Mental Health in Schools: The Role of the School Nurse Vickie Southall, MSN, RN, NCSN Tia Campbell, RN, MSN, NCSN, FNASN Tracy White, MA, BSN, RN

Every school needs a school nurse every day

In 2012, the CDC (Centers for Disease Control & Prevention) reported that: 9% of students have been diagnosed with asthma 23,000 children are diagnosed with diabetes each year 8% of students have experienced a food allergy 467,711 children have a seizure disorder 1 in 68 children have been identified as having a disorder on the autism spectrum More than one in every three students are overweight or obese Asthma leading cause of hospitalization for children

If a school does not have a nurse, students still have health issues If a school does not have a nurse, students still have health issues. In a 2011 time study, Baisch and associates costed the time spent by teachers, administrators, support staff, and clerical staff to deal with health issues in the absence of a nurse. How much was spent in replacing the services that one school nurse could have provided at a school? $52,000 $74,000 $96,000 $133,000 You might be able to get two school nurses for that! Baisch, M.J., Lundeen, S.P. & Murphy, M.K. (2011). Evidence-based research on the value of school nurses in an urban school system. Journal of School Health, 81, 74-80. doi: 10.1111/j.1746-1561.2010.00563.x

Researchers have studied what happens when school clinics are not staffed by RNs. What did they find? Three and a half times as many students are dismissed from school by non-nurse school personnel as are dismissed by school nurses. There is no difference in the rate of dismissal by school nurses and non-nurse school personnel. School nurses send students home more often than unlicensed personnel. (Pennington & Delaney, 2008) Students need to be in class to learn.

According to the Code of Virginia (§22 According to the Code of Virginia (§22.1-274), which of the following is true? Teachers cannot be required to administer insulin. Instructional assistants and clerical staff may not refuse to administer oral medications. If a school does not have an RN, both the parents of a child with diabetes and the child’s health care provider, must approve whether any other person can administer insulin to the child. All of the above. None of the above. §22.1-274

Healthy People 2010 and the American Academy of Pediatrics recommend that professional school nurses have a minimum of a baccalaureate degree in nursing. What ratio of students (without special needs) to nurses did they recommend? 500:1 750:1 1000:1 2000:1

True or False In Virginia, school divisions are required to have at least one school nurse per 2500 students.

Role of the School Nurse in Behavioral of Students (NASN) “School nurses recognize that positive behavioral health is essential for academic success. School nurses are critical to the school mental health team in that they can help address and reduce the stigma of a behavioral health diagnosis, decrease fragmentation of care, and remove barriers to behavioral health services. School nurses, because of their regular access to students and their experience with care coordination, are also uniquely equipped to assist school and community-based behavioral health professionals in providing services including prevention, assessment, early identification/intervention, and treatment of mental illness and substance use disorders.” (NASN Position Statement, 2017)

Why are school nurses considered frontline in mental health care? First responders to any health issue Accessible—any student can go see the school nurse ∅ social stigma Crisis intervention/mass casualty/triage training (more recently)

Children who are bullies and children who are victims of bullying both visit the school nurse more often than other students (Vernberg, 2011)

Barriers to School Nurse Involvement Not being included on teams (child study, mental health teams, suicide and concussion response teams) Lack of information re: school nursing for other professionals Silo practice No universal school nurse assessment tool Lack of full-time school nurses in each school Limited resources in some communities

Emerging Trends in Behavioral Health Care in Schools “Health in All Policies” the move from narrowly focused to comprehensive approaches the move from fragmentation to coordinated/integrated intervention the move from problem specific and discipline- oriented services to interdisciplinary programs the move from viewing health programs as "supplementary services" to policy changes that recognize physical and mental health services as an essential element in supporting learning

“Could someone help me with these? I’m late for math class.” We note that one student has her backpack on the way to class. We note that the other student is also coping with the “baggage” of illness, hunger, and homelessness to get to class in order to learn. No one person or discipline can take on all the issues the student has. Only by working together can we make sure the student comes to class ready and able to learn.

Every Student Succeeds Act (ESSA) ESSA references Specialized Instructional School Personnel (SISP) and further states, “As SISP, school nurses are the basic infrastructure for the health of students in school and provide a critical link between student health and learning” (NASN, 2016, p. 1). ESSA recognizes the school nurse’s role in chronic disease management in the school setting. School nurses are the health care professionals responsible for health promotion and student health services

Expanded Role of the School Nurse Picking up the slack Team Member Education Health & Chronic Disease Crisis Management Resource Management Health Promotion

Benefits of Collaboration with School Nurses Improves quality of health care delivered to student Improves health outcomes of student and/or school population Increases understanding, respect, knowledge and capacity of each team member Increases awareness of Social Determinants of Health and their role in both healthcare and education and impact on student learning outcomes. Limits professional silos, increase communication. Implement care coordination framework principle into student focused interventions Incorporate quality improvement processes into daily school nurse practice to document the provision of care rendered

Resources Adelman, H., & Taylor, L. (n.d.). Mental Health In Schools: New roles for school nurses. In http://smhp.psych.ucla.edu/. Retrieved August 14, 2018, from http://smhp.psych.ucla.edu/pdfdocs/nurses/unit1.pdf Baisch, M.J., Lundeen, S.P., & Murphy, M.K. (2011). Evidence- based research on the value of school nurses in an urban school system. Journal of School Health 81(2), 74-80. Jonnoson, J., Maltestam, M., Tops, A. B., & Garmy, P. (2017, November 23). School Nurses’ Experiences Working With Students With Mental Health Problems. Journal of School Health. Mazyck, D. (2016). Mental Health in Schools [Online podcast]. National Public Radio.

Resources Pennington, N., & Delaney, E. (2008). Number of students sent home by school nurses compared to unlicensed personnel. Journal of School Nursing, (24)5, 290-297. Vernberg, E.M., Nelson, T.D., Fonagy, P, & Twemlow, S.W. (2011). Victimization, aggression, and visits to the school nurse for somatic complaints, illnesses, and physical injuries. Pediatrics 127(5), 842-848. The Role of the 21st Century School Nurse (n.d.). National Association of School Nurses. Retrieved August 14, 2018, from https://www.nasn.org/advocacy/professional-practice- documents/position./ps-role National Association of School Nurses. (n.d.). Mental Health in Schools: The role of the school nurse. In NASN.org. Retrieved June 14, 2017, from https://www.nasn.org/advocacy/professional-practice- documents/position-statements/ps-behavioral-health

School Nurse Toolbox Brandt, N. E. (2012). Building School Nurses' Toolbox: Strategies for Helping Students with Mental Health Needs. Retrieved July 23, 2018, from http://csmh.umaryland.edu/media/SOM/Micr osites/CSMH/docs/Conferences/ship/SHIPArc hives/SHIPSchoolNurses.pdf

Any other questions? Thank you!

Discussion questions: The following slides may help school nurses interface with teachers, staff and student support colleagues and reinforce how to the school nurse can help promote mental health in schools.

What mental health prevention supports does your school nurse provide? Table Talk: Question 1 What mental health prevention supports does your school nurse provide?

How can an interprofessional teams approach benefit our students? Table Talk: Question 2 How can an interprofessional teams approach benefit our students?

Table Talk: Question 3 What would you like to see the school nurse do as part of an interdisciplinary team?

What is the potential scope of mental health education in schools? Table Talk: Question 4 What is the potential scope of mental health education in schools?

Table Talk: Question 5 Why is it important to map and analyze existing mental health resources in your community?