C A R O L I N A Annual School Health Services Report

Transcription

1 N O R T H C A R O L I N A Aual School Health Services Report North Carolia Departmet of Health ad Huma Services Divisio of Public Health Wome s ad Childre s Health Sectio Childre ad Youth Brach School Health Uit

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3 Table of Cotets Executive Summary 1 Survey Populatio 3 Profile of Studets Erolled i N.C. Public Schools 3 Profile of Nurses Employed i Schools 4 Employmet ad Fiacig of School Health Services 6 School Health Services 9 Chroic Health Coditios 9 School-Based, School-Liked Health Ceters 10 Pregacy 11 Suicide/Homicide 12 Studet Use of Tobacco 13 Health Couselig 13 Health Teachig 14 Health Care Procedures at School 14 Medicatios at School 15 Health Care Coordiatio ad Case Maagemet 18 Emergecy Care 18 Services by NC Oral Health Sectio Staff 18 Health Screeig, Referral, Follow-up ad Securig Care 19 Health Policies 21 Commuity Ivolvemet 23 Coclusio 23 Appedices 25 Appedix A: Chroic Health Coditios 25 Appedix B: Reported Ijuries 26 Appedix C: School Nurse to Studets Ratio by LEA 27 Map of Admiistrative Resposibility for School Nurses 29 Map of School Nurse-to-Studets Ratio 30 i

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5 Executive Summary North Carolia takes the positio that health ad educatio are iterdepedet; therefore the idetificatio of health-related barriers to learig is crucial to the provisio of a appropriate educatioal pla for every studet. To meet that objective, North Carolia has istituted comprehesive school health services i every school district. The state has made comprehesive school health services a priority through strategies such as the N.C. Healthy Schools Coordiated School Health program, the N.C. School Health Leadership Assembly, through local fudig ad state fudig directed toward school health services ad persoel, ad through implemetatio of a regioal ad state etwork of school urse cosultats. The Natioal Ceter for Educatio Statistics puts North Carolia as the 10th largest state public school system i the coutry. The umber of childre i North Carolia public schools icreased oe percet over the past two school years, from millio i to millio i Durig the same period, the umber of full time school urse positios icreased from a full-time equivalece of 1,147 to 1,169 urses. School urses i North Carolia are employed by a variety of agecies. Amog the 115 school health programs, more tha two-thirds (70%) were admiistered by school districts. The remaiig third of the programs were admiistered by local health departmets, hospitals, or a combiatio of all three. Fudig for school urse positios comes from a variety of sources icludig local ad state fuds, federal Title V block grats, categorical fuds, ad public ad private foudatios. The ratio of school urses to studets improved from 1:1,225 i to 1:1,207 this past school year. Over the past decade, the school urse-to-studets ratio has bee cut i half, eablig more studets to access health services from a school urse. I August 1998, about 556 school urses delivered services i 87 couties, carryig caseloads of about 2,450 studets each. Te years ago, studets i 13 couties had virtually o access to a school urse. To eable school urses to deliver comprehesive health care to studets, the America Academy of Pediatrics, the Ceters for Disease Cotrol ad Prevetio, ad the Natioal Associatio of School Nurses recommed a ratio of o more tha 1 urse per 750 studets. The school urse must be expert i cliical ursig; oral ad writte commuicatio; utilizatio of epidemiological priciples, icludig moitorig for clusters of symptoms that may idicate a emergig health threat for studets ad staff; educatig the school commuity o curret health topics; advocatig for studets; crisis maagemet ad leadership. Natioal certificatio i school ursig is the stadard by which school urses are judged to have the kowledge ad skills ecessary to provide health services i the school settig. Durig , the percetage of atioally certified school urses i North Carolia icreased ie percetage poits, to 50 percet. A critical fuctio of school urses is idetifyig studets with chroic health coditios. The umber ad percetage of studets with chroic health coditios cotiues to icrease. I , school urses idetified 75,576 studets with asthma, 18,439 studets with severe allergies, ad 4,584 studets with diabetes. I additio to idetifyig these studets, school urses develop idividual health care plas ad trai school staff members to give ecessary medicatios ad perform medical procedures ordered by health care providers. School urses provided more tha 80,000 health couselig sessios to studets ad staff ad more tha 30,000 health educatio programs i group settigs durig They facilitated visio, hearig ad detal screeigs 1

6 coducted i schools. More tha a half-millio school childre were screeed for visio, ad more tha 33,000 studets were see by physicias or eye care professioals as a result of the referrals from school health professioals for comprehesive eye exams. Nurses were authorized to process more tha 30,000 orders for medicatio, ad school urses esured that this was doe i a safe maer. School urses work with their local School Health Advisory Coucils (SHAC) to develop ad implemet local programs desiged to prevet illess ad promote health. The SHACs are madated by the North Carolia State Board of Educatio Healthy Active Childre Policy (GCS-S-000). They also assist with disaster/emergecy plaig for their commuities. As the health eeds of childre i school cotiue to grow, so must the availability of school urses, util the recommeded ratio of 1:750 is reached ad, ideally, there is at least oe school urse i every school i North Carolia. Methodology This report is compiled from data submitted by school urses, based o their kowledge of health services provided by school urses ad other health professioals i their schools. Iformatio is o health services i North Carolia public schools oly. It does ot iclude data from state charter or residetial schools, or federal, private or parochial schools. Data specialists ad school urse cosultats i the N.C. Divisio of Public Health s Childre ad Youth Brach developed the survey istrumet ad distributed it to School Health Program Supervisors i each school district (LEA: Local Educatio Agecy) at the start of the school year. All 115 LEAs 100 percet participated i the data collectio ad submitted data oto the survey istrumet electroically. The data was sorted by brach staff ad aalyzed by staff i the School Health Uit of the Childre ad Youth Brach. 1 Additioal data for this report was collected from other sources, icludig: North Carolia Departmet of Public Istructio North Carolia Departmet of Health ad Huma Services, Divisio of Public Health: Wome s ad Childre s Health Sectio Oral Health Sectio The Natioal Society to Prevet Blidess North Carolia Affiliate, Ic. North Carolia Child ad Family Support Teams Iitiative Additioal data is available for further review by request. Cotacts: Jessica Gerdes, State School Nurse Cosultat, Jessica.Gerdes@dhhs.c.gov Elizabeth Mizelle, Childre & Youth Brach Data Maager, Elizabeth.Mizelle@dhhs.c.gov Michael Saderso, Best Practices Uit Maager, Michael.Saderso@dhhs.c.gov DATA SOURCES 1 N.C. Aual School Health Nursig Survey: Summary Report of School Nursig Services N.C. Divisio of Public Health Departmet of Health ad Huma Services Public Schools of North Carolia Departmet of Public Istructio 2

7 Itroductio For more tha a doze years, the North Carolia Divisio of Public Health has collected school health data from each school district. This report summarizes curret data ad provides iformatio o treds. The survey to the school health service programs also asks for commets regardig outcomes ad successes durig the past school year ad goals for future years. This report icludes a small selectio of the accouts of successful outcomes; they are labeled local outcomes. Survey Populatio Profile of Studets Erolled i North Carolia Public Schools North Carolia s 1.41 millio school childre are as diverse as the state s populatio. They come from all socio-ecoomic backgrouds ad a icreasig umber of ethic backgrouds. The majority are male (51%) ad white (54%). Other racial ad ethic populatios i our schools are: black or Africa America, 31%; Asia, 3%; Hispaic, 11%; America Idia, 1%. They atted our 2,399 public schools i 115 educatioal districts (100 districts orgaized by couty ad 15 by city). A additioal 35,131 studets atted oe of the 97 North Carolia public charter schools. Pre-kidergarte (Pre-K) Studets North Carolia state govermet ad the federal govermet provide fudig for studets i pre-school programs. I the public schools, those studets eroll i More at Four Pre-Kidergarte programs, Title I Preschool, ad Exceptioal Childre Preschool. Because the North Carolia Office of School Readiess promotes the health ad physical coditio of childre whe they eter school as oe of the idicators of school readiess, the state s school urses serve those studets as well. May of the studets i these programs are developmetally delayed, have disabilities, ad/or have special health care eeds. Durig this school year, the school urses reported servig 21,533 pre-k studets erolled i their districts. The preschool studet erollmet is i additio to the erollmet i kidergarte through 12th grades, ad is ot couted i the formula that results i the school urse-to-studet ratio. Exceptioal Childre Approximately 189,266, or 13 percet, of public school childre i North Carolia are erolled i Exceptioal Childre s (EC) Programs. Itellectual, emotioal ad health impairmets are amog the disabilities that egatively impact a studet s learig to the degree that leaves them eligible for Exceptioal Childre services. Studets i the EC program require the assistace of school urses, as may of them have additioal coditios beyod their primary disability that require health care plas, emergecy actio plas, ad other health accommodatios. Most school urses care for these studets i additio to studets i regular educatio. A small percetage of school urses, fewer tha 2 percet, work oly i the EC program. L O C A L O U T C O M E Withi a moth after the school urse coordiated a effort to eable a middle school child with spia bifida to become idepedet i [uriary care], the child became idepedet. All studets eligible for EC services must meet criteria for oe primary disability, ad may meet criteria for additioal disability services. This school year, Other Health 3

8 Impairmet was the primary disability of 30,153 studets, the 3rd most frequet amog 16 classificatios for primary disability. (The most frequet classificatio amog studets i EC programs i North Carolia was Specific Learig Disability ; the 2d most frequet was Speech or Laguage Impaired. ) The state EC program classified aother 6,042 studets with these primary disabilities: Traumatic Brai Ijured, Severe & Profoudly Hadicapped, Hearig Impaired, Orthopedically Impaired, ad Multi-Hadicapped. With each studet who has a chroic health coditio, the school urse is ivolved i plaig, delegatig ad otherwise carig for the studet. School urses ofte arrage for ad provide geeral supervisio of other urses i the school settig. I some LEAs (19 this school year), private-duty urses provided care to studets who were medically fragile ad eeded care o a oe-o-oe basis durig the etire school day. Profile of Nurses Employed i N.C. Public Schools The school urse is a registered urse (RN) i a specialized professioal practice that requires differet educatioal preparatio, experieces, skills ad kowledge tha that of urses workig i acute care or other commuity settigs. The America Academy of Pediatrics has affirmed that the school urse has a crucial role i the seamless provisio of comprehesive health services to childre ad youth. 2 The Academy s positio statemet of May 2008 states that icreasig umbers of studets eter schools with chroic health coditios that require maagemet durig the school day. School urses provide prevetive services, early idetificatio of problems, itervetios, ad referrals that serve to improve health ad educatioal outcomes. I North Carolia, the school urse ofte fuctios as a member ad occasioally as the coordiator of the local School Health Advisory Coucil. School urses are ivolved i each of the eight compoets of a Coordiated School Health Program: health services, health educatio, physical educatio, utritio services, health promotio for staff, couselig ad psychological services, healthy school eviromet, ad family/commuity ivolvemet. 2 America Academy of Pediatrics: Policy Statemet Role of the School Nurse i Providig School Health Services May 2008 L O C A L O U T C O M E The urse s quick actio may have saved the lives of two teachers at her schools oe with worrisome symptoms of a aeurysm, aother with symptoms of a heart attack. [Both teachers are ow doig well.] The doctor of the oe with symptoms of a heart attack praised the urse for prompt, appropriate first aid. Educatioal Preparatio of School Nurses School urses are registered urses (RN) who are licesed by the North Carolia Board of Nursig. Educatioal preparatio for etry ito registered ursig is through oe of three Ukow Masters 3% 6% Educatioal Preparatio PhD 0.05% BS 5% Diploma 3% ADN 15% BA 1% BSN 67% B.S.N. Bachelor of Sciece i Nursig Diploma Hospital Based Nursig A.D.N. Associate Degree i Nursig 4

9 routes: hospital-based diploma i ursig, commuity or techical college preparatio for a associate degree i ursig, or bachelor s degree from a four-year college or uiversity. Icreasigly, urses whose iitial etry ito registered ursig was at the diploma or associate-degree level have see the eed for more educatioal preparatio ad have completed bachelor s degrees i ursig or other health-related fields. School urses must have the expertise required to meet icreasigly complex health eeds, ad the skills ad educatio to provide for the comprehesive rage of services that school childre require. Natioal ad state leaders promote the baccalaureate degree as miimum requiremet for professioal school ursig. 3 I North Carolia, more tha 80 percet of school urses report holdig a baccalaureate degree or higher. School urses i North Carolia obtai cotiuig educatio activities offered through the ie regioal Area Health Educatio Ceters (AHECs), through a umber of Colleges of Nursig, ad through a etwork of state ad regioal school urse cosultats withi the N.C. Divisio of Public Health. New school urses lear their ew roles ad resposibilities through cotiuig educatio provided by the state Divisio of Public Health ad its co-sposors, as well as durig orietatio offered by their school district, health departmet or hospital employers. 3 America Academy of Pediatrics: Policy Statemet Qualificatios ad Utilizatio of Nursig Persoel Deliverig Health Services i Schools (RE7089). Natioal School Nurse Certificatio The Departmet of Public Istructio requires that all school urses hired by LEAs after July 1, 1998, hold atioal school urse certificatio. No-certified urses hired after this date may be employed but must achieve certificatio withi three years of date of employmet. School urses ot employed by LEAs are ecouraged, ad i some cases required, through their fudig parters, to obtai certificatio as a mark of achievig this icreasigly recogized stadard. Curretly, slightly more tha half (50.1%) of North Carolia urses workig i public schools hold atioal school urse certificatio from either (or both) of the atioal certifyig bodies: the America Nurses Credetialig Ceter (ANCC) or the Natioal Board for Certificatio of School Nurses (NBCSN). This rate is a ie percet icrease from the previous school year. This icrease ca be attributed to several factors: L O C A L O U T C O M E 100% of the studets beig case-maaged by a professioal registered school urse showed improvemet i oe or more of the areas addressed. the additioal 45 urses hired uder the School Nurse Fudig Iitiative (SNFI) durig the school year achieved certificatio durig school year. (May of the SNFI urses were ot certified whe hired i 2007 ad early It is recommeded that school urses experiece a full year i the practice before attemptig the certificatio examiatio); the work of the school urse cosultats i the School Health Uit providig educatioal support ad ecouragemet; ad the work of the Easter AHEC (Allied Health Educatio Ceter), which sposored a educatioal offerig, which was revised to icorporate iformatio i the 2008 textbook, Natioal School Nurse Certificatio. School urses i North Carolia, as a group, have may years of experiece i school ursig as well as i prior practice settigs. Durig the school year, 57 percet had more tha 3 years experiece. Ratio of School Nurse to Studets The atioal recommedatio for the school urse-to-studets ratio is 1:750 for the geeral studet populatio; 1:235 for schools i which 5

10 the studet populatio may require daily professioal school ursig services or itervetios; ad 1:125 for studets with severe ad profoud disabilities ad complex health care eeds. 4 Those are the ratios that would allow all studets to have their health eeds safely met while i the school settig, icludig appropriate prevetative, health promotio, early idetificatio ad itervetio services. For this report, school urse-to-studets ratios were based o full-time equivalecies (FTEs 5 ) of positios budgeted for school urses to work i local educatio agecies (LEAs). School urses workig solely as admiistrators, without caseloads of studets, were ot couted i the FTE or ratio. Usig that defiitio, there were 1, FTE budgeted school urse positios durig the just-completed school year. That total is 23 more full-time positios i the state durig tha durig The school urse-to-studets ratio varies widely across the state. At the ed of the school year, the statewide average ratio of school urse to studets was 1:1,207. Thirty-ie LEAs met the target ratio of 1:750, o chage from the previous year. The ratios durig the school year raged from 1:253 i Pamlico Couty to 1:3,309 i Davidso Couty. For a breakdow of school urse to studets ratio by LEA, see Appedix C, page Natioal Associatio of School Nurses, Positio Statemet, Caseload Assigmets, Adopted 1972, Rev. 2006; See also CDC Healthy People FTE = Full Time Equivalecy for school urse positios (37.5 or more hours/ week=1.0 FTE) Number of: Studet Populatio, School Nurse Staffig, ad Nurse-to-Studets Ratios School Year School Year School Year School Year School Year LEAs Schools* 2,182 2,227 2,338 2,354 2,399 Studets** 1,332,009 1,363,695 1,386,363 1,404,957 1,410,497 School Nurse FTEs , , , Average N.C. School Nurse/ Studet Ratio * Public Schools of North Carolia, Facts ad Figures , February 2009 ** NC DPI. Fial ADM. Retrieved 7/20/2009 1: 1,593 1:1,571 1:1,340 1:1,225 1:1,207 L O C A L O U T C O M E Our coordiated school health program has bee selected by the CDC as oe of six outstadig atioal programs (out of 80 evaluated). Employers of School Nurses School urses are primarily employed by their local educatio agecies (LEA). The admiistrative resposibility for almost 70 percet of school health services programs i North Carolia lies withi the LEA. The chart below shows the yearly icrease i North Carolia public school urses i the past five years. A relatively small umber of school urses are employed part-time. 6

11 Number of Idividual School Nurses (icludig part-time urses) School Nurses ,083 1,266 1,231 Admiistrative Resposibility for School Nursig Services Fiscal Aget Percet of school districts (LEAs) Local Educatio Agecy (LEA) 70% Health Departmet 16% Hospital/ Health Alliace 4% Fudig from a combiatio of sources 10% Fudig for School Nurses Although the local school board, or LEA, is the primary employer of North Carolia school urses, the moey for school urses comes from a wide variety of sources. Rarely is the etire school health services program fuded through a sole source. Fudig sources iclude: local tax reveue, through property taxes allocated to the local school ad local health departmet; North Carolia Geeral Assembly appropriatios, such as through distributios from the state Departmet of Public Istructio ad state Divisio of Public Health; federal reimbursemet, icludig approved Medicaid expese reimbursemets or federal Title V grats ad categorical fuds; hospitals; health care orgaizatios ad private foudatios. I recogitio of the eormous health eeds of school-age childre ad the relatioship betwee health ad academic success, the North Carolia Geeral Assembly has appropriated fuds through the School Nurse Fudig Iitiative (SNFI), which bega i the school year. These fuds are distributed by the Divisio of Public Health to local health departmets, local educatio agecies, ad hospitals employig school urses. I 2005 the Child ad Family Support Teams Iitiative was iitially authorized ad fuded by the NC Geeral Assembly. It was reauthorized i the 2007 ad 2009 state budgets. The iitiative provides recurrig state fuds to team 100 school urses with a equal umber of school social workers at 102 schools i 21 school districts across the state. The purpose of the Iitiative is to provide schoolbased professioals to scree, idetify ad itervee for childre who are potetially at risk of academic failure or out-of-home placemet due to physical, social, legal, emotioal or developmetal factors. Through these state ad local efforts to icrease fudig for school urses, the umber of LEAs meetig the recommeded ratio of 1:750 has early quadrupled i the five years betwee the ad school years Studet erollmet i North Carolia public schools icreased this past school year by 5,540. The labor demad for all urses, icludig qualified school urses, has grow rapidly i recet years. School health program supervisors, 47 of whom are registered urses, re-doubled efforts to attract ad retai school urses. I this past school year, they succeeded i fillig 99 percet of all school urse positios. 7

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13 School Health Services School urses provide basic ad comprehesive school health itervetios to all childre i the populatio served, icludig childre with special health care eeds resultig from acute ad chroic complex medical coditios. L O C A L O U T C O M E Oe of my studets has sickle cell ad a history of sub-stadard care at the Africa coutry from which he emigrated. He was crippled. The studet had o isurace or Medicaid. He bega to eter a pai crisis. Oe day, he lay out i a ditch i frot of the school ad sobbed because of the pai. [The studet s family was uable to receive help at a umber of cliics ad hospitals due to isurace status.] I called my cotact [at couty huma services] ad she did some checkig ad foud aother ceter had a ew patiet appoitmet the very ext day. The staff was able to get the studet see at hospital cliic without isurace. I the worked with the studet s family to help him obtai isurace. This sprig, the studet became a U.S. citize ad has isurace. He is scheduled for surgery to correct his legs. His pai is ow well-maaged. The studet stops by my office ofte just to say hello. His father cried while thakig me for the help I gave. Chroic Health Coditios A icreasig umber of studets with chroic health coditios atted school. Sice these coditios ca affect attedace, school performace, ad the studets level of well-beig, school urses work closely with studets, their families, health care providers ad school staff to reduce the egative impact of illess o learig. Nurses serve as case maagers, evaluate activities of daily livig, ad develop appropriate modificatios for the learig eviromet. The percetage of public school studets with chroic health coditios has rise almost every year for the past decade. The umber ad percet of studets with reported chroic health coditios are illustrated i the table below. Asthma, a major chroic illess amog school childre, is the leadig cause of school abseteeism atiowide, accordig to atioal experts o lug disease. The umber of North Carolia studets reported with asthma 75,576 accordig to the school urse reports, shows a 13 percet decrease (dow 10,861 studets from the prior school year). The lowered overall total icludes some school districts with higher reported umber tha last year ad some with lower. The North Carolia Divisio of Public Health Asthma Program has ot see similar reductio i umber of childre of school age with reported asthma. It is importat to ote that this report does ot report total icidece; it reports studet health coditios that are kow to ad reported by school urses. The reduced cout may reflect a chage i the workig defiitio of asthma amog school childre that school urses use. School urses are ecouraged to cout studets with curret asthma ad who eed medicatio either at school or at home, if kow. School urses are discouraged from coutig those whose asthma is described by parets vaguely, such as asthma as a ifat or oly whe he has a cold, ad this report may reflect removal of some studets from a school urse s list of studets with asthma. The lower umber may also be a outlier that will adjust itself i future years reports. Similarly to a lowered cout of studets with reported asthma, fewer studets were reported with severe allergies tha i the previous school year. Severe allergies are those for which a 9

14 studet carries or is provided medicatio at school, such as peaut allergies or isect stig allergies. This past school year, 18,439 were listed as havig severe allergies, 1,093 fewer tha durig school year Whether this reduced cout reflects a tred or a sigle outlier remais to be see. I North Carolia public schools, studets with asthma ad allergies may carry ad admiister their ow asthma medicatios after idetifyig the eed to school admiistratio ad health professioals. Studets who are self-medicatig for asthma should seek the help of a school urse to assist them i case of emergecy or iability to self-admiister the medicatios. There was a six percet rise i the umber of studets erolled who were reported with diabetes: 4,584. I respose to the icreasigly complex eeds ad high techology related to school-day maagemet of diabetes, school urses trai staff to care for studets with diabetes. The staff traiig icludes traiig of diabetic care maagers, a school fuctio established by the Geeral Assembly i 2003, ad developmet of diabetic care plas idividual health plas for studets with diabetes who eed care durig the school day. Studets with diabetes are ecouraged to self-maage their symptoms, which will most likely last their lifetime. School staff members assist studets as eeded. For a more extesive list of the types of chroic health coditios that were maaged at school, see Appedix A, page 25. Diabetes: 4,584 studets reported with diabetes 3,548 moitor blood glucose at school 2,101 receive isuli ijectios at school 1,544 maage isuli pumps 2,527 are kow to self-carry their medicatio L O C A L O U T C O M E Two ewly diagosed adolescets with diabetes were defiat ad o-compliat. After itesive ursig itervetio, they made sigificat progress i idepedece ad avoided hospitalizatio. Number ad Percet of Idetified Chroic Health Coditios School Year Number ad Percet ,035 (8%) ,765 (9%) ,589 (11%) ,329 (10%) ,877 (10%) ,559 (12%) ,052 (15%) ,718 (15%) ,940 (17%) ,245 (17%) ,528 (17%) School-based, School-liked Health Ceters Adolescets, who are ofte less likely to see a physicia for routie check-ups, i some school districts have access to medical care o the school grouds or earby. A few eve operate from travelig vas or buses to serve several schools. I school year , as i the previous year, there were 52 school-based, school-liked health ceters operatig i more tha 20 of the state s couties. Differet from a school urse s services, access to these ceters is limited to those with paretal permissio. Ceters provide primary care ad prevetive cliical services durig the school day, miimizig iterruptio of the studet s 10

15 time i class ad icreasig likelihood that the studet is healthy ad ready to lear. Ceters deped o a combiatio of govermet appropriatios, patiet reveues, private foudatio fuds/doatios ad i-kid resources to support the health services that they provide. The majority 28 are partially fuded by the N.C. Divisio of Public Health. These fuds are used to leverage additioal resources at the local level. Parters i these ceters iclude N.C. Departmet of Public Istructio, N.C. Divisio of Medical Assistace, families, private medical practices, local health departmets, ad the N.C. School Commuity Health Alliace (NCSCHA). Iformatio below represets reports submitted by the 28 ceters that receive partial fudig from N.C. Public Health. Additioal iformatio o school based health ceters may be obtaied from the NCSCHA website, Durig school year: 16,626 studets had paret/guardia permissio to utilize all services of the school based health ceter. Amog those studets, there were 85,984 studet visits, a average of five visits per studet durig the year. Studets were see by a variety of health care providers, icludig medical doctors; registered dieticias; behavioral ad metal health professioals; ad certified urse practitioers. Pregacy Three hudred fewer studets were kow to experiece a pregacy this school year, as reported by school urses. Although 4,660 adolescet pregacies is a serious cocer, this 5 percet decrease from the previous year is a ecouragig outcome as it follows several years of icreasig pregacy rates i the schools. This percetage decrease correlates closely with the 7 percet decrease i tee pregacies reported for 2008 by the October 2009 report of the Adolescet Pregacy Prevetio Coalitio of North Carolia (APPCNC). The percetage decrease was greatest i elemetary grade levels (50%) although the absolute umber is relatively low, with a decrease of 27 percet amog middle school females ad a decrease of 3 percet amog high school females. Although the majority, 77 percet, maaged the pregacy well eough to remai i school durig ormal school hours, 23 percet of studets, either i the preatal or postpartum period, received home-boud istructio for a time durig their pregacy. L O C A L O U T C O M E The school urse met with a distraught pregat tee who had just bee kicked out of her secod home. The urse met with the studet ad paret metor from the Y to arrage temporary housig ad trasportatio to school ad medical care. The appropriate referrals were made for a more permaet arragemet. Status of School Erollmet for Studets Kow to be Pregat Kow pregacies Studets receivig homeboud istructio due to pregacy (08-09) Elemetary Middle School High School Total : : : : : 4, : 4, : 4, : 4, ,338 1,398 11

16 School Year Pregacies reported to school staff % icrease or decrease from previous year ,089 N/A ,830 35% ,721 4% decrease ,316 22% ,914 12% decrease , % ,697 8% decrease ,131 16% ,406 9% ,072 20% ,422 9% ,904 11% ,660 5% decrease Suicide ad Homicide Itetioal death of studets, either through suicide or homicide, is a public health cocer. Although the umber is small by compariso with the adult populatio, the loss of a studet through homicide or suicide is a traumatic evet for the etire commuity. I North Carolia schools this past year, fewer studets died as a result of suicide or homicide. Accordig to reports from the LEAs, 17 public school studets died through homicide, a 4 percet decrease from the prior year. Suicide ad attempted suicide also were dow from the previous year, accordig to school health reports. Suicide was reported to be attempted by 422 studets, a decrease of 7 percet (from 455) from the prior year. There were fewer deaths by suicide: 15 i Noe of the deaths, either by suicide or homicide, occurred at school. Death by Suicide/Homicide: School year Elemetary Middle School High School Total Deaths from suicide Suicides occurrig at school Death from homicide Homicides occurrig at school Kow / Reported Suicide Attempts: School year Elemetary Middle School High School Total Attempts by grade level

17 L O C A L O U T C O M E The urse ad the couselor recogized sigs of suicide i a studet with severe medical problems ad depressio. After a referral ad proper medicatio, he is doig much better. Studet Tobacco Use Effective Aug. 1, 2008, all schools must adopt, implemet, ad eforce tobacco-free 6 school campus policies. I additio to state law ad school policy, schools commuicate tobaccofree messages to youg people through health educatio programs, social marketig messages, cessatio classes for studets or staff, ad through the day-to-day modelig ad iteractios amog staff ad studets. School urses also offer classes ad programs to reiforce restrictios agaist smokig ad to ecourage cessatio. L O C A L O U T C O M E As a result of programs ad couselig by the urses ad others, the tobacco ad substace abuse percetages were decreased this year, accordig to the YRBS survey. Health Couselig Studets cotact the school urse for aswers to questios ragig from ormal growth ad developmet to serious emotioal ad metal health cocers requirig referrals to metal health professioals. Durig the school year, the umber of such ecouters reported by school urses icreased 22 percet, from 65,000 durig to 80,000 last year. The sigle greatest percetage icrease, 49 percet, was for idividual couselig to middle-school-age studets about sexual ad reproductive health, icludig puberty ad persoal hygiee. The other categories for which idividual couselig sessio umbers wet up across all grade levels were for child abuse or eglect; substace abuse, ad tobacco use. Idividual discussios aroud depressio/ suicide wet dow across all grade levels. Idividual Health Couselig Sessios Couselig Topic Elemetary Middle High Total Percet chage i total couselig to Child Abuse/Neglect 2, ,815 21% Depressio/Suicide 751 2,004 3,824 6,579-27% Grief/Loss 1,188 1,048 2,075 4,311 3% Pregacy 83 1,317 9,254 10,654 10% Puberty / Hygiee / Reproductive Health 15,004 13,738 12,665 41,407 49% Substace Abuse ,677 3,828 44% Tobacco Use 315 1,051 2,770 4,136 15% Violece/Bullyig 1,704 1,922 1,644 5,270-7% Total 21,501 22,785 35,714 80,000 22% 6 School policy totally prohibits tobacco use for all studets, staff, ad visitors i the school buildigs ad exteds to the etire campus, vehicles, ad all school evets icludig outdoor evets. The policy exteds to hours after regular classroom schedules, 24 hours a day, seve days a week ad icludes off-campus school sposored studet evets. 13

18 Health Teachig School urses were ivolved i a variety of health teachig ad istructioal sessios to groups ad i classrooms. Classroom istructio icluded short presetatios o such topics as hygiee, first aid, welless ad fitess promotio, Ope Airways ad other asthma maagemet programs, AIDS peer educatio, smokig prevetio ad cessatio, violece prevetio, puberty, ad preatal ad paretig programs. Istructio to faculty ad staff icluded the topics of medicatio admiistratio, ifectio cotrol, OSHA blood-bore pathoge regulatios, CPR, use of AEDs, first aid, ad chroic disease maagemet, icludig geeral traiig o the sigs ad symptoms ad first aid for diabetes, ad itesive traiig for the care of idividual studets with diabetes. The urses also coducted health fairs ad made presetatios to paret orgaizatios, school boards, ad civic ad commuity groups. All i all, the urses reported providig 30,206 programs ad presetatios durig the school year, up 17 percet from the previous school year. 43 LEAs (37%) have asthma educatio programs for staff. 51 LEAs (44%) have asthma educatio programs for studets. Ofte, the school urse is the first health care provider that the studet sees. I some cases, the urse is the oly health care provider the studet sees for mior illesses ad ijuries. Last school year, school urses maaged early 50 percet more idividual ecouters with L O C A L O U T C O M E Oe child was abset with asthma very frequetly; he took my Ope Airways class, ad dad started takig him to the doctor more appropriately; he was started o a differet medicatio ad oly missed 2 more days due to asthma the rest of the year. studets to assess ad maage a illess or ijury that origiated at home. It is ot kow whether the health isurace status or ecoomics of those families caused this icrease i usig the school urse for primary care. Durig the school year, urses evaluated at school more tha 257,628 studet ijuries ad acute illesses that had origiated outside of school, up from 172,734 the previous year. I additio to providig care ad guidace, urses assist families by locatig medical ad detal resources ad referrig studets to providers for the diagosis ad treatmet of a wide variety of health problems. Health Care Treatmets ad Procedures at School Some studets with chroic illesses, physical hadicaps ad/or disabilities require health care procedures to be performed durig the school day. The urses reported processig orders for at least 29,705 idividual medical treatmets or procedures, a icrease of 5,542, or early 25 percet, i orders over the previous year. The icrease reflects icreased umbers of cases ad/ or icreased use of medicatios ad treatmets durig the school day. L O C A L O U T C O M E I am case-maagig a eight-year-old child with diabetes. By sprig, his A1C improved two poits from the begiig of the year, ad he is ow able to recogize ad articulate the sigs ad symptoms of hyper ad hypoglycemia. He is able to admiister his ow ijectio, usig excellet techique, ad usually does ot require ay verbal cues. 14

19 Number of Specified Health Care Procedures (partial list) Health Care Procedure Total Cetral Veous Lie 38 Diastat (rectal diazepam [Valium ] 1,316 Glucago Ijectio 2,365 Nebulizer Treatmets 1,948 Shut Care 181 Tracheostomy Suctioig & Cleaig 99 Tube Feedig 560 Use of Epi-pes 9,595 Bladder Catheterizatios 314 Orders for emergecy treatmets for seizures ad severe allergies cotiued to icrease this school year, leadig all other icreases for specific health care procedures. The orders for Diastat, a medicatio used to treat sudde ad prologed seizures, icreased 16 percet durig school year It is importat to ote that the umber of studets for whom Diastat is ordered does ot ecessarily mea that the medicatio, which is admiistered rectally, was give. It is usually prescribed for prologed, itractable seizures, ad seizures amog school-age childre, oce diagosed ad uder medical maagemet, may rarely maifest themselves i school to this degree. Orders for ijectible epiephrie (EpiPe ) for severe allergies icreased 8 percet, followig a 35 percet icrease i the previous two school years. Orders for ijectible glucose (Glucago ) for diabetes remaied essetially uchaged at 2,365 durig school year , i cotrast to a combied 31 percet icrease i the umbers of orders betwee the two school years from 2006 through Orders for the other health care procedures listed remaied essetially uchaged from the prior year. As stated, a existig order for a treatmet or procedure idicated as eeded rather tha routiely admiistered, may ot, o ay sigle child, eed to have bee admiistered durig the school year or durig the school day. I future years reports, the data will iclude how ofte some of these emergecy drugs were admiistered. L O C A L O U T C O M E I referred oe of my asthmatic studets with frequet flares to the doctor. He was referred to a allergy specialist ad was foud to have several food allergies. He is doig much better sice those foods have bee elimiated from his diet. Medicatig Studets Admiistratio of medicatios to studets by school staff is a serious resposibility requirig coscietious attetio to givig the correct medicatio i the correct dose to the correct studet every time. Secretaries, classroom teachers, ad teacher assistats are primarily the school staff members who admiister routie medicatios o a daily basis i the majority of school systems i North 15

20 Carolia. To esure that school staff perform this task with safety ad accuracy, it is essetial that a school urse be available to review ad participate i the developmet of school policy ad procedures; trai ad supervise teachers ad other staff about all aspects of givig medicatios correctly; ad serve as coordiator amog parets, medical providers, ad the school. I early all of the LEAs, school urses provided formal traiig programs for school employees who were desigated to admiister medicatios. They also coducted periodic audits of medicatio charts ad records to assure compliace with all physicia ad paret orders ad to assess the studets resposes to medicatio therapy. Durig the school year, urses reported that 30,034 medicatios were give daily to studets while at school, a umber essetially uchaged from the previous year. Some received medicatio daily o a log-term basis (20,766) for chroic coditios, ad others for a shorter duratio (9,268), such as to treat a ifectio. Medicatios received most frequetly o a daily basis icluded psychotropic cotrolled substaces, icludig Ritali, Dexedrie, ad Lithium. However, there was a 24 percet icrease i the umber of medicatios ordered o a as-eeded basis either for serious coditios such as severe allergies, diabetic episodes, ad acute asthma episodes, or for less serious coditios such as temporary pai from a procedure or ijury. The 24 percet icrease i the umbers of these medicatio orders from 39,985 to 49,456 is of cocer to school health professioals ad pediatricias if the icrease reflects frequet use of over-the-couter (o-prescriptio) drugs for temporary ad/or mild coditios. The America Academy of Pediatrics recommeds that school childre take medicatio at school oly whe ecessary ad whe the medicatio caot be give at home. (America Academy of Pediatrics, October 2009, positio statemet) Sice a umber of over-the-couter drugs ca cause side effects or mask serious illesses or coditios, state recommedatios are to discourage ulimited use of o-prescriptio medicatios for school childre ad require ot oly paretal authorizatio but also medical provider authorizatio for ay medicatios give i school durig the school day, whether or ot a prescriptio is required for the product. Over-the-couter drugs give i some school districts iclude atihistamies such as Clariti ad Beadryl, pai relievers such as Advil ad Tyleol, ati-acids such as Tums, sublock products, cough drops ad others. While o more tha approximately two percet of the studet populatio at ay particular time is takig a medicatio that is ordered for every day at the same time, school urses are maagig early twice that umber, early 50,000, medicatios that are ordered as eeded. Determiig whether the studet is describig a situatio that requires that as-eeded medicatio ivolves iterviewig the studet, assessig the situatio, ad decidig o a course of actio. The school urse ofte trais a o-health care professioal, also called Ulicesed Assistive Persoel, to hadle those studet medicatio situatios. Additioal school urse ivolvemet may be eeded whe a medicatio is ordered with parameters, such as oe or two pai relievers depedig o pai level, or two types of allergy medicatios depedig o relief obtaied by the primary medicatio. L O C A L O U T C O M E A studet i alterative school previously scored oes o EOGs. He was referred to the school urse for possible ADD. The urse was resposible for gettig the studet referred ad o medicatio, ad the studet scored two 4 s ad a 3 o this year s EOG tests. 16

21 The followig table ad graph provide a 10-year overview of the umbers ad percetage of studets receivig medicatios as reported by school urses. There is a otable decrease i umbers of daily medicatios durig this decade, by early 50 percet, ad a icrease i those give itermittetly for episodes or symptoms. This shift ca be attributed to a chage i dosage from short-actig to loger-actig formulas for a variety of coditios ad to a rise i the umbers of medicatios for episodic coditios such as asthma, seizure, allergy, or chroic coditios that flare up. This chage has held steady over the past few years. Number ad Percet of Studets Receivig Medicatios Admiistered at School School year # Studets Daily Medicatios No-Daily (Itermittet) Medicatios ,237,794 50,554 (4%) N/A ,243,442 49,303 (4%) N/A ,271,995 35,319 (3%) N/A ,279,468 24,477 (2%) N/A ,311,163 29,321 (2%) N/A ,332,009 19,541 (2%) N/A ,363,695 19,772 (1%) N/A ,386,363 27,990 (2%) N/A ,404,957 30,433 (2%) 39,985 (2.2%) ,410,497 29,814 (2%) 49,456 (3.5%) Number of Studets Receivig Daily Medicatios at School 60,000 50,000 40,000 30,000 20,000 10, School Year 17

22 Health Care Coordiatio ad Case Maagemet The school urse s role ofte exteds beyod the school settig. Childre with chroic or serious acute illesses ad coditios ofte require frequet daily ursig itervetios ad case maagemet to eable them to remai i school. School urses utilize a variety of strategies to commuicate with all those ivolved i the care of a studet. Nurses serve as liaisos with physicias, detists, commuity agecies ad families while supportig ad carig for the health eeds of studets. Amog the strategies school urses elist to provide health care coordiatio ad case maagemet is makig visits to the homes of studets. More tha 13,574 home visits were coducted durig the school year to assist families with studet health issues. This umber reflects a icrease of almost 10 percet, or 1,229 more home visits. support, psychosocial itervetio, ad documetatio ad evaluatio. Through collaboratio with a research project at East Carolia Uiversity, school urses are fidig additioal evidece for comprehesive maagemet of studets with chroic health coditios. I additio, case maagemet is part of the North Carolia Child ad Family Support Teams Iitiative. Regardless of the model used, coordiatio of care of a studet with special health care eeds serves to icrease a studet s ability to maage the coditio i school, with a goal of icreased educatioal achievemet ad improved health outcomes. L O C A L O U T C O M E The school urse did such a good job applyig a butterfly badage to a gapig woud o a studets elbow, that the doctor said there would be o eed for stitches. L O C A L O U T C O M E Two studets were case-maaged for bipolar ad depressio/axiety problems. Both felt very trapped ad hopeless, ad felt their coflicts were ot ever goig to improve whe I started workig with them. By the ed of the year, both studets had goe through medical treatmets ad family couselig which did actually help reduce coflicts; grades improved i both cases, ad they felt a icrease i self esteem. Oe studet is graduatig ad goig ito ursig school ad is lookig forward to college ad movig out of state. Case maagemet has bee foud to be a useful model through which to coordiate a studet s health care. I early a fifth of the school districts (22), the process has bee formalized ito a Case Maagemet Program with core compoets of assessmet, health care maagemet, commuity resources ad Emergecy Care Ijuries ad illesses are commo occurreces i the school-aged populatio. Because the majority of school urses cover more tha oe school buildig, few schools have a school urse o duty durig the etire school day. Therefore, school urses must assure that school persoel are traied to provide first aid i emergecies. Sixty-five percet (75 of 115) of the LEAs reported havig First Respoders available daily i each school buildig. May mior icidets occur to studets ad staff durig the course of the school day ad are ofte hadled by teachig ad office staff. School urses are frequetly required to assist with major ijuries, of which there were more tha 20,932 this past year, a slight decrease of about 1,000. Serious ijuries are defied as medical emergecies requirig a Emergecy Medical Service (EMS) call or immediate medical care plus the loss of oe-half day or more of school. 18

23 Of the serious ijuries reported, most occurred o the playgroud or school sports fields (27%) ad i physical educatio (27%), ad aother 25 percet occurred i the classroom. For a complete breakdow of type ad place of ijury, refer to Appedix B o page 26. Two studets died from their ijuries, ad both deaths were related to high school football. Eleve studets were permaetly disabled, with disabilities ragig from permaet erve damage, to loss of a digit, to reduced brai fuctio. More of the ijuries ivolved law eforcemet this year: 1,048 compared to 821 i school year Services by NC Oral Health Sectio Staff The Oral Health Sectio (OHS) of the North Carolia Divisio of Public Health is the oly program that develops ad implemets a statewide program of school-based detal services, with a emphasis o childre, to reduce tooth decay ad promote oral health. OHS public health detal hygieists, primarily state fuded, workig i elemetary schools throughout the state, provide detal screeigs, referrals, follow-up, ad educatio, as well as prevetive detal sealats ad fluoride mouthrise for low icome childre at high risk for tooth decay. School urses i may couties collaborate o a umber of detal health services, icludig sealats, fluoride mouthrise ad follow-up for care. For more detailed iformatio, see the Oral Health Sectio Aual Report, available at Health Screeig, Referral, Follow-up, ad Securig Care Volutary mass screeigs by grade or school are ofte coducted with the assistace of traied voluteers or other health professioals (example: audiologists, detal hygieists, ad speech/laguage pathologists). Visio screeigs are coducted by school urses as well as by other school staff ad voluteers. School urses follow up o those referred for visio examiatio ad i may cases are the persos who locate sources of free care for those uable to afford treatmet. Sigificat umbers of studets who were referred to a detist or doctor based o the screeig process did ot or were ot able to secure that care from a health professioal. Additioal staff, to provide appropriate follow-up ad care maagemet services for studets, may reduce this gap i the completio of the screeig process. I some situatios, securig additioal health care providers may also reduce the gap. L O C A L O U T C O M E The urses quickly secured fuds for studets eedig eye exams ad glasses before the ed-of-grade tests. More families are havig fiacial struggles, ad urses cotiue to assist them o a oe-by-oe basis. 19