School Health Services Update: September 17, 2018

Dear Colleagues,

Thank you for participating in our statewide meeting last week.  It’s always a full agenda!  And wonderful to see so many in attendance and ready for a day packed full of information and resources!  Thank you for your presence.  And remember, the next one is scheduled for Wednesday, December 5th and we hope to see all of you (and those that weren’t able to attend this week) along with your School Mental Health Providers: school social workers, school  counselors (both guidance and adjustment), school  psychologists and any other interested staff members.  The agenda includes information related to mindfulness in schools, a grassroots School Mental Health organization, and a focus on evaluating chronic absenteeism among other topics.  We hope you plan to be there and to invite a mental health provider from your district to come along!

Just a reminder that the State Epidemiologist is available 24/7 to respond to your questions and concerns about immunization requirements and any infectious disease concerns you may have and can be reached at 617-983-6800.  Please contact them for the expert advice needed to address these concerns.

We have received a number of calls concerning CPR training for athletic coaches….the MDPH and MIAA recognize only the American Heart Association and the American Red Cross as providers of this training in schools.  See more information here:

I want to thank the school nursing leaders who responded so quickly, and so professional, to the gas explosions and related disaster in the Northeast last week.  Nursing Directors for Andover, Rita Casper, North Andover, Cheryl Barczak, and the consulting nurse for Lawrence Public Schools, Nancy Walsh, all responded to requests for needed assistance within the Red Cross shelters established across the Region.  And thank you to the Northeast Regional Consultant, Shanyn Toulouse, who kept us all apprised of needs, resources and ongoing efforts to resolve the situation.  Thank you for your time, professionalism and dedication to the children and families in the Northeast!

Once again, there are many announcements to include this email!  Thank you for all you do to maintain the standards of practice for the care of students in our schools!

Your School Health Team,

Mary Ann, Alison and Janet

Be silent, if you choose; but when necessary, speak — and speak in such a way that people will remember it.  — Wolfgang Amadeus Mozart, composer and musician


Congratulations to Jennie MacDonald and Liz Lopes from the Sandwich Public Schools for passing the National School Nurse Certification Exam!   Jennie and Liz join others on the team with the National School Nursing Certification including Kathy Grant, Beth Recker, and Jennifer Blackington.

Brockton Public School Nurse Tracy Politano intervened to a recent stabbing incident outside of her school.  The individual suffered a deep gash to his upper left arm.  Brockton Public Schools now has Stop the Bleed kits in every school in the main AED cabinets along with tourniquets.  We commend Tracy for her quick action and clear thinking in this emergency.  It is the goal for the Brockton Public schools to teach tourniquet application and the use of stop the bleed kits at every CPR training this year. The use of these kits has proven to have more favorable out comes with severe bleeding injuries.

The Commonwealth is pleased to announce that it received federal approval to expand the School-Based Medicaid Program (SBMP) to cover additional provider types and health services. This expansion will take effect July 1, 2019. The additional health services must meet Medicaid Medical Necessity requirements and may include services pursuant to an individualized education program (IEP) (currently covered), as well as an individual health care plan (IHCP), an individualized family service plan (IFSP), or a Section 504 plan, or be otherwise medically necessary.
Preparation efforts for this expansion need to begin during the current (2018-19) school year. During this year, districts must execute amended provider contracts, participate in trainings that explain program implementation changes districts need to undertake, and obtain parental consent.
Regarding consent, in accordance with DESE’s student records regulations and federal law, school districts must first obtain parental consent for MassHealth-enrolled students in order to seek reimbursement via services claims or inclusion in eligibility statistics. An updated advisory (28M/13) is available along with updated model parental consent forms in five languages. Schools and districts are encouraged to communicate with MassHealth eligible parents about completing consent forms as early as possible in order to be ready for July 2019. Additional details about the School-Based Medicaid Program expansion can be found in a May 2018 bulletin from MassHealth.
School-Based Medicaid Program Back to School Trainings will take place on September 24, 25, and 28 (the same training on three different dates) in Shrewsbury. These trainings are for Random Moment Time Study coordinators, Medicaid billing staff, special education directors, health services directors, and business managers. Please email to register or to learn more about the trainings or the School-Based Medicaid Program in general.
Anyone with questions about the consent process can contact DESE’s Office of Student and Family Support at (781) 338-3010 or


Date: November 6, 2018
Location: DoubleTree by Hilton Hotel Leominster
Registration Fee: $115

This interactive, one-day workshop will deepen your understanding of products, risks, trends, and approaches to address adolescent vaping and cannabis use.

Workshop Topics Include:

  • Historical perspective and policy
  • Popular vape and cannabis products
  • How to talk to students
  • Assessment and referrals
  • Strategies for prevention of substance use
  • Successful school interventions

Target Audience:

All school education professionals, in particular, school nurses, counselors, PE/wellness educators and school administrators

Featured Speakers:

  • Jennifer Flanagan, Commissioner, Massachusetts Cannabis Control Commission
  • DJ Wilson, Tobacco Control Director, Massachusetts Municipal Association
  • Dr. Lester Hartman, Pediatrician, Westwood-Mansfield Pediatric Associates
  • Dr. Nicholas Chadi, Pediatrician, Adolescent Substance Use Program, Boston Children’s Hospital
  • Wanda Visnick, Former School Nurse Leader and Psychiatric Nurse Practitioner Candidate

Continuing Nursing Education Provider Unit, Boston University School of Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Contact Hours: 6.25

* JUUL e-cigarettes were introduced in 2015. They are a type of e-cigarette that utilizes nicotine salts that exist in leaf-based tobacco for its key ingredient.

To register please visit  Please see the flyer for information that ALL school staff should have!


The school survey is a bit delayed this year due to a new release of the MIIS,  While this new release will not change any of the process steps to completing an immunization survey in the MIIS, it will affect the look and feel of the MIIS overall.  It was decided  to wait to send the surveys until this release was deployed to prevent any confusion caused by the change in the appearance of the MIIS. At this time the plan is to send an email to school nurses early next week with survey materials and instructions on accessing the kindergarten and grade 7 surveys.  It is requested  that any nurse registered with the MIIS complete their survey in the MIIS.  Anyone who has yet to register is encouraged to register as soon as possible, but will have the option of completing this year’s survey using Survey Monkey.  There are no changes to the survey questions from last year.  The deadline will again be a hard deadline in mid-December.   Please don’t hesitate to call 617-983-4330 with any school survey questions.


The PATCH Act is an Act to protect access to confidential healthcare (Chapter 63 of the Acts of 2018), was signed by the Governor into law on March 30, 2018. This law fixes a crucial barrier to accessing health care by ensuring that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient.

Learn more about how to utilize these new confidentiality protections:


Grant Writing Basics:

Community Health Assessment: Using Health Models to Explore the Determinants of Health


It’s that time of year again!  Time FOR ALL SCHOOL NURSES FROM MASSACHUSETTS to consider submitting an abstract for the NASN Annual Conference.

NASN2019 is scheduled for June 28 – July 1, 2019 (preconference on June 27th) in Denver, Colorado.  Please consider sharing your experience with school nurses from around the country and world.  Your practice changes could positively impact other school nurses and school districts.

The deadline for submitting an oral abstract is Wednesday, October 10, 2018 at 11:59 p.m. Eastern.   Learn more or start submitting you abstract today.  If you have questions, please contact the NASN conference team at


Make sure kids are in school, ready to learn.  Schools are back in session, but are all students back in school each day? School nurses know better than anyone about the social determinants and health barriers to daily school attendance. The majority of ESSA state plans include chronic absenteeism as a measure of school quality, and all new school report cards starting this fall must include chronic absenteeism rates. So, this will be an issue very much on the mind of parents and school administrators this fall.

Join the Alliance for a Healthier Generation, Healthy Schools Campaign, and the National Association of School Nurses to learn about the opportunities ESSA provides school nurses as they collaborate with school staff, students, families and community partners to take action to reduce chronic absenteeism.

Webinar Recording  Download Slides

Webinar Resource Links


Are you looking to expand your knowledge about and ability to implement the USDA National School Lunch and School Breakfast Programs? Join us in SY 2018-19 for one or all of the Nuts & Bolts of School Nutrition Programs Continuation Series and gain vital information and skills to improve program operations. Both online and in-person sessions are available throughout the school year.

Online Webinar Sessions

All online sessions will take place via webinar from 2:00pm to 3:30pm and provide 1.5 hours of professional development at no cost.

  • Back to School Basics on September 20, 2018
  • Engaging your Community in School Wellness on January 15, 2019
  • Three Bids and A Buy on February 12, 2019
  • Afterschool Meals on April 11, 2019

In-Person Sessions at FSU

All in-person sessions will take place at Framingham State University from 8:30am to 3:00pm and provide 5.5 hours of professional development. Cost: $40 per session includes continental breakfast starting at 8:00am and lunch.

  • Keeping it Local on October 23, 2018
  • USDA Foods Utilization Check Up on November 15, 2018
  • Hot Topics in Food Safety on December 4, 2018
  • Production Records, Recipes, CN Labels, and Product Formulation Statements on March 21, 2019

Please visit us online for more details, session descriptions, deadlines and registration.


Two upcoming climate change events for nurses hosted by the MGH Institute in Boston.

  1. November 8th, 5-7 pm, Boston, MA: Climate Change, Climate Justice, and Environmental Health: An Introductory Workshop for Health Care Providers. View more details here:
  2. April 6th, 2019, All day symposium, Boston, MA: Reducing the Impact of Climate Change: The Role of Health Care Professionals. View more details here:

See flyers for more information:


Massachusetts school policies that ban students from bringing peanuts from home or require classrooms to be “peanut free” have no effect on the rate at which school nurses administer epinephrine to kids who are allergic to peanuts or tree nuts, according to a study published in the Journal of Allergy and Clinical Immunology. The study suggests one policy may be effective: Prohibiting peanut products at certain tables in the cafeteria.

As students start back to school each fall, campus administrators and individual teachers decide which foods kids can pack with their lunches or bring in as snacks. As more youth are diagnosed with peanut allergies and the nation faces a continued shortage of EpiPens, education officials are trying to limit students’ exposure to peanuts and peanut products. Peanuts are the most common food allergen among children in the United States, posing a serious health risk to almost 2.5 percent of all kids under age 18, according to research published in November 2017 in the Annals of Allergy, Asthma & Immunology. That represents an increase of 21 percent since 2010.  Nationwide, over the years, school officials have adopted a variety of policies to keep peanuts away from allergic kids — from bans that apply to everyone on an entire campus to restrictions within certain classrooms or parts of the cafeteria.

A team of nine researchers sought to determine which school policies may be best for reducing allergic reactions. Their study, “Impact of School Peanut-Free Policies on Epinephrine Administration,” was published in August 2017. It’s the first study to examine the topic, according to the authors. The main takeaway: While no policy was associated with a complete absence of allergic reactions, schools with peanut-free tables had lower rates of epinephrine administration than schools that didn’t. The researchers say peanut bans are probably difficult to enforce, which may explain why peanut-free schools and schools with peanut-free classrooms do not have lower rates of epinephrine administration. They note that families and school officials may have different interpretations of what a peanut-free food is. Also, parents might not read product labels carefully before sending food with their kids.

It might be easier to monitor what’s eaten at peanut-free tables, which serve a limited number of children. “Purely in terms of safety, the presence of peanut-free cafeteria tables may lead to reductions in allergic reactions,” two of the authors, Lisa Bartnikas and Wanda Phipatanakul, told Journalist’s Resource in an e-mail. Bartnikas, Phipatanakul and their colleagues analyzed records completed by school nurses at 2,223 public schools across the Bay State between 2006 and 2011. They matched rates of epinephrine administration to different school policies.

In Massachusetts, school nurses are required to report epinephrine administration to the Massachusetts Department of Public Health. Because some reports only cited “nut” as the likely trigger of an allergic reaction, the researchers included reports related to peanuts and tree nuts in their analysis.  Here are some of their other key findings:

  • Nurses administered epinephrine to treat an allergic reaction to peanuts or tree nuts 45 times during the 2010-11 academic year. Epinephrine administration increased by 23 percent each year between 2006 and 2011, on average.
  • Elementary schools were more likely than middle schools and high schools to adopt policies prohibiting or restricting peanuts. For example, 97.9 percent of middle schools and high schools allowed students to bring peanuts from home, compared to 85.5 percent of elementary schools. Meanwhile, 96.2 percent of elementary schools had peanut-free tables while only 81.6 percent of middle schools and high schools did.
  • “A unique finding of our study was the diversity of school policies restricting peanuts. From 2006 to 2011, 56.6 percent to 59.1 percent of schools banned peanuts from being served, 90.5 percent to 91.1 percent had peanut-free tables, 65.6 percent to 67.4 percent had peanut-free classrooms, and 6.3 percent to 10.3 percent banned peanuts from home. Importantly, there was considerable variability in how schools defined a self-designated peanut-free school, making the term misleading and open to misinterpretation,” the researchers write.

The authors note in their paper that regardless of what policies are in place, it’s important to “remain vigilant that food allergens may still make their way into schools despite such policies, and to always have ready access to epinephrine for timely treatment.”

Some other helpful resources for journalists:

  • A 2018 study published in Clinical Reviews in Allergy & Immunology, “Possible Role of Environmental Factors in the Development of Food Allergies,” looks at how breastfeeding, maternal diet, household dust and other factors might help explain why allergies develop.
  • A 2018 study in The Journal of Pediatrics, “Peanut Allergy: An Epidemiologic Analysis of a Large Database,” provides an analysis of children enrolled in the Riley Peanut Registry project, 67 percent of whom reported having a peanut allergy and 33 percent of whom reported having “peanut sensitization.” Of these 1,070 kids, 78 percent were white and 63 percent were male. More than half of the children reported allergic reactions involving the skin.
  • Several organizations are working to raise awareness about food allergies, including Red Sneakers for Oakley, Kids With Food Allergies and the Food Allergy & Anaphylaxis Connection Team.

Citation: Bartnikas, Lisa M.; et al. “Impact of School Peanut-Free Policies on Epinephrine Administration,” Journal of Allergy and Clinical Immunology, August 2017. DOI: 10.1016/j.jaci.2017.01.040.


See the attached BCH Fall Program Flyer for all programs listed

Tuesday November 6th Voting Day Conference
The Forefront Center for Meetings & Conference
Waltham, MA
8am to 3pm
Nursing Contact hours pending
Register NOW

Children’s Hospital Waltham – DEVEBER conference room
2.0 Nursing Contact Hours
Light Dinner Provided
$65 per session
See flyer for program information

Wednesday October 10th
Let’s Declutter! Register NOW
Wednesday December 12th

Unleashing Your Creativity: Learning the Art of Meditation via Zentangle
Register NOW

If you would like to register for both, please click HERE.

Children’s Hospital Waltham – DEVEBER conference room
6.0 Nursing Contact Hours
Light Dinner Provided
$175 for all 3 sessions ($20 dollar savings!)
See flyer for dates/topics

RETELL Ready Courses
Register NOW

Children’s Hospital Waltham – DEVEBER conference room
2.0 Nursing Contact Hours
Light Dinner Provided
$65 per session

Monday October 22nd
Trachs, Vents & Oxygen
Didactic & Hands On
Register NOW

Tuesday October 23rd
Triggers, De-escalation Techniques and Coping Strategies for Children in the School Setting
Register NOW
Registering for both, click HERE

All flyers attached to see further information on programs or if you would rather register via regular mail/check. Also, feel free to pass along to anyone you think may be interested! If you have programming questions, please contact  All are welcome! Handouts for all programs are now sent electronically.  If you register and do not receive handouts before the lecture please reach out to to ensure you have everything you need for the programs.  Purchase orders are accepted and group discounts available with groups of 5 or more from a school district.  Please contact: for more information.


It’s back to school time and we want to provide some resources for transgender and gender non-conforming students, families of these students, teachers and school administrators. There’s a lot in the news right now about trans rights in Massachusetts because of the Yes on 3 campaign, so we want to make sure that everyone is as prepared as they can be for this upcoming year!

Resources for students:
Bending the Mold: An Action Kit for Transgender Students (Lambda Legal)
Dealing with Hostility and Opposition (GSA Network)
Campus Pride (college students)
Boston Area Trans Support Group (late teens to mid-30s)

Resources for families:
GenderJabber : a resource for people who interact with young children and who want to think inclusively about gender.
Family Acceptance Project : a research and education initiative that works to prevent health and mental health risks for LGBT) children and youth in the context of their families, cultures and faith communities.
GLAD Answers : free & confidential information, assistance and referrals.

Resources for teachers, administrators, and counselors:
MA Department of Education Safe Schools Program for LGBTQ Students
GLSEN : an organization that works to ensure that LGBTQ students are able to learn and grow in a school environment free from bullying and harassment.
Gender Spectrum : an organization that helps to create gender sensitive and inclusive environments for all children and teens.
MaeBright Group : Training and technical assistance on evaluating and improving climates for LGBTQ people.
GenderJabber : a resource for people who interact with young children and who want to think inclusively about gender.


EOHHS Region Name Office Phone Cell Phone Email
State Epidemiologist 617-983-6800    
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 Linehan 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: