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Beth Anne Bahn Acting Director Division of School Health Bureau of Community Health Systems April 14, 2011 PowerPoint Presentation
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SCHOOL HEALTH UPDATE 2011. Beth Anne Bahn Acting Director Division of School Health Bureau of Community Health Systems April 14, 2011. DIVISION OF SCHOOL HEALTH. Beth Anne Bahn, Acting Director Vacant, State School Health Consultant Mary Taylor, Administrative Officer

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Beth Anne Bahn Acting Director Division of School Health Bureau of Community Health Systems April 14, 2011


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    1. SCHOOL HEALTH UPDATE 2011 Beth Anne Bahn Acting Director Division of School Health Bureau of Community Health Systems April 14, 2011

    2. DIVISION OF SCHOOL HEALTH • Beth Anne Bahn, Acting Director • Vacant, State School Health Consultant • Mary Taylor, Administrative Officer • Administrative Support • Six Regional School Health Consultants

    3. REGIONAL SCHOOL HEALTH CONSULTANTS NW – Donna Leffler 724-662-6068 dleffler@state.pa.us NC – Deb Frey 570-327-3400 defrey@state.pa.us NE – Kristen Cheslick 570-826-2062 kcheslick@state.pa.us SC - Linda Katherman 717-787-8092 lkatherman@state.pa.us SE – Sheri Mountz 610-378-4352 smountz@state.pa.us SW – Joseph Donahue 724-830-2701 jodonahue@state.pa.us

    4. ACT 104 of 2010 (HB101) • Allows CRNP/PA to complete physicals for: • Teacher Certification • School Staff • Mandated Student Examinations

    5. ACT 104 of 2010 • Epinephrine Auto-injectors • School policy on possession and use of asthma inhalers need to include Epi-pens • Demonstrate competency • Specify conditions could lose privilege • Require updated prescription and parental approval annually

    6. ACT 104 of 2010 • Food Allergy Reaction Management • Part of Wellness Policy • Development of Guidelines • Co-chair of committee with PDE, Division of Food and Nutrition Services • Pattern after Diabetes Guidelines • Stakeholder meeting April 21

    7. IMMUNIZATION REGULATIONS • Published in PA Bulletin May 29, 2010 • http://www.pabulletin.com/secure/data/vol40/40-22/984.html • Effective August 1, 2011 for the 2011-2012 school term

    8. IMMUNIZATION REGULATIONS For New School Enterers in Kindergarten or First Grade NOW: NEW: • 4 doses tetanus (DTaP, DT, Td) • (1 dose on or after 4th birthday) • 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday) • 3 doses polio • 2 doses measles (MMR) • 2 dose mumps (MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • 2 doses varicella or 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) • 1 dose mumps (MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • varicella immunity • (vaccine or history of disease)

    9. IMMUNIZATION REGULATIONS For Attendance In All Grades NOW: NEW: • 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) (1 dose on or after 4th birthday) • 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday) • 3 doses polio • 2 doses measles (MMR) • 2 doses mumps (MMR) • 1 dose rubella(MMR) • 3 doses hepatitis B • 2 doses varicella or immunity (vaccine or history of disease)

    10. IMMUNIZATION REGULATIONS For Entering 7th Grade NOW: NEW: • 4 doses tetanus (DTaP, DT, Td) • (1 dose on or after 4th birthday) • 4 doses diphtheria (DTaP, DT, Td) • (1 dose on or after 4th birthday) • 1 dose tetanus/ diphtheria/ acellularpertussis (Tdap) • 3 doses polio • 2 doses measles (MMR) • 2 doses mumps (MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • 2 doses varicella or immunity (vaccine or history of disease) • 1 dose meningococcal conjugate • 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)

    11. School Immunization Requirements for school attendance for all grades according to PA school law. Does the student have the following immunization requirements for attendance in all grades? Does the student have at least one dose of DT, OPV/IPV, MMR, HepB and Varicella? • 4 doses of tetanus • 4 doses of diphtheria • 3 doses of polio • 2 doses of measles • 2 dose of mumps • 1 dose of rubella • 3 doses of hepatitis B • 2 doses of varicella (chickenpox) or history of disease Deny admission until one dose of each antigen listed to the left is received. NO NO YES YES • Place on provisional status and review every 60 days for 8 months. • May exclude from school if non-compliance continues past provisional period. In Compliance NOTE: If the student is attending 7th grade, do they also have? • 1 dose MCV • 1 dose of Tdap (if 5 years have elapsed since last tetanus immunization) • Place on provisional status and review every 60 days for 8 months. • May exclude from school if non-compliance continues past provisional period. NO YES Foreign exchange students or foreign students visiting PA schools need at least one-dose of each antigen to attend or visit PA schools, then they will be placed on provisional status. In Compliance March 2010

    12. IMMUNIZATION REGULATIONS OLD

    13. IMMUNIZATION REGULATIONS • Grace Period • 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 • Considered a valid dose Example: MMR Example: hepatitis B

    14. IMMUNIZATION REGULATIONS • Children <5 years old, 28 Pa. Code § 27.77 (ACIP recommendations) • Children 5 years and older, follow School Health regulations, 28 PA Code, Chapter 23, Subchapter C

    15. IMMUNIZATION FAQs • Can a parent ask for moral exemption after student has had several doses of vaccine? • Case by case basis • Determined by school administration • Needs to be in writing • Can sign back of immunization card • Not required to be renewed annually

    16. IMMUNIZATION FAQs • Doctor office not providing immunizations, citing HIPAA • Share joint guidance HIPAA/FERPA • Include parent release on school forms • Encourage use of PA-SIIS • Can school policy require students to have immunizations on the 1st day of school, no provisional? • Have to follow DOH regulations

    17. SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU) • Provide Hepatitis B, MCV4, Tdap, and Varicella • Students unable to obtain through their medical homes • School districts plan, develop, and implement programs • Consultation from local Health Department. • Protocols available from the Division of Immunizations • Vaccine is provided at no cost to school districts for VFC eligible students

    18. IMMUNIZATION RESOURCES • Resources available on What’s New with School Health, www.health.state.pa.us/schoolhealth • Slide presentation from March 15, 2011 webinar, “Update to School Immunization Regulations” • Division of Immunizations website • Law and regulations regarding immunizations •  Updated Immunization Manual (when available) •  Information on ordering immunization cards and new rack cards

    19. IMMUNIZATION RESOURCES • PDE, Basic Education Circular (BEC), Education for Homeless Students • Joint Guidance on HIPAA and FERPA • PA State Immunization Information System (PA-SIIS) • CDC Childhood and Adolescent Immunization Scheduler • Assist in determining immunization compliance • Provides an "instant picture of immunity.“

    20. REFUGEE HEALTH • DOH and DPW • Provider Network • Timely comprehensive health assessment for each arriving refugee • Identify communicable diseases • Identify and treat health conditions or health-related issues • http://www.portal.state.pa.us/portal/server.pt/community/refugee_health/19001

    21. TB TESTING OF STUDENTS • PA Public School Code • Section 14-1402 (a) & (f) • 28 PA Code • Section 23.9 • Modification • Encouraged since 1997

    22. TB TESTING OF STAFF • PA Public School Code • Section 14 – 1416 & 14 – 1418 • 28 PA Code • Section 23.44 • Law doesn’t allow for modification of TB testing for staff • Does allow for alternative testing methods

    23. TB TESTING OF STAFF • Volunteers • Must comply with TB testing requirement if: • In direct contact with students for 10 or more hours per week

    24. MEDICALLY IMPAIRED DRIVER LAW • Effective October 9, 2010 • CRNP and PA • When conducting physical exams for driver’s permits or in determining whether person has a disorder affecting ability to drive safely • Report to PennDOT within 10 days • Any patient 15 years of age or older diagnosed with condition that could impair ability to safely operate motor vehicle. • Don’t need to report conditions expected to last less than 90 days

    25. MEDICALLY IMPAIRED DRIVER LAW • Diabetes • Severe hypoglycemic reactions or symptomatic hyperglycemia • Not qualified to drive • Unless continuous period of at least 6 months free from disqualifying episode • Request on-line access • https://www.dot3.state.pa.us/contact_us/medicalEmail.jsp

    26. MEDICALLY IMPAIRED DRIVER LAW • Report to Primary Care Provider • Diabetics • Severe hypoglycemic reactions (requires outside intervention or assistance of others) or produces confusion, loss of attention or loss of consciousness • Symptomatic hyperglycemic (caused loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, or both) and confusion reactions • Seizure activity • Cardiovascular • Syncopal attack, loss of consciousness, vertigo, paralysis or loss of qualifying visual fields

    27. MEDICALLY IMPAIRED DRIVER LAW http://www.dot3.state.pa.us/centers/medicalReportingCenter.shtml

    28. AED • Check Battery & pads for expiration dats • Potentially greater liability than not having an AED • Grants/funding- Kiwanis, Lions, Rotary, PTA, booster clubs

    29. MEDICATION ISSUES • Field Trips (pp. 18-19 medication guidelines) • Can’t refuse student attendance on field trip because nurse not available (IDEA/504) • May not request waiver of liability from parent (Berlin Brothers Valley SD) • Advance notice to nurse for planning • Limit # of field trips from building per day

    30. MEDICATION ISSUES • Field Trips • Invite parent or parent designee • Utilize licensed nurse from sub list • Licensed parent volunteer • Need clearances • Approval as district volunteer • Provider permission to change dosage time or skip a dose

    31. MEDICATION ISSUES • Out of state field trips • Check with Board of Nursing • Get in writing • Delegation to student by parent • Student under school jurisdiction • Zero tolerance drug policies • Self-administration by student • Emergency medications only

    32. MEDICATION ISSUES • Extracurricular activities • Same rules as field trips • Early Intervention Programs • School District responsibility • Integral part of school program • Located in school district building • Medications, immunizations & emergency care • Screenings for baseline (optional)

    33. MEDICATION ISSUES • Emergency Medications • PA Public School Code- self carry and administer asthma inhalers/epinephrine auto-injectors • May train unlicensed staff to assist with their administration • Diastat, glucagon etc. require licensed medical professional to administer

    34. SPECIAL NEEDS STUDENTS • Medical Plans of Care • Standard of Care- “If you didn’t write it, you didn’t do it.” • Emergency Care Plan (ECP) • Individualized Health Care Plan (IHP) • Individualized Education Plan (IEP) with medical component • 504 Service Agreement

    35. SPECIAL NEEDS STUDENTS • Nurse should be part of team for IEP and 504 • Nurse who has student as part of their caseload • Should not sign legal document if not involved in development of plan • Reasonable accommodations for student

    36. SPECIAL NEEDS STUDENTS • Students with newly diagnosed or unstable Type 1 Diabetes and an IEP • Medical provider can write as part of Medical Management Plan • Nurse required in school building at all times • Federal funds to cover cost

    37. SPECIAL NEEDS STUDENTS • Factors to Consider • Individualized Transition Plan (ITP) • Transition Healthcare Checklist • Who can legally provide Care? • Dietary Accommodations

    38. SPECIAL NEEDS STUDENTS • ITP • Effort to standardize assessment of student transportation needs • Resources and training available • Working with Bureau of Family Health and PDE Bureau of Special Education

    39. SPECIAL NEEDS STUDENTS • Transition Healthcare Checklist • Required to start transition planning by age 14 • School responsible for successful transition • Should include a health component • Most likely area for failure according to PATTAN statistics • Checklist updated in 2010 • Also available in Spanish • http://www.portal.state.pa.us/portal/server.pt?open=514&objID=558090&mode=2

    40. SPECIAL NEEDS STUDENTS • Provision of Care • Care of Medically Fragile Child • http://www.aft.org/pdfs/healthcare/medicallyfragilechild0409.pdf • Scope and Standards (ANA) • Code of Ethics (ANA) • PA laws and regulations

    41. SPECIAL NEEDS STUDENTS • Dietary Accommodations • Special dietary needs medical form has been • updated • http://www.portal.state.pa.us/portal/server.pt/community/national_scho • ol_lunch/7487/special_dietary_needs_in_school_nutrition_programs-_resources/509222. • Must be signed by physician • Share medical form with Food Services • Director • Collaboration with Food Services is critical for • appropriate provision of health and food services

    42. CONTINUING EDUCATION • Act 48 • DSH will submit hrs reported for courses from ANCC, ANA, AMA, AGD and PADHS • Fax certificates to 717-783-4790 or e-mail to c-paschool@state.pa.us along with PDE ID • Act 58 • If CSN, Act 48 hours count for RN CE

    43. LEARNING MANAGEMENT SYSTEM (LMS) • All School Personnel & Supplemental Licensed Health Staff • Offers on-line courses for school staff • Act 48 hours through the Division of School Health • Act 58 hours through the Dept. of Health • To become a registered user: • www.paprepared.net

    44. PA ASTHMA PARTNERSHIP • www.PAasthma.org • Resources • Partners Sharing Newsletter • Funding Opportunities • Research Articles

    45. THE CENTER (CNAP) • Formerly PA Advocates for Nutrition and Physical Activity • Now Center for Nutrition and Activity Promotion at Penn State Hershey Children’s Hospital www.nrgbalance.org

    46. nrgZone Enrollment • March 14 – April 22, 2011 • www.nrgbalance.org/schools • Click on Healthy Schools Campaign • 25- question assessment • Online resources • Monthly eNewsletter • Annual events (ex. Apple Crunch)

    47. PROPOSED CH. 12 REGULATIONS • Establish baseline nutritional & physical activity standards • Adopted by State Board of Education May 6, 2010 • Approved by Governor’s Office November 6, 2010 • Currently in Attorney General’s Office

    48. PROPOSED CH. 12 REGULATIONS • Physical Activity • 30 minutes daily • Moderate – to – vigorous • Physical Education • 150 minutes at elementary level • 225 minutes at secondary level • To be removed in final version

    49. PROPOSED CH. 12 REGULATIONS • Encourages active commuting (bike or walk) safely to & from school • Establish & maintain coordinate school health advisory committee • Coordinated School Health plan • Student nutrition, health & physical activity • Includes the wellness policy

    50. PROPOSED CH. 12 REGULATIONS • Nutrition Standards • Encourages school gardens or farms • Guidelines for classroom celebrations • Offer sample party menus • Comply with nutrition standards • Non-food rewards & celebrations • Fundraising • Comply with nutrition standards • Set standards for competitive foods & beverages