School Health Services Update: March 6th, 2019

Dear Colleagues,

NASN’s Framework for 21st Century School Nursing Practice ( https://www.nasn.org/nasn/nasn-resources/professional-topics/framework) provides structure and focus for the key principles and components of current day, evidence-based school nursing practice. Central to the Framework is student-centered nursing care that occurs in collaboration with the students’ family and school community. Surrounding the students, family, and school community are the key principles of Care Coordination, Leadership, Quality Improvement, and Community/Public Health. These principles are surrounded by the fifth principle, Standards of Practice, which is evidence-based, clinically competent, quality care. School nurses daily use the skills outlined in the practice components of each principle to help students be healthy, safe, and ready to learn.

We know that the number of children who attend school and have a chronic health condition such as asthma, food allergies, seizure disorders, diabetes, or poor oral health are increasing. Each day, these and other health conditions must be managed for the student to remain present and ready to learn at school. Evidence demonstrates the important link between student health and academic success. While federal and state regulations require schools to provide services and accommodations for students with chronic health conditions, efforts to at the school level are often fragmented. School administrators and special education staff may receive little or no guidance from education or health agencies—to implement protocols for collaboration and coordination. Yet research suggests that students who receive direct healthcare and/or care coordination by school nurses have fewer visits to healthcare provider offices, urgent care centers, and emergency rooms, and report fewer hospitalizations. Care coordination is a key principle in school nursing practice for the 21st century. Attached is the NASN White Paper which describes this key element to the care we provide our students in school every day.  It is essential that school nurses become skilled in care coordination to improve attendance and increase the academic success of our students.

Let’s keep hoping that Spring is near….I’m tired of the frigid weather of the past few days!

Thanks for all you do….every day!

Mary Ann and the School Health Team

“With tireless energy and eager zeal, colored women have, since their emancipation, been continuously prosecuting the work of educating and elevating their race, as though upon themselves alone devolved the accomplishment of this herculean task.” – – Mary Church Terrell,  Civil Rights Activist and First President of The National Association of Colored Women

SCHOOL NURSES IN THE NEWS!

• Congratulations to Ellen Claflin, RN BSN NCSN, a school nurse in the Scituate High School on achieving national certification in school nursing practice!!
• The MetroWest Health Foundation has selected the Framingham Public Schools -School Health Services as the recipient of the 2019 Deborah Blumer Community Health Leadership Award. The award is being presented in recognition of the work our nurses do every day to improve the health and wellness of Framingham’s school-aged children!  Judith Styer, RN, Director of Health and Wellness for the Framingham Public Schools, will accept the award on behalf of the district’s school nurses at the foundation’s Annual Dinner Meeting on March 28.  Congratulations to Judy and her team!!
• Please click on the link:  https://www.berkshireeagle.com/stories/a-day-in-the-life-of-a-school-nurse,566165 to read the article that appeared recently in the Berkshire Eagle highlighting Richmond Consolidated Elementary School Nurse, Cristina Lenfest. Be sure to see the sidebar in the article that provides a “log” of the school nurse’s day!

UPCOMING SBIRT TRAININGS:

Introductory SBIRT trainings (required for DESE initial School Nurse licensure) registrations with available space in them:

• 3/25/2019 in Ludlow MA
• 4/8/2019 in Boston MA
• 5/15/2019 in Dartmouth MA

Register here: SBIRT in Schools

For additional trainings related to implementation (for districts who have never implemented SBIRT) and mastering SBIRT (for districts who have never implemented SBIRT) please complete the training request found at:  https://www.masbirt.org/training-request

NEW NASBE STATEMENT: EXAMINING CHRONIC ABSENCE THROUGH A STUDENT HEALTH LENS

Attached is an article from the National Association of State Boards of Education (“School Committees” here in MA)  that discusses how they can be involved with reducing chronic absenteeism.  For example, do the local and state budget support students’ access to school nurses, social workers, psychologists, and counselors?  Students who experience poverty and disproportionate rates of illness and who lack transportation and healthcare options benefit most from regular school attendance. They are often also the least able to make up for missed instruction and lack of access to nutrition programs and support services.

MIAA:  TEEN SEXUALITY & HEALTHY RELATIONSHIPS

Who Should Attend? School Administrators, Wellness Coordinators, Athletic Directors, Teachers, Club Advisors, Guidance Counselors, Nurses, Coaches and anyone interested in learning more about effective model programs and best practices in wellness

Friday, April 12, 2019 at the MIAA Office, Franklin, MA

Registration: 8:00am

Workshop Time: 8:30am–1:30pm

Fee: $40 per person includes light breakfast, lunch and materials

Featured Presentations:

• Promoting Healthy Relationships and Creating Safe Environments, Jason Wheeler, DESE Safe Schools Programs
• Beyond Us: Project-Based Learning, Aaron Polansky, Authentricity
• Coming Out: How to Support LGBTQ+ Students,  State Rep Jeffrey Roy/Nate Roy

There is a 72-hour cancellation policy for this program. Please direct all billing questions to the MIAA accounting department.

5 PD Hours      For more information contact: cbohmiller@miaa.net

The physiology of addiction: effects of drug-taking behavior on the brain

Ruth Potee, MD,  a much sought after speaker on substance use, addiction, and recovery will be speaking at the Nashoba Regional High School at 50 Mechanic Street Bolton, MA 01740 on March 21st from 6:30 – 7:30. This is a FREE event  open to all in the community and students ages 14 and up.  Prior to her presentation at 5:30, Hidden in Plain Sight and representatives from Learn to Cope will be available.  Please share this with your parents, staff, age appropriate students and community.   A flier is attached for your convenience.

“KIDS AND THE LAW/LOS MENORES Y LA LEY” 

Rebecca Pries, who is the founder and former Executive Director of Adolescent Consultation Services, has written a book that has proven to be a valuable resource that explains the MA laws that impact our students and families. “Kids and the Law/Los Menores y la Ley” can support your practice in addressing the needs of the whole child in your school community. It comes recommended by the Massachusetts Secretary of Health and Human Services, Mary Lou Sudders, “This book has been proven to be an indispensable resource for children and families involved with juvenile court and for those who serve them.”  See the attached flier for information on how to purchase this resource.

Nursing and the Health of Populations

A reminder of the upcoming program at Boston University:

Featured speakers:

Maureen Bisognono, President Emerita and Senior Fellow, Institute For Healthcare Improvement

Barbara Stilwell, Executive Director, Nursing Now

APR 2

3 to 5:30 p.m.

Doors open at 2:30 p.m. Reception to follow.

Hiebert Lounge, 72 East Concord Street, Boston

Where has nursing made the most difference in population health worldwide? Where can it make a difference moving forward? This half-day symposium will address the state of nursing science and practice and its intersection with the evolving field of global population health. The meeting aims to ask questions and encourage provocative answers, pointing to future synergies between nursing and population health. Cohosted with the Nursing Now campaign and the Institute for Healthcare Improvement.

REGISTER HERE:  http://www.bu.edu/sph/news-events/signature-programs/deans-symposia/nursing-and-the-health-of-populations/      

MDPH: IMMUNIZATION PROGRAM NEWS

This message is from Dr. Susan M. Lett, Medical Director, MDPH Immunization Program. Please share this advisory with all pertinent colleagues and staff within your practice or institution.

The 2019 Immunization Schedule for those 0-18 years has been posted by CDC at: http://www.cdc.gov/vaccines/schedules/index.html.  The changes in the schedule are reviewed in the February 8, 2019 MMWR at: https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6805a4-H.pdf.   Changes to the 2019 immunization schedule for children and adolescents from birth through 18 years of age are outlined below:

General Schedule Updates

• The schedule cover page now includes basic instructions on how to use the schedule and lists routinely recommended vaccines and their standardized abbreviations and trade names.
• Web links are provided throughout the document and website versions for downloading helpful resources such as: the CDC Vaccine Schedules App; reference materials on vaccines; vaccine-preventable disease surveillance; reporting postvaccination adverse events to the Vaccine Adverse Event Reporting System; the General Best Practice Guidelines; traveler’s vaccines; etc.
• Table 3, which provides recommended immunizations by medical condition and other indications, distinguishes between precautions, delay and contraindications. It now includes definitions of these terms:
• Precaution – vaccine might be indicated if benefit of protection outweighs risk of adverse reaction is highlighted in orange.
• Delay in vaccination – vaccine should not be given during pregnancy is highlighted in pink.
• Contraindicated or use not recommended – vaccine should not be administered because of risk factors for serious adverse reaction is highlighted in red.
• The notes (previously known as footnotes) in the schedule have been reordered alphabetically by vaccine. They provide concise information describing vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations.
• Mumps and Meningococcal Disease Outbreaks:
• In the “Additional Information” section at the beginning of the vaccine notes, it now directs providers to their state or local health department for information regarding vaccinations during an outbreak. As a result, language regarding the use of measles, mumps, and rubella (MMR) vaccine in the setting of an outbreak or the use of Meningococcal (Groups A, C, W-135, and Y) conjugate (MenACWY) and Meningococcal Group B (MenB) vaccines in the setting of meningococcal disease outbreaks has been removed from the MMR and meningococcal vaccine notes.

Influenza Vaccine:

• The influenza row in Table 1 and Table 3 is modified to reflect CDC recommendations for use of inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) among children 24 months and older. LAIV and IIV are listed separately.
• Any licensed influenza vaccine that is appropriate for age and health status of the patient may be used.
• Guidance for the use of influenza vaccine in patients with egg allergy is included.
• Recommendations for the use of LAIV also include contraindications and precautions.

Hepatitis A Vaccine:

• The hepatitis A row in Table 1 now reflects recommendation for use among infants 6-11 months for international travel. A purple bar for unvaccinated travelers age >12 months has been added
• Homelessness has been added an indication.
• Information about the use of combination HepA-HepB vaccine (Twinrix) has been added for use in those >18 years of age and older.

Hepatitis B Vaccine:

• The word “all” was added for the birth dose recommendation for medically stable infants (>2,000 grams) born to hepatitis B surface antigen (HBsAg) negative mothers. This was added to emphasize the importance of the universal birth dose.
• Information regarding CPG-adjuvanted hepatitis B (Heplisav-B) vaccine as well as the combination Hep A-HepB vaccine (Twinrix) for use in those >18 years of age has been added.

Men B Vaccine:

• In Table 3, the pregnancy box has been changed to orange for a Precaution.

IPV Vaccine:

• Within the IPV note, a bullet has been added regarding the use of combination vaccine: 4 or more doses of IPV can be administered before the 4th birthday when a combination vaccine is used. However, a dose is still recommended after the 4th birthday and at least 6 months after the previous dose.

Tdap Vaccine:

• On the Tdap row in Table 1 of the schedule, the bar for persons aged 13-18 years has been split into a half green and half purple bar to represent catch-up vaccinations and use in pregnant adolescents, respectively.
• The Tdap note has been updated to indicate those who receive a dose of Tdap or DTaP at age 7-10 years inadvertently or as part of the catch-up series should still receive the routine does of Tdap at age 11-12 years.

An additional helpful resource is the AAP policy statement Recommended Childhood and Adolescent Immunization Schedule — United States, 2019 which is available at

http://pediatrics.aappublications.org/content/pediatrics/early/2019/02/01/peds.2019-0065.full.pdf and will be published in the March issue of Pediatrics.

Printable versions of the 2019 immunization schedules for persons ages 0 through 18 years also are available on the CDC website in several formats, including portrait, landscape, and pocket-sized versions. Catch-Up Vaccine Job-Aids for DTaP, Hib and Pneumococcal Vaccines are available again this year.  The 2019 CDC Vaccine Schedule App will be available in early March.  If you have questions about the immunization schedule, please call the MDPH Immunization Program at 617-983-6800 and ask to speak to an immunization epidemiologist or nurse.

Susan M. Lett, MD, MPH, Medical Director, Immunization Program, Division of Epidemiology and Immunization, Massachusetts Department of Public Health

Run4KidsMA!

Swift River School and the Mahar Girl’s Track Team proudly host Run4KidsMA! Runners coming together for a fun day of miles and smiles! We will run the Mahar track to accomplish our goals. Join us for our 5th Run4KidsMA! A 6 Hour Running Party!  Looking for a family friendly running event? This is the event for you!  Laps are run on a safe, flat, ¼ mile, high school track in Central Massachusetts.  Set a Goal: 5K, 10K, ½ Marathon, 25K, Marathon, 50K, and we’ll help you reach it!  Rain or Shine! Come For An Hour, Or Stay All Day!  Pizza by the slice will be available at midday for purchase, or feel free to bring a picnic!  This is a cup-free event! Please bring a water bottle. We’ll have water for refilling!

REGISTER ONLINE OR AT THE EVENT (r4k2019.racewire.com)

Your FREE registration entitles you to a day of running fun with your friends and family! Please register to help us plan for enough goodies.
Purchase a Swag Bag for $10 and you will receive the new 100 Mile Club headband, dog tags and a race bib! See attached flier for more information.

9^TH ANNUAL INTEGRATIVE NURSING CONFERENCE:  EMPOWER_~ INNOVATE_~ CULTIVATE: CHANGE STARTS WITH YOU!

Overview:  Join us for nurses week! Indulge yourself mind, body and spirit.  Let us pamper you with breakfast and lunch, motivational speakers, experiential Yoga sets to reset your nervous system. Raffles and shopping too.  Top it off with contact hours to complete the day.  Let us fill your cup.

Fee:  Only $99 for the general public.

New This Year! T-shirts – order your BMC Integrative Nursing t-shirt. They are blue, short sleeve and cost $20.  You can pre-order on the website and pick it up at the conference.

Poster Session:  Submit a poster on your institution’s latest integrative nursing techniques.  For more information, click here.

Presented by: Boston Medical Center Integrative Nursing Council

Sponsored by: Sponsored by the Anna Ross Committee of the Massachusetts Memorial Hospital Nurses’ Alumnae, Inc. and the Boston Medical Center Nursing Department.

To more information and to register for this program, click here:  REGISTRATION

PAX GOOD BEHAVIOR GAME TRAININGS

We thank you for your response to It is now time to Register the Team from your school that you enlisted to attend the PAX Good Behavior Game Training – the free Social and Emotional Learning (SEL) professional development opportunity offered to school administrators,  1st and 2nd grade teachers, and support staff.. As you know from the DESE Newsletters, this evidence-based instruction is supported by the Massachusetts Departments of Public Health and Elementary and Secondary Education.

The one-day training (March 25 in Sturbridge; March 26 in Lowell; March 27 in Taunton; March 28 in Boston; or March 29th in Westborough), classroom materials, and implementation support will be offered at no charge. As a result of this training, the concepts of self-management and social skills are integrated into the regular curriculum by classroom teachers and increase the time-in-learning. Teacher stress is significantly decreased, and research has shown an improvement in academics. As you know, children’s success along these dimensions helps to prevent later alcohol, opioid, and other substance misuse.

Special Education personnel, Psychologists, School Adjustment Counselors, and Social Workers can often become effective supporters of this social and emotional learning process. Each person is asked to register individually as soon as possible (or by March 13, 2019) at one of these locations:

·   March 25, 2019 – Sturbridge: http://www.cvent.com/d/06q1vk (about 1 – 1 1/2 hours from Boston)
·   March 26, 2019 – Lowell: http://www.cvent.com/d/76qq81
·  March 27, 2019 – Taunton: http://www.cvent.com/d/w6qq84
·  March 28, 2019 – Boston: http://www.cvent.com/d/g6qqky
·  March 29, 2019 – Westborough: http://www.cvent.com/d/m6qqkh

Because this opportunity will be most meaningful coming from you, we ask that you also forward this to your team.

For more information on the SEL program visit Good Behavior Game.  For details on the Massachusetts initiative contact Kathleen Herr-Zaya at the Department of Public Health (Kathleen.Herr-Zaya@massmail.state.ma.us or 617-624-5143).  If you have any questions relating to the registration, please contact:
Marion Clark-Jalbert , Training Coordinator, AdCare Educational Institute, Inc., by email at: Marion@adcare-educational.org

IMMUNIZATION PROGRAM UPDATE ON THE NATIONAL MEASLES OUTBREAK

From January 1 to February 21, 2019, 159* people from 10 states (CA, CO, CT, GA, IL, KY, NY, OR, TX, and WA) have been reported as having measles. Six outbreaks (defined as 3 or more linked cases) have been reported, in Rockland County, New York; Monroe County, New York; New York City; Washington; Texas; and Illinois. Of these outbreaks, 2 outbreaks are ongoing from 2018.

In Massachusetts, there were two confirmed cases in Massachusetts residents during 2018, and an additional case in an international visitor. Control measures involved: contacting hundreds of people who were potentially exposed, MMR vaccination clinics, immune globulin for exposed infants, and lengthy quarantine of people with no evidence of immunity to measles who were not vaccinated 3-5 days after the exposure, or could not receive MMR vaccine.

CDC is asking for your help to ensure that all patients are up to date on MMR vaccine. When it comes to vaccinations, parents trust the expertise of their doctor more than anyone else. Explain to patients that MMR vaccine is the best protection against measles infection.

What Should Clinicians Do?

• Listen and respond to parents’ questions. When parents have questions, it does not necessarily mean they won’t accept vaccines. Sometimes, they simply want your answers to their questions.
• Ensure all patients are up to date on measles, mumps, rubella (MMR) vaccine.
• Children need 2 doses of MMR: one dose at 12-15 months and another dose at 4-6 years.
• Before any international travel, infants 6-11 months need 1 dose of MMR vaccine, children 12 months and older need 2 doses separated by at least 28 days, and teenagers and adults who do not have evidence of immunity against measles need 2 doses separated by at least 28 days.
• Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and conjunctivitis), and ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
• Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the health department.
• Suspect cases of measles should be reported immediately by calling the MDPH Division of Epidemiology at 617-983-6800 (24/7). Epidemiologists will provide assistance with testing at the MA State Public Health Laboratory, and recommendations for measles control. Providers in Boston should call the Boston Public Health Commission at 617-534-5611.

For more information, including guidelines for patient evaluation, diagnosis and management, visit: https://www.cdc.gov/measles/hcp/index.html

Other Resources

• Talking with Parents about Vaccines for Infants
• Preparing for Questions Parents May Ask
• Infant Immunization FAQs in English and Spanish
• Measles fact sheet for parents in English and Spanish

Share information about measles with parents and the public in your office.

• Recent article for parents about measles: http://www.cdc.gov/features/measles/
• Printable fact sheets, posters, and printable infographics: https://www.cdc.gov/measles/resources/parents-caregivers.html

For healthcare professionals:

• View TEDMED at CDC: Measles—Making a Disease Disappear conference talk from 2013: https://www.youtube.com/watch?
• View a CDC Expert Commentary video on Medscape about measles: http://www.medscape.com/viewarticle/828508

*Preliminary data reported to CDC’s National Center for Immunization and Respiratory Diseases.

REGIONAL CONSULTANT CONTACT INFORMATION:

Mary Ann Gapinski, MSN, RN, NCSN

Director of School Health Services

MA Department of Public Health

250 Washington Street – 5^th Floor

Boston, MA  02108

mary.gapinski@state.ma.us

Website: https://www.mass.gov/orgs/school-health-services