Shelby County Schools Department of Coordinated School Health

1. Shelby County SchoolsDepartment of Coordinated School Health Child Health—A School, Family, and Community Issue. . . Shunji Q. Brown-Woods, Ed.D., MHA Director Coordinated School Health Presented June 2013 and July 2013 Student Services Discipline Academy

2. Every day in America, children come to school not ready to learn Reducing the Barriers to Learning No AYP Community and Parental Involvement is one component of CSH Bullying ADHD Diabetic ASTHMA Absenteeism

3. Session Objectives • Understand CSH structure, purpose and responsibilities • Establish expectations for deliverables related to Coordinated School Health Services • Review and discuss school health policy and procedure • Share rationale for determination of school nursing allocation and assignment priorities • Individualized Health Care Plans • CAADS (cardiac, asthma, allergy, diabetes, and seizure related chronic health issues) • Explain Tennessee Coordinated School Health Law, Scope and Components overview

4. Coordinated School Health Dr. Shunji Brown-Woods Director of Coordinated School Health Administrative Assistant Clinic/Health Promotion Manager Coordinated School Health Manager) Health Services/School Nursing Manager Mental Health Center Services Manager Coordinated School Health Program Assistant Nursing Supervisor District/Charge Nurse Assistant for Mental Health Center Services Manager Assistant for Health Services/School Nursing Manager Research Analyst Employee Health Clerk Supervising Psychologists Clerical Assistants Special Project Coordinator

5. CSH Purpose & Responsibilities • Ensure delivery of high quality health services • Oversee: • School Nursing/health services • Mental Health Center services • Four (4) regional School-based clinics • Northside High, East High, Westwood High, and Sheffield High School • Family Care Centers (employee health clinics) • 901-473-2628 appointment line • State Coordinated School Health grant functions • School Health Compliance • Special Projects • CPR/AED/First Aid training • Vision/Hearing Screening for students • CDC HIV/YRBS grant • Bloodborne Pathogen (BBP) Exposure training and immunization program for Hepatitis B

6. Establish expectations for deliverables related to Coordinated School Health Services To dos: Medical records/medication administration designee (July 24, 2013) Healthy School Team Administrator Coordinator (July 29, 2013) Healthy School Team Leader (July 29, 2013) Healthy School Team Roster (September 6, 2013) AED protocol and list of Trained CPR/First Aid/AED staff (September 6, 2013) Immunization audit (October 1, 2013)

7. Review and discuss school health policies and procedures Health Care Management Policy #6043 (Comprehensive policy)

8. Purpose • To provide an efficient and effective district-wide school health program to address the health education and health service needs of students attending Shelby County Schools. • Policy Statement • The Shelby County Schools’ Board believes that academic success is impacted by the overall well-being of the student; and that a fundamental mission of the school system is to help students remain healthy. It is therefore the policy of Shelby County Schools to provide an effective system of programs to support student health and learning.

9. Responsibility • The principal shall be responsible for ensuring that health care services are available for students attending his or her school. • The office responsible for Coordinated School Health Services is responsible for implementing internal protocols; and for administering this policy. • The Superintendent is responsible for ensuring that this policy is followed.

10. Policy Summary • Provides definitions for the following: • Early Periodic Screening, Diagnosis, and Treatment (EPSDT) • First Aid • Periodic Health Screening/Evaluation • Individualized Health Plan (IHP) • Inter-Periodic Screening/Evaluation • Replaces legacy MCS and SCS health related policies • Covers 11 broad areas in health care management: • First Aid, Student Accident Reports, Physical Examinations, Immunizations, IHPs, Medication Administration, Diabetes, Seizure, Allergy, Communicable Diseases, AIDS, and Psychological as well as social services.

11. First Aid and Emergency Medical Care • Faculty and staff of each school shall be prepared to provide basic first aid in response to general medical emergencies. • The objective of the SCBE is to have an adequate number of staff at each site who are trained and certified in CPR and other first aid emergency techniques. • In accordance with state law any person who in good faith provides emergency care or assistance at the place of the emergency or accident will not be liable for any civil damages as a result of any act or omission.

12. Student Accident Reports • Any accident involving students that occur on the property of Shelby County Schools and/or while under the approved supervision of District employees shall be reported in writing to the office responsible for student services within twenty-four (24) hours after the accident occurs. • Report should include the following; • Person’s name • Date of the accident • An explanation of the accident • Care used for treating the individual • Principal signature • Reports should be kept on file in the principal’s office for one (1) yr.

13. Student Physical examinations and Immunizations • Physical examinations, except as exempt by statute, shall be required of students: • Entering school for the first time (applies to any student entering a District School, including Pre-K for whom there is no health record); or • Participating in interscholastic athletics (including any strenuous physical activity program covered by TSSAA) • The principal shall ensure that there is a complete physical examination of each student prior to enrollment. • Cost of the examination shall be borne by the parent or guardian of the student. • Physical examinations will not be conducted without parental consent. • An invasive physical examination does not include hearing, vision, blood pressure, height, weight, or scoliosis screening. • Parents will be notified of dates and times when screenings will be conducted and will receive written notification of any screening results.

14. School Health Screenings/Evaluations Services • Services include: • Vision and Hearing assessments • Body Mass Index (BMI=Height and Weight) assessments • Blood Pressure • EPSDT • The district will provide healthcare services (preventive and early intervention health services) and health referral services whose test results indicate a possible condition that may interfere or tend to interfere with the student’s academic progress. • Services shall be conducted by qualified healthcare providers. • School-Based Health Clinics shall be available to increase access to healthcare services for all Shelby County students. • Health Care monitoring will occur through school based health screenings for students entering PK, K, 2, 4, 6, 8, and Lifetime Wellness courses. • Students entering the District from another district will be asked to provide evidence of completion of an EPSDT or preventive well-child screening within the last 12 months.

15. Confidentiality Employees Volunteers and Contractors Shall safeguard student medical information from unauthorized disclosure except as permissible by law or as a required function to perform his/her job responsibilities; and/or in cases where the student poses an imminent threat of harm to him/herself or others. An employee who misuses, alters, removes, or improperly uses confidential student medical information shall be subject to disciplinary action up to and including termination. Volunteers whose activity may place them in a position where they may gain knowledge of a student’s healthcare information as well as other entities contracted by or working in collaboration with the District shall be held to the same professional standards as an employee of Shelby County Schools. Sanctions for breach of confidentiality may apply.

16. Medical Documentation Accurate Medical Information • Parents/Guardians are responsible for informing school personnel of significant medical conditions • Medical information will be requested by SCS and completed by the parent/guardian each school year • The principal shall assure that any/all information concerning the medical conditions of students is identified by: • Directing a systematic review of all registration forms and medical documentation • Mandating that information (suspected or confirmed) received by a staff/faculty member be reported to the Principal; and • Encouraging parents/guardians to alert the Principal of any medical condition

17. Medical Documentation Validation of Medical Condition • The principal shall recommend that the parent/guardian of each student identified as having a medical condition (or possible medical condition) be contacted for the purpose of clarifying the extent of the medical condition, especially in cases needing further clarification. • A statement from a health care provider should be provided by the parent in those cases in which the medical condition appears to warrant: • A modification in the standard curriculum or school related activities; • The need to supervise and/or administer medication during the school day; or • A special alert for school personnel regarding a possible requirement for emergency first aid.

18. Individualized Healthcare Plans • IHPs shall be written by school nurse staff to address student specific health conditions and shall include: • A specified timeframe to develop a student IHP that must be reviewed with the parent/guardian (at least once per school year); • The medical condition; health assessment; emergency plan; identified health needs; and procedures/treatments required during school hours; • Relevant documents, such as a physician’s statement. • The IHP should be distributed to school employees with a legitimate need to know. • Special Cases: • If a student is identified as special education, IHP shall be a part of the IEP and shall be maintained in the special education records. • HIV/AIDS cases are considered to be unique and shall be responded to in accordance with policy and corresponding rules and regulations.

19. Administering Medicines to Students If under exceptional circumstances a student is required to receive medication during school hours and parent cannot be at school to administer the medication, only the school nurse or the Principal’s designee will administer the medication in compliance with the regulations that follow: (see policy for detailed regulations) • General • Written instructions will be signed by the parent or legal guardian. • Signed instruction form will be kept on file at the school. • All medication must be brought to school by the parent or guardian, unless other arrangements have been approved by the school Principal, but under no circumstances shall a student bring the medication to school by himself/herself • Parents of the student must assume responsibility for informing the school Principal of any change in the student’s health or change in medication. • Should medications of an invasive nature be required to be given the school personnel for emergency action, proper physician orders and instructions will be obtained and proper training will be given to appropriate personnel. • The school system retains the discretion to reject a request for administration of medicine. • A copy of this procedure will be provided to parents upon their request for administration of medication in the schools.

20. Administering Medicines to Students The Principal or his/her designee will: • Inform appropriate school personnel of the medication being taken. • Keep a record of the administration of medication on a designated form and will keep this record on file at school. • Keep medication in a locked area (exception: Students may self-carry emergency medications such as rescue inhalers and epinephrine). • Returned unused medication to the parent only or discard appropriately. If discarded at school, see policy for guidelines and also through full-length medication administration training.

21. Accommodating Students with Diabetes • The administrator in charge of student health services is to: • Consult and coordinate with the parents and health care providers of students with diabetes; • Prior to the beginning of the school year, or upon a student’s diagnosis, train and supervise the appropriate staff in the care of students with diabetes; and • Annually provide in-service on the procedure for parents to notify schools of specific health needs. • School administrators shall notify their Assistant Principals and teachers of the students who will use glucose monitoring devices in his or her school.

22. Accommodating Students with Diabetes Parent-Designated Adult Letter of Intent Additional Requirements Indemnity The District shall develop and follow an emergency/or IHP for each student with diabetes. The health plans shall be updated annually and more frequently as needed.

23. Seizure Management • T.C.A. 49-5-415 shall permit an employee, who has been properly trained by a registered nurse, to volunteer to administer anti-seizure medication in emergency situations to a student in compliance with the student’s IHP. • However, if a school nurse is available and on-site, the nurse shall administer the anti-seizure medication to the student. • For training of volunteers and administration of anti-seizure medications, including diazepam gel, the district shall adhere to Tennessee’s “Guidelines for Use of Health Care Professionals and Health Care Procedures in a School Setting”. • The District office responsible for Coordinated School Health will determine the criteria and response for seizure emergency in Shelby County Schools based on guideline recommendations by the State of Tennessee.

24. Life-Threatening Allergy Management • Shelby County Schools shall have an allergy program to promote the safety and well-being of students with life threatening allergies. • Therefore, It is the intent of the Board to ensure that safeguards are implemented for students with allergies determined to be life-threatening by a medical professional. • Parents/guardians of students diagnosed with a life threatening allergy should promptly notify the school upon diagnosis of the allergy. • An IHP tailored to the needs of each individual child at risk for anaphylaxis, with accommodations for allergy management will be developed following the “Guidelines for Managing Life-Threatening Food Allergies in Tennessee Schools.” • The District shall provide training for school based staff in the appropriate administration of epinephrine.

25. Communicable Diseases Policy • Students with a communicable disease may be allowed to attend school provided their presence does not create a substantial risk of illness or transmission to other students and/or employees. • The Board will follow guidelines and recommendations from Shelby County Health Department regarding communicable disease handling. • Re-admission • In the case of a communicable disease, the student may be readmitted on presentation of a written statement from the family physician, and/or completion of the period of exclusion required by the State Department of Public Health. • In the case of ringworm, impetigo, or scabies, the student may be readmitted once treatment has begun and proof of treatment is presented to the Principal or designee. • In the case of pediculosis (head lice), a student may be readmitted for inspection following treatment. If proof of treatment is presented to the Principal or designee and no live lice are present, the student may return to class. • Please see policy for guidance on Tuberculosis or any other communicable disease and exclusion and/or other requirements for re-admission.

26. Acquired Immune Deficiency Syndrome • Mandatory screening for communicable diseases not spread by casual, everyday contact, such as HIV infection, will not be a condition for school entry or attendance. • If a student’s parents/guardians choose to disclose the child’s HIV status, all matters pertaining to that student will be under the direct supervision of the Superintendent or his designee. Upon disclosure, the Superintendent or his designee shall: • Request medical records from the parent or legal guardian and the student’s physician; • Gather information regarding the student’s cumulative school record; and • Meet with the evaluation team designated by the State Department of Education. • Annually, the Superintendent shall ensure that all employees, including newly hired staff, receive current HIV training to include: • HIV Epidemiology • Methods of treatment and prevention • Bloodborne pathogens • Universal precautions • Psychological and social aspects of HIV • Related federal and state laws and policies; and • School procedures and policies regarding HIV-related issues. • Under no circumstances shall information identifying a student with AIDS be released to the public.

27. Psychological and Social Services • The District shall make psychological and social service programs available for all students of Shelby County Schools. • Each school shall provide a social service program for all students through cooperative efforts of the principal, teachers, and school counselors. • The Principal, in consultation with the social service provider and the office responsible for student support and Coordinated School Health, shall ensure the development of a program of social services. • Confidentiality in Psychological Services • Confidentiality shall be maintained by any District employee providing services related to psychology services except: • Where there is a clear and present danger to the student or other person; • To consult with another psychologist when it is in the best interest of the student; • When the student and/or parent waives this privilege in writing; or • When required by federal law.

28. Share rationale for determination of school nursing allocation and assignment priorities Individualized Health Care Plans CAADS (cardiac, asthma, allergy, diabetes, and seizure related chronic health issues) Concussion Protocol

29. Overview of Common Chronic Illness High Priority Health Conditions– • CCardiac • AAllergy • AAsthma • DDiabetes • SSeizure

30. How we Identify Priority Health Conditions • Confidential Student Health Forms • Nurse reviews health information and communicates with parents/guardians to determine the appropriate level of care needed to address student health needs at school. • Once information is shared at the school level a school health plan (IHP), Health Information Fact or Condition Sheet is developed and shared with school staff who have a legitimate need to know. (HIPAA) (FERPA)

31. What do you need to know? Any physical activity restrictions or limitations? Is there an IHP or a Health Information Fact or Condition Sheet? What are the signs and symptoms of a potential problem? C A A D S “C” CardiacIssues

32. Unable to keep up physically with other kids Getting out of breath with activity sooner than other kids Getting sweaty with exercise sooner than other kids Turning blue around the gums /tongue Chest pain with exercise Passing out Palpitations or heart skipping or beating abnormally Dizzy with exercise C A A D S “C”CardiacIssues

33. What do you need to DO? KNOW WHERE THE AED IS LOCATED! If you are concerned, please call the school nurse If you are not sure err on the side of caution and stop the activity It is easier to stop the activity and call for the nurse before you need to call 911 C A A D S “C” CardiacIssues

34. Food Environmental Medication Insects Severe Allergy Plan Specific information and training is required for each student Response plan varies student to student Some students MAY carry their medication C A A D S“A”Allergy*Legislation & SCS Policy

35. TYPES Controlled Asthma Uncontrolled Asthma Asthma Medication Asthma Triggers Exercise induced Asthma (EIA) Asthma Action Plan Specific information Missed School Days Medication Identify Triggers A student with both identified Allergy and Asthma may have a more severe asthma attack C A A D S“A”Asthma* Legislation & SCS Policy

36. Students with Diabetes will have an IHP The student’s academic schedule is key in the development of the IHP since many of the management tasks are time sensitive The timing and location of Blood Glucose testing, school lunch (snack times) and physical activity including recess are included in the development of the IHP IHP will spell out the timing and frequency of the student’s diabetes management tasks during the school day C A A D S“D”Diabetes*Legislation and SCS Policy

37. Students with Diabetes are protected under IDEA and must have free unrestricted access to water and the restroom Accommodations for standardized testing Students with Diabetes should have fast acting carbohydrates accessible in each classroom including specials Assign a buddy to a diabetic student Students with Diabetes must be able to test their blood sugar and see the nurse when they symptomatic When in doubt if blood sugar is high or low give the student a snack Do not allow a diabetic student who is not feeling well to walk to the clinic for a snack or to test C A A D S“D”Diabetes* Legislation & SCS Policy

38. C A A D S “S”Seizure Folks may experience a seizure for many reasons: • Head injury • Temperature • Brain tumor • Brain Hemorrhage • Low Blood Glucose • Or perhaps no reason at all • There are many different types of seizures and seizure activity • For students with a known history of seizure the school nurse will develop an IHP

39. C A A D S“s” Seizure*Legislation & SCS Policy • Seizure response protocol • Provide routine First Aid for Seizure • Call 911 if a 1st time seizure or > than 5 minutes • Mark the time seizure started • Record all activity on a seizure log • Place student on their side • Place something under the head • Loosen any tight clothing • Do not restrict movements or place an object in the mouth • Protect them from injury by clearing objects out of the area • Do not leave student alone • Continue to monitor, record and observe the student throughout and after the seizure

40. Head Injury –Concussion Awareness & Response • When is a head injury serious? • When is a head injury a concussion? • Who is at the greatest risk for Concussion? • Most concussions occur without loss of consciousness.

41. What is a Concussion? • Concussion - type of brain injury that changes how the brain usually works. • Concussion - can be caused by a bump, blow or jolt to the head. • Concussions - can also occur from a fall or blow to the body that causes the head and brain to move rapidly back and forth. • Even a MILD bump can be serious.

42. Protocol for Head Injury • If a nurse is available, have the nurse assess any student who sustains a head injury however minor • If the nurse is not available to assess the student have the student sit out and take the next appropriate action • Follow the CDC’s Concussion ABC’s • Be aware to the signs and symptoms of a head injury • Complete an SCS accident report • The individual who is a witness to an injury is the individual who completes the accident report • Make voice contact with a parent/guardian before the end of the school day • A voice or email mail message is not acceptable parental notification

43. Student Health Services &Protecting Student Health Information

44. Confidential Student Health Information • “. . .personal, sensitive information obtained most often by a health professional concerning the physical, developmental, or mental health of an individual student. A student’s health history might also include sensitive family information.” • Source: Guidelines for Protecting Confidential Student Health Information. Pg. 11. Published by ASHA National Task Force on Confidential Student Health Information

45. Important Notes on Student Health Information • Student health information can be multiple forms • Oral, written, or transmitted electronically. • Records often include: • Mandated immunizations • Health and physical assessment data • Health screenings for vision, hearing, blood pressure, height, weight, scoliosis, dental, etc. • Injury/incident reports • Incident reports of alcohol or drug us in school • Health assessments and other evaluation reports related to eligibility for services under the Individuals with Disabilities Act (IDEA) and 504 of the Rehabilitation Act of 1973 and • Referrals for suspected child abuse

46. Important Notes on Student Health Information • Additional health information might include: • Student-initiated visits to the health room, assessments, interventions, and referrals (narrative notes) • Records of meetings between education and health professionals for planning or identifying assessment measures, recommended interventions, and student outcomes • Records for in-school medication, including original, signed orders from a physician, written consent from parent, and/or guardian to administer a drug and medication logs for both routine and as-needed (PRN) medications • Physicians’ orders, correspondence, evaluation reports, copies of treatment records, institutional or agency records • Individualized emergency care plans for students with special health care needs, including routine and emergency interventions and methods for evaluating student outcomes • Health-related goals and objectives or Individualized Health Plan (IHP) or part of a student’s Individualized Education Program (IEP) for students whose health conditions affect their educational needs • Case notes, evaluations, and interventions by other Student Services, Department of Exceptional Children, or Coordinated School Health staff

47. Access to Student Health Information • Varies by type and purpose • Medical records from outside health care providers and hospitals are generally accessible only to health professionals. • Staff who provide health and education services to students must be adequately informed about a student’s condition as the consequence of inadequate knowledge can be serious. • It is often a challenge to establish systematic structure for assuring appropriate safeguards to protect confidentiality while enabling education and health professionals to share information that promotes the student’s health and academic success.

48. Ethical Responsibilities & Issues • Responsibility to Respect Privacy • “Privacy” is a fundamental right of individuals to be free from intrusion. • Responsibility to Do No Harm • Careful consideration of “need to know” balanced with best interest of individual students • Can disclosure be justified for the student’s benefit? • To what extent might personal bias affect my judgment? • Responsibility to Disclose Some Types of Information • Suspected Child Abuse • Self-injury or Suicide • Possible Harm to Another Person • Duty to Warn • If known threat exists to a student has been identified by health professionals, then this information should be disclosed.

49. Legal Obligations & Confidentiality • The ability of more students with various health problems to attend school has increased the amount of confidential health information with which schools must contend. • Support services and federal programs also often make decisions based on health information. • Professional school staff working in schools should become familiar with relevant laws affecting student records.

50. Legal Obligations & Confidentiality • Family Educational Rights and Privacy Act of 1974 • FERPA provides parents with access to all their child’s school records, including health records, and stipulates that these records may not be released outside the school without specific parental consent except in a few circumstances: • When a student intends to enroll in another school • Research and/or evaluation studies focused on improving instruction or care; or • An emergency in which disclosure is necessary to protect the health or safety of the student or other individuals. Only that information necessary to reduce the danger may be shared and then only with necessary medical, administrative, or law enforcement personnel.