WELCOME !

1. WELCOME !

2. Healthy Students: Developing A School-Based Health Center

3. By the end of our time together today you should be able to: • Identify the steps involved with opening a school-based health center • Understand the intersection of health and education • Differentiate roles of school nurses and school based health center personnel

4. Can someone help me with these, I’m late for math class?

5. More education contributes to: Higher incomes (and the purchase of better food and housing, more health care, etc.) More skills, knowledge and resources to protect health More social support and stronger social networks Lower rates of unhealthy behavior How education improves health * J.W. Richardson, PhD

6. Healthy children and young people: Attend school more Pay attention to what goes on in classroom See, hear and understand the teacher Focus more on education as a goal How better health contributes to school achievement * J.W. Richardson, PhD

7. “You cannot educate a child who is not healthy and you cannot keep a child healthy who is not educated.” Jocelyn Elders Former Surgeon General

8. The virtuous circle of education and health • Freudenberg

9. The Health-Academic Outcomes Connection • Graduation • GPA • Standardized test scores Health Risk Behaviors Educational Outcomes • Substance use • Mental health • Poor diet • Intentional injuries • Physical illness • Self-esteem • Sexualbehaviors SBHCs • Attendance • Dropout Rates • Behavioral Problems Educational Behaviors Source: Geierstanger, S. P., & Amaral, G. (2004). School-Based Health Centers and Academic Performance: What is the Intersection? April 2004 Meeting Proceedings. White Paper. Washington, D.C.: National Assembly on School-Based Health Care.

10. Freudenberg’s Seminal Article

11. “ • Rarely has a single problem—high school drop out rates—contributed to so many adverse social, economic, and health conditions. Our nation’s young people deserve no less than a concerted effort to improve school completion rates and thus give young people a gateway to lifetime health and success. School failure is a public health concern “ Source: Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Des 2007;4(4). http://www.cdc.gov/ped/2007/oct/07_0063.htm

12. “ • If medical researchers were to discover an elixir that could increase life expectancy, reduce the burden of illness, delay the consequences of aging, decrease risky health behavior and shrink disparities in health, we would celebrate such a remarkable discovery. Robust epidemiological evidence suggests that education is such an elixir Education = Elixir “ Source: Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Des 2007;4(4). http://www.cdc.gov/ped/2007/oct/07_0063.htm

13. Health Care in Schools

14. Continuum of Health Care Services in Schools

15. SBHC Partnerships: School Nurses • Source: NASBHC Census 2004-2005

16. School Nursing Health Services HEALTH CARE • Promote high quality school health services to all children within the community; HEALTH EDUCATION • Support the educational process; COLLABORATION OF PUBLIC HEALTH CARE • Link the school health service program to all aspects of the health care delivery system that serves children and their families.

17. School Nurses On average: • 98% of the student body are seen annually, and 80% are seen 4 or more times. • 93% of students return to class following a school nurse visit. • 50 - 100 students per day seen for acute and chronic health care needs. • 15 – 30 school staff per day seen for acute and chronic health care needs. • 80% of the student body access school nurses office for mandated state screenings. • 50 student access school nurses office for medication administration.

18. School Nurses • Assess for new onset illnesses and for chronic diseases such as asthma and diabetes • Refer to the student’s primary care provider or to the school-based health center for immunization follow up, diagnosis and treatment plan • Provide health education and support for preventative and confidential health care concerns Assess Refer Provide health education and support

19. School Nursing Services • Assessments and treatment of students, staff and even visitors as needed • Physical/Psychological/Behavioral health conditions – with referrals to primary care providers, E.R. services, and/or counseling services • Reassurance/Supportive care • the school nurse offices are safe places for students • Education • Providing nursing coverage in each building allows students to attend school regardless of health conditions. Enabling ALL Fitchburg students to be prepared and ready to learn. • Resources for health education and/or health careers • Connections and coordination to primary care practices and health insurance • Modeling of positive health practices • Hand washing, nutrition, physical activity, and continued learning.

20. School Nursing Mandated Screenings • Vision • 4,677 students screened • 979 referred • Hearing • 4596 students screened • 247 referred • Postural Screening • 1,789 students screened • 52 referred • Heights and Weights • 3,274 students screened • BMI’s for grades 1,4,7, & 10 • 1417 students screened • 51% students within normal BMI range • 49% outside of normal BMI range

21. Health Conditions • 37% of our students have Special Health Care Needs requiring nursing intervention (compared to 2007-2008 ESHS schools = 24%) Special Health Care needs are defined as those that require health and related services of a type or amount beyond those required by children generally: • Life threatening allergies • Arthritis • Asthma • Blood dyscrasias • Cancer • Cardiac conditions • Diabetes • ADHD • Depression • Migraine headaches • Neurological conditions • Eating disorders • Mental Health/Emotional issues

22. Health Procedures Health / Nursing Procedures include: • Blood Glucose Testing • Blood Pressure monitoring • Catheterizations • Tube Feedings • Nebulizer treatments • Wound Dressing changes • Otoscopic Exam • Many Others

23. Communications • Parent/Guardian communications about individual health issues 8,650 = 865 per month • (typical ESHS districts reporting 550.8 communications per month) • Staff communication regarding student health issues 2,637 = 263.7 per month • (typical ESHS districts reporting 297 meetings per month) • Communication with Health Care Providers and/or agencies 601 = 60.1 per month • (typical ESHS districts reporting 25.8 communications per month ) • Phone calls regarding IEP’s and 504 Plans 86 = 8.6 per month • (typical ESHS districts reporting 15.1 meetings per month)

24. Health Care Today is influenced by: • Family structure changes • Family employment status • Diverse cultural and linguistic ethnicities within our community • Increase in complex health conditions • Severity of illness and special health care needs • Insurance coverage

25. Differentiated/Coordinated Health Services School Nurses and School-Based Health Centers (SBHC) SBHC Comprehensive Risk & Resiliency Assessment Conduct laboratory tests (i.e. strep, ear infection) Diagnose, establish treatment plan & if necessary medication prescription as needed School Nurse Relationship Building/ Initial Assessment Refer to SBHC/Primary Care Provider Carry out treatment plan Continued follow up/Reassessment

26. What is a School-Based Health Center? Accessible, Convenient, Consistent & Confidential

27. School-Based Health Centers • School and community health partnerships • On-site primary and mental health services • Accessible comprehensive health care to underserved populations Outcome = Decreased time out of school; increased time on learning

28. School-Based Health Centers • With permission from parent, provide quality comprehensive health care services • Collaborates with the school administration and school nurse to maximize utilization of health care services available. Including scheduling appointments to maximize student’s time in the classroom. • On site enrollment into eligible health care programs • Cost effective delivery site

29. Elm Park Community School - Worcester Rogers Middle School Lowell Taunton High School Lowell High

30. Steps to Opening a School-Based Health Center

31. #1 Create A Pre-Planning Team

32. Planning Committee • Fitchburg Public School Superintendent • Lead School Nurse • State Legislator • Community Health Connections, Inc Staff • Massachusetts Coalition of School-Based Health Centers

33. #2 Create A Planning Team

34. Planning Committee • Fitchburg Public Schools • HealthAlliance Hospital • State Legislators • Massachusetts Coalition of School-Based Health Centers • CAVU Foundation • Community Health Connections, Inc

35. Role of the Planning Committee • Create strategic development and implementation plan • Monitor the process • Engage Key Stakeholders • Establish An Advisory Committee

36. Role of the Planning Committee • Conduct Surveys • Identify the Financial Feasibility • Assist with School Board Approval • Support the Physical Infrastructure & Licensure Processes • Share information and make recommendations to the Advisory Committee

37. #3 Create A Timeline

38. Create A Timeline

39. #4 Create An Advisory

40. Advisory Committee Members • Advisory Committees are essential in guiding the development of School-Based Health Center services – including a school and community perspective. • The Advisory Committee should have a diverse representation of the community including: • sponsoring health agency, participating school, clergy, community based agency representatives, municipality staff, parents/PTO members and students.

41. What is the Role of the Advisory Committee • To provide guidance around the development and operation of the School-Based Health Center • Identify services offered both on and off-site • Provide feedback & make recommendations • Establish the Mission & Vision of the School-Based Health Center • Serve as Ambassadors of the School-Based Health Center at school and community meetings

42. Advisory Committee Meetings • Initially meet monthly to proactively address its responsibilities: • Mission & Vision statements, progress review & feedback discussion with Planning Committee, engaging support with School Committee, etc. • Advisory Committee will help determine the meeting schedule that best suits their calendars. • Planning Committee representatives will coordinate meetings, take notes, and provide minutes.

43. #5 Conduct Needs Assessments & Surveys

44. Resource Mapping

45. #6 Establish Vision & Mission

46. Fitchburg High School’s School-Based Health Center Vision Statement “Our Vision is that all Fitchburg High School students will have health care.”

47. Fitchburg High School’s School-Based Health Center Mission Statement “Our Mission is to provide access to complete, consistent and comprehensive health care to all Fitchburg High School students, responsive to a culturally and linguistically diverse population, partnering with students to make healthy decisions, provided in a safe and caring environment, to improve student engagement in their learning.”

48. # 7 Identification of Suitable Space and Location Options

49. Fitchburg High School SBHC LOCATION FHS SBHC expansion within the Nursing Station: • The strongest School-Based Health Center is usually co-located within the Nursing Office. • At Fitchburg High School’s Nursing Office the basic floor-plan would remain in-tact utilizing an unused exam room with minor renovations to include dirty utility, NP office & staff space. • The caveat with this lay-out is the need of a DPH waiver to accept Behavioral Health Counseling space down the hall in the Guidance Dept. meeting space.

50. Fitchburg High School SBHC LOCATION The benefits of partnering the 2 units (nursing dept. & the SBHC) in the space together: • Staff connectivity/awareness; • Stronger student support services; • Stronger student accessibility to the SBHC. • SBHC Sustainability