Beth Anne Bahn Acting Director

Division of School HealthBureau of Community Health

Systems

April 14, 2011

SCHOOL HEALTH UPDATE 2011

DIVISION OF SCHOOL HEALTH

• Beth Anne Bahn, Acting Director

• Vacant, State School Health Consultant

• Mary Taylor, Administrative Officer

• Administrative Support

• Six Regional School Health Consultants

REGIONAL SCHOOL HEALTH CONSULTANTS

NW – Donna Leffler 724-662-6068 dleffler@state.pa.us

NC – Deb Frey 570-327-3400 defrey@state.pa.us

NE – Kristen Cheslick 570-826-2062 kcheslick@state.pa.us

SC - Linda Katherman 717-787-8092 lkatherman@state.pa.us

SE – Sheri Mountz 610-378-4352 smountz@state.pa.us

SW – Joseph Donahue 724-830-2701 jodonahue@state.pa.us

ACT 104 of 2010 (HB101)

• Allows CRNP/PA to complete physicals for:

Teacher CertificationSchool StaffMandated Student Examinations

ACT 104 of 2010

• Epinephrine Auto-injectorsSchool policy on possession and use of asthma inhalers need to include Epi-pens

Demonstrate competency Specify conditions could lose privilegeRequire updated prescription and parental approval annually

ACT 104 of 2010

• Food Allergy Reaction ManagementPart of Wellness PolicyDevelopment of Guidelines

Co-chair of committee with PDE, Division of Food and Nutrition ServicesPattern after Diabetes GuidelinesStakeholder meeting April 21

• Published in PA Bulletin May 29, 2010http://www.pabulletin.com/secure/data/vol40/40-22/984.html

• Effective August 1, 2011 for the 2011-2012 school term

IMMUNIZATION REGULATIONS

For For NewNew School Enterers in Kindergarten or First Grade School Enterers in Kindergarten or First Grade

• 4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4 years old)• 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4 years old)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or history of disease)

NOW:NOW: NEW:NEW:• 4 doses tetanus (DTaP, DT, Td)(1 dose on or after 4th birthday)• 4 doses diphtheria (DTaP, DT,

Td) (1 dose on or after 4th birthday)

• 3 doses polio• 2 doses measles (MMR)• 2 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• 2 doses varicella or immunity

(vaccine or history of disease)

IMMUNIZATION REGULATIONS

For Attendance In All Grades For Attendance In All Grades

• 3 doses tetanus (DTaP, DT, Td)• 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)

NOW:NOW: NEW:NEW:

•4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4th birthday)

•4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday)

•3 doses polio•2 doses measles (MMR)•2 doses mumps (MMR)•1 dose rubella (MMR)•3 doses hepatitis B•2 doses varicella or immunity (vaccine or history of disease)

IMMUNIZATION REGULATIONS

For Entering 7For Entering 7thth Grade Grade

NOW:NOW: NEW:NEW:

• 4 doses tetanus (DTaP, DT, Td) (1 dose on or after 4th birthday)• 4 doses diphtheria (DTaP, DT, Td) (1 dose on or after 4th birthday)• 1 dose tetanus/ diphtheria/ acellular pertussis (Tdap)• 3 doses polio• 2 doses measles (MMR)• 2 doses mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• 2 doses varicella or immunity (vaccine or history of disease)• 1 dose meningococcal conjugate

• 3 doses tetanus (DTaP, DT, Td) • 3 doses diphtheria (DTaP, DT, Td)• 3 doses polio• 2 doses measles (MMR)• 1 dose mumps (MMR)• 1 dose rubella (MMR)• 3 doses hepatitis B• varicella immunity (vaccine or history of disease)

IMMUNIZATION REGULATIONS

•1 dose MCV•1 dose of Tdap (if 5 years have elapsed since last tetanus immunization)

NOTE: If the student is

attending 7th grade, do they

also have?

Place on provisional status and review every 60 days for 8 months.•May exclude from school if non-compliance continues past provisional period.

NO

In Compliance

YES

Place on provisional status and review every 60 days for 8 months.•May exclude from school if non-compliance continues past provisional period.

•4 doses of tetanus•4 doses of diphtheria•3 doses of polio•2 doses of measles•2 dose of mumps•1 dose of rubella•3 doses of hepatitis B•2 doses of varicella (chickenpox) or history of disease

Does the student have the following immunization requirements

for attendance in all grades?

Does the student have at least one dose of DT, OPV/IPV, MMR, HepB and Varicella?

Deny admission until one dose of each antigen listed to the left is received.

NONO

YES

In Compliance

YES

School Immunization Requirements for school attendance for all grades according to PA school law.

Foreign exchange students or foreign students visiting PA schools need at least one-dose of each antigen to attend or visit PA schools, then they will be placed on provisional status.

IMMUNIZATION REGULATIONS

OLD

•Grace Period•Vaccine dose administered within the 4-day period prior to the minimum age for the vaccination or prior to the end of the minimum interval between doses

•Considered a valid dose

Example: MMR Example: hepatitis B

IMMUNIZATION REGULATIONS

• Children <5 years old, 28 Pa. Code § 27.77 (ACIP recommendations)

• Children 5 years and older, follow School Health regulations, 28 PA Code, Chapter 23, Subchapter C

IMMUNIZATION REGULATIONS

IMMUNIZATION FAQs

• Can a parent ask for moral exemption after student has had several doses of vaccine?

Case by case basisDetermined by school administrationNeeds to be in writing

Can sign back of immunization card

Not required to be renewed annually

IMMUNIZATION FAQs

• Doctor office not providing immunizations, citing HIPAA

Share joint guidance HIPAA/FERPAInclude parent release on school formsEncourage use of PA-SIIS

• Can school policy require students to have immunizations on the 1st day of school, no provisional?

Have to follow DOH regulations

• Provide Hepatitis B, MCV4, Tdap, and Varicella

Students unable to obtain through their medical homes

• School districts plan, develop, and implement programs

Consultation from local Health Department. Protocols available from the Division of Immunizations

• Vaccine is provided at no cost to school districts for VFC eligible students

SCHOOL IMMUNIZATION CATCH-UP PROGRAM (SICU)

IMMUNIZATION RESOURCES

• Resources available on What’s New with School Health, www.health.state.pa.us/schoolhealth

Slide presentation from March 15, 2011 webinar, “Update to School Immunization Regulations”Division of Immunizations website

 Law and regulations regarding immunizations Updated Immunization Manual (when available) Information on ordering immunization cards and new rack cards

IMMUNIZATION RESOURCES

• PDE, Basic Education Circular (BEC), Education for Homeless Students

• Joint Guidance on HIPAA and FERPA• PA State Immunization Information System (PA-

SIIS)• CDC Childhood and Adolescent Immunization

Scheduler Assist in determining immunization compliance Provides an "instant picture of immunity.“

REFUGEE HEALTH

• DOH and DPW• Provider Network• Timely comprehensive health assessment

for each arriving refugeeIdentify communicable diseasesIdentify and treat health conditions or health-related issues

• http://www.portal.state.pa.us/portal/server.pt/community/refugee_health/19001

TB TESTING OF STUDENTS

• PA Public School CodeSection 14-1402 (a) & (f)

• 28 PA CodeSection 23.9

• ModificationEncouraged since 1997

TB TESTING OF STAFF

• PA Public School CodeSection 14 – 1416 & 14 – 1418

• 28 PA CodeSection 23.44

• Law doesn’t allow for modification of TB testing for staff

• Does allow for alternative testing methods

TB TESTING OF STAFF

• VolunteersMust comply with TB testing requirement if:

In direct contact with students for 10 or more hours per week

MEDICALLY IMPAIRED DRIVER LAW

• Effective October 9, 2010• CRNP and PA

When conducting physical exams for driver’s permits or in determining whether person has a disorder affecting ability to drive safely Report to PennDOT within 10 daysAny patient 15 years of age or older diagnosed with condition that could impair ability to safely operate motor vehicle.Don’t need to report conditions expected to last less than 90 days

MEDICALLY IMPAIRED DRIVER LAW

• DiabetesSevere hypoglycemic reactions or symptomatic hyperglycemia

Not qualified to driveUnless continuous period of at least 6 months free from disqualifying episode

• Request on-line accesshttps://www.dot3.state.pa.us/contact_us/medicalEmail.jsp

MEDICALLY IMPAIRED DRIVER LAW

• Report to Primary Care ProviderDiabetics

Severe hypoglycemic reactions (requires outside intervention or assistance of others) or produces confusion, loss of attention or loss of consciousness Symptomatic hyperglycemic (caused loss of consciousness or an altered state of perception, including, but not limited to, decreased reaction time, impaired vision or hearing, or both) and confusion reactions

Seizure activityCardiovascular

Syncopal attack, loss of consciousness, vertigo, paralysis or loss of qualifying visual fields

MEDICALLY IMPAIRED DRIVER LAW

http://www.dot3.state.pa.us/centers/medicalReportingCenter.shtml

AED

• Check Battery & pads for expiration dats

Potentially greater liability than not having an AED

• Grants/funding- Kiwanis, Lions, Rotary, PTA, booster clubs

MEDICATION ISSUES

• Field Trips (pp. 18-19 medication guidelines)

Can’t refuse student attendance on field trip because nurse not available (IDEA/504)May not request waiver of liability from parent (Berlin Brothers Valley SD)Advance notice to nurse for planningLimit # of field trips from building per day

MEDICATION ISSUES

• Field TripsInvite parent or parent designeeUtilize licensed nurse from sub list Licensed parent volunteer

Need clearancesApproval as district volunteer

Provider permission to change dosage time or skip a dose

MEDICATION ISSUES

• Out of state field tripsCheck with Board of NursingGet in writing

• Delegation to student by parentStudent under school jurisdictionZero tolerance drug policies

• Self-administration by studentEmergency medications only

MEDICATION ISSUES

• Extracurricular activitiesSame rules as field trips

• Early Intervention ProgramsSchool District responsibility

Integral part of school programLocated in school district buildingMedications, immunizations & emergency careScreenings for baseline (optional)

MEDICATION ISSUES

• Emergency MedicationsPA Public School Code- self carry and administer asthma inhalers/epinephrine auto-injectorsMay train unlicensed staff to assist with their administrationDiastat, glucagon etc. require licensed medical professional to administer

SPECIAL NEEDS STUDENTS

• Medical Plans of CareStandard of Care- “If you didn’t write it, you didn’t do it.”Emergency Care Plan (ECP)Individualized Health Care Plan (IHP)Individualized Education Plan (IEP) with medical component504 Service Agreement

SPECIAL NEEDS STUDENTS

• Nurse should be part of team for IEP and 504

Nurse who has student as part of their caseloadShould not sign legal document if not involved in development of planReasonable accommodations for student

SPECIAL NEEDS STUDENTS

• Students with newly diagnosed or unstable Type 1 Diabetes and an IEP

Medical provider can write as part of Medical Management Plan

Nurse required in school building at all timesFederal funds to cover cost

SPECIAL NEEDS STUDENTS

• Factors to Consider Individualized Transition Plan (ITP)Transition Healthcare ChecklistWho can legally provide Care?Dietary Accommodations

SPECIAL NEEDS STUDENTS

• ITPEffort to standardize assessment of student transportation needsResources and training availableWorking with Bureau of Family Health and PDE Bureau of Special Education

SPECIAL NEEDS STUDENTS

• Transition Healthcare ChecklistRequired to start transition planning by age 14School responsible for successful transitionShould include a health component

Most likely area for failure according to PATTAN statisticsChecklist updated in 2010Also available in Spanishhttp://www.portal.state.pa.us/portal/server.pt?open=514&objID=558090&mode=2

SPECIAL NEEDS STUDENTS

• Provision of CareCare of Medically Fragile Child

http://www.aft.org/pdfs/healthcare/medicallyfragilechild0409.pdf

Scope and Standards (ANA)Code of Ethics (ANA)

PA laws and regulations

•Dietary Accommodations•Special dietary needs medical form has been updated •http://www.portal.state.pa.us/portal/server.pt/community/national_scho ol_lunch/7487/special_dietary_needs_in_school_nutrition_programs-_resources/509222.•Must be signed by physician•Share medical form with Food Services

Director•Collaboration with Food Services is critical for appropriate provision of health and food services

SPECIAL NEEDS STUDENTS

CONTINUING EDUCATION

• Act 48DSH will submit hrs reported for courses from ANCC, ANA, AMA, AGD and PADHS Fax certificates to 717-783-4790 or e-mail to c-paschool@state.pa.us along with PDE ID

• Act 58If CSN, Act 48 hours count for RN CE

LEARNING MANAGEMENT SYSTEM (LMS)

• All School Personnel & Supplemental Licensed Health Staff

• Offers on-line courses for school staff Act 48 hours through the Division of School HealthAct 58 hours through the Dept. of Health

• To become a registered user:www.paprepared.net

PA ASTHMA PARTNERSHIP

• www.PAasthma.org

• Resources• Partners Sharing Newsletter• Funding Opportunities• Research Articles

THE CENTER (CNAP)

• Formerly PA Advocates for Nutrition and Physical Activity

• Now Center for Nutrition and Activity Promotion at Penn State Hershey Children’s Hospital

www.nrgbalance.org

nrgZone Enrollment

• March 14 – April 22, 2011• www.nrgbalance.org/schools

Click on Healthy Schools Campaign25- question assessment

• Online resources• Monthly eNewsletter• Annual events (ex. Apple Crunch)

PROPOSED CH. 12 REGULATIONS

• Establish baseline nutritional & physical activity standards

• Adopted by State Board of Education May 6, 2010

• Approved by Governor’s Office November 6, 2010

• Currently in Attorney General’s Office

PROPOSED CH. 12 REGULATIONS

• Physical Activity30 minutes daily Moderate – to – vigorous

• Physical Education150 minutes at elementary level225 minutes at secondary levelTo be removed in final version

PROPOSED CH. 12 REGULATIONS

• Encourages active commuting (bike or walk) safely to & from school

• Establish & maintain coordinate school health advisory committee

• Coordinated School Health planStudent nutrition, health & physical activity Includes the wellness policy

PROPOSED CH. 12 REGULATIONS

• Nutrition StandardsEncourages school gardens or farmsGuidelines for classroom celebrations

Offer sample party menusComply with nutrition standardsNon-food rewards & celebrations

FundraisingComply with nutrition standards

Set standards for competitive foods & beverages

SCHOOL HEALTH WEB PAGE

• Data/reports from Annual Report Database• Laws and Regulations• Policies and Procedures• Manuals, Guidelines and Forms• Training opportunities, Grants and Funding• Information on Current and Future Health

Issues• What’s New

www.health.state.pa.us/schoolhealth

HAPPY SCHOOL NURSE’S DAY May 11, 2011