Health Check Points in Schools: Adolescent Immunizations, New Dental Exam and HealthCheck with Focus on Grade 7 Rebecca King, WVDE-State School Nurse Consultant, Jeff Neccuzzi, WVBPH Director of Division of Immunizations, Robert Wines, WVDHHR-HealthCheck Director, Dr. Jason Roush, State Dental Director and Teresa Marks, WVDHHR- Oral Health Program Director

Webinar Objectives: 1. Summarize the WVBE Policy 2423-Health Promotion and Disease Prevention which includes health check points for adolescent immunizations, HealthCheck and dental examinations for students; 2. Identify key strategies for recruiting parents to provide the 2017 proof of adolescent immunizations, dental examinations and HealthChecks for enrollment and progression in school; 3. Understand the importance of assisting families with enrollment and/or reenrollment of medical and dental insurance; 4. Discuss quality improvement measures for adolescent vaccinations; 5. Discuss the quality improvement measures for completion of HealthCheck components including vision and hearing screenings; 6. Understand the new dental examination requirement for new enterers in Pre-K or K, Grade 2 and Grade 7 in 2017/18; 7. Review the importance of a dental examination (comprehensive) versus a dental assessment (last resort); 8. Discuss how the school nurse can assist with linkage to local dental providers and public health certified dental hygienist to complete the dental assessments for students without an exam or dental home; and 9. Review the supporting educational and promotional materials for students, parents, providers and medical community awareness.

WHY DO STUDENTS NEED A HEALTHCHECK AND DENTAL EXAM?

Status of Health in WV

Status of Children’s Oral Health More time is lost when students miss school because of toothaches. An estimated 51 million school hours per year are lost due to dental related illness. Overall, children with good oral health spend more time in school learning.

Vision Ensuring Medical and Dental Home Check points to promote Health and Wellness for academic success for new enterers and Grades 2, 7 and 12 –Immunizations –HealthCheck –Dental Exam

Salute Since 2007, there has been an increase of 22% in well child visits for ages 3-5 years

Salute School Nurses Make a Difference in Daily Attendance Rates The 2015/16 School Nurse Needs Data showed West Virginia School Nurse RNs kept students in school more than one half of a million days (641,700) by returning students to class instead of sending them home. This means that school nurses returned 3,565 students back to the classroom each day during the 2015/16 school year! This is up 28% from 500,000 days in 2014/15 and returning 2,777 students back to the classroom each day. WAY TO GO WV SCHOOL NURSES!

WVBE Policy 2423 § Health Promotion through School Screenings/Examinations All schools support and assist students in being healthy learners through promoting annual well child examinations, biannual dental examinations by a licensed dentist, up-to-date immunizations, emergency information, preventive health care and enrollment for children and families into health care insurance. A public/private partnership is easily accomplished through school nursing services, local WVDHHR/Bureau services, school-based services (including medical, mental and oral health), non-profit services, private sector services, businesses, etc. The school nurse is the school health expert who is qualified to lead the coordination and monitoring of health promotion through school screenings and examinations.

WVBE Policy 2423 § Health Promotion through School Screenings/Examinations. Section 5.2. HealthCheck: New enterers in West Virginia public school at first entry of either prekindergarten (Pre-K) or Kindergarten and all students progressing to grades 2, 7 and 12 should have on file within 45 days of enrollment/entry or prior to the first day of school attendance a record of a HealthCheck screening, or other comprehensive health screening comparable to the HealthCheck protocol. The following transition plan will require each new enterer in Pre-K and Kindergarten and all students entering grades 2, 7 and 12 to show proof of a HealthCheck screening: beginning the school year (SY) 2015/16 all new enterers in Pre-K and Kindergarten; beginning SY 2016/17 all students entering grade 2; beginning SY 2017/18 all students entering grade 7; and beginning SY 2018/19 all students entering grade 12. All screening forms shall be signed and dated by the child’s licensed health care provider and completed within the prior 12 calendar months. If the student does not have proof of a HealthCheck the classroom teacher shall be informed to ensure any potential learning deficits (vision, hearing, speech and language, developmental, etc.) will be referred to the appropriate school personnel for screening as individually indicated. Counties can retain the right to conduct follow-up screening (W. Va. Code § , W. Va. 126CSR28, WVBE Policy 2525, West Virginia’s Universal Access to Early Education System, Governor’s KidsFirst Initiative and Superintendent’s Interpretation of June 29, 2007).

WVBE Policy 2423 § Health Promotion through School Screenings/Examinations. Section 5.3. Oral Health: New enterers in West Virginia public school Pre-K or Kindergarten and students progressing to grades 2, 7 and 12 should have on file within 45 days of entry or prior to the first day of school attendance a record of an oral health examination. The following transition plan will request each new enterer in Pre-K and Kindergarten and grades 2, 7 and 12 to show proof of an oral health examination beginning the school year (SY) 2015/16 all new enterers in Pre-K and Kindergarten; beginning SY 2016/17 all students entering grade 2; beginning SY 2017/18 all students entering grade 7; and beginning SY 2018/19 all students entering grade 12. All examination forms shall be signed and dated by the student’s dentist and completed within the prior 12 calendar months. If the student does not have proof of an oral health examination during the grade of requirement, the student may be enrolled into the WVDHHR-Oral Health Program’s (OHP) Oral Disease Prevention Project. The Oral Health Prevention Project will provide an oral health assessment from a dental provider regardless of the ability to pay if the parent/guardian provides approval/consent for the student to participate.

WVBE Policy 2423 § Disease Prevention Measures through Immunizations Students must be in compliance with the required immunization schedule as set forth by the Bureau Commissioner. The Commissioner, or his/her designee Immunization Officer shall make determinations on request for a medical exemption to the compulsory immunization requirements set forth by the Bureau. A medical exemption request must be made by a licensed physician and state that the physical condition of the child is such that immunization is contraindicated or there exists a specific precaution to a particular vaccine. The Immunization Officer’s decision on a request for an exemption to the compulsory immunization requirements of this section may be appealed to the State Health Officer. The final determination of the State Health Officer is subject to a right of appeal pursuant to the provisions of W. Va. Code §29A-5-1 et. seq. The immunization record shall be a public health record to be entered and reviewed annually into the WVSIIS.

WVBE Policy 2423 § Disease Prevention Measures through Immunizations All children entering Pre-K, kindergarten or any West Virginia public school for the first time must have immunizations and show proof upon enrollment as defined by W. Va. Code § and W. Va. 64CSR95. All Pre-K students shall also meet requirements found in 126CSR28, WVBE Policy 2525, West Virginia’s Universal Access to a Quality Early Education System Beginning in the school year , two additional vaccine requirements shall be added for students entering the 7th and the 12 th grades, in accordance with the guidance from the Advisory Committee on Immunization Practices (ACIP) and the revised rule of the Bureau, (W. Va. 64CSR95). Proof of Tdap and Meningococcal vaccinations shall be presented upon entry to 7 th and 12 th grade as indicated in and W. Va. Code §16-3-4, W. Va. 64CSR95, Interpretive Rule, Immunization Requirements and Recommendations for New School Enterers. Immunization records for each student entering grades 7 and 12 shall be examined for the age appropriate doses of these two vaccines. The information shall be entered into WVSIIS in order to ensure that updated immunization information is readily available to health officials in the event of a communicable disease outbreak that presents an imminent danger to students or other members of the community.

WVBE Policy 2423 § Disease Prevention Measures through Immunizations County boards of education should consider providing one credit hour of community service to students in high school for obtaining and showing proof of their annual influenza (flu) vaccination as a great way to support attendance rates, academic success, well workforce and overall wellness.

Phase-In Plan Dental Examination and HealthChek –2015/16 PreK and K –2016/17 PreK, K and grade 2 –2017/18 PreK, K, grades 2 and 7 –2018/19 PreK, K and grades 2, 7 and 12

WVBE Policy 2423 § Quality Assurance for School-Based Services. Section 7.1. All community services performed in the school setting should be regular and ongoing services that are evidence-based or a promising practice and follow best practices and guidelines. The terms regular and ongoing services as referenced refer to community services that are provided within the school in an agreed upon manner between the school and community partner(s) which work toward promoting both the academic, health and social service needs of students. Section 7.1.c. Oral Health services shall incorporate the protocols set forth by the WVDHHR-OHP.

Health Check Points in Schools Adolescent Immunizations Jeff Neccuzi, Director Division of Immunization Services Bureau for Public Health October 25, 2016

WV Vaccine Requirements for 7 th and 12 th Graders 7 th Grade School Entry Requirement 12 th Grade School Entry Requirement WV Code § and 64CSR95 18 VaccineRequirementProvisional Enrollment Tdap (tetanus, diphtheria, acellular pertussis) Proof of booster dose of Tdap vaccine.No provisional enrollment permitted. MCV4 (meningococcal/meningitis) Proof of 1 st dose of MCV4 vaccine.No provisional enrollment permitted. VaccineRequirementProvisional Enrollment Tdap (tetanus, diphtheria, acellular pertussis) Proof of booster dose of Tdap vaccine.No provisional enrollment permitted. MCV4 (meningococcal) One or two doses required. One dose of MCV4 is required if received after the 16 th birthday. Second dose is required if first dose was before 16 th birthday. No provisional enrollment permitted.

Adolescent Vaccinations NOT Required HPV Nearly 39,000 cases of HPV-associated cancers diagnosed annually between ,700 (79%) of these cancers attributed to HPV and 93% by HPV types preventable by HPV9 vaccine Cervical cancer is responsible for more than 4,200 death per year in the U.S. West Virginia has the highest rate of cervical cancer in the U.S. Vast majority of HPV cancers are oropharyngeal and cervical Oropharyngeal cancers disproportionately affect males Boys need HPV vaccine, too! 19

Adolescent Vaccinations NOT Required Meningococcal B (Men B) Even when treated, meningococcal disease fatality rate is approximately 15% Up to 20% of survivors will suffer disabilities such as hearing loss, brain damage, amputations, nervous system problems, or severe scars from skin grafts Persons with weakened immune systems and adolescents and young adults 16 through 23 years old are among those at increased risk from Men B disease Meningococcal B vaccine also recommended for administration to non-high-risk groups subject to individual clinical decision making for persons years of age (16-18 years of age preferred) 20

Vaccination Rates 21

NEW HPV9 VACCINE RECOMMENDATION On October 19, 2016 the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend a two dose series of HPV9 for males and females 9-14 years of age The 2 nd dose of HPVP recommended 6-12 months after 1 st dose The recommendation has not been formally accepted by the CDC, WV Bureau for Public Health or the Vaccines for Children (VFC) program Males and females years still recommended to receive a 3 dose series 22

Tdap and MCV4 Vaccinations 7 th Grade enters must have one dose of Tdap Only one dose of Tdap is recommended for students; 12 th grade enterers are not required to have a 2 nd Tdap Additional doses of Tdap recommended only during pregnancy One dose of MCV4 is required for 7 th grade enterers An additional (booster) dose of MCV4 vaccine is required for 12 th grade entry if the first dose was before 16 th birthday. 23

WVSIIS Practice Management Tools  Reminder/Recall notices an important tool for notifying patients due or overdue for vaccinations  Generates patient list, mailing labels, postcards, or form letters  Vaccine forecasting feature displays vaccinations that are past due and past due for any patient.  Can generate a patient detail report in which it lists all a patients within a selected time frame and displays each patient’s name and past due immunizations. 24

Vaccine Forecasting Feature 25

Contact Information Bureau for Public Health Division of Immunization Services or (within WV) West Virginia Statewide Immunization Information System (WVSIIS) or

Promotion of Medical and Dental Home

What does it mean? Need to request parent/guardian bring in proof of HealthCheck and dental examination completed in the last 12 month of pre-enrollment or day they bring exam with date. The dental Exam needs the signature of the Dentist. Lack of a Dental Exam data base/module. Concerns are completion of screening components of the HealthCheck. Lack of dental insurance, Dentist limiting the number of Medicaid patients, lack of dental providers in your area, etc. Finding Medical and Dental homes for students Documentation? Children in Head Start? What happens when the parent/guardian does not provide proof of a HealthCheck and/or Dental Exam?

HealthCheck Robert Wines, WVDHHR-HealthCheck Director

What is the HealthCheck? HealthCheck is the name for West Virginia's EPSDT Program. The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program is a child preventive health component of Medicaid. Federal law requires that state Medicaid programs provide medically necessary health care services to Medicaid-eligible children. The building blocks of EPSDT are:

What is the HealthCheck? The HealthCheck Program promotes regular preventive medical care and the diagnosis and treatment of any health problem found during a screening. There is no separate enrollment in HealthCheck. If a child is eligible for Medicaid and is under the age of 21, they automatically receive EPSDT services. HealthCheck primary medical providers will provide children regular check-ups, screenings and preventive services based on a schedule established by medical, dental and other health care experts, including the American Academy of Pediatrics. Primary medical providers can also treat children when they are sick or refer them to an appropriate specialist if they need to see one. A HealthCheck primary medical provider may be an: MD - Doctor of Medicine DO - Doctor of Osteopathic Medicine APRN - Advanced Practice Registered Nurse PA - Physician Assistant

Revised HealthCheck Forms

Resources

Other Resources at WVDE Tools for Schools WVDE School Readiness Brochure WVDHHR Parent Information: Preventive Care Tips WVDHHR Preventive Health Care Tips and Resources: Bullying, Autism, Immunizations, etc.

Quality Assurance Measures Periodicity Schedule BrightFutures Medical Advisory Board Regional HealthCheck Specialist Concerns related to completion of vision and hearing screenings on HealthCheck

Dental Exam

FACT Dental sealants are effective in preventing dental decay. School-based dental sealant programs have been shown to reduce dental decay on the chewing surfaces of back teeth by 60 percent over a five-year period. They are 100 percent effective when fully retained.

What is the Difference? Oral Health Screening, Dental Assessment and Dental Examination An oral health screening is usually completed by a nurse or medical provider to see if your child has any possible concerns with their teeth or mouth to detect any type of mouth ulcers or oral diseases or concern with your child’s teeth to make a referral to a Dentist. A dental assessment is completed by a dental hygienist or Dentist to provide a simple structural assessment of your child’s mouth with the aid of an x-ray. Your child should see a Dentist for a dental examination inclusive of an x-ray within 6 months of the dental assessment. Last Resort for new recommendation. A dental examination is a complete oral health assessment inclusive of an x-ray of the dental bones to diagnose and treat any dental concerns for oral health prevention completed by a Dentist. Primary focus for new recommendation.

Importance of working with local dental providers…establishing dental homes

FACT Unfortunately, many parents cannot afford or access dental care. Schools can help children receive necessary preventive care in order to stay healthy and in school. School-based dental services keep students healthy in schools and learning versus absent for toothaches and leaving a full day for a one-hour appointment with a Dentist.

What is the recommended documentation? Students must provide proof that they have had a dental examination within the last 12 months at the time of enrollment. At a minimum, it must show the date the exam was given and the dentist’s signature. There is no special form to show proof of examination. In order for the school and ODPP to assist with follow-up care coordination with your Dentist, it would be beneficial if the information indicated need for restorative care.

Documentation Future…Oral Health Data Base populated by dental providers which talks to WOW to share dental exam and oral health assessment information with schools. Single-point sign-on.

Documentation Children in Head Start

Key strategies for the 2017/18 pre-enrollment Outreach to staff…HealthCheck Tools for Schools & Dental Exam School Tool Kit Parents and community…HealthCheck Tools for Schools and Dental Exam School Tool Kit Outreach to local Dentist and dental hygienist…meeting, letter, , wellness meetings, etc. Head Start already has dental exam requirement School-based dental services Work with local public health certified dental hygienist to assist with dental assessments if needed Work with Marshall University-Oral Health Coordinators for education, fluoride rinse and oral health support

FACT Portable dental equipment can be set up in a school gymnasium, library, classroom corner or a hallway if necessary. It takes approximately 45 to 60 minutes to set up equipment and supplies and approximately 30 to 45 minutes to disassemble and pack up.

Current Supports KidsFirst Team has insurance payors send out letter to notify parents/guardians of children who are in the ages to attend PreK, Kindergarten, Grade 2, and now Grade 7. HealthCheck Tools for Schools including a FAQ on documentation and a Preenrollment Schematic WVDHHR-HealthCheck Periodicity Schedule for Education Dental Exam Tool Kit Oral Health Technical Assistance Log Regional supports (HealthCheck Specialist, Oral Health Coordinators, RESA-Wellness network, etc.) Provide outreach to medical providers and dental offices to ensure they understand the need for this documentation and develop plans to encourage parents to make appointments.

Promotional Resources A Family’s Guide to School Readiness Brochure New School Health Requirements Banner, Poster and Postcard

QUESTIONS?

Thank You! Healthy Students and Better Learners!!

Robert Wines WVDHHR-HealthCheck Program and Teresa Marks WVDHHR-Oral Health Program Director

Immunization Contact Information Bureau for Public Health Division of Immunization Services or (within WV) West Virginia Statewide Immunization Information System (WVSIIS) or