Changing the Way We Do Business:
Working SMARTER not HARDER ?
Rebecca King RN, CSN, MSN, MEd
School Nurse Liaison
WVDE-Office of Healthy Schools

Objective #1:
• Participants will be knowledgeable of the vision for school health service initiatives at a national, state and local level.

WV State Board of Education
(Promulgate educational rule for PreK-12, adult vocational, institutional education facilities and the school for the deaf and blind)
State
Superintendent of Schools
Deputy
Superin tendent
RESA OEPA
WVDE Offices

Coordinated School-Public Health Structure

• Work Plan
– Local Wellness
– Bullying (S3 high schools)
– Substance Abuse (SBIRT)
– Suicide Prevention (ASPEN)
– Teen Pregnancy (HEAP, PREP grants)
– Physical Activity (Let’s Move)
– Nutrition (current WVDE-OCN initiatives)
– Tobacco Prevention (Quit Kits)

• SN ratio of 1:1500 K-7 (W.Va. Code §18-5-22)
• WVBE Policy 2422.7-Standards for Basic and
Specialized Health Care Procedures in the
School Setting
• WVBE Policy 2422.8-Medication
Administration (Prescribed and OTC)
• WVBE Policy 2423-Communicable Disease
Control (HIV & Comm. Dx Inservices)

• WVBE Policy 5200-
Certification…Authorization, Permit, Full
Certification, Short or Long-Term Substitute and PPST
• Asthma laws-W.Va. Code §18-5-22b
• Diabetes laws- W.Va. Code §18-2K-1
• High Acuity Funding-W.Va. Code §18-5-22

Top 5 Medical Diagnoses/Procedures
2010/11 School Nurse Needs Assessment
Medical Diagnoses In-School Specialized
Health Care Procedures
Asthma
Behavioral Disorders
Anaphylactic Reaction
Inhalers for Asthma
Emergency Medications
Long-Term Medications
Obesity Special Diets per Federal Form
Mental Disorders (Depression,
Bipolar, Schizophrenic, Suicidal)
Close 5 th places…..
Ear, Nose and Throat/
Migraine or Severe
Headache/Seizures
Seizure Management

Diabetes Type II
2010/11
Student Medical Diagnoses
Diabetes Type I
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
238
852
2147
4213
11491
16145
Seizures
Anaphylactic
Reaction
Behavioral
Disorders/ADD/
ADHD/OCD/Anxi ety
Asthma

Efficiency
• Multidisciplinary Team (SN, LPN,
Aides, Health Clerk/Secretary)
• Utilization HealthCheck examination for new school enterers…No mass school screenings
• Evidence-based practices and policies (BMI, Scoliosis,
Screenings, Lice, Prevention
Programs, etc.)
• SBHC with full array medical, dental and mental
•
Model
YOUR County
 WVDE-Healthy Schools at http://wvde.state.wv.us/healthyschools/quicklinks.html
.

1:750 Well child
1:225 Chronic conditions
1:125 Complex conditions
1:1 as needed for multiple disabilities

1340 + 150 + 10 + 2 =
750 225 125 1
1.66 + .66 + .08 + 2 = 5.28 nurses

1340 + 150 + 10 + 2 =
750 225 125 1
1.66 + .66 + .08 + 2 = 2 RNs
1 P/T LPN
1 clerk

• Identify school nurse delivery models
(school nurse caseloads, credentials, experience, etc.) necessary for quality nursing care
• School nurses must identify and measure outcomes expected as a result of quality school nursing care

• Identify factors that measure the impact of nursing care over and above other factors
• Outcomes “sensitive” enough to distinguish between the effects of family and community and the effects of the quality and the quantity school nursing interventions on child, family and school community outcomes

• WV children with increased insurance coverage
• Expansion of Primary Care Center services and funding
(currently serving 1 in 5 West Virginians)
– School-Based Health Services
• Dental
• Mental Health
• Family Planning
Helping us move to full-service communities/schools

Objective #2:
• Participants will be familiar with evidencebased practice recommendations in school health and challenged to fully utilize them in daily practice.

• Immunizations, Immunizations,
Immunizations
• HealthCheck, Parent and Provider
Education, HealthCheck, Common language, HealthCheck, Medical home concept
• Evidence-based Practice and
Programs

• USPSTF recommends Medical provider screening for 6 -18 year old with comprehensive weight management program. Inclusive of counseling, diet, physical activity and behavioral interventions which are beyond our scope as nurses.

• CDC (2007) recommends surveillance only not census or population-based screening by school personnel.
• Health and physical education including modeling school meals and physical activity for schools.
• Medical home management.

Acanthosis nigricans (AN)
• CDC is aware that some groups are interested in AN screening of children in school settings to identify those at high risk to develop type 2 diabetes. Although some studies have observed that half the children with type 2 diabetes had AN, insufficient evidence exists for us to conclude that having AN will lead to type 2 diabetes.
Therefore, at this time, CDC scientists strongly discourage AN screening of children in school or community settings.

Acanthosis nigricans (AN)
• While AN is a reliable and independent marker of hyperinsulinemia , the extent to which AN predicts the development of type 2 diabetes is unclear. In this study, none of the 233 students screened had hyperglycemia .
• CDC scientists are not aware of any systematic guidelines for clinical detection of AN or a uniform AN case definition. The repeatability, reliability, and validity of AN screening, relative to expert diagnosis (gold standard), is unknown . This makes it impossible to meaningfully interpret AN screening results.
Therefore, the utility of using AN as a screening tool for diabetes prevalence or as a predictor of developing diabetes is currently unknown .

Acanthosis nigricans (AN)
• Those adolescents who have AN can be stigmatized by the screening process and subsequent identification. We are also concerned that if AN status becomes a part of adolescents' medical records, it might jeopardize their future insurance benefits.
• Most importantly, there are now no known interventions or protocols to treat those who have AN . There is some evidence that those with AN might benefit from physical activity.
Because improved physical activity benefits everyone in school or communities, it makes sense to encourage physical activity for all children, regardless of AN status .
• Medical home screening.

Acanthosis nigricans (AN)
• Given the absence of a uniform case definition and intervention protocols for those with AN and considering the risk of stigmatization for those with AN , CDC scientists believe that it is not ethical or cost-effective to mass screen children for
AN. CDC recommends that state diabetes control programs consider an alternative primary prevention approach and use available resources to improve physical activity and nutrition in schools and communities.

• Affects only 2-3% of entire US Population.
Do the math.
• USPSTF did not find GOOD evidence to support this screening for early detection.
• Accuracy of current screening test
(forward bending or scoliometer) is
VARIABLE .
• Only a small amount (minute) of the nationally 2-3 % cases actually have health benefits more cases are not clinically significant.

• USPSTF found idiopathic scoliosis detected through screening leads to
MODERATE HARM…concluding that harms of screening out weigh the potential benefits.

• By West Virginia Dental Laws, this is outside of the scope of a nurse.
• We do individual “oral health assessments” based on an individual complaint NOT massive screenings.

• Are massive screening conducive to accurate screenings?
• Do they detect a high population of needs?
• Can you do a diagnosis, treat or referral to a specialist?
• Is the medical home an unneeded entity in a child’s life?
• Do you coordinate health services and share health information with them?

• Outdated
• Lack of supportive research to show need or true gaps in birth up to three year old screenings and medical home care.
• The concept of surveillance and screening in a medical home is continuity of care.

• PreK is the new enterer with approximately 15, 000 (71%)students entering last year leaving only 6,000 new enterers in kindergarten.
• Follow PreK rule under
WVBE…HealthCheck and now
Superintendent’s Interpretation from
2007 which is rule for 6,000 kindergarten enterers.
• Prioritize your time stop rescreening!

Objective #3:
• Participants will be provided with the current status of school nursing and school health services in the state of West Virginia
(changing of the guards, current data and trends, national certification and continued recruitment, working toward full-service schools, etc.).

• School Nurses
• Principals
• Health Services Directors
• Superintendents
• Offsite PreK collaboratives

• Lack of preventive care.
• Adolescents without well-child visits and immunizations.
• Poor oral hygiene and health.
• 17% increase in teen pregnancy population.
• Below proficiency on HEAP scores throughout the state.
• Leading in Asthma, Obesity, Hepatitis
B and C, prescription drug abuse, etc.

• Completing Electronic Data Entry
(Immunizations required on WVEIS, Ipad Grant requires HealthCheck data, High Acuity funds require HCP for certain specialized health procedures, medication logs, sick bay). PreK
Child Accomplishment Summaries.
• Increasing the use of WV Statewide
Immunization Information System
(WVSIIS)…feeding into WVEIS.

• Capitalization of funding sources…what are they?
• Training of staff to recognize early signs and symptoms of communicable diseases, provide fluoride rinse programs, health promotion programs, enhancing health and physical education, physical activity, nutritional programs, relationships with hospitals, programming to assist school health, filling in the resource gaps, etc.

• Ensuring children receive annual Well Child visit and Dental exam for continued health promotion and prevention practices
• Incorporation of nursing students (LPN to
NP and Doctorate in the school setting) and others.
• Developing MOUs/Contracts for a county medical director (Primary Care Centers,
School-Based Health Centers, Private) or
Medical Advisory Board

• Ensuring children receive annual Well Child visit and
Dental exam for continued health promotion and prevention practices.
• Developing and maintaining working relationships.
• Developing supports at the RESA
• Developing a seamless health and medical record with the most influential people working together for the best of each student.

• School which provides for the whole child with integration of the eight components of school health through medical, behavioral and dental services, parent supports and services in the school, community supports…Making your school friendly with a whole child, family and community focus.


• Ensures leadership skills, quality care, efficiency, annual professional development and evidence-based practice.

• Know legislative rule, state rules and county policy.
• Know your nursing practice act and the role of LPN and UAPs.
• Support the Medical and Dental Home concept to move West Virginia towards preventive health.
• Validate immunization records and follow provisional enrollments through to completion.
• Make adolescent vaccinations and well-child visits YOUR priority NOT an AFTER THOUGHT!

• Follow and implement evidence-based practice. Obtain a medical consultant or form medical advisory board for your county’s school health services program.
• Form collaborative teams/ relationships with public health .
• Form collaborative teams/initiatives with medical, dental and behavioral health providers/communities .

Rebecca King
WVDE-Coordinator
School Health and Coordinated School-Public Health rjking@access.k12.wv.us
304.558.8830