Using School Health Data Effectively

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Using School Health Data Effectively

• Cheryl Resha, Ed.D., RN
• School Health Consultant
• Connecticut Department of Education
• Anne H. Sheetz, MPH, CNAA
• Director of School Health Services
• Massachusetts Department of
• Public Health

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Objectives

• Identify where to access data sources at the
  national, state, and local level
• Examine what data is needed at the district and
  building level
• Practice examining data to extrapolate meaning to
  inform decisions
• Understand how to interpret and analyze data

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National Association of State School Nurse
Consultants (NASSNC)

• Who are our members?
• Currently over 50 state school nurse consultants
• Employed by both state departments of health and
  education
• Represent 40 states

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Mission

• NASSNCs mission is to promote the health
• and learning of the nation's children and
• youth by
• providing national leadership and advocacy,
• impacting public policy,
• collaborating, and
• proactively influencing school health programs
  and school nursing practice.

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Special thanks to

• Kate Bell, NL, Concord PS
• Marie DeSisto, NL, Waltham PS
• Kate Johnson, NL, Westfield PS
• Paula Dobrow, NL, Marblehead PS
• Marie Fahey, NL, Bridgewater/Raynham PS
• Kathy Hassey, Former NL, Hudson PS
• Jane Kisielius, NL, Quincy PS
• Diane Sneider, SN, Concord PS
• Karen Jarvis-Vance, NL, Northampton PS
• Katie Vozeolas, Former NL, North Andover PS

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Special thanks to (2)

• Massachusetts School Nurse Organization
• Massachusetts Department of Public Health Staff
• - Francis Dwyer
• - Laura Hayes
• - Robert Leibowitz
• - C. Lynne McIntyre

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Why collect and use data

• Evidence based practice
• Data driven decision-making (research-based)
• Demonstrate the link between health and
  achievement
• Information from research is more reliable
• Without information from research, decisions are
  often ineffective and even harmful

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Data-Driven Decision Making

• Indicators of Data-Driven Decision Making
• Leaders enable the systematic collection of
  information pertaining to school, district, and
  state goals and standards.
• Principals and staff analyze and interpret the
  data to inform decision making.
• Educators and staff at every level are trained to
  use and analyze the data.
• Source North Central Regional Educational
  Laboratory

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Evidence-based Nursing (EBN)

• The process by which nurses make clinical
  decisions using the best available research
  evidence, their clinical expertise and patient
  preferences.
• Source University of Minnesota

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Steps to practice EBN

• Clearly identify the issue or problem based on
  accurate analysis of current nursing knowledge
  and practice
• Search the literature for relevant research
• Evaluate the research evidence using established
  criteria regarding scientific merit
• Choose interventions and justify the selection
  with the most valid evidence
• Clinical Decision-making drawing conclusions
  based on EBN, clinical expertise, patient
  preference, and other factors such as
  cost-benefit analysis, availability of
  alternatives, etc. 
• Source University of Minnesota

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Health and Achievement

• Educating the Whole Child (ASCD)
• Research on health and achievement
• Incorporating health data into school strategic
  or school improvement plans

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Where to find data

• Peer-reviewed journals
• National databases
• CDCs YRBS,
• School Health Policies and Programs (SHPPS),
• School Health Profiles
• US Department of Education
• SAMHSA

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Parental Involvement
and Risky Behaviors
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Where to find data (continued

• State databases
• State Departments of Education and Health
• State Social Service agencies
• State advocacy groups
• Voices for Youth
• Non-governmental agencies
• Health insurers.

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Where to find data (continued)

• Local data
• School Health and School Based Health Clinics
  reports
• Community health care providers
• Local health departments
• Police departments
• Juvenile justice departments
• Hospitals and social service agencies
• Local universities

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How data can be used

• Monitoring
• Trends/surveillance
• Utilization of services and resources
• Outcomes
• Informing stakeholders
• Developing policies
• Developing and implementing school health
  programs and practices
• Allocating resources, including the need for
  school nurses

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Stakeholders

• Parents
• Teachers
• Administrators
• School Committees
• Primary Care Providers/Hospitals
• Local Officials
• Statewide Decision Makers

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Methods of Data Collection

• Paper Mandated epinephrine reporting
• Electronic Essential school health service data
  Major challenge
• Survey (Survey Monkey, etc.)
• Teleform Client satisfaction
• Have a goal before beginning!

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Uses of Data

• Inform stakeholders
• Monitor utilization
• Develop policies
• Relate health and educational achievement
• Implement programs/allocate resources
• Monitor performance improvements/outcomes
• Provide health indicator surveillance

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The Essential School Health ServicesSchool
Nurse Data Report 2004-2005(102 MA School
Districts have the ESHS grant covering 550,000
studentsrepresenting half the 1.1 million
students in Massachusetts)

• School Nurse Student Encounters 5,930,181
  (Just under 6 million)
• 88.5 of students were returned to class after
  assessment and/or treatment by the School Nurse
• Staff/Personnel Encounters (Assessment and/or
  treatment) 147,624
• School Nurse Referrals to Primary Care Providers
  160,980
• 12,253 referrals to new Primary Care Providers
  (linking students with PCP)
• Emergency Referrals 10,855
• 17 911/ambulance services
• 83.9 Parents transported to emergency services
  or Primary Care Provider
• Medications Doses Administered per month (Daily
  as needed) 93,709
• (930,709 annually)
• Student Injuries 40,022
• 10.1 Intentional (assaults) or (self-inflicted
  injuries, overdose, suicide attempts)
• 69.5 Unintentional
• 20.4 Unknown

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Statewide Essential School Health Service
Encounters (538,618) FY 06
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Statewide ESHS Data (2006) Injuries

• 7.4 Injury Reports Intentional Injuries
  Assaults and Self Inflicted
• Referrals to Emergency Services11,357 times
• 911 Calls 1,973 (17.4) of these events
• Remaining 9,384 (82.6) events parents or others
  were called to transport the student to emergency
  health services.

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Statewide Data Referrals to Primary Care
Providers (FY06)

• Total Referrals 170,677
• New Primary Care Providers (PCPs) 12,121
  referrals to new PCPs (7.1) or 1.0 referrals per
  1,000 enrolled students per month
• Existing PCPs 158,556 referrals (92.9) or 22.6
  referrals per 1,000 enrolled students per month

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Community A (4491) Health Office Activity

• Over 48,200 visits for illness, injury,
  medication or a procedure
• This equates to 33.5 visits per day per school
• 95 of the students returned to class
• 63 students assessed and referred for emergency
  care due to illness or injury
• In 04-05, 86 of the student body visited the
  nurse at least once for a non-screening visit, up
  from 80 in 03-04
• 11,229 medications administered
• 929 staff related health office visits

Based on Year End s for 04-05
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Community C (4731) Nursing Procedures
performed in 2005-2006

• 3,431 Nursing Procedures included
• Blood Glucose Testing
• Blood Pressure monitoring
• Insulin Pump care and monitoring
• Nebulizer treatments
• Otoscopic Exam
• Others

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Community C (4731) Classroom Presentations by
the Nurse
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Community C (4731) Parent Communication
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Monitor Utilization of Health Services

• Trends in types of visits
• Establishment of benchmarks
• - Percentage of students using health
• services
• - Average number of visits per student

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Community D (1858) Chronic Health Conditions
requiring increased health office visits past 3
years
In 3 years, 11 increase in students requiring
care resulting in a 65 increase of visits
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Community D (1858) Medical Management of Complex
Health Conditions

• Diabetes 3-7 visits per day
• Asthma 1-3 visits per day
• Headaches/Migraine 1-3 visits per day
• Depression/Anxiety 1-3 visits per day
• Seizure/Epilepsy visits vary
• Allergies-food and environmental visits vary
• Cardiology 1-2 visits per day
• ADHD 1-2 visits per day

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Community E (6482) Utilization (6 mos.)
What is the percentage of enrolled students that
received health services at least once during the
school year? (Walked over the threshold)
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Community E (6482) Utilization
What is the percentage of enrolled students that
received health services in the category Office
Visits (6 mos.)
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Community E (6482) Utilization
What is the average number of encounters (all
office visits, excluding phone contacts and
screenings) per student? (6 mos.)
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Community F (2757) District Student Office Visit
Frequency (FY05)
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Develop Policies

• Care of the child with life threatening allergies
• Nutrition and physical activities
• Safety in the schools

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Statewide Data (FY 2006) Epinephrine
Administration
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Statewide Data (FY 2006) Students with Unknown
Allergies
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Community G (3071) BMI comparisons 2004-05,
2005-06 Grades 1,4,7
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Community H (3397) REASONABLE ACCESS CONTROL
ANOTHER TOOL FOR SAFER SCHOOLS

• The U.S. Justice Department 2003-2004 statistics
• - Controlled access to school buildings 83
• - Use of security cameras 28 of elementary
  schools, 42 of middle schools and 60 of high
  schools
• - 48 schools staff photo identification/visito
  r badges

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Community H (3397) 2

• Local schools employing combination of single
  point of entry, locked and electronically
  accessed doors and cameras Holyoke, West
  Springfield, Easthampton, East Longmeadow,
  Hampden/Wilbraham, Ludlow, South Hadley (Middle
  and Plains schools only), Hadley, Granby and
  Ware.

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Relate Health and Educational Achievement

• Early dismissals
• Effect of increased school nurse staffing
• Management of chronic illnesses in schools
• Vision/hearing screening related to educational
  achievement
• Critical area for evidenced based practice!

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State Level Data 1 Disposition of Students
(FY06)

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Community F (2757) Decrease in Dismissal Rate
with Nurse in Every Building
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Monitor Performance Improvement

• Follow-up of vision screening referrals
• Client Satisfaction
• Preschool vision screening by primary care
  providers

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Community C (4731) Vision Screening

• 3,600 students screened
• 380 students referred to a vision specialist
• 80 of the vision referrals completed
• 90 of the completed referrals needed treatment

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Community A (4491) Referrals Sent vs. Referrals
Returned Mid-year Results
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Community C (4666) Parent Satisfaction Survey
(FY 05)

• Surveys were mailed to a random sample of
  parents.
• Response Rate 39
• Results sent to School Committee by the Dept of
  Public Health in June 2006

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Community C (4666) Parent Satisfaction Survey
(FY 05)

• I am very satisfied with the care my child
  receives from the school nurse
• 95 strongly agreed/agreed
• If I have a question or concern, I can reach the
  school nurse for help without any problem
• 87 strongly agreed/agreed

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Community C (4666) Parent Satisfaction Survey
(FY 05)

• In an emergency at school, my child can get
  nursing care quickly
• 90 strongly agreed/agreed
• 10 not sure

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Allocation of Resources/Program Implementation

• Implement preventive or teaching programs
• Review related issues, e.g., physical or
  psychosocial environment
• Assess staffing needs

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Community E (6482) Allocation of Resources (6
mos.)
What percentage of encounters involves children
diagnosed with Asthma
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Community E (6482) Allocation of Resources (6mo.)
What percentage of encounters involves children
diagnosed with Diabetes
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Provide Illness Surveillance

• Chronic Disease Surveillance
• Asthma surveillance
• Life threatening allergies
• Changes in health condition management
  responsibilities of school nurse
• BMI Surveillance
• Injury Surveillance

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Statewide Reported Asthma Prevalence
State Prevalence 9.2 9.5 10.0
10.6
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Community I (6003) Student Injury Reports
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Community D (1858) Chronic Health Conditions
requiring increased health office visits past 3
years
Greater than 250 increase in students requiring
care.
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Recommendations

• Distribute data reports.
• Always be ready with data.
• Present the data based on the goals of the target
  audience.
• Have a strategic plan as to what you will collect
  and why.
• Continue to ask questions!

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Evidence Based Practice

• As school nurses we need data to develop our
  evidence based practiceand we need to use it to
  tell others what we do for children!

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Websites

• www.mass.gov/dph/asthma
• http//www.mass.gov/dph/fch/schoolhealth/
  index.htm
• masnrn.org

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Contact information

• NASSNC at http//www.nassnc.org
• Cheryl Resha at cheryl.resha_at_ct.gov
• Anne Sheetz at Anne.sheetz_at_state.ma.us