA)
A resource to support schools in meeting school health requirements
Web site: www.panaonline.org Email: [email protected] Phone: 717-948-6315
PANA Pediatric Energy Balance Program
For pediatricians and family practice physicians
Provide 1 hour of training Clinical guidelines for prevention,
treatment and management of childhood obesity
Patient education Network
PANA
Pediatric Energy Balance Program Partners the physician with a
community organization Pilot this summer in Harrisburg and
Hershey
National Assembly on School-Based Health Care- PA Chapter
Currently trying to re-establish PA Chapter Updated list of school-based health
centers Applying to national organization for
recognition as a state affiliate Contact: Ann Duerst
English as Second Language (ESL) Considerations
Requirement of “No Child Left Behind” Medical forms available : exam forms,
asthma/action plans, parent/guardian screening notifications, health history, etc
Translated into 20 most common languages in PA
Transact – Contract through PDE www.transact.com
Legislative Items
Web site: www.legis.state.pa.us Search for bill status with H.B. or S.B. and
the number Search for bills by subject – School Health
or Registered Nurses
Who may donate blood?
16 year olds may donate blood with parent permission
17 year olds may donate blood on their own signature
Per Act 63 of 2007 signed into law November 20, 2007 [HB 191 of 2007].
In a voluntary and non compensatory blood collection program.
Pending Legislation affecting Schools or School Nurses S.B. 456 Amend 1949 Code. Requires CPR
Training for school nurses Referred to Education committee 3/14/07
S.B. 753 – School lunch and breakfast funding/School Nutrition Incentive Prog.
Referred to Education committee 04/10/07 H.B. 2090 – School Nurse Task Force which is
being asked to study the feasibility of lowering the current ratio of 1,500 students to 1 nurse
To be known as “Every Child Needs a School Nurse ACT”
Referred to Education committee 12/05/07
Additional Pending Legislation S.B. 509 – Amend 1949 Code. Training
of School employees in Diabetes Care Referred to Education committee 03/19/07
H.B. 2002 – Amend 1949 Code. Training of School employees on Diabetes Care Referred to Education committee on 11/2/07
Additional Pending Legislation
SB 1312 Introduced by Senator Vance on
March 14, 2008, Increase DOH school nurse
reimbursement from $7.00 to $12.00 per ADM (approximately $10 million increase)
Federal Legislation“Healthy High Performance Schools”
Part of “Energy Independence and Security Act of 2007” signed by President Bush 12/19/07
To locate specifics: Search Bill: H.R. 6 ENR; Scroll down to Subtitle E : Healthy High Performance Schools
HHPS - “Healthy High Performance Schools”
For the first time HHPS directs EPA to promote healthy school environments by working with state agencies, by creating federal guidelines for the siting of schools and by developing model guidelines for children’s environmental health in schools.
Appropriations of $10m over five years are authorized with additional $1m over five years for a comprehensive study
HAPPY SCHOOL NURSE’S DAY May 7, 2008