Using School Health Data Effectively

1. Using School Health Data Effectively Cheryl Resha, Ed.D., RN School Health Consultant Connecticut Department of Education Anne H. Sheetz, MPH, CNAA Director of School Health Services Massachusetts Department of Public Health

2. Objectives Identify where to access data sources at the national, state, and local level Examine what data is needed at the district and building level Practice examining data to extrapolate meaning to inform decisions Understand how to interpret and analyze data

3. National Association of State School Nurse Consultants (NASSNC) Who are our members? Currently over 50 state school nurse consultants Employed by both state departments of health and education Represent 40 states Alaska, Hawaii, Idaho, Michigan, Montana, Nevada, South Dakota, Rhode Island, WyomingAlaska, Hawaii, Idaho, Michigan, Montana, Nevada, South Dakota, Rhode Island, Wyoming

4. Mission NASSNC�s mission is to promote the health and learning of the nation's children and youth by: providing national leadership and advocacy, impacting public policy, collaborating, and proactively influencing school health programs and school nursing practice. Represent and advocate for school nurses and school health issues at all levels � state and national Partner with many national organizations Participate in national task forces, coalitions, and committee Contribute to the NASN newsletterRepresent and advocate for school nurses and school health issues at all levels � state and national Partner with many national organizations Participate in national task forces, coalitions, and committee Contribute to the NASN newsletter

5. Special thanks to: Kate Bell, NL, Concord PS Marie DeSisto, NL, Waltham PS Kate Johnson, NL, Westfield PS Paula Dobrow, NL, Marblehead PS Marie Fahey, NL, Bridgewater/Raynham PS Kathy Hassey, Former NL, Hudson PS Jane Kisielius, NL, Quincy PS Diane Sneider, SN, Concord PS Karen Jarvis-Vance, NL, Northampton PS Katie Vozeolas, Former NL, North Andover PS

6. Special thanks to (#2): Massachusetts School Nurse Organization Massachusetts Department of Public Health Staff - Francis Dwyer - Laura Hayes - Robert Leibowitz - C. Lynne McIntyre

7. Why collect and use data� Evidence based practice Data driven decision-making (research-based) Demonstrate the link between health and achievement Information from research is more reliable Without information from research, decisions are often ineffective and even harmful

8. Data-Driven Decision Making Indicators of Data-Driven Decision Making Leaders enable the systematic collection of information pertaining to school, district, and state goals and standards. Principals and staff analyze and interpret the data to inform decision making. Educators and staff at every level are trained to use and analyze the data. Source: North Central Regional Educational Laboratory

9. Evidence-based Nursing (EBN) The process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences. Source: University of Minnesota

10. Steps to practice EBN Clearly identify the issue or problem based on accurate analysis of current nursing knowledge and practice Search the literature for relevant research Evaluate the research evidence using established criteria regarding scientific merit Choose interventions and justify the selection with the most valid evidence Clinical Decision-making: drawing conclusions based on EBN, clinical expertise, patient preference, and other factors such as cost-benefit analysis, availability of alternatives, etc.� Source: University of Minnesota

11. Health and Achievement Educating the Whole Child (ASCD) Research on health and achievement Incorporating health data into school strategic or school improvement plans

12. Where to find data� Peer-reviewed journals National databases CDC�s YRBS, School Health Policies and Programs (SHPPS), School Health Profiles; US Department of Education SAMHSA

15. Where to find data (continued State databases State Departments of Education and Health State Social Service agencies State advocacy groups Voices for Youth Non-governmental agencies Health insurers.

16. Where to find data (continued) Local data School Health and School Based Health Clinics� reports Community health care providers Local health departments Police departments Juvenile justice departments Hospitals and social service agencies Local universities

17. How data can be used� Monitoring Trends/surveillance Utilization of services and resources Outcomes Informing stakeholders Developing policies Developing and implementing school health programs and practices Allocating resources, including the need for school nurses

18. Stakeholders Parents Teachers Administrators School Committees Primary Care Providers/Hospitals Local Officials Statewide Decision Makers

19. Methods of Data Collection Paper: Mandated epinephrine reporting Electronic: Essential school health service data: Major challenge Survey (Survey Monkey, etc.) Teleform: Client satisfaction Have a goal before beginning!

20. Uses of Data Inform stakeholders Monitor utilization Develop policies Relate health and educational achievement Implement programs/allocate resources Monitor performance improvements/outcomes Provide health indicator surveillance

21. The �Essential School Health Services�School Nurse Data Report 2004-2005(102 MA School Districts have the ESHS grant covering ~ 550,000 students�representing half the 1.1 million students in Massachusetts) School Nurse Student Encounters: 5,930,181* (Just under 6 million) * 88.5% of students were returned to class after assessment and/or treatment by the School Nurse Staff/Personnel Encounters (Assessment and/or treatment): 147,624 School Nurse Referrals to Primary Care Providers : 160,980* *12,253 referrals to new Primary Care Providers (linking students with PCP) Emergency Referrals: 10,855 17% 911/ambulance services 83.9% Parents transported to emergency services or Primary Care Provider Medications Doses Administered per month: (Daily & as needed) 93,709 (930,709 annually) Student Injuries: 40,022 10.1% Intentional (assaults) or (self-inflicted injuries, overdose, suicide attempts) 69.5% Unintentional 20.4% Unknown

22. Statewide Essential School Health Service Encounters (538,618): FY 06

23. Statewide ESHS Data (2006): Injuries 7.4% Injury Reports: Intentional Injuries: Assaults and Self Inflicted Referrals to Emergency Services:11,357 times 911 Calls: 1,973 (17.4%) of these events Remaining 9,384 (82.6%) events: parents or others were called to transport the student to emergency health services.

24. Statewide Data: Referrals to Primary Care Providers (FY06) Total Referrals: 170,677 New Primary Care Providers (PCPs): 12,121 referrals to new PCPs (7.1%) or 1.0 referrals per 1,000 enrolled students per month Existing PCPs: 158,556 referrals (92.9%) or 22.6 referrals per 1,000 enrolled students per month

25. Community A (4491): Health Office Activity Over 48,200 visits for illness, injury, medication or a procedure This equates to 33.5 visits per day per school 95% of the students returned to class 63 students assessed and referred for emergency care due to illness or injury In 04-05, 86% of the student body visited the nurse at least once for a non-screening visit, up from 80% in 03-04 11,229 medications administered 929 staff related health office visits 12 staff members referred for emergency care or 911 call, 929 staff related encounters logged12 staff members referred for emergency care or 911 call, 929 staff related encounters logged

26. This bar graph represents several categories of health encounters that occurred within the health offices over the past three years. Although the combined categories of first aid and illness assessment continue to increase the number that is most evident is the increase in the number of students that returned to class after a visit to the health office. This is an indicator that the school nurse�s role has a direct impact on keeping students in school. I would now like to introduce Noreen O�Connell, the school nurse at Central Middle School.This bar graph represents several categories of health encounters that occurred within the health offices over the past three years. Although the combined categories of first aid and illness assessment continue to increase the number that is most evident is the increase in the number of students that returned to class after a visit to the health office. This is an indicator that the school nurse�s role has a direct impact on keeping students in school. I would now like to introduce Noreen O�Connell, the school nurse at Central Middle School.

27. Community C (4731): Nursing Procedures performed in 2005-2006: 3,431 Nursing Procedures included: Blood Glucose Testing Blood Pressure monitoring Insulin Pump care and monitoring Nebulizer treatments Otoscopic Exam Others�

28. Community C (4731): Classroom Presentations by the Nurse

29. Community C (4731): Parent Communication

30. Monitor Utilization of Health Services Trends in types of visits Establishment of benchmarks - Percentage of students using health services - Average number of visits per student

31. Community D (1858): Chronic Health Conditions requiring increased health office visits past 3 years

32. Community D (1858): Medical Management of Complex Health Conditions Diabetes: 3-7 visits per day Asthma: 1-3 visits per day Headaches/Migraine: 1-3 visits per day Depression/Anxiety: 1-3 visits per day Seizure/Epilepsy: visits vary Allergies-food and environmental: visits vary Cardiology: 1-2 visits per day ADHD: 1-2 visits per day

33. Community E (6482): Utilization (6 mos.)

34. Community E (6482): Utilization

35. Community E (6482): Utilization

36. Community F (2757): District Student Office Visit Frequency (FY05)

37. Develop Policies Care of the child with life threatening allergies Nutrition and physical activities Safety in the schools

38. Statewide Data (FY 2006): Epinephrine Administration

39. Statewide Data (FY 2006): Students with Unknown Allergies

40. Community G (3071): BMI comparisons 2004-05, 2005-06: Grades 1,4,7

41. Community H (3397): REASONABLE ACCESS CONTROL: ANOTHER TOOL FOR SAFER SCHOOLS The U.S. Justice Department 2003-2004 statistics: - Controlled access to school buildings: 83% - Use of security cameras: 28% of elementary schools, 42% of middle schools and 60% of high schools - 48% schools: staff photo identification/visitor badges

42. Community H (3397) #2 Local schools employing combination of single point of entry, locked and electronically accessed doors and cameras: Holyoke, West Springfield, Easthampton, East Longmeadow, Hampden/Wilbraham, Ludlow, South Hadley (Middle and Plains schools only), Hadley, Granby and Ware.

43. Relate Health and Educational Achievement Early dismissals Effect of increased school nurse staffing Management of chronic illnesses in schools Vision/hearing screening related to educational achievement Critical area for evidenced based practice!

44. State Level Data #1: Disposition of Students (FY06)

45. Community F (2757): Decrease in Dismissal Rate with Nurse in Every Building

46. Monitor Performance Improvement Follow-up of vision screening referrals Client Satisfaction Preschool vision screening by primary care providers

47. Community C (4731): Vision Screening 3,600 students screened 380 students referred to a vision specialist 80% of the vision referrals completed 90% of the completed referrals needed treatment

48. Community A (4491): Referrals Sent vs. Referrals Returned: Mid-year Results

49. Community C (4666): Parent Satisfaction Survey (FY 05) Surveys were mailed to a random sample of parents. Response Rate 39% Results sent to School Committee by the Dept of Public Health in June 2006

50. Community C (4666): Parent Satisfaction Survey (FY 05) I am very satisfied with the care my child receives from the school nurse: 95% strongly agreed/agreed If I have a question or concern, I can reach the school nurse for help without any problem 87% strongly agreed/agreed

51. Community C (4666): Parent Satisfaction Survey (FY 05) In an emergency at school, my child can get nursing care quickly 90% strongly agreed/agreed 10% not sure

52. Allocation of Resources/Program Implementation Implement preventive or teaching programs Review related issues, e.g., physical or psychosocial environment Assess staffing needs

53. Community E (6482): Allocation of Resources (6 mos.)

54. Community E (6482): Allocation of Resources (6mo.)

55. Provide Illness Surveillance Chronic Disease Surveillance Asthma surveillance Life threatening allergies Changes in health condition management responsibilities of school nurse BMI Surveillance Injury Surveillance

56. Statewide: Reported Asthma Prevalence

57. Community I (6003): Student Injury Reports

58. Community D (1858): Chronic Health Conditions requiring increased health office visits past 3 years

59. Recommendations Distribute data reports. Always be ready with data. Present the data based on the goals of the target audience. Have a strategic plan as to what you will collect and why. Continue to ask questions!

60. Evidence Based Practice As school nurses we need data to develop our evidence based practice�and we need to use it to tell others what we do for children!

61. Websites www.mass.gov/dph/asthma http://www.mass.gov/dph/fch/schoolhealth/ index.htm masnrn.org

62. Contact information NASSNC at http://www.nassnc.org Cheryl Resha at cheryl.resha@ct.gov Anne Sheetz at Anne.sheetz@state.ma.us