School Health Services Update: August 24, 2018

Dear Colleagues,

Welcome to the beginning of a new school year!  Like the children and adolescents we serve, I hope you have come back refreshed, renewed and excited for the many opportunities to improve the health and safety of our students!  There is much happening across the state….the email below is filled with important updates, new guidance, valuable resources and available continuing professional development programs for all School Health personnel!  (There are also  five attachments included with this email.)  Please be sure to forward this to your colleagues in your school building, in your district and in your community!

A reminder to mark your calendar for the first statewide meeting for all School Nurse Managers to be held on Wednesday, September 12th, at our new location in Westborough.  An School Nurse Leadership orientation program for all nurses new to their role in a leadership capacity is scheduled for Friday, September 21st.  Registration for both of these programs is available soon on the SHIELD website and open to all school nurses in leadership roles.

Our best wishes for a wonderful and productive school year!

Mary Ann, Janet and Alison
MDPH School Health Team


Congratulations to Brenna Quinn, PhD, RN, NCSN, CNE,  and her co-authors, Jean C. Solodiuk, PhD, RN, Dominick Morrill, MPH, and Sangeeta Mauskar, MD, MPH for their publication in the American Journal of Nursing (AJN), August 2018, on their research related to, Pain in Nonverbal Children with Medical Complexity: A Two Year Retrospective Study.  The findings reveal the importance of including childhood ailments as potential pain sources.  Brenna has worked as a school nurse and is currently an assistant professor at the Solomont School of Nursing, University of Massachusetts Lowell. Jean C. Solodiuk is the clinical manager and Dominick Morrill is a project manager in the Pain Treatment Service, Department of Anesthesia, at Boston Children’s Hospital. Sangeeta Mauskar is director of the Complex Care Service Inpatient Program at Boston Children’s Hospital.   Brenna continues to work with school nurses to improve pain assessment skills of non-verbal students.  She also serves on the National Board for the Certification of School Nurses, representing school nurses in Massachusetts!

 Shanyn Toulouse, MEd, BSN, RN, NCSN, Northeast Regional Consultant and a Children’s Vision Massachusetts (CVMA) attended the 2018 Focus on Eye Health National Summit.  Prevent Blindness held its 13th annual “Eyes on Capitol Hill” program on Tuesday, July 17, 2018, in Washington, D.C. Members of CVMA and Prevent Blindness met with congressional and senate members and their staff to relate their personal stories and experience in vision and eye health, discuss the prevalence and prevention of vision conditions, and the impact of unnecessary vision loss in Massachusetts.

From right: Gayathri Srinivasan, OD, NECO; Clifford Scott, Past President, NECO; Paulette Tattersall, Director, Co-Chair of CVMA, and Priscilla Kelangi, Mgr of Comm and Dev., Prevent Blindness NE; Stacy Lyons, OD, NECO; Shanyn Toulouse, RN, NE School Nurse Consultant, Haverhill Public Schools; Marcia Feist-Moore, Educator; Bruce Moore, OD, Emeritus Professor, NECO, Co-Chair of CVMA; and Jack Huang, Volunteer.


The below information will be posted in ELAR and the License Requirements Tool on the DESE website with relation to the orientation requirement for licensure as a School Nurse in Massachusetts:

If you complete the school nurse orientation program through the Boston University School Health Institute for Education and Leadership Development (SHIELD) prior to 7/1/18, please submit a copy of your certificate of completion for each one of the three following mandated trainings:

  • Foundations of School Nursing Practice;
  • Medication Administration in a School Setting: School Nursing Practice in Massachusetts; and
  • Mandated Screening Training.

Individuals completing the school nurse orientation program on or after 7/1/18 will need to submit copies of the above noted certificates of completion and a copy of your certificate of completion for the SBIRT in Schools mandated training. Information regarding the orientation program mandated trainings may be found here.

  • Foundations of School Nursing Practice;
  • Medication Administration in a School Setting: School Nursing Practice in Massachusetts; and
  • Mandated Screening Training
  • SBIRT in Schools mandated training


Northeastern University no longer offers the school nurse orientation program. However, if you completed the school nurse orientation program through Northeastern University on or after 7/1/12, please submit a copy of your certificate of completion for each one of the following three trainings: Introduction to School Nursing in Massachusetts, or Professional School Nursing Practice in Massachusetts; Medication Administration and Delegation in MA Schools; and Mandated Screening Training for School Nurses, or Mandated Screenings Competency Check for School Nurses. If you completed the school nurse orientation program through Northeastern University prior to 7/1/12, please submit a copy of your certificate of completion for either Introduction to School Nursing in Massachusetts or Professional School Nursing Practice in Massachusetts verifying the completion date. Information regarding obtaining a certificate of completion from the Northeastern University School Health Institute may be found here.

Please note that documents may be uploaded into your ELAR account or mailed to the Office of Educator Licensure. Information regarding the uploading and mailing of documents may be found here.  Basically, this means the following and how candidates will be transitioned:

  • If a candidate applied prior to 7/1/18 and completed the BU training/orientation prior to 7/1/18, have satisfied the orientation requirement.
  • If they applied after July 1, 2018 but they had completed all of the BU orientation prior to the SBIRT section implemented on 7/1/18, they have satisfied the orientation requirement.
  • If they apply on/after 7/1/18 and have not completed all of the orientation by 7/1/18, now need to complete SBIRT section of orientation in order to satisfy the requirement.


The Department of Elementary and Secondary Education  (DESE) recently released AED in Schools Guidance, related to An Act Requiring Automated External Defibrillators (AEDs) in Schools. This law takes effect July 1, 2018 and requires that each school district, vocational district, charter school, approved private day or residential school, and collaborative school shall provide and maintain at least one AED on site at each school facility. These guidelines can also be found on the Emergency Management Planning for Schools webpage.

Additionally, please note that updated Medical Emergency Response Plans are required to be submitted by Sept. 1, 2018 via the MERP DropBox. A model plan (download) and submission information are on the Medical Emergency Response Plans webpage.


We’ve heard about different ways that schools districts and nurses are planning to implement the new requirement in the fall for all religious exemptions for immunizations to be renewed annually.  While policies around enforcement of exclusion for unimmunized or partially immunized children are developed by individual schools/school districts, we’d like to share some best practices to consider when requesting annual renewal of religious exemptions.

We do not recommend a form be used for religious exemptions, rather that parents or guardians state in writing that a vaccine or vaccines are against their sincerely religious belief.  For obtaining annual renewal of these statements of religious exemptions, we’d suggest a targeted approach of reaching out to families of students with an exemption currently on file to request an updated statement. This is generally a small number of families—the state average is 1.4% of kindergarten students with an exemption.

Please share this information with your school administrators.  For more information on school immunizations, including our school immunization data, school requirements, and other resources, please visit our School Immunizations website and School Immunization Information for School Nurses website.   If you have questions or wish to share feedback on your experience with annual exemption renewals, please contact that Immunization Program’s Assessment Unit at 617-983-4330.

DPH has worked with BU School of Public Health and SHIELD to develop another free online training program on concussion management and return to play and school.  This training is 90 minutes long. Here is a direct link to the course:

You need to set up a one-time username and password to access the course.  A flyer about the course is attached so feel free to distribute wide and far.

Also just as a reminder we have another free online training on our website that we developed in partnership with Brain Injury Association and Mass. Medical Society and this can be accessed at:


On July 11, DPH launched a statewide public information campaign to educate parents of middle and high school aged children on the dangers of vape pens and e-cigarettes. The campaign, The New Look of Nicotine Addiction, seeks to spread the word that these high-tech products are not harmless – they contain nicotine which can damage a teenager’s developing brain, and lead to addiction. The campaign’s online destination is  The site has general facts and information about vaping products as well as specific sections for parents and schools/community based organizations.  The schools/organization section will be populated with a toolkit and additional resources in August.  Campaign ads will be featured in online and social media channels.  Billboards and transit ads (buses and transit stations) will follow in August.  Collateral materials include a poster (English/Spanish), a flyer (English/Spanish), Frequently Asked Questions, and a tip sheet for parents on how to talk with their kids about vaping.  These materials are available for download or ordering on the Massachusetts Health Promotion Clearinghouse website.


Please see the attached newsletter with news and information from the Office of Local and Regional Health at the MDPH.  Some of this information is of importance to school nurses!

UPDATES ON SBIRT TRAININGS (Also see attached information):

Introduction to Verbal Substance Use Screening

This 6 hour workshop provides information on conducting verbal substance use screenings according Massachusetts law and approved practice standards. Learners will be introduced to the Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Schools program. This training is required for school nurses seeking DESE license and for all other school health personnel who will be involved in the screening process.  This workshop is for school professionals who have not yet attended an Introduction to SBIRT Workshop. There is no “Train the Trainer” model for SBIRT in Schools and all those participating in SBIRT screening should attend.

The training includes:

  • An administrative overview of the SBIRT mandated screening program,
  • An introduction to the CRAFFT II screening tool and instructions on how to use the tool,
  • Motivational Interviewing skills to use immediately by the screener while discussing verbal screening results with students.

Mastering SBIRT

Mastering SBIRT Workshop is a newly developed 3 hour long skills training to increase confidence and skills in responding to the CRAFFT-II screening results using Motivational Interviewing (MI) techniques.  The training includes discussion and practice of the REACT model for healthy reinforcement of healthy decisions (negative CRAFFT screening) and the Brief Negotiated Interview model to be used for discussion with those students who screen positive for substance use. Discussion about referral, consent and confidentiality as well as a closer look about how to talk to teens about substances will be included.  NOTE: this training DOES NOT replace the requirement for all school health personnel involved in SBIRT screening to attend the required SBIRT in Schools Training:  Introduction to Verbal Substance Use Screening Using the CRAFFT-II training.

We are looking for Districts who would like to host the Mastering SBIRT Training Workshops.  Our goal is to offer this new workshop twice in each region throughout the school year.  Up to 3 classroom-like spaces needed for up to 25 participants per space should be available to host training in a school or other building in your district. If you are interested, please contact Wanda Visnick, MDPH SBIRT in Schools Coordinator as soon as possible.

  • School Health Resources and Training opportunities, including SBIRT are available and will be posted on the SHIELD website.
  • Links to MGL, SBIRT materials, resources and the MDPH Data Collection Tool can be found on the MASBIRT website.

All SBIRT materials will be updated over the Summer.  Be sure to update your resources from in the Fall!


The Office of Medicaid is implementing changes in the Direct Service Claiming (DSC) Program and the Administrative Activity Claiming (AAC) Program effective July 1, 2019. Details regarding the program changes, including the addition of newly reimbursable services and provider types, were described in the MassHealth School-Based Medicaid Bulletin 31 in May 2018. (Found here: )

MassHealth made several changes to the contract, including the following:

  • Adding newly covered services and newly covered provider types
  • Clarifying LEAs are responsible for ensuring that direct service RMTS staff meet all qualifications for reimbursement under the program
  • Clarifying interim billing requirements
  • Clarifying provider reporting requirements
  • Updating the privacy section and Appendix A
  • Additional technical edits and corrections

In order to allow for timely processing, lease return the original executed agreements by February 28, 2019. Additional guidance and a variety of trainings will be available for LEAs throughout the implementation process. For additional information or clarification on the contract or trainings, please email UMMS at or call 1-508-856-7640.  Please see the attached flier with information for upcoming training programs!!

The Mass Concussion Management Coalition is sponsoring a FREE lecture for healthcare providers (RNs, MDs, PAs, NPs) at St. Luke’s Hospital in New Bedford on September 13th from 5 -8PM.   Southcoast is an approved provider for nursing continuing education credits and the lecture has been approved for 2.25 – see attached flyer.

Boston Medical Center’s (BMC) Grayken Center for Addiction has a new collaboration with the Partnership for Drug-Free Kids that will provide critical support for parents across the state who have a child struggling with substance use. Through this new partnership, the following free resources are available to anyone in Massachusetts who is concerned about their child or young adult:

  • A dedicated phone and text helpline – call 844-319-5999 or text HOPEMA to 55753 – answered by a trained specialist who will listen to parents’ challenges and connect them to appropriate resources.
  • A website portal – – with details on resources and tools for Massachusetts families.
  • Access to trained parent coaches who have had personal experience dealing with a child with a substance use disorder.


Find answers to your questions about adolescent marijuana use

A collaboration between IRETA and the National Institute on Drug Abuse (NIDA).
An online course exploring why some adolescents use marijuana and how to converse with youth about substance use and referral to treatment.
An hour of informative content for free, and you can start and stop whenever you want. PCD and NAADAC CEUs are available.
Online now at
Click here! After a quick registration, you can get started immediately.


Tentative dates for Substance Use Prevention Curriculum training are:
Good Behavior (PAX) Game trainings on Tuesday, October 2nd – Friday October 5th; and
Life Skills Training (LST) on October 16-19th
A link to registration will be posted as soon as the dates and locations are finalized.


23rd Annual MIAP Pediatric Immunization Skills Building Conference
Thursday, October 18, 2018
9:00a.m. – 4:00p.m.
New Location!
Sheraton Hotel and Conference Center
Framingham, Massachusetts


Please see the attached flyer with dates for upcoming informational sessions from MassHealth at the UMass Medical Center Campus in Shrewsbury.


MassHealth and the Children’s Behavioral Health Initiative are pleased to announce the publication of our informative brochure MassHealth Services for Children and Youth, that describes home and community-based behavioral health services available to MassHealth enrolled children and youth under the age of 21.You can download or order the brochure on the CBHI Brochures and Companion Guide web page.

Resources for schools can be found here:   You can also call MassHealth Customer Service at (800) 841-2900 and request a brochure.


The U.S. Food and Drug Administration today took additional action to mitigate shortages of EpiPen (epinephrine) auto-injector by extending the expiration date of specific lots of 0.3 milligram products marketed by Mylan by four months beyond the labeled expiration date. This change beyond the approved 20-month shelf life is based on stability data provided by Mylan and reviewed by the FDA. To help ensure patient safety, these products, which already have been dispensed to patients, should have been — and should continue to be — stored as labeled.

While product is currently available, multiple factors, including regional supply disruptions and manufacturer issues, have contributed to EpiPen’s limited availability in certain areas in the U.S. The FDA continues to work closely with Mylan on EpiPen production and supply, and also has been in contact with the other manufacturers of epinephrine auto-injectors, including Adrenaclick and Auvi-Q, regarding their supply as the school year begins since this is historically accompanied by increased product demand. The agency also recently approved the first generic version of EpiPen.  Mylan also has established a customer service number, which we have posted on the FDA’s website, to help pharmacies and patients locate EpiPens if necessary. Information on supply information of other approved epinephrine autoinjector products can also be found on the agency’s website.


The FDA on Thursday approved a generic version of EpiPen and EpiPen Jr that is not manufactured by Mylan—two years after Mylan came under fire for raising the devices’ prices. According to the Washington Post‘s “To Your Health,” the new device “is the first to be deemed a therapeutic equivalent of the EpiPen, which means that it can be automatically substituted at the pharmacy counter for prescriptions for EpiPen or EpiPen Jr.  The FDA said it approved a generic version of EpiPen and EpiPen Jr made by Teva Pharmaceuticals for adults and children who weigh more than 33 pounds. FDA said the generic epinephrine auto-injector “is intended for immediate administration to patients” in the same manner as branded EpiPens.


Many of you are familiar with the statistic that one in five young people in the U.S. lives with a mental health or substance use challenge, yet few reach out for support. That’s why it’s so important that everyone knows how to recognize and respond when a young person may be in need.  Please share the newest PSA “Said No Teen Ever,” because we know there are signs that tell us when a young person might be suffering, but it’s up to us to know what to say and how to help. Youth Mental Health First Aid teaches adults how to reach out to a young person in need to get them the care they need.   You can also share these four PSAs to highlight mental health challenges that young people experience every day like anxiety, depression, eating disorders and self-harm.


Friday – Sunday
September 21 – 23, 2018
Westin Boston Waterfront
Boston, Massachusetts

Registration Now Open!

This course sold out last year.
To ensure your spot in the 2018 program, we strongly recommend early registration.

Advancing Excellence in Transgender Health was developed in response to the high volume of queries from clinicians and health care staff seeking to learn about providing high-quality care for adults, adolescents, and children who are questioning their gender identity or who identify as transgender or gender non-binary.

This conference is designed to train the whole health care team in providing competent and confident gender-affirmative health care, grounded in research evidence and best clinical practices. Sessions are led by expert faculty specialized in transgender-focused research and patient care. The conference is appropriate for all members of health care teams, including physicians, behavioral health care providers, physician assistants, nurses, and other staff.

Conference topics will include:
·       Gender-Affirmative Health Care: Terminology, Demographics, and Epidemiology
·       Gender Identity Development in Children and Adolescents
·       Transgender Adults Community Panel
·       Family Systems of Transgender Children
·       Diagnosis, Treatment, and Prevention of Sexually Transmitted Infections for Transgender People
·       Behavioral Health Assessment and Referrals for Gender-Affirming Surgery
·       Primary Medical and Preventative Care Needs of Transgender Clients
·       Reproductive Options for Transgender Persons
·       Gender-Affirming Hormone Therapy
·       Behavioral Health Care for Gender Diverse Children and Adolescents
·       Transgender Youth Community Panel
·       Transgender People and HIV
·       PrEP and Transgender Communities: Evidence-Informed Practices
·       Gender-Affirming Surgeries
·       Collecting Sexual Orientation & Gender Identity Data in EHRs
·       Transgender and Gender Non-binary People of Color
·       Creating a Trans Youth Clinic
·       What Health Care Providers Need to Know about Transgender Legal Issues

In addition to didactic presentations, attendees will learn from panels of transgender community members and have the opportunity to engage in interactive case discussions that highlight medical and behavioral health approaches to gender-affirmative care, led by experienced clinicians specialized in transgender health.  Scholarship information is available here


EOHHS Region Name Office Phone Cell Phone Email
Central Kate Maher 978-567-6190, ext. 21122
Metrowest Jean Afzali 781-848-4000, ext. 7841 781-724-4018
Northeast Shanyn Toulouse 978-420-1919 978-761-2307
Southeast Ann Klaver 508-580-7363
West Diane Colucci 413-750-2511
Therese Blain 413-750-2007

Mary Ann Gapinski, MSN, RN, NCSN
Director of School Health Services/ School SBIRT Coordinator
MA Department of Public Health
250 Washington Street – 5th Floor
Boston, MA  02108

SBIRT information: