OSPI Update School Nurse Organization of Washington Robin fleming, RN, Phd Health services program administrator October 9, 2015

Today’s Agenda Policy/regulatory issues School Nurse Corps and District Assessment Data Results of Nurse Asthma Case Management Program Educational events and opportunities

CMS “Free Care” Rule Update State Agency Partnerships National partnerships (NASN and NASSNC) OSPI, HCA, OFM and the state’s two agencies that provide billing services for school districts claiming reimbursement for SN services for students with IEPs have met to scope out ways to implement the new CMS ruling that technically allows school nurses to bill for eligible services to all Medicaid eligible students. OSPI continues to work with NASN, NASSNC, and the Healthy Schools Campaign to share strategies and information that other states and organizations are using to implement this new rule to assist in reimbursing and funding nurses to provide better care to students as well as to provide improved school nurse staffing levels.

SSB 5083 Sudden Cardiac Arrest Information Pamphlet UW Center for sports cardiology; WIAA; Nick of Time Foundation On a yearly basis, prior to participating in an9interscholastic athletic activity a sudden cardiac arrest form10stating that the online pamphlet was reviewed shall be signed by the11youth athlete and the athlete's parents and/or guardian and returned12to the school.13 (4) Every three years, prior to coaching an interscholastic14athletic activity coaches shall complete the online sudden cardiac15arrest prevention program described in this section. Coaches shall16provide a certificate showing completion of the online sudden cardiac17arrest prevention program to the school

SB 5052 Permits Medical MJ in Schools SB 5052 permits use of medical marijuana in schools; conference call with U.S. DOE; still waiting to hear back with guidance. Law takes effect July 1, 2016.

Telehealth Services Now Eligible for Medicaid Reimbursement Allowable mode of health care delivery for Medicaid eligible students who are in special education and have Individual Education Plans Qualifications, services covered, procedure codes available at http://www.hca.wa.gov/medicaid/billing/documents/guides/schoolbasedhealthcareservices_bi.pdf Effective 10/1/15

Statewide Managed Care for Foster Children Coordinated Care of Washington to manage services For more than 25,000 children in Foster care HCA mmoved to a single MCO to better manage the physical and mental health care of foster and adoption support youth enrolled in Washington Apple Health (Medicaid). The move is expected to provide a system of consistent and coordinated health care services. CCW will offer a comprehensive and coordinated medical benefit, including primary care; ancillary services and outpatient mental health benefits. Continuity of care will be assured if foster children have changes in placement.

Board of Health Vision Screening Rule Revision Expected to be in rule by September 2015. Traning plan --- free webinars, new NASN best practice guide, SNOW presentation by BOH

Vaccine Compliance Letter to superintendents encouraging maintenance of staff vaccine records was sent by Superintendent Dorn in April VAC DOH partnership Introduction of new legislation

Washington Initiative for Student Health Transitioning from agency-led initiative to broader stakeholder movement Fiscal sponsor is Foundation for Healthy Generations Working on convening a summit in 2016 Working on convening a Summit sometime in January to identify opportunities for stakeholder activities to help ensure that students have access to the health services they need, when they need them, in the amounts they are needed, where students are located

School Nurse Corps Quality Control and Assurance Nursing and Administrative Resources Ambassadors of Professional School Nursing Collect Annual District Assessment data of School Health Services Established by the Legislature in 1999 – still funded by legislative proviso. Located in 9 Educational Service Districts: Quality and control of assurance: Recommend best practices; protect nurses and districts by helping to ensure compliance with state and federal laws; Serve as a resource for all school nurses within their region by providing technical assistance, consultation, training, and professional development Serve as Ambassadors for the Profession of School Nursing: Demonstrating leadership in their communities by engaging in and informing local initiatives including Accountable Communities of Health and serving as resources for educational administrators and other stakeholders * Providing evidence of the state of school nursing in our state by assisting districts in completing District Assessments of School Health Data every year, compiling the information and providing it to OSPI. In 2013 Secretary of Health John Weisman presented the SNC with the prestigious Warren Featherstone Reid award for excellence in health care. This is an award presented annually to health care organizations that provide quality and efficiency in health services

Assessment of District Student Health Services 2014-15 Reporting: 267 Districts (92 Class I districts; 175 class 2) = 90.5% response rate Data represents 930,801 students (out of 1.04 million) = 89.5% of students

DA Data: Policies/Procedures # orders Epi Diastat MidAzolam Glucagon 17,967 826 327 2166 Admin, by RN/LPN 119 85 59 3 None administered by PDA # UAP EPI 49 Midazolam 3 Self admin 19 Districts with a medication policy addressing nasal midazolam: 123 Districts with stock epi: 9

DA Data: Care Plans, Medications, Treatments Numbers for Health and Emergency care plans reflects the 2001-02 school year; not the 2003-04 school year. On the District Assessment, the question regarding IHPs and ECPs was combined so that reports now reflect only care plans. The numbers for IHPs and ECPs, therefore, for comparative purposes, reflect the 2013-14 year.

Being in school leads to succeeding in school “One of the most effective strategies for providing pathways out of poverty is to do what it takes to get students who live in high-poverty neighborhoods to attend school every day…This alone, even without any additional qualitative improvements in the American education system, will drive up achievement, high school graduation, and college attainment rates…” Balfanz, R., & Byrnes, V. (2012). Chronic Absenteeism: Summarizing What We Know From Nationally Available Data. Baltimore: Johns Hopkins University Center for Social Organization of Schools.

Chronic Absence is Especially Challenging for Low-Income Children A child’s regular attendance at school sets the stage for academic success and graduation. A child is considered “chronically absent” when she misses 10% or more of school days in a school year for any reason. Poor children are 4x’s more likely to be chronically absent in K than their highest income peers. Children in poverty are more likely to face systemic barriers to school: Unstable Housing Poor Transportation Inadequate Food and Clothing, Lack of Safe Paths to School Due to Neighborhood Violence Chaotic Schools with Poor Quality Programs, etc. Romero, M., & Lee, Y.-S. (2007). A National Portrait of Chronic Absenteeism in the Early Grades. New York, NY: National Center for Children in Poverty.

5th Grade Math and Reading Performance By K Attendance The Chronic Early Absence Is Most Troubling for Poor Children Chronic K Absence predicted lower 5th grade performance even for if attendance had improved in 3rd grade. 5th Grade Math and Reading Performance By K Attendance Source: ECLS-K data analyzed by National Center for Children in Poverty (NCCP) Note: Average academic performance reflects results of direct cognitive assessments conducted for ECLS-K.

Nurse Asthma Case Management Program Year two Sites; students served

School Nurse Asthma Project 2014-15 School Year 2014-15 Attendance (N=20) Days Absent Average 15.05 Median 12 Mode 5 Range 0-39

School Nurse Asthma Project Math 2014-15 School Year Change in Math Test Score (Pre to Post) Total Improvement more than one full grade level from the pre to posttest exams 1 Improvement up to one full grade level from pre to posttest exams 4 Negative grade level change from the pre to posttest exams 2 No change in grade level from the pre to posttest exams 10 (blank) 8 25 With information unknown for 8 students, the net effect would have been a slight increase in math outcomes.

School Nurse Asthma Project English Language Arts(ELA) 2014-15 School Year Change in Reading Scores Pre to Post Total Improvement up to one full grade level from pre to posttest exams 8 Negative grade level change from the pre to posttest exams 3 No change in grade level from the pre to posttest exams 9 (blank) 5 25

Possible Asthma Considerations Clearly communicate expectations for attendance to students and families. Children’s attendance is affected by what happens to parents. Multiple maternal and family risk factors increase chronic absence. Make attendance a priority, set targets and monitor progress over time. Engage parents and students in identifying and addressing school, family, and community issues that contribute to chronic absence. Combine targeted interventions with universal strategies that nurture an engaged learning environment, build a culture of attendance and ensure physical health and safety at school.

Manuals Diabetes – working with DOH, Seattle Children’s and other stakeholders Medication – in OSPI review chain – thanks to Nursing Commission and Pharmacy Commission Staff Model Home hospital complete and heading up ospi approval chain

OSPI K-20 October 21 1-4 p.m. Legal issues in school nursing Calandra Sechrist, JD Director OSPI Office of Equity and Civil Rights Emma Gillespie, JD Panel Counsel for Washington Schools Risk Management Pool Top reasons for health-related claims against school districts Best practices for protecting your patients, yourself, and your district Reporting requirements for accidents and injuries Confidentiality: Understanding HIPAA and FERPA Documentation Essentials Participate in a Case Study Three FREE clock hours! Broadcast to all ESDs and the Clover Park School District October 21 1-4 p.m.

Transitioning to school after a concussion

NASSNC Studies and Issues Nurse staffing; free care; data collection for Step Up Be Counted