School Health Issues Update

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School Health Issues Update

• Dorothy Caldwell
• School Health Initiative Coordinator
• Healthy Schools Leadership Assembly
• Friday Center October 14, 2004

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Nutrition PE/PA
Overweight
Diabetes
Tobacco Use
Asthma
Bullying
Special Health Care Procedures
Meds at School
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• Todays Goal
• Overweight/Obesity Prevention
• School Health Services 2003-04 Report
• School Nurse Funding Initiative
• Look Ahead

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Prevalence of Overweight (BMI gt95th) in NC
Children by Age, 2002
Source Children seen in North Carolina Public
Health Sponsored Clinics for WIC, Child Health,
or School Based Health during Calendar Year 2002.
Percentiles were based on the CDC/NCHS Year
2000 BMI Reference.
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Increase in Overweight NC Children by Age,
1995-2000
Age in years
Source NC Institute of Medicine, NC Child
Advocacy Institute, 2001 Child Health Report Card
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UNC Study

• More than one in eight (13.5) NC rural school
  children tested had 3 or more risk factors for
  metabolic syndrome
• Study included 3,203 students between ages 8 and
  17

Joanne Harrell, PHD, RN UNC School of Nursing
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CDC scientists predict that 30 of children born
in 2002 will have diabetes in their lifetimes
Slide courtesy of Dr. Jim Marks, CDC
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2003-04 SH Services Report

• 3,643 students with reported diabetes
• 29,289 monitor blood glucose at school
• 1,622 receive insulin injections at school
• 1,132 have insulin pumps
• ??? Type II diabetes

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Asthma

• 62,075 students have asthma
• 3,516 students use peak flow monitoring at school
• 65 LEAs have asthma education programs
• 2,761 students taught Open Airways curriculum

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43 of 115 School Districts are 100 tobacco free,
up from 6 in 1999
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Student Tobacco Use

• 48 LEAs offered alternatives to suspension
• 48 LEAs offered smoking cessation classes

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Other LEA Written SH Policies

• 98 - Medication Administration
• 89 - Prevention/Control of Communicable
  Disease
• 77 - Injury Reporting
• 70 - Special Health Care Services
• 68 - Maintenance of SH Records

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More LEA Written SH Policies

• 48 - Health Screenings
• 36 - Health Care Referral and Follow-up
• 26 - Health Problem Identification

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Medications at School

• 93,561 students received medications at school in
  03-04
• About a third were daily, long term
• primarily Ritalin, Dexedrine, Lithium and other
  psychotropic controlled substances

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Students Requiring Health Care Procedures at
School

• Epi-pens -- 4,255
• Glucagon Injection -- 1,624
• Nebulizer Treatments -- 1,535
• Tube Feeding -- 364
• Urinary Catheterizations -- 305
• Shunt Care - 167
• Tracheostomy Care - 78

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Emergency Care

• 527,935 Minor Injuries and illnesses
  reported 03-04
• 8,837 Serious Injuries reported
• 758 involved lawenforcement intervention
• 7 students permanently disabled
• Only 30 of LEAs had school nurse available most
  of time when student injuries occurred

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Fewer than 700 School Nurses in 2002-03
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School Nurse to Student Ratio

• 2003 General Assembly Special Provision Budget
  Bill requested SBE to
• Review standards for SN in Basic Education Plan -
  being met?
• Compare BEP standards with national
  recommendations
• Consider legal requirements for provision of
  school health services

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SBE Recommendations

• Expansion of SN services to reach a 1750 ratio
  by 2014 - 10 year plan
• Process for lead heath officials of DPI and DHHS
  to collaborate and coordinate planning and
  implementation
• Sustain current DPI standards and definitions of
  school nursing
• Encourage ongoing dialogue with Joint Legislative
  Education Oversight Com.

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Planning

• PH Task force recommended 4-year implementation
  plan - 263 nurses/yr
• Expansion Budgets
• DPH requested 13 million
• DPI requested almost 5 million

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Results

• School Nurse Funding Initiative
• HB 1414 passed July 18, 2004
• 80 permanent positions
• 65 2-year positions - part MCHB
• 50,000 per position per year
• 8,250,000

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School Nurse Funding Initiative

• Ensures SN for 4 LEAs w/o one
• Increases LEAs meeting 1750 ratio from 10 to
  24
• Lowered average ratio from 11897 to 11568
• Highest ratio in state now 4,633

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Major Needs Remain

• Using 2003-04 School Enrollment and SN after
  165 added
• 2 LEAS above 4,000
• 4 LEAs between 3,000 and 3,999
• 19 LEAs between 2,000 and 2,999
• Enrollment continues to increase in some LEAs

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Criteria

• General Assembly required criteria
• Nurse to student ratio
• Economic status of community
• Health needs of students
• Others to be developed by DPI and DPH
• 13 criteria selected
• ranked 115 LEAS from highest need to lowest (115
  to 1) on each criteria
• Total became need score

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SNFI Process

• DPI Paula Collins, Dr. Elsie Leak, and
  DPI data staff
• DHHS Sec. Odom, Dr. Devlin, Ryan, Tant,
  Asay, Sanderson, Buescher, and
  Caldwell

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The Envelope Please.

• Total need scores ranked highest to lowest
• Top 80 LEAs allocated permanent nurse
• Recalculated need score with new SN ratio
• Top 65 need scores allocated 2-year nurse

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Who Hires?

• Local Health Department
• responsibility to meet with LEA(s) and determine
  best local decision
• Decisions
• 46 LHDs - DPH Agreement Addenda
• 28 subcontracting to LEA or Hospital
• 24 LEAs and 2 Hospitals have direct contract with
  DPH

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The Future?
?????????
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School Nurse Funding Initiative

• Governor Easleys SNFI press release called for
  1750 ratio in every school in 5 years
• Public Health Task Force revised their
  recommendation to reach 1750 by 2009-2010
• State Board of Education 10-year plan would reach
  1750 by 2014

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Nurses Cant Do it All

• Need to remain focused on
• Overweight Prevention
• Nutrition and Physical Activity collaboration
  with DPI others
• Collaborate on EPA and CDC Asthma Grants
• Strengthen collaboration with EPI Section on
  HIV/STD Prevention
• Strengthen Behavioral Health collaboration

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Schools Conflicted

• There is a real health crisis for children out
  there, and schools are conflicted about their
  role in the solution.
• Source Dr. Michael Ward, President CCSSO April
  15, 2003

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Just a little exaggeration
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Moving Our Children Toward a Healthy
WeightFinding the Will and the WayFocus on
Healthy Eating and Physical Activity

• Individual Will
• Community Will

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HB 303(introduced)

• Require Physical Activity
• 150 minutes/week in elementary
• 225 minutes in middle schools
• Sponsored by former school administrator

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NCSBA/DPH Overweight and Obesity Prevention Survey

• 93 believe serious/very serious problem in their
  community
• 96 believe important/very important for schools
  to have nutrition standards
• 93 believe important/very important to provide
  daily PE in preK-8 grade
• 63 believe important/very important to provide
  daily PE in grades 9-12

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NCSBA Overweight and Obesity Prevention Survey

• Greatest obstacles to improving student nutrition
• lack of interest/support among students and
  parents
• Lack of funds
• Greatest obstacles to daily PE/PA
• Lack of time
• Lack of funds

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Cost of Change is High

• Cost of inaction is higher
• Childhood overweight is an epidemic
• Stigma --social discrimination
• Type 2 Diabetes
• Heart Disease and stroke
• Cancer
• Skyrocketing Health Care Costs

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Coordinated School Health Model
Health Education
Health Services
Family Community
Staff Wellness
Physical Education
Counseling
Nutrition Services
School Environment
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Healthy Schools/Healthy Communities
Healthy Children
School Performance
Increased Social Capital
Healthy Communities
The relationship between schooling and health
outcomes is one of the strongest generalizations
to emerge from empirical research in the U.S.
Nagya R. (2000). Applied Economics, 32, 815-822
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