Division of School Health Bureau of Community Health Systems

1. SCHOOL HEALTH UPDATE 2012 Division of School Health Bureau of Community Health Systems

2. DIVISION OF SCHOOL HEALTH • Beth Anne Bahn, Director • Linda Pavlesich, State School Health Consultant • Jill Clodgo, State School Health Consultant • Mary Taylor, Administrative Officer • Bureau Administrative Support • Six Regional School Health Consultants

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

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 (HB101) • Epinephrine Auto-injectors (Epi-pens) • Update current policy on asthma inhalers to include Epi-pens • Student demonstrates competency to CSN • Specify conditions which could cause loss of privileges • Require annual prescription and parental approval

6. ACT 104 of 2010 (HB101) • PA Guidelines for Management of Food Allergies in School • Part of Wellness Policy • Development of Guidelines • www.health.state.pa.us/schoolhealth • “What’s New with School Health” • http://www.portal.state.pa.us/portal/server.pt/community/national_school_lunch/7487/special_dietary_needs_in_school_nutrition_programs-_resources/509222

7. FOOD ALLERGY GUIDELINESREQUIRED CONTENT The guidelines shall assist schools in addressing the following: • Scope of problem and impact on student health • Types of policies and protocols to help prevent allergic reaction emergencies • Multi-disciplinary team approach needed • Role and training of school staff in preventing exposure to allergens

8. FOOD ALLERGY GUIDELINESREQUIRED CONTENT • Responsibilities of parent/guardian, school staff, and primary care provider • Emergency Response Protocols • Roles of staff members in care of students with life-threatening allergies

9. FOOD ALLERGY GUIDELINESSECTIONS • Understanding the Disease • Addressing Student Needs • Tools for Effective Food Allergy Management in Schools • School Responsibilities Under Law • Appendices

10. STAFF TRAINING: TWINJECT • Twinject (Epinephrine) • Unlicensed school personnel may only give the first dose of an auto-injector • Second dose should be administered by a medical professional

11. STAFF TRAINING: ANAPHYLAXIS • Previously Undiagnosed Anaphylaxis • Include in board-approved policy made in consultation with school solicitor • Standing order if approved by school physician • Order for medical professionals only • Student assessed by nurse and Epi-pen administered • Unlicensed school staff should not give Epi-pen, call 9-1-1

12. STAFF TRAINING: GOOD SAMARITAN ACT • 42 Pa.C.S. § 8337.1 • An officer or employee of a school • In good faith believes that a student needs emergency care, first aid or rescue • Provides emergency care, first aid or rescue • Shall be immune from civil liability

13. STAFF TRAINING: EPI-PEN • According to the PA Board of Nursing • Nurses may train an unlicensed person in how to respond using an Epi-pen or rescue asthma inhaler

14. FOOD ALLERGY MANAGEMENTRESOURCES • Additional Resources • National School Boards Association • “Safe at School and Ready to Learn: a Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies” • PA School Boards Association • Template Food Allergy Management Policy • Administrative Guidelines

15. ACT 101 of 2011 (SB200) • Departments of Health (TBI Program) and Education (Safe Schools) developing guidelines for concussion management • Specifically for athletic activities • Removal from play • Return to play • Training for Coaches • In beginning stages

16. ACT 101 of 2011 (SB200) • Traumatic Brain Injury (TBI) Program website • http://www.portal.state.pa.us/portal/server.pt/community/grants___funding/14140/traumatic_brain_injury/666239 • Brain STEPS (Strategies, Teaching, Educators, Parent, and Students) • Child & Adolescent Brain Injury School Re-entry Program

17. IMMUNIZATION REGULATIONS • FAQs on Exclusion of Students due to end of provisional period • Sent via PENN*LINK to administrators on March 9, 2012 • Sent through CSN contacts on March 9, 2012

18. IMMUNIZATIONREGULATIONS • Questions • Authority to exclude students • Exclude now or end of school year • May provision period be renewed • Classification for absence • Provision of homebound instruction

19. IMMUNIZATION REGULATIONS • Questions (cont) • May I exclude? • Students with IEPs and 504s • Students younger than 8 • Homeschooled/Private Tutored Students • Immigrant/refugee students • Homeless students

20. IMMUNIZATIONREGULATIONS • Questions (cont) • Requirements for school year 2012-13 • Department of Health assistance

21. SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU) • Vaccine provided at no cost to school districts by the Department of Health • Hepatitis B, MCV4, Tdap, and Varicella vaccines for students who are unable to obtain these vaccines through their medical homes • Students MUST be VFC Eligible (uninsured, underinsured, Medical Assistance)

22. SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU) • School districts plan, develop, and implement programs with consultation from their local Health Department • Protocols for planning and implementing a SICU program are available at the Department of Health, Division of Immunizations • http://www.health.state.pa.us/schoolchildrenimmunizations • Updated forms will be available on website approximately May 1 for school year 2012-13

23. 2012-13 SCHOOL FLU INITIATIVE • Injectable and nasal influenza vaccine available • Department of Health provides • Vaccine with supplies • Informational packet for parents • For more information, visit http://www.portal.state.pa.us/portal/server.pt/community/immunizations/14141/school_children_immunizations/557995

24. IMMUNIZATION RESOURCES • Available at “What’s New with School Health” www.health.state.pa.us/schoolhealth • Updated Immunization Manual • Information on ordering immunization cards and new rack cards • CDC Pink Book • http://www.cdc.gov/vaccines/pubs/pinkbook/index.html

25. IMMUNIZATION RESOURCES • PA- Statewide Immunization Information System (PA-SIIS) • View-only access for school nurses • http://www.portal.health.state.pa.us/portal/server.pt/community/pa_statewide_immunization_information_system_%28pa-siis%29/14281/school_nurses/556459 • Send application to Attention: Frank Caniglia

26. OFFICE OF HEALTH EQUITY • Office of Health Equity (OHE) • Provides leadership to increase public awareness of health inequities and disparities in PA • Creates awareness and proposes actions to address existence of health inequities and mobilizes individuals, statewide agencies and communities to reduce and/or eliminate health disparities in PA • Disparities often caused by societal, economic, or environmental factors, such as poor housing, poverty, or discrimination

27. DIVERSITY • Diversity • Commitment to recognize similarities and celebrate people’s differences in order to highlight their uniqueness and create inclusiveness in a gradually diverse world community • Diversity Awareness • Creates respect and appreciation of the mixture of characteristics that make individuals unique and groups distinctive from one another

28. OFFICE OF HEALTH EQUITY • Health Inequities • Exist when one population or group of people experience worse health outcomes or a lesser quality of health care when compared to other populations • Intercultural Communication • Form of interpersonal communication where cultural influences are sufficiently great and may interfere, distort, or result in miscommunication and / or lack of understanding

29. REFUGEE HEALTH • Partnership • Federal Office of Refugee Resettlement • Department of Public Welfare • Department of Health, Office of Health Equity • Department of Health, Bureau of Epidemiology • Goal • Ensure all newly arriving refugees receive a comprehensive health screening as soon as possible after entering the United States

30. REFUGEE HEALTH • Refugee • Defined in international law as a person who is outside his or her country of nationality and who is unable or unwilling to return because of fear of persecution • Served by Refugee Program • Refugees • Asylees • Cuban/Haitian Entrants • Amer-Asians • Victims of Human Trafficking • Unaccompanied Alien Children • Survivors of Torture

31. OFFICE OF HEALTH EQUITY • OHE • http://www.health.state.pa.us/healthequity • Refugee Health • http://www.portal.state.pa.us/portal/server.pt/community/refugee_health/19001

32. AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) • Check battery & pads for expiration dates • Potentially greater liability than not having an AED • Grants/funding - Kiwanis, Lions, Rotary, PTA, booster clubs, http://aedgrant.com/

33. AED PRODUCTS • Schools eligible to receive state pricing for Zoll products, as a COSTAR • For information on specific products and pricing, contact Michael Chalifoux at: • mchalifoux@zoll.com • 800-242-9150 ext. 9565 • Cell phone: 804-240-4388

34. SCHOOL HEALTH SERVICES

35. SCHOOL HEALTH SERVICESPART TIME CSN • Part-time CSN • Who is covering when CSN not in district? • Students must be added to covering CSN caseload • Students are to be under CSN caseload at all times

36. SCHOOL HEALTH SERVICESSUPPLEMENTAL STAFF • Supplemental Staff • Can’t carry a caseload • Function under their own license • Under the direction of the CSN • CSN must go to all assigned buildings on regular basis • Can’t cover caseload you never see

37. SCHOOL HEALTH SERVICESCHIROPRACTORS • Provision of services by: • Chiropractors • Scope of practice limited to the neuro-muscular system • May write excuses for PE and school if within scope of practice • Not in their scope of practice to: • Complete student or staff physicals • Write prescriptions for medications • Sign medical exemptions for immunizations • Write dietary restrictions

38. SCHOOL HEALTH SERVICESEMTs • Provision of services by: • EMTs • 28 PA Code, § 1003.23 • Scope of practice performed under medical command or Statewide BLS medical treatment protocols • Scope of practices does not include • Routine administration of medications • Supervising students self-administering medications

39. SCHOOL HEALTH SERVICESATHLETIC TRAINERS • Provision of services by: • Athletic Trainers • Act 123 of 2011 • Management and provision of care of injuries to a physically active person • Use of modalities such as mechanical stimulation, heat, cold, light, air, water, electricity, sound, massage and the use of therapeutic exercises, reconditioning exercise and fitness programs • Shall not include administration of any controlled substance

40. SCHOOL HEALTH SERVICESAGENCY STAFF • Provision of services by: • Agency Staff • CSN still responsible for students receiving 1:1 nursing care while under school jurisdiction • School needs medical orders to provide care in case agency nurse is absent

41. SCHOOL HEALTH SERVICES • Licensed Private Academic • Non-public/Non-licensed • Career and Technology Centers • Full-time • Part-time • Intermediate Units • Alternative Education

42. DELEGATION • Delegation • Nurses may not delegate per PA Nurse Practice Act • Principals may not delegate per CSPG #95 • Non-medical school staff shall not be directed to engage in health-related activities per CSPG #101

43. DELEGATION • Delegation • “in loco parentis” pertains only to conduct and behavior • Waiver of Liability • Possible violation of federal laws • Office of Civil Rights (OCR) - Berlin Brothersvalley SD (1988)

44. SCHOOL HEALTH SERVICES • Suggestions • Routinely monitor school board policies • CSN should be part of the discussion when policies are reviewed and updated • Concern with policy or administrative directive • Put concerns in writing • Contact School Health Consultant in your district

45. DOCUMENTATIONSUSPECTED CHILD ABUSE • Child Abuse • Document in health record • Statement made by student • Assessment and treatment of injuries • Notification of ChildLine • Copy of CY-47 form in file with note of outcome of investigation • Photos of injuries • Part of school district policy

46. DOCUMENTATIONFERPA • Sharing Health Information • Expectation of privacy • FERPA - educational need to know • Health Concern Lists • PA Public School Code, § 14-1409 Confidentiality, transference and removal of health records • All health records established and maintained pursuant to this act shall be confidential, and their contents shall be divulged only when necessary for the health of the child or at the request of the parent or guardian to a physician

47. DOCUMENTATION • 49 Pa. Code § 21.18 • Standards of nursing conduct, require a registered nurse to safeguard the patient’s dignity, the right to privacy and the confidentiality of patient information. • ANA Code of Ethics for Nurses • Nurse safeguards patient’s right to privacy • Duty to maintain confidentiality

48. DOCUMENTATIONELECTRONIC • Electronic vs. paper records • May keep health record electronically • Not necessary to maintain paper record • If student transfers, print copy of record to send to receiving school • Security: who has access • Keep track of changes to record

49. DOCUMENTATION • Health logs • Sign-in logs okay (name, time of arrival, time of departure) • Individual record for each student for assessment and treatment • Medical plans of care • Standard of nursing practice

50. DOCUMENTATION 101 • Documentation 101: • Timely Charting • Use of abbreviations • Didn’t chart it, didn’t do it • Don’t use white out • Cross out error with single line and initial, date and time