Developing a School Health Program

School nurses have an essential role to play in creating equity for students related to health and their education. School nurses have a unique vantage point because so often they are helping a students and their families to get all of their basic needs met in order to ensure that they maintain health and prevent disruptions in learning. These can be maintained and they can be in school and ready to learn. School nurses connect families with housing, employment, food security and other necessities referrals, assisting with forms, address structural and individual racism, build trauma informed communities or even direct contacts, going on home visits and so much more. More and more school nurses are recognizing the powerful effects of the relationships they have with students and their families and are using them to ensure students have health and academic access.

The Whole School, Whole Child, Whole Community Model expands on the traditional model of Coordinated School Health. It recognizes that health and education are always working together to help students thrive. In order to understand the unique needs in a school and district, the formation of a School Health Advisory Committee (SHAC) is recommended.

Formation of a SHAC should directly reflect the needs of the school district. In order to understand the many factors that affect health and learning, membership should be diverse.

SHAC members may include:

• District administration
• School board members
• Teacher representation from all buildings and a variety of grade levels
• School Nurses
• Physical education teachers
• Health educators
• Counselors/Social Workers
• Nutrition services
• Health and Safety Representatives
• Wellness Committee Representatives
• Students
• Parents/Guardians
• Providers from local clinics or hospitals
• Public health partners
• Community members and business owners
• Community organizations that work with schools

It is important that the SHAC membership represent the diversity of the community and the school. The committee's collective knowledge, expertise, and influence can be a powerful force on behalf of implementing a Whole School, Whole Child, Whole Community approach to serving students.

Essential responsibilities of a SHAC:

• Completing a district or school needs assessment
• Reviewing local, state and federal laws around school health and ensuring their implementation.
• Using the needs assessment to recommend program implementation and guidelines for all 10 areas of the WSCC model
• Regularly evaluating health and social problems affecting students and families and developing partnerships and resources for addressing these needs
• Serve as an advocate for the school health program and improved health status for children, youth and families in the community.
• Recommend resources for the school health program.
• Participate in evaluating the effectiveness and outcomes of the school health program.

The health needs of the students, families, staff and community must be assessed and documented. One of the major tasks of the SHAC is to recommend to the school administration and health staff what school health services, programs, projects, resources, or materials are needed as a result of this assessment. Programs should be implemented in response to the specific health and safety needs of the district-not because it appears to be a good idea or has been implemented successfully in another school district.

A needs assessment may be conducted by communicating with representatives of the school and community through surveys, face-to-face interviews, and focus groups and/or by reviewing health statistics and student data (one example might be the Minnesota Student Survey) from state and local sources. It may also include reviewing existing research and consulting with experts on the content and method proposed. It is important for all members of the SHAC including the school administration, school board and licensed school nurse to have a clear understanding of the needs and services in order effectively implement successful school health programs.

The American Association of Pediatrics has worked closely with schools to develop a free, Health services Assessment Tool for Schools (HATS) that can be used to evaluate the school health services specifically.

The CDC has excellent tools for examining wellness, physical education, and health education. The following tool can be used to assist districts in gathering comprehensive information about what their health services and nursing needs might be.

• School Health Index
• Health Education Curriculum Analysis Tool
• Physical Education Curriculum Analysis Tool

School District Information to Assess:

Licensed School Nurse and School Health Office Data

The Licensed School Nurse collects and has a significant amount of aggregate health services and student data. If a district does not have a Licensed School Nurse it is important to understand that recording and protection this information is a necessary function in a school. If it is not being collected, stored and protected this is a significant gap that should be identified and named in the assessment. If the data is available, it should be used in assessing the school health program and the past health services provided to student and their families such as:

• Total number of students served in the health office annually
• Number of individual health plans (IHPs) and emergency care plans (ECPs)
• Number of students with chronic health conditions, then further divided into subcategories of specific condition
• Students receiving medications
• Students with emergency medications that require additional planning and staff training
• Students receiving treatments
• Students on IEPs that require health involvement (not just students who currently do, but all students who by law should have nursing assessment and planning)
• Students with PCA services through medical assistance
• Number of buildings the nurse serves
• Nurse involvement in student support teams
• Number of Incident reports annually
• Staff training
• Care coordination
• Classroom education
• Infectious disease monitoring and intervention
• Screenings, kinds of screening, numbers screened and interventions resulting
• Family education

Early Childhood Screening

Early Childhood Screening is a requirement for school in Minnesota. It is used to identify potential health or developmental problems in young children who may need a further evaluation such as a health assessment, diagnostic assessment or educational evaluation.

This data source can be used to understand the incoming students and their needs at school. It can also be used to help schools identify how they are communicating and partnering with families of young children.

Early Childhood Family Education (ECFE)

ECFE is a program for all Minnesota families and their children, from the time they are born until kindergarten entrance. The program is offered through the school districts. ECFE engages families as a child's first and most significant learning environment. The goal of ECFE is to enhance the ability of all families to provide the best possible environment for their child's learning and growth.

As a result of these goals and the population they serve, ECFE programs are closely tied to the community and can provide rich data about the needs and participation they see.

Special Education Program and the American Disabilities Act (Section 504)

Looking at district Special Education and Section 504 data is helpful in identifying and establishing priorities and where there is need for improvement. Sometimes, as a result of not understanding these two very complicated areas, and their connection to health, schools do not include a nurse or nursing assessment when they are essential legal obligations. When examining this data it is important to ask if health is consistently assessed, using a person educated and licensed to do so? Sometimes untrained professionals dismiss things should be included on the assessment that are essential to a student's ability to learn. Understanding how this process happens in each district is important to obtaining a clear picture of school health services. These areas are highly regulated so there is rich documentation collected. In order to adequately meet the needs of the student and the law, accurately assessing health service needs is essential to understanding a district's needs. Coordination and consultation with teachers, families and health care providers should occur regularly to meet the student's needs.

Third Party Billing/Medicaid funds for Children with IEPs

Medicaid funds are available to pay for health related services provided by Minnesota public districts to eligible children through an Individualized Education Program (IEP) or Individualized Family Service Program (IFSP). Minnesota Statutes 125A.21, Subd. 2(a) requires Minnesota public school districts to "seek reimbursement from insurers and similar third parties for the cost of services provided by the districts whenever the services provided by the district are otherwise covered by the child's health coverage."

Understanding how many students are receiving billable services, who is supervising that care and if the care and the supervision are appropriate is essential to evaluating the quality and needs of a health services program.

Community, State and Federal Data to Consider:

Local Public Health Community Assessment and Planning

In Minnesota, the local public health agencies are required to complete a Community Health Assessments through their Community Health Boards (CHBs). Using the Community Health Assessment, which includes schools and districts, the CHB creates their ten priority areas. The information gathered in the Community Health Assessment about future and current students and their families is valuable information for the school's needs assessment.

More information is available from the Office of Performance Improvement at the Minnesota Department of Health.

Minnesota Student Survey

Minnesota Student Survey results are available for each school district that participates and can be used to assist in facilitating and completing a school health services needs assessment.

The Minnesota Student Survey (MSS) is a survey of young people, completed every 3 years, regarding a variety of risk and protective factors. The survey asks young people questions about their activities, opinions, behaviors and experiences. It includes questions on an array of issues, such as substance abuse, school climate, violence and safety concerns, healthy eating, out-of-school activities, connections to school, community and family and many other questions. The survey is administered in schools, alternative learning centers and juvenile correctional facilities. The purpose of the survey has been to:

• Provide data for program planning and evaluation.
• Meet state and federal student survey requirements.
• Address relevant issues confronting students.
• Mark trends over time.
• Involve schools/other educational settings statewide and provide data for local use.

Even if your school district did not participate in the survey, the data is a great resource for thinking about what is affecting Minnesota youth.

Minnesota Department of Education Data Center

The Minnesota Department of Education (MDE) has a wealth of information. In the MDE data center there is general information about Minnesota as a state and there are many tools to help schools understand the demographics and needs of their students. There are also tools to learn about schools in the same county or schools of similar makeup. This is also the information that is available to the public when they look to learn more about a district.

Head Start

Head Start and Early Head Start programs support the mental, social, and emotional development of children from birth to age 5. In addition to education services, programs provide children and their families with health, nutrition, social, and other services. Head Start services are responsive to each child and family's ethnic, cultural, and linguistic heritage. Like ECFE, Head Start encourages the role of parents as their child's first and most important teachers. Programs build relationships with families that support positive parent-child relationships, family well-being, and connections to peers and community. Head Start began as a program for preschoolers. Early Head Start serves pregnant women, infants, and toddlers. Early Head Start programs are available to the family until the child turns 3 years old and is ready to transition into Head Start or another pre-K program. Early Head Start helps families care for their infants and toddlers through early, continuous, intensive, and comprehensive services.

As a result of Head Start's requirements for comprehensive services they have an extensive knowledge about the students, families and communities they serve. Head Start also has a systematic process for connecting with community resources. Partnering with Head Start to both access and understand this information will be essential in understanding the upcoming school age population.

Family Home Visiting (FHV)

The goal of the Family Home Visiting Program is to foster healthy beginnings, improve pregnancy outcomes, promote school readiness, prevent child abuse and neglect, reduce juvenile delinquency, promote positive parenting and resiliency in children, and promote family health and economic self-sufficiency for children and families. These are all areas that significantly affect health and education outcomes that the SHAC is very invested in. Program administered at the local level. Grants are distributed to local public health departments and tribal governments related to needs.

FHV data can assist districts in understanding the needs of students and their families. FHV nurses may also be partnering with schools and providing some intervention during school. Understanding these relationships and supports helps schools build a complete picture of what is happening around the health of their students

Minnesota Children and Youth with Special Health Needs (CYSHN)

Working together with statewide partners, the Children & Youth with Special Health Needs (CYSHN) section strives to reduce the number of children who have special health needs and assure that those children and youth with special health needs, and their families, are well supported in the communities they live in.

As a result of their very broad and extensive work, CYSHN is able to help a SHAC understand the special health needs in the state and resources available. There are also many intensive monitoring programs that can be utilized to understand the variety of needs and interventions that may be required of a district.

Minnesota Department of Health's Maternal Child Health (MCH)

The programs within the Maternal and Child Health (MCH) Section strive to improve the health status of children and youth, women and their families. The MCH Section provides a focal point for influencing the efforts of a broad range of agencies and programs committed to this goal. The Section supports their efforts by providing administrative and program assistance to Local Public Health, Tribal Governments, schools, voluntary organizations, and private health care providers. The role of the MCH Section within Minnesota's health care delivery environment includes:

• Assessing the health needs of mothers, children, and their families
• Using that information to advocate effectively on their behalf in the development of policies concerning organizational and operational issues of health systems
• Advocating for programs and funding streams which have the potential to improve maternal and child health.

The Maternal Child Health Section is where you can find the State School Health Consultant. This position is a great resource for understanding what is happening throughout the state in school health services. In addition to providing assistance to problem solve specific situations or concerns in consultation, the School Health Consultant can also connect districts to great resources and examples of best practices in school health.

Minnesota Department of Health's State Health Improvement Partnership (SHIP)

Schools are an important partner in the Statewide Health Improvement Partnership (SHIP). SHIP focuses on increasing physical activity, improving nutrition and reducing the number of people who use tobacco or are exposed to it. Since, young people are acquiring lifestyle habits in these early years it is important the school settings model an environment that supports healthy choices. To get connected with local health departments and local SHIP school contacts, please visit SHIP Communities.

The SHIP model provides support through local and tribal public health in working with schools primarily on healthy eating and Active School initiatives. In addition, SHIP can be an excellent resource in evaluating health and wellness policies that are currently in place, and looking at model policies to aide with revisions. SHIP also has research and information about how wellness impacts education. A number of helpful wellness resources are located online at Minnesota Department of Education.

Minnesota Interagency Children's Mental Health and Family Service Collaborative

In Minnesota, the Children's Mental Health and Family Service Collaborative exist in communities across the state. These partnerships coordinate services and funding for at-risk children. Collaborations were envisioned and created as an approach to:

• Address the needs of children with complex mental health needs
• Maximize results and resources by enhancing coordination and reducing duplication among systems
• Involve communities and especially families, in system redesign and implementation so their needs are effectively met.

School districts are legally required (MN Statute 124D.23) to be partners in this process, therefore can easily gain access to the needs assessments in the local area. This information, as well as an understanding of resources and gaps, helps schools adequately plan for the needs of the children they serve. For more information about the specific programs in your area, contact your local human service, mental health or public health agency.