PENNSYLVANIA DEPARTMENT of HEALTH Division of School Health

1. PENNSYLVANIA DEPARTMENT of HEALTHDivision of School Health SCHOOL HEALTH UPDATE 2008

2. Presented by Beth Anne Bahn and Rosemary Danchick-Moyer State School Health Consultants March 30, 2008

3. DIVISION OF SCHOOL HEALTH • Jon Dale, Director • Beth Anne Bahn, State School Health Consultant • Rosemary Danchick-Moyer, State School Health Consultant • Stephanie Weigle, Administrative Officer • Bill Barbour, STEPS School Health Coordinator • Valerie Morgan, Administrative Support • Six Regional School Health Consultants

4. Diabetes Cardiovascular Injury Prevention Chronic Disease Tobacco Prevention Maternal Child Health Special Needs Health Care Public Health Educator HIV STD Communicable Disease Environmental Health Sanitarians Tuberculosis Immunization EMS Program Specialist District Office Program Staff

5. Regional School Health Consultants NW - Linda Deeter 724-662-6068 ldeeter@state.pa.us NC - Andrea Dale 570-327-3400 adale@state.pa.us NE – Lois Elick 570-826-2062 lelick@state.pa.us SW - Cindy Thomas 412-565-5101 cythomas@state.pa.us SC – Linda Katherman 717-787-8092 lkatherman@state.pa.us SE - Sue Templin 610-378-4352 stemplin@state.pa.us

6. School Health Consultant Caseload

7. School Immunization Requirements School Immunization Requirements NOW: School Immunization Requirements PROPOSED: http://www.pabulletin.com/secure/data/vol38/38-6/217.html

8. School Immunization Requirements For New School Enterers in Kindergarten or First Grade NOW: PROPOSED: • 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) • 2 doses mumps(MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • varicella immunity • (vaccine or history of disease) • varicella immunity (vaccine or history of disease) 2 doses phased in by year 2010/2011 • 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)

9. School Immunization Requirements For Attendance In All Grades NOW: PROPOSED: • 4 doses tetanus (DTaP, DT, Td) • 4 doses diphtheria (DTaP, DT, Td) • 3 doses polio • 2 doses measles (MMR) • 2 dose mumps (MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • varicella immunity (vaccine or history of disease) 2 doses phased in by year 2010/2011 • 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)

10. School Immunization Requirements For Entering 7th Grade NOW: PROPOSED: • 3 doses tetanus (DTaP, DT, Td) • 3 doses diphtheria (DTaP, DT, Td) • 1 dose tetanus/diphtheria/acellular pertussis • 3 doses polio • 2 doses measles (MMR) • 2 dose mumps (MMR) • 1 dose rubella (MMR) • 3 doses hepatitis B • varicella immunity (vaccine or history of disease) 2 doses phased in by year 2010/2011 • 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)

11. Additional Proposed Changes to School Immunization Regulations • Grace Period - A 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 shall be considered to be a valid dose of the vaccine.

12. Additional Proposed Changes to School Immunization Regulations

13. Reporting Requirements OLD WAY: • All Schools Self Report Aggregate Counts (Department Form) • # of students attending by grade level • # of students attending by grade-level completely immunized • # of students attending school by grade level classified as medical exemptions • # of students attending school by grade-level classified as religious exemptions • # of students provisionally admitted • # of students denied admission with inability to qualify for provisional enrollment

14. Reporting Requirements PROPOSED: • Schools will self report (Department Form) • # of students attending in a specific grade level or age group • # of vaccine dose(s) of every enrolled student in grade level or age group (as requested on reporting form) • May request information for only 1 or 2 grades or age levels • Will continue to request same information for exemptions, provisional enrollments and denied admissions

15. School Immunization Law Report (SILR)

16. Statewide Immunization Information Registry (SIIS) • Began in 1996 • Used primarily by hospitals, state health clinics • Now marketing to private providers • No cost to enter immunizations or view data • “View only” access for school nurses

17. Benefits of Statewide Information Immunization System (SIIS) • Prevents extra and unnecessary doses of vaccines- decreasing costs • More accurate immunization records for those enrolled in the system • Access by State Health Clinics, Providers and Schools to accurate and complete vaccine administration records

18. Statewide Information Immunization System (SIIS) • To enroll for view-only access: • Go towww.health.state.pa.us/pasiis • Click on Provider enrollment • Complete the application and fax or mail it to the Department

19. “No Child Left Behind” and Immunization Exclusion • There is no evidence found in “No Child Left Behind” that would prevent excluding students for inadequate immunizations. • This was determined after discussions with the PA Department of Health, Division of Immunizations and Legal Counsel; the PA Department of Education; NCLB Compliance Office and Legal Counsel; and the US Dept. of Education Compliance Office

20. Pre-K Counts Grant Programhttp://www.pde.state.pa.us/early_childhood/cwp/view.asp?A=316&Q=125765 • Established by Dept. of Education • Provide high quality pre-K education for 3 and 4 yr. olds • Free to families • Focus on children at risk of academic failure • Approximately 300 early learning programs participating

21. Pre-K Counts Grant Program • Immunizations: • Follow 27.77 regulations, Immunization requirements for children in child care group settings. Have up to 60 days to provide immunizations http://www.pacode.com/secure/data/028/chapter27/s27.77.html • Reimbursement • May not count these students under K4 ADMs on Annual Health Report

22. Pre-K (K4) Programs • Immunizations: • Follow 27.77 regulations, Immunization requirements for children in child care group settings. Have up to 60 days to provide immunizations http://www.pacode.com/secure/data/028/chapter27/s27.77.html

23. Pre-K (K4) Programs • Integral part of the school program • Students counted in ADMs for reimbursement • Required to have physical and dental examinations • Required to have mandated screens (vision, hearing, growth) • Required to have nursing services

24. TB Testing of Students • PA Public School Code of 1949 • Section 14-1402. Health services • (a) Each child of school age shall be given… (4) tests for tuberculosis under medical supervision… • (f) The Secretary of Health, upon petition of the school board…,may modify for individual school districts the school health services program specified in this section.

25. TB Testing of School Staff • PA Public School Code of 1949 • Section 14-1418. Medical examinations of teachers and other persons • (b) Each teacher, any other school employe and any person providing services for school children under contract shall be given tests for tuberculosis…

26. TB Testing • 485 out of 501 school districts in PA have asked for modifications of their routine TB testing of students • New school employees when hired and volunteers are still required to have a TB test

27. TB Report to Dept. of Health • Historically, schools have been submitting a “School Tuberculin Testing Report” (form H516.488) to the Department on an annual basis. • Provided aggregate data on students and staff that had been tested or sent for follow-up testing during the previous year.

28. TB Report to Dept. of Health • The Department has determined that this aggregate data is no longer useful as a surveillance tool • Effective immediately, it is no longer necessary to submit the School Tuberculin Testing Report.

29. PE and Dental Modifications • Districts may request modifications to accept mandated physical exams up to one year prior to the year they are required • School Board must vote to make the modification; then the district sends a letter to DOH, Division of School Health, providing notice of the board decision

30. SHARRS • School • Health • Annual • Reimbursement • Request • System

32. Common Errors on Health Exams, Screens & Select Services ERROR: Entering the number of CONTACTS under Students Requiring Skilled Nursing. CORRECT: Should be the number of INDIVIDUAL students, not the number of contacts.

33. Health Exams, Screens, & Select Services (cont.)

34. Common Errors on Health Exams, Screens & Select Services (cont’d) ERROR: Counting only 6th grade for Scoliosis screenings when mandated for Grades 6 & 7. CORRECT: If a student had his/her scoliosis screening done by a private provider during the 6th grade physical, it gets counted.

35. Health Exams, Screens, & Select Services (cont.) The sum of A, B & C do not match #13 and 14.

36. Common Errors on Health Exams, Screens & Select Services (cont’d) ERROR: Number 13 & 14, respectively, match the sum of the at-risk categories A, B, and C CORRECT: 13 and 14 – Should be the total number of students screened with BMI-for-age percentile • A, B, and C: Total number of students in each of the at-risk categories • Students in healthy ranges are automatically calculated by the computer

37. These 3 numbers must match

38. Common Errors on Health Exams, Screens & Select Services (cont’d) ERROR: Nature, Time and Location of Injury categories don’t match CORRECT: Nature, Time and Location of Injury categories have the same total

39. The numbers in the Other, Doses by Individual or Standing Order, should be low. These fields should only include medications that do NOT fall into the other nine (9) categories.

40. Data Entry Errors • Small errors in data make large errors in percentages. • When data is widely variable it is not considered to be valid.

41. Data Entry Errors • Everyone needs to keep their tally sheet, no matter how you keep track of your numbers. (BMI for age percentile groups; diabetics, procedures, etc.) • When you have collected your numbers you should calculate your percentages. (i.e. What percentage of your student population is obese? What percentage of your student population has a diagnosis of asthma? etc.

42. School Districts Providing Services for Private/Non-Public Schools • If the Private/Non-Public school asks for school health services the Public school must provide these services. • 28 PA Code § 23.51. Children to be provided nursing services. A child in private, parochial and public schools shall be provided with school nurse services in the school which the child attends.

43. School Districts Providing Services for Private/Non-Public Schools

44. School Districts Providing Services for Private/Non-Public Schools • Provide school nurse services • Review of health care needs including IHPs and emergency plans as needed

45. School Districts Reporting Data for Private/Non-Public Schools • If the school district is providing school health services to private/non-public • ADMs included on Annual Health Report • Also include data for: • Health exams, screens and select services • Chronic diseases • Serious School Injuries • Medication Administration

46. Transfer of Health Records • 24 P.S. Section 14-1409. Confidentiality, transference and removal of health records • “… the district or school wherein the child is newly enrolled shall request and the district or school where the child previously attended shall surrender the health record of the child.” • “…shall not destroy a child’s health record for a period of at least two years after the child ceases to be enrolled,…”

47. Maintenance of Health Records • Pennsylvania Code, Section 23.55, Health Services • Maintenance of health records • “Health records shall be maintained for each child. These records shall be kept in the school building where the child attends school and shall be available to the school nurse at all times. Records shall be transferred with the child when he moves from one school to another or from one district to another.”

48. Proposed Amendments to Chapter 27 Regulations • Communicable and Non-Communicable Disease Regulations • DOH proposed revisions near completion • To be published in PA Bulletin for comment • www.pabulletin.com

49. Medication Issues • Do school nurses need a doctor’s order to administer over-the-counter medications to students? • SBN regulation @ 49 PA Code § 21.14. Administration of drugs. • (a)  A licensed registered nurse may administer a drug ordered for a patient in the dosage and manner prescribed.

50. Medication Issues • Who can administer tylenol? • Nurses can, when a licensed provider, authorized to prescribe, has written a prescription. • Dental Hygienists have no such authority.