School Health Issues Update

1. School Health Issues Update Dorothy Caldwell School Health Initiative Coordinator Healthy Schools Leadership Assembly Friday Center October 14, 2004

2. Nutrition PE/PA Overweight Diabetes Tobacco Use Asthma Bullying Special Health Care Procedures Meds at School

3. Today’s Goal • Overweight/Obesity Prevention • School Health Services 2003-04 Report • School Nurse Funding Initiative • Look Ahead

5. Prevalence of Overweight(BMI >95th%) in NC Children by Age, 2002 Source: Children seen in North Carolina Public Health Sponsored Clinics for WIC, Child Health, or School Based Health during Calendar Year 2002. Percentiles were based on the CDC/NCHS Year 2000 BMI Reference.

6. Increase in OverweightNC Children by Age, 1995-2000 Age in years Source: NC Institute of Medicine, NC Child Advocacy Institute, 2001 Child Health Report Card

7. UNC Study • More than one in eight (13.5%) NC rural school children tested had 3 or more risk factors for metabolic syndrome • Study included 3,203 students between ages 8 and 17 Joanne Harrell, PHD, RN UNC School of Nursing

8. CDC scientists predict that 30% of children born in 2002 will have diabetes in their lifetimes Slide courtesy of Dr. Jim Marks, CDC

9. 2003-04 SH Services Report • 3,643 students with reported diabetes • 29,289 monitor blood glucose at school • 1,622 receive insulin injections at school • 1,132 have insulin pumps • ??? Type II diabetes

10. Asthma • 62,075 students have asthma • 3,516 students use peak flow monitoring at school • 65 LEAs have asthma education programs • 2,761 students taught “Open Airways” curriculum

11. 43 of 115 School Districts are 100% tobacco free, up from 6 in 1999

12. Student Tobacco Use • 48 LEAs offered alternatives to suspension • 48 LEAs offered smoking cessation classes

13. Other LEA Written SH Policies • 98% - Medication Administration • 89% - Prevention/Control of Communicable Disease • 77% - Injury Reporting • 70% - Special Health Care Services • 68% - Maintenance of SH Records

14. More LEA Written SH Policies • 48% - Health Screenings • 36% - Health Care Referral and Follow-up • 26% - Health Problem Identification

15. Medications at School • 93,561 students received medications at school in 03-04 • About a third were daily, long term • primarily Ritalin, Dexedrine, Lithium and other psychotropic controlled substances

16. Students Requiring Health Care Procedures at School • Epi-pens -- 4,255 • Glucagon Injection -- 1,624 • Nebulizer Treatments -- 1,535 • Tube Feeding -- 364 • Urinary Catheterizations -- 305 • Shunt Care - 167 • Tracheostomy Care - 78

17. Emergency Care • 527,935 Minor Injuries and illnesses reported 03-04 • 8,837 Serious Injuries reported • 758 involved lawenforcement intervention • 7 students permanently disabled • Only 30% of LEAs had school nurse available most of time when student injuries occurred

18. Fewer than 700 School Nurses in 2002-03

19. School Nurse to Student Ratio • 2003 General Assembly Special Provision Budget Bill requested SBE to: • Review standards for SN in Basic Education Plan - being met? • Compare BEP standards with national recommendations • Consider legal requirements for provision of school health services

20. SBE Recommendations • Expansion of SN services to reach a 1:750 ratio by 2014 - 10 year plan • Process for lead heath officials of DPI and DHHS to collaborate and coordinate planning and implementation • Sustain current DPI standards and definitions of school nursing • Encourage ongoing dialogue with Joint Legislative Education Oversight Com.

21. Planning • PH Task force recommended 4-year implementation plan - 263 nurses/yr • Expansion Budgets • DPH requested $13 million • DPI requested almost $5 million

22. Results • School Nurse Funding Initiative • HB 1414 passed July 18, 2004 • 80 permanent positions • 65 2-year positions - part MCHB • $50,000 per position per year • $8,250,000

23. School Nurse Funding Initiative • Ensures SN for 4 LEAs w/o one • Increases # LEAs meeting 1:750 ratio from 10 to 24 • Lowered average ratio from 1:1897 to 1:1568 • Highest ratio in state now 4,633

24. Major Needs Remain • Using 2003-04 School Enrollment and # SN after 165 added: • 2 LEAS above 4,000 • 4 LEAs between 3,000 and 3,999 • 19 LEAs between 2,000 and 2,999 • Enrollment continues to increase in some LEAs

25. Criteria • General Assembly required criteria • Nurse to student ratio • Economic status of community • Health needs of students • Others to be developed by DPI and DPH • 13 criteria selected • ranked 115 LEAS from highest need to lowest (115 to 1) on each criteria • Total became need score

26. SNFI Process • DPI Paula Collins, Dr. Elsie Leak, and DPI data staff • DHHS Sec. Odom, Dr. Devlin, Ryan, Tant, Asay, Sanderson, Buescher, and Caldwell

27. The Envelope Please…. • Total need scores ranked highest to lowest • Top 80 LEAs allocated permanent nurse • Recalculated need score with new SN ratio • Top 65 need scores allocated 2-year nurse

28. Who Hires? • Local Health Department • responsibility to meet with LEA(s) and determine best local decision • Decisions • 46 LHDs - DPH Agreement Addenda • 28 subcontracting to LEA or Hospital • 24 LEAs and 2 Hospitals have direct contract with DPH

29. The Future? ?????????

30. School Nurse Funding Initiative • Governor Easley’s SNFI press release called for 1:750 ratio in every school in 5 years • Public Health Task Force revised their recommendation to reach 1:750 by 2009-2010 • State Board of Education 10-year plan would reach 1:750 by 2014

31. Nurses Can’t Do it All • Need to remain focused on • Overweight Prevention • Nutrition and Physical Activity collaboration with DPI & others • Collaborate on EPA and CDC Asthma Grants • Strengthen collaboration with EPI Section on HIV/STD Prevention • Strengthen Behavioral Health collaboration

32. Schools Conflicted • “There is a real health crisis for children out there, and schools are conflicted about their role in the solution”. Source: Dr. Michael Ward, President CCSSO April 15, 2003

34. Just a little exaggeration…

35. Moving Our Children Toward a Healthy Weight Finding the Will and the Way North Carolina Department of Health and Human Services “Moving Our Children Toward a Healthy Weight…Finding the Will and the Way”Focus on Healthy Eating and Physical Activity • Individual Will • Community Will

36. HB 303(introduced) • Require Physical Activity • 150 minutes/week in elementary • 225 minutes in middle schools • Sponsored by former school administrator

37. NCSBA/DPH Overweight and Obesity Prevention Survey • 93% believe serious/very serious problem in their community • 96% believe important/very important for schools to have nutrition standards • 93% believe important/very important to provide daily PE in preK-8 grade • 63% believe important/very important to provide daily PE in grades 9-12

38. NCSBA Overweight and Obesity Prevention Survey • Greatest obstacles to improving student nutrition • lack of interest/support among students and parents • Lack of funds • Greatest obstacles to daily PE/PA • Lack of time • Lack of funds

39. Cost of Change is High • Cost of inaction is higher • Childhood overweight is an epidemic • Stigma --social discrimination • Type 2 Diabetes • Heart Disease and stroke • Cancer • Skyrocketing Health Care Costs

40. Coordinated School Health Model Health Education Family & Community Health Services Staff Wellness Physical Education Counseling Nutrition Services School Environment

41. Healthy Schools/Healthy Communities HealthyChildren School Performance Increased Social Capital Healthy Communities “The relationship between schooling and health outcomes is one of the strongest generalizations to emerge from empirical research in the U.S.” Nagya R. (2000). Applied Economics, 32, 815-822