May 21, 2008

1
School Health Services Advisory Committee

• May 21, 2008
• Stevens Point

2
Introductions

• Name
• Title/Job
• Location

3
Partners Involved

• Wisconsin Association of School Nurses (Rita
  Simon)
• Wisconsin Department of Public Instruction
  (Rachel Gallagher)
• Wisconsin Association of Local Health Departments
  and Boards (Judy Crouch-Smolarek)
• Wisconsin Department of Health and Family
  Services, Division of Public Health (Margaret
  Schmelzer)
• Wisconsin Public Health Association (Gretchen
  Sampson, Sarah Beversdorf)
• Medical College of Wisconsin (Marie Wolff)
• Others Linda Caldart-Olson, Kaija Zusevics

4
Background

• 1-year grant focused on identifying the
  strengths, weaknesses, opportunities and threats
  of the school health services system in Wisconsin
• Activities
• Advisory committee
• Survey
• Focus groups
• Analysis of administrative rules

5
Result of Process

• A policy report that addresses school health
  services issues
• (Fall 2008)

6
Role of Advisory Committee

• Provide general feedback and suggestions
  regarding project processes and evaluation
• Facilitate identification of survey and focus
  group questions and participants
• Contribute data as available
• Review and comment on data
• Develop policy recommendations
• Lead next steps as appropriate

7
Review of Previous Meeting

• Previous meeting November 15, 2007
• Reviewed status of health and school health
  services (health status of children, statutes,
  number of nurses, etc.)
• Breakout groups focused on
• What three actions/interventions/efforts need to
  take place to improve Wisconsin school health
  services?
• What steps can be taken to move the policy report
  forward?
• In order to accomplish the (just-) identified
  strategies, who else needs to be engaged in this
  advisory group or in some other manner?

8
Review of Previous Meeting

• What three actions/interventions/efforts need to
  take place to improve Wisconsin school health
  services?
• Build the case for why school health matters
• Identify data needs and create systems to collect
  data
• Engage in strategic partnerships, including with
  traditional partners like DPI and DHFS, as well
  as non-traditional partners like HMOs,
  legislators and the business community
• Assure/Establish standards of care and standards
  for school nurses

9
Review of Previous Meeting

• What steps can be taken to move the policy report
  forward?
• Be smart and strategic about marketing the plan
  for the policy report potentially include
  stories, data, logo, specific strategies for
  parents, etc.
• More and better data, data tracking and
  evaluation
• Distribute widely to traditional and
  non-traditional partners
• Tailor messages to specific sectors

10
Review of Previous Meeting

• In order to accomplish the (just-) identified
  strategies, who else needs to be engaged in this
  advisory group or in some other manner?
• Wisconsin Manufacturers and Commerce
• Health care providers, clinics and hospitals
• Wisconsin Nurses Association
• Private and parochial schools
• Others

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Expected Outcomes for Today

• Increase understanding of available survey and
  focus group data
• Identify 3 policy priorities
• Identify strategies to move the policy priorities
  forward
• Identify key elements of the policy report
• Target audiences
• Primary message
• Distribution mechanisms
• Other

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Survey Results
13
A Special Thank You

• The survey would not have been possible if not
  for the direct support and contributions of the
  following
• Wisconsin Association of School Nurses (WASN)
• Wisconsin Association of School Boards (WASB)
• Wisconsin Parent-Teacher Association (PTA)
• Wisconsin Department of Public Instruction (DPI)
• Family Voices
• We are very grateful for the time and energy that
  these organizations contributed.

14
Survey

• Online surveys were conducted with five
  constituency groups in Spring 2008
• School Nurses
• Superintendents
• Pupil Services Directors
• School Board Members
• Parents

15
Survey Distribution and Responses
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Survey Results -- General

• Nearly every county represented
• More rural and small town respondents for nurses,
  superintendents, school board, and pupil
  services over 50 medium and large city for
  parents
• Children with special health care needs
• Pupil services directors and superintendents were
  more likely to perceive very low numbers

17
Survey Results -- General

• Based on respondent results
• Between two-thirds and three-fourths of districts
  employ a school nurse directly
• Majority of schools have less than 2 nurse FTEs

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Overall Quality and Effectiveness
How would you describe the overall quality and
effectiveness of your districts current school
health services?
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Complexity of Health Needs
In the past 5 years, the complexity and severity
of the health needs ofchildren in your district
have
20
Changes in Nursing Services
In the past 5 years, your school districts
nursing services have
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Top Health Concerns in District
22
Top Actions/Services Needed
23
Accidental Injury
Does the school district have policies and
procedures for accidental injury?
24
Illness Management
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Medication Administration
Does the school district have policies and
procedures for medication admin?
If yes, are policies and procedures reviewed by
the school board annually?
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Training
Does the school district require training for the
personnel who provide first aid?
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Training
How often does the training for first aid occur?
28
Medication Administration
What is the job title of the person primarily
administering medication on a day-to-day basis?
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School Nurse Job Description

• Approximately 1 in 10 respondents
  (superintendents, school nurses, and school board
  members) indicated there is not a school nurse
  job description.

30
Effectiveness of Emergency Services
1Very Safe, 2Somewhat Safe, 3Neutral,
4Somewhat Unsafe, and 5Very Unsafe. DNDont
know.
31
Safety of Medication Administration
1Very Safe, 2Somewhat Safe, 3Neutral,
4Somewhat Unsafe, and 5Very Unsafe. DNDont
know.
32
Collaborative Relationship with Governmental
Public Health
33
Focus Group Results
34
A Special Thank You

• The focus groups would not have been possible if
  not for the direct support and contributions of
  the following
• Wisconsin Association of School Nurses (WASN)
• Wisconsin Parent-Teacher Association (PTA)
• Wisconsin Association of Local Health Departments
  and Boards (WALHDAB)
• We are very grateful for the time and energy that
  these organizations contributed.

35
Focus Groups Held
Please note that 3 additional focus groups were
attempted but not held due to limited
participation. One was with school nurses and
two were with parents.
36
Focus Group Results

• Factors affecting quality of school health
  services
• Nurses do not have enough time
• Increase in severity and quantity of illnesses
• Delegation issues
• Standardization issues
• No minimum level of care or regulatory guidelines
• Roles and relationships with the nurse are
  unclear
• Continuity of care
• Family issues no health care, no money, no
  primary care provider
• Parent advocacy

37
Focus Group Results

• Impact of those factors
• Childrens safety at risk
• Prevention taking a back seat
• School nurse expertise not maximized
• Trends in population health may be missed
• Community efforts not maximized
• Lack of continuity of care

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Focus Group Results

• Addressing the challenges (see handout for
  complete list)
• Practice changes
• Statute changes
• Local policy and infrastructure changes
• State policy and infrastructure changes
• Awareness/marketing
• Link student achievement to school health
  services

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Discussion
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Discussion Topics

• Reflections on data
• Policy priorities
• Policy priorities strategies
• Policy report

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Next Steps

• Draft policy report (Summer 2008)
• Circulate policy report (Summer 2008)
• Identify future grant focus areas (Summer/Fall
  2008)
• Finalize policy report (Fall 2008)
• Distribute policy report (Fall 2008)
• ??Kick-off??
• ??Other??

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• THANK YOU!