11/20/2020 MDPH School Health Unit Update

Greetings from the School Health Unit!

It has been a tough week for me.  Maybe it was for you too.  Then something happened in a meeting I was part of.  Someone expressed their thanks in a moving and heartfelt way and that caused an avalanche of gratitude in the comments; for the original “thanker”, as well as for others in the meeting.  All of a sudden, everything seemed a wee bit lighter.  There were tears in my eyes, but a smile on my face.  I know intellectually that gratitude is good for me, but it’s quite another thing to experience it so viscerally.

This email will be short, and I won’t send one next week, so I want to take this opportunity, just before Thanksgiving, to TRY to express to you my deep, deep gratitude for all you have done, all you are doing, and all I know that is still to be done.  I know intimately the work you are doing, and the physical, mental and emotional toll it is surely taking on you.  Not even the holiday break feels much like a break; many of you will work and most of you will have a holiday that looks nothing like what it usually does.  SO, if no one has told you today, the work you are doing is important, it is valuable, and it is work only you can do.  THANK YOU.

I highly recommend taking a few minutes to watch this video, and perhaps try a gratitude experiment of your own:

An Experiment in Gratitude | The Science of Happiness

With great appreciation,



We are pleased to inform you that the online Health Screening course is now open!  This online course replaces the formerly offered live workshop: School Health Screening.  Designed as an “on your time” training, learners may register and take this course at any time that is convenient for them.  This course prepares every public and private School Nurse to conduct school health screenings, namely BMI, hearing, postural, and vision, according to Massachusetts laws, regulations, and best practice recommendations.
This is one of four training workshops mandated by the Massachusetts Department of Public Health in order to be licensed as a School Nurse and it is designed for:

  • Nurses seeking Department of Elementary and Secondary Education (DESE) as a School Nurse in Massachusetts (mandated course).
  • Any School Nurse seeking to refresh their knowledge of school health screenings in Massachusetts schools.

*please note that screenings are still waived; we are continuing to offer this course routinely to assist nurses seeking licensure.

Our next statewide CSHS meeting is Thursday, December 10th from 1-3 pm and registration is now open here.  This meeting will focus on conducting Continuous Quality Improvement Projects, and on the Plan/Do/Study/Act cycle in particular.  There is a 30-minute section of pre-work, consisting of watching several short videos.  The program itself will last about 1.5 hours and then there will be an optional 30-minute mindfulness presentation at the end; we hope you can stay on and give yourself the gift of self-care.  This meeting will be recorded and available at a later date if your work keeps you from joining us; after surveying in regards to the timing of these meetings, the answers were pretty evenly split, so we will try this time slot and see how it goes!  A reminder that these meetings are required for CSHS grantees, but also open to any interested school nurse leader.


Karen Robitaille, MBA, MSN, RN, NCSN
<she, her, hers>
Director of School Health Services
Division of Child/Adolescent Health and Reproductive Health
Massachusetts Department of Public Health
250 Washington St. 5th floor, Boston, MA 02108
cell 781-675-0463
Personal Webex room:


MDPH SCHOOL HEALTH UNIT UPDATE: 11/12/2020 Perfectionism

Please see the following communication below from Karen Robitaille, Director of School Health Services, MDPH School Health Unit. 

Greetings from the School Health Unit!

Perfectionism.  I’ve got it.  In fact, I have struggled with this my entire life.  I’m a Capricorn, an INFJ (Meyers-Briggs personality profile), and the daughter of two parents with perfectionism, so maybe it’s in my DNA.  At times it has served me very well, but more often than not I can see that it harms me, as well as those about me.  Consider the definition from Oxford (and while you’re at it, note the marked increase of the term in the last twenty years or so):

I bring this up for two reasons.  First, I feel like many nurses also struggle with perfectionism.  It’s a piece of what can be a very damaging culture in the quest to become a nurse.  Sometimes it makes sense; after all, in our profession, lives are at stake.  Mistakes can have terrible consequences.  But perfectionism also stifles creativity and learning, focuses on the negative, and makes what could be seen as an opportunity for growth into a personal failing.

Which brings me to the second reason for writing about this.  Recently I came to understand that perfectionism is also a characteristic of white supremacist culture, which shocked me right to my core.  In my personal endeavors to learn more about how to be an anti-racist, I’m determined not to look away when a concept does this to me.  I encourage you not to look away either.  Perfectionism does far more damage than I ever realized, but I have also learned that there are antidotes.  My favorite is creating a culture, “where it is expected that everyone will make mistakes and those mistakes offer opportunities for learning” (  I think this is probably super important for us to try to practice at this point in our history.  I’m going to try harder (but not perfectly!) to let go of this damaging behavior.  Care to join me?

With great respect,



School Health Updates

I have received multiple questions in regards to the CSHS Monthly report much like this one:

Could you clarify on the monthly report, section 9, special assignments...are we trying to capture the number of times that each nurse has been utilized as  MWR, contact tracer, resource nurse etc…for the activity or is this just asking for the number of FTE in that particular position?

We understand that school nurses are fulfilling multiple responsibilities at this time, and on any given day may perform the functions noted in the report.  However, with this measurement we are definitely looking for folks that have been more or less permanently assigned to those positions; so essentially, even if temporary, a change in role for school health staff. I hope this helps to clear these questions up.

BU SHIELD updates

November regional meetings are upon us!  This month we focus on working with local health departments. Registration information can be found here.  Please note that regional meetings for December have been canceled.  We have made this decision in order to make space for any training that may be needed for those implementing BinaxNOW testing in schools.

Also, a reminder that our clinical update continues in November:

November Clinical Update: Asthma in home and in school

This exciting program will be delivered live via Zoom over four 1.5-hr sessions. Topics will include racial equity, safe cleaning, indoor triggers, medications, and medical management, particularly in relation to COVID-19. Learn what's coming in the soon to be issued National Guidance for the Diagnosis and Management of Asthma. We will be welcoming subject matter experts from CDC, MDPH Asthma Prevention and Control Program, BUSPH, and more.

Course Length: 1.5 hours per session. All sessions will run from 3:30-5:00 pm
Registration Fee: $120 for four sessions

More information and registration here.

Karen Robitaille, MBA, MSN, RN, NCSN
<she, her, hers>
Director of School Health Services
Division of Child/Adolescent Health and Reproductive Health
Massachusetts Department of Public Health
250 Washington St. 5th floor, Boston, MA 02108
cell 781-675-0463
Personal Webex room:


MDPH School Health Unit Update: 10/30/2020

Greetings from the School Health Unit!

It was so good to see so many of you at our October regional meetings.  I hope that you are finding these meaningful and useful, and a reminder that feedback is always welcome.  In November we will focus on Working with Local Health Departments, and we hope to see you there!

As I walked my dog Harley the other evening, I began thinking about Halloween, and how different and sort of sad it has been for me in the last few years with my own children grown and (mostly) gone.  When they were young it was SUCH a big deal for our family; the anticipation of goodies, the costume planning, and the break-in routine (Outside!  At dark!  On a school night!).  Then I thought about how everything this year is so altered for our students; the rhythm of the year, the celebrations (or lack thereof), the loss of connection.  The upcoming holiday season is sure to be very different, bringing that sadness into stark relief.  We are all going to have to get creative while remembering that for many of our students, holidays are ALWAYS hard and require extra patience and understanding on our part.  Here is a great article from CNN outlining safer ways to celebrate on Saturday, and there are certainly many more resources out there that your families might welcome you sharing.

Stay safe this weekend, and a few updates follow.

With great respect,



Comprehensive School Health Services (CSHS) Grant Orientation

This program introduces nurse leaders to CSHS grant management and requirements; the recorded version is also now available:

Course Recording and Materials

To access a recording of this training (1 hour, 17 minutes), click on this link:

Additionally, Caitlin, Bob, and Juliet worked to take important tasks related to the grant and explain them in individual job aids; links to these are below and they “live” on the BU SHIELD website for access by anyone who needs them:

  1. School Health Data Collection Tools
  2. Guidelines for Choosing Professional Development Offerings
  3. PDSA Cycle Job Aid
  4. CSHS Grant Budget Job Aid
  5. CSHS Data Reporting and Statistics Job Aid
  6. CSHS Performance Measures Job Aid

November Clinical Update clarification  

STARTS NEXT WEEK, PLEASE REGISTER NOW!  The first session features Craig S. Andrade, RN, DrPH. Associate Dean of Practice, Activist Lab Director, Boston University School of Public Health, presenting Antiracist School Health Services:The Time is Now.

Anyone can register for any number of the sessions using the Zoom links provided. There is no cost to do this. There IS a $120 fee for the credits for the bundle of four sessions.  Due to the amount of work involved, we are not able to separate these for credit/payment purposes and you must attest to the fact that you participated in each session for the credits. The recorded program will be offered in a similar fashion – watch each, pay for the whole. This way, you can attend one live session and watch three recorded sessions and still be able to access credit without re-registering.  If you have any further questions about this offering, please do contact BU SHIELD directly.

Information about registering for the Clinical Update can be found here.


Juliet is still working on getting FY20 reconciliation forms out to districts.  We will keep you updated as to the progress so that you can keep an eye out for them.

A few points of clarification regarding FY21 amendments:

  • Each new budget year starts with the final budget from the previous year.  I know that you may have received conflicting information in this regard, but this is how most of us are used to working with our budgets, and that is how we will function moving forward.  If you amended your budget last year, you will start with the amended budget, which may be further amended as needed.
  • We had already provided guidance on allowable expenses in regards to COVID and these are outlined below:
    • Consumable supplies needed to safely provide care during COVID (may include gloves, masks, eye protection, scrub/gowns), for school health staff ONLY. Not to exceed 10% of the total budget.
    • Reallocation of case management staff hours to address COVID case management  during school hours in the form of dedicated nursing staff performing contact tracing and/or case management for COVID cases in the school community (ie referral to testing, referral to community resources for isolation & quarantine) under an agreement with the LBOH.
    • Health office equipment that addresses COVID-19 emergency response and that will be used in the health office, medical waiting room, or AGP room (may include physical barriers and filtration units for those spaces ONLY). Not to exceed 15% of the total budget.
  • If you are finding that you wish to amend your budget beyond these parameters in a way that significantly changes your planned programming (for example, your district is fully remote and implementing a BRYT program has been put on hold), please contact Juliet for specific instructions on providing an amendment justification for the changes.


Recognizing the impact the COVID-19 pandemic is having on children’s mental health, the Office of the Child Advocate (OCA) joined forces with the Executive Office of Health and Human Services (EOHHS) and the Department of Mental Health (DMH) to launch, a new family-friendly website for parents and guardians of school-aged children who are concerned about their child’s mental health. provides families with tips, tools, and resources designed to help them navigate their child’s mental health journey with confidence. The content, which is targeted to families with kids age 6-12 years, was developed by a team of mental health and child development experts as well as family and community partners. A creative team from IDEO Cambridge designed the user experience and branding.

The content on is organized in three main sections:

  • Should I worry? This section helps parents/guardians explore if their child is just being a kid or if their behavior is something to worry about. Families can learn about signs to look for and get suggestions on what to do next.
  • What can I do? These are tips, tools, and strategies that have worked for other families in the past and are things they can learn about or do from home.
  • Who can help? The final section includes carefully selected community organizations and government resources to help families find the right mental health services. was developed with input from individuals representing the diversity of Massachusetts’ communities, and is available in six languages: English, Spanish, Portuguese, Simplified Chinese, Haitian Creole, and Vietnamese.

Karen Robitaille, MBA, MSN, RN, NCSN
<she, her, hers>
Director of School Health Services
Division of Child/Adolescent Health and Reproductive Health
Massachusetts Department of Public Health
250 Washington St. 5th floor, Boston, MA 02108
cell 781-675-0463
Personal Webex room:


Janet Guertin-Moruzzi BSN, RN, NCSN

Central Region School Nurse Consultant

444 Wellesley Street

Weston, MA 02493


Mission Statement: The Central Massachusetts School Nurse Managers promote holistic wellness of school communities through leadership and collaboration

10/15/20 MDPH School Health Unit Update

Greetings from the School Health Unit!

It was so wonderful to see so many of you at the CSHS state meeting last week!  I hope you found it as helpful as I did to hear about self and collective care from our very talented colleagues from the BRYT program.  We had about 90 participants in the live course and the recorded version should be ready very soon.  Once we collect data from both versions on preferred meeting times, we will set the times for the remaining meetings and communicate those to you.  Regional Nurse Leader meetings are starting up again this week and next, so don’t forget to register!  Additionally, we are holding a CSHS grant orientation meeting on October 15th with a repeat session on October 29th; please join us if you are a new nurse leader in a grant funded district or even if you are experienced nurse leader who just wants to brush up on grant essentials.  Lastly, we are hosting a virtual clinical update throughout November (four sessions each running 1.5 hours), in collaboration with other DPH partners, focusing on asthma.  The program will cover such topics as: how healthcare inequities and social determinants of health impact asthma management, current medication management, asthma in the time of COVID, and more!  Registration information for all these programs can be found here.



EXAMPLE_DPH Grant Amendment Request

Guidelines for Submitting Budget Amendments

A few updates and articles are below. I hope your three day weekend was restful and somewhat rejuvenating.  As the days get shorter and colder, please put that oxygen mask on regularly.  A reminder of my goals for self-care (and permission to steal!):

  • Reduce the word “should” in my vocabulary.
  • Recognize that rest is not just a reward for exhaustion.
  • Resist wearing my stress as a badge of honor.
  • If I need help, ask for it.

Here is a link to a Brene Brown podcast in which she discusses the book, “Burnout: The Secret to Unlocking the Stress Cycle” with the authors Emily Nagoski, PhD and Amelia Nagoski, DMA.  It’s about an hour long, but if you can make the time it is chock full of insight and tips on avoiding or reducing burnout, all based in research on the human physiological response to stress.  I found myself saying “ohhhhhhh” a lot while listening.



UPDATE on CSHS funds

You may have noticed in the Governor's budget, released yesterday, that the School Health line item seems to have been reduced.  The reduction is primarily the removal of some one-time funding in FY20 which we were ultimately unable to award. Also, this line has typically had a number of earmarks which are (as is usual) eliminated in the Governor's budget.  We do have enough funding to maintain the contracts that we have with all the existing CSHS grants, including the Regional Consultant funding, as well as all our staff.  We're very encouraged to see that our revised budget is the same as the Governor's initial pre-pandemic budget, and so we are essentially level-funded.


A few things to note:

  • All payment vouchers have gone out and you should look for payments within two weeks or so of returning PV’s to us. We may need to issue funds in three payments this year (you will notice a smaller first payment).  This was to allow for the state budget to be finalized; as you may be aware it has been delayed due to COVID and difficulty predicting revenues this year. Please sign the PV on the gray shaded area where it says Vendor Certification and email  back to Juliet at your earliest convenience. Do not put in the U.S. Postal mail as we are still not working from our offices and have limited access to our mail.
  • The FY20 reconciliation form submission deadline has been extended from October 15 to October 30.
  • We hope to have reconciliation forms sent out by Friday October 16th.  If that is delayed, we will extend the deadline further.
  • Amendments can be submitted anytime up until March 31st. We may be able to extend this deadline, and will let you know if we can.
  • Updated instructions, a blank form for amendments and an example of an amendment are attached to this email.  Please email Juliet Berk with any questions in regards to budgets.

School nurses in the news!

School Nursing and Public Health: The Case for School Nurse Investigators and Contact Tracing Monitors of COVID-19 Patients in Massachusetts (written by Westfield school nurse Elizabeth A. Flaherty!):


An article recently published in the New York Times:

Now Taking the Stage in the Pandemic: The School Nurse


Karen Robitaille, MBA, MSN, RN, NCSN
<she, her, hers>
Director of School Health Services
Division of Child/Adolescent Health and Reproductive Health
Massachusetts Department of Public Health
250 Washington St. 5th floor, Boston, MA 02108
cell 781-675-0463
Personal Webex room:

Community Impact Survey from MA-DPH

By Andree EntezariOctober 15th, 2020in SHIELD Updates

Dear School Health Colleagues, 

The Massachusetts Department of Public Health (MA-DPH) is trying to hear from communities so that it can better help people through the COVID-19 crisis. By taking this survey, you can help find new solutions to community problems, and give MA-DPH the information they need to take action and support the communities that need it most. MA-DPH is committed to sharing information back in ways that will help us all take collective action

I believe this effort will help us better understand the impact of COVID-19 on our communities and would encourage anyone who is 14 years old or older to participate using this link that will take you to the survey in 7 languages:

Please share this link to the survey with the organizations and stakeholders you work with and take the survey yourself.


            What is CCIS? The COVID-19 Community Impact Survey (CCIS) is an online survey aimed at collecting data to better understand and identify the social, economic, and health needs and inequities resulting from the COVID-19 pandemic.

How will the findings be used? Findings from this survey will be used to improve DPH’s ability to act - helping address the most critical needs, partnering with communities to support local efforts, and informing state policy with accurate information on what people need now and in the long term. Results will be available to community-based organizations for their own planning and action purposes.

Who should take this survey? Anyone 14 or older who lives in MA can and should take the survey. Even people who have not had COVID-19 can take this survey. We have a particular interest in gathering responses from communities who have been impacted the most, including people of color, immigrants, individuals who are LGBTQ+, people with disabilities, essential workers, people experiencing housing instability, older adults, and those in geographic areas hardest hit by COVID-19.

What important information should I know? The survey is available in six common languages spoken in MA: English, Chinese (standard and traditional), Spanish, Portuguese, Haitian Creole, and Vietnamese.

Where may I find additional information? Additional information about the CCIS Initiative may be found in the FAQ document here. If you have questions, please contact

In particular, I would urge you to share this survey with your school communities, including students over 14, caregivers, and staff. 

If you use social media, you could also promote it there using one of the following "sound bytes":

  • MA-DPH is learning how to better help people through COVID-19. Even if you haven’t been sick, your answers can help. Take the survey.
  • The COVID-19 Community Impact Survey will help MA-DPH learn about needs across the state, so it can plan resources and support around COVID-19. Take the survey.
  • COVID-19 unfairly impacts people of color more than others. Help MA-DPH learn how it can plan resources and support around COVID-19. Take the Community Impact Survey.

Thank you so much for helping us to collect this important information!


Karen Robitaille, MBA, MSN, RN, NCSN
<she, her, hers>
Director of School Health Services

Division of Child/Adolescent Health and Reproductive Health
Massachusetts Department of Public Health
250 Washington St. 5th floor, Boston, MA 02108
cell 781-675-0463
Personal Webex room:

“Certificate of Immunization” Definition

By Andree EntezariOctober 15th, 2020in SHIELD Updates

We wanted to be sure you were aware that many of the Flu Materials have been updated for the 2020-2021 season. Immunization Action Coalition (IAC) has updated their Model Standing Orders, Screening Forms, Flu Products Chart, and have VISs available in many different languages.  MDPH has updated sample influenza vaccine consent and screening forms that can be used for school immunization clinics. We have also included a link to MDPH’s Important Resources for Fall Vaccination Clinics document, which links to many important CDC resources and provides a framework for vaccinating during this COVID pandemic.

IAC Model Standing Orders (IAC):

Screening Forms (IAC):

Flu Products Chart (IAC):

VISs: (latest version is 2019)


MDPH sample flu consent and screening form for school clinics

MDPH Important Resources for Fall Vaccination Clinics

How to Complete an Immunization Survey Through MIIS

By Andree EntezariOctober 15th, 2020in SHIELD Updates

Please see the forwarded email from Karen Robitalle regarding important upcoming dates and meeting registration information.  There is also a school immunization survey infographic, How to Complete an Immunization Survey Through the Massachusetts Immunization Information System (MIIS), from the MDPH Immunization Division attached to this email update.