Staff and Student: Each Healthy and Ready to Learn

Staff and Student: Each Healthy and Ready to Learn Jessica Gerdes, MSN, RN, NCSN, IL-PEL/School Nurse Illinois State Board of Education Principal Consultant / School Nursing, Health Issues Physical Education and Health Education

Today s flight pattern

Federal Admin SPED, Ed Health Services School Board Policy School Statutes, Nurse Practice Act 504, IDEIA, HIPAA, FERPA (Shannon & Gerdes, 2015)

Student and Staff Privacy FERPA and ISSRA for students Exceptions for serious and imminent threats to health and safety Required release related to vaccine compliance HIPAA for staff: Definition of HIPAA covered entity Release of information related to outbreaks of communicable disease

OHI: Health qualifier Involvement of nurse: In the initial health evaluation and re-evaluations In the present level of functioning In the treatment plan In the educational plan Consider first evaluating and reporting on health strengths Health impairments compared to adequate function

Transition Plans School Code requires that transition plans be in effect on or before a student turns age 14 ½ Federal law requires transition plans by age 16, but states can provide at younger age Goals and services in the area of independent living skills are required to be provided (in addition to post-secondary goals and services in areas of training, education and employment) For students with IEPs and health needs, consider a nursewritten transition service and goal for the student Examples: be able to define his or her condition using medically accurate terms; be able to list his daily medications; be able to provide self-care, such as personal hygiene, medical treatments, refill of prescriptions

Monitoring Disease and Preserving FERPA Monitoring of ILI (Influenza-like Illness) Charts with initials should not be used outside of temporary school need No initials or other identification may be released outside of school Mandate to Report Reportable Diseases Posters produced by IDPH and mailed by ISBE Immediate and within three hours reports justifiable without parental permission

State Admin SPED, Ed Health Services School Board Policy School Statutes, Nurse Practice Act, Health Laws 504, IDEIA, HIPAA, FERPA (Shannon & Gerdes, 2015)

State Law State Legislation on minor s rights to health care School requirements Consent laws Medication laws (self-carry, epinephrine, diabetic care, etc.) Access to family planning State Nurse Practice Acts Scope of practice Delegation Differ from state to state

Student vaccinations Implementation of vaccine against meningitis Compliance / enforcement measures Medical Schedule; Medical Contraindications; Physician Statement of Immunity Religious Objections (SB 4510 now P.A. 99.0249

CPR/AED Training in High School Public Act 98-0632 became effective July 1, 2014 Beginning with 2014-15 school year, training on CPR and AEDs shall be included in the curricula for all secondary schools Guidance on ISBE website Amends the Act that describes all health education requirements, available at: http://www.ilga.gov/legislation/ilcs/ilcs3.asp?actid=1015& ChapterID=17

CPR / AED Training Implementation guidance Instructor hold current CPR/AED certificate No certificate of passing or completion is required for the student Do not need to catch up for transfer student if the training was offered prior to transfer in, and no penalty if a student was absent (local decision) Not a requirement for graduation Does not specify when in the curriculum it must be offered

Recently enacted laws Teach students about dangers of powdered caffeine Establish concussion policy, protocols and procedures Religious objection needs to be signed by health care provider and required with grade levels at required physical examinations: Kindergarten First entry to Illinois school Sixth grade Ninth grade Anytime a new vaccine is required if not in those grade levels

Required Training for School District Personnel Updates in laws specifying staff health training Federal and state OSHA laws Suicide, Mental health Resources at ISBE and elsewhere IDPH Suicide Prevention Program IL-AWARE program

Physical Fitness Assessment in Schools Public Act 98-0859 requires fitness testing of students Indicators to be reported to ISBE on aerobic capacity (grades 4-12), body composition, muscular strength, endurance and flexibility and other data including demographic information (grade, gender) Development of protocols to protect students confidentiality and individual identifiers Established Task Force; Report and Recommendations available at: http://www.isbe.net/epe/pdf/setfpe-report-040115.pdf Current state law: all students in K - 12 public schools to be offered daily, high-quality physical education in order to promote academic achievement and realize the lifetime benefits of fitness

Epinephrine P.A. 98-0795 Guidance document available at http://www.isbe.net/speced/pdfs/guidance-15-02-self-admin-epi.pdf Rule pending board approval August 19 Authorizes but does not require undesignated epinephrine to be available in Illinois schools Allows administration of undesignated epinephrine to any person not previously known to have severe allergy and/or not previously given a prescription for epinephrine Requires a report to ISBE within three days of the administration of undesignated epinephrine to one not previously known or not with a previous medical order Required reporting form at http://www.isbe.net/speced/pdfs/34-20-undesignated-epinephrine-rptg.pdf Summary of reports 2014-15 school year coming October

Nurse Extenders What constitutes a nursing activity vs a nursing task (Illinois Nurse Practice Act) The duty to provide registered professional nursing practices, as defined in Section 50-10 of the Nurse Practice Act, shall not be included among the functions assigned to any school district personnel not covered by the job description required for school nurses (ISBE 23 ILLINOIS ADMINISTRATIVE CODE 1.760 SUBTITLE A SUBCHAPTER Section 1.760 Standards for School Support Personnel Services; Amended at 38 Ill. Reg. 6127, effective February 27, 2014)

The 21 Tasks of the CNA Personal Care Tasks Such as: Meal preparation Meal set-up Oral feeding Oral care Nail care Basic hygiene Bathing Dressing Toileting Ambulation assistance Catheter: changing of bags and charting amounts Ostomy care: empty, clean, change appliance Turn and position Changing bed clothes Charting requested information Recreation activities The only tasks that might be considered medical or nursing are obtaining vital signs and clipping toenails of diabetic client.

Comprehensive Sexual Health Education Public Act 98-0441, effective January 1, 2014, requires schools that teach sex education in any of grades 6-12 to include instruction in both abstinence and contraception, and to teach with materials that are evidence-based and medically accurate. CDC Award to ISBE to carry out exemplary sexual health education and improve policy and practice statewide. Contact Dr. Reginald Patterson, Ed.D, for more information and resources

Medication Administration Nurse Practice Act regarding delegation of medication: RN may not delegate to unlicensed person medication administration Proposed rule created by Department of Financial and Professional Regulation creates Licensed Medication Aide Pilot program proposed in long term care facility (skilled nursing facility) does not apply to schools LMA would assist with medication administration while under the supervision of an RN Would change Nurse Practice Act regarding delegation of medication: RN may not delegate to unlicensed person medication administration except may delegate medication administration to a licensed medication aide in a qualified facility as authorized by Public Act 98-9900 effective August 18, 2014 Public comment ended January 2015; update possibly end of summer

ISBE Admin SPED, Ed Health Services School Board Policy, Guidance School Statutes, Nurse Practice Act 504, IDEIA, HIPAA, FERPA (Shannon & Gerdes, 2015)

Immunization Data New this past year - a question on exemptions related to homeless status question to be refined to decrease over/under reporting of noncompliance Religious objection - SB 1410 passed by General Assembly and signed by Governor Rauner 8/3 requires specified form and signature from health care provider regarding benefits of vaccination to student and community By December 1 of each year, schools must make publicly available the immunization data they are required to submit to the Illinois State Board of Education (P.A. 097-0910) How are your schools making the data publicly available? Compliance checks

Home and Hospital Instruction Medical certification form in draft Does not require a 504 plan Special Education credentials if IEP Q&A on ISBE website: http://www.isbe.net/funding/pdf/home_hospital_qa. pdf

Health Evaluation for Special Education IDEA requirement to rule out medical issues (among others) for students determined to have learning disability Personnel qualified to perform Medical Review Components of Medical Review Not just a health history No other personnel qualified to perform

Health Education include special education State laws require these selected topics: Sexual assault awareness age appropriate, developmentally appropriate, culturally appropriate Daily physical education student with adapted sports activity outside of school can petition for waiver from daily PE Teen dating violence policy Sex education: if taught, follow law on content CPR: can waive participation in this class; consider cognition as well as physical skills

Pending rules Epinephrine Act (rules similar to guidance) Employee screening for tuberculosis Highly qualified teachers of physical education http://www.isbe.net/rules/default.htm

Performance Evaluation of Student Support Personnel School Code states that to improve the educational services of the elementary and secondary public schools of Illinois... all certified school district employees be evaluated on a periodic basis "teacher" means any and all school district employees regularly required to be certified under laws relating to the certification of teachers consideration of student growth is to be considered a significant factor in the rating of the teacher's performance Student Support Personnel (SSP) in non-teaching roles are not required to show student growth as part of their professional evaluation ISBE guidance related to professional evaluation of SSP is under development

ISBE Staff Admin SPED, Ed Health Services School Board Policy School Statutes, Nurse Practice Act 504, IDEIA, HIPAA, FERPA (Shannon & Gerdes, 2015)

Revisions of Manuals Medication Administration Guidelines Management of Chronic Infectious Diseases in School Children

Medical Review Evaluation for Special Education 381 RNs have completed the course 80 spring 2014 71 summer 2014 76 fall 2014 74 winter 2015 80 spring 2015 2 RNs have indicated completed test option Classes scheduled through Spring 2016 Significant of July 1, 2016 Components of medical review Qualifications of persons to conduct medical review Role of RN on IEP teams Form on which to document designation for IEP for non-isbe school nurses coming soon

Re-Licensure of School Nurses Professional Development requirements for Registered Nurses (and other student support personnel) who hold ISBE professional educator license changed in November 2014. Prior to November 2014, 120 hours of professional development were required in order to renew an ISBE license. At time of next renewal, applicant will attest that she or he has current and active RN license issued by State of Illinois and has satisfied the professional development requirements of IDFPR. At time of next renewal, those school nurses who hold IDFPR license are deemed to have satisfied the renewal requirement and only need to pay registration fee on the educator license. Illinois Nurse Practice Act requires registered nurses to complete 20 hours of continuing education per two-year renewal period. Reference: Section 5/21B-45 of School Code http://www.isbe.net/licensure/html/license-renewal.htm

Your School or District Admin SPED, Ed Health Services School Board Policy School Statutes, Nurse Practice Act 504, IDEIA, HIPAA, FERPA (Shannon & Gerdes, 2015)

The no nit police Protects the Student Assure the Parents Protects the School Informs the School Staff Protects YOU! The School Nurse Gives School Nursing visibility Makes our jobs easier!

Head lice: Treatment, not Isolation

Reimbursement for School Nursing Services: Really? Really!

Reimbursement for Nursing Services Special education: guidance issued May 20, 2015 Fully licensed School Nurse Noncertified Health Aide Individual Student Aide Medicaid free care rule letter and follow-up HFS website: Medicare/Medicaid Services The Centers for Medicare and Medicaid (CMS) recently released the "Medicaid School Based Administrative Claiming Guide". The Guide offers instructions on submitting claims for school based administrative costs and implementing and managing administrative claiming programs in accordance with statutory and regulatory requirements. The Illinois Department of Public Aid is currently reviewing the new Guide in the context of the approved Illinois program and will be notifying school districts of any changes in the program via the School Based Health Services website http://www.sbhsillinois.com/, provider notices and training opportunities. Further information about the School-Based Health Services program is available by E-mail or by calling the SBHS office at 217-782-3953

Step Up Be Counted! School Nurse Data Set Project 76% of states participating, including Illinois Voluntary School nurse consultants at IDPH and ISBE supporting and coordinating with NASN and NASSNC 187 Illinois school districts and/or schools entered data into the software set up by NASN (National Association of School Nurses) For more information: http://www.nasn.org/r esearch/stepupbecoun ted

Illinois Student Health Services Workforce 2014-15* RN FTE direct service 978 LPN FTE direct service 120 Health Extenders Direct & Regular Service 220 RN Supplemental 31 RN special assignments 100 * Preliminary data of school nurses reporting

Diagnosed Chronic Health Conditions 2014-15* asthma 59,473 life threatening allergy 15,139 939,875 Students counted Type 1 Diabetes 2,383 seizure disorder 9,127 Type 2 Diabetes 1,486 * Preliminary data of school nurses reporting

Health Office Dispositions (pending) students were returned back to the class for academic instruction students were sent home due to illness students required emergency services or 911

Staff Wellness http://healthyschoolscampaign.org/blog/improving-school-health-from-all-angles

School Nurse Leadership Award -Healthy Schools Campaign- Sandy Lawinger, RN, MS, PEL SN, district nurse, Community Consolidated School District #89

Component of CDC Model Coordinated School Health Employee Wellness Committee Representation from variety of buildings and job descriptions Staff flu clinics Staff blood pressure clinics Wellness screenings, with results leading to action and activities (weight loss, nutritious vending, after school sports or physical activity, Zumba, yoga, etc.) Blood drives Stress reduction measures Life Satisfaction quality of life indicators social-emotional skills

References In addition to ISBE resources and School Code, these resources were used in preparation of this session: American Academy of Pediatrics, Council on School Health: (2004). School Health Policy and Practice (6 th Ed.) Elk Grove Village., IL: American Academy of Pediatrics. American Academy of Pediatrics, National Association of School Nurses. (2011) The Scope and Standards of Practice for School Nursing American Academy of Pediatrics, Council on School Health and Committee on Infectious Diseases (2015) PEDIATRICS Volume 135, number 5, May 2015 Gelfman, Mary; Schwab, Nadine. (2005). Legal issues in school health services Illinois Department of Financial and Professional Regulation, accessed at http://www.idfpr.com/profs/info/nursing.asp Illinois General Assembly, http://www.ilga.gov

Contact Information JESSICA GERDES DIVISION OF SPECIAL EDUCATION SERVICES JGERDES@ISBE.NET 312-814- 5560