Measuring Our Impact Identifying & Measuring School Nurse Case Management Outcomes Maria Bonaiuto, RN, MSN, NCSN Director of School Health Division Mecklenburg County Health Department, Charlotte, NC

Student Case Management is...  a collaborative practice which can include parents, teachers, school psychologists, support staff, social workers, physicians, other practitioners, caregivers and the community.  a process that encompasses communication and facilitates care along a continuum through effective resource collaboration and networking in the education setting.

Why Purpose of Case Management  To Improve  Attendance  Behavior  Educational Outcomes  Health Outcomes/Compliance  Quality of Life  To Demonstrate  Effectiveness of School Health Services

Students to be considered for case management are:  those with whom the nurse has multiple interventions, including but not limited to students who have, a chronic condition with or without chronic absences attendance or academic concerns, which may have health issues as a possible contributor a health/psychosocial issue, which may interfere with learning

The School Nurse will identify students in need of case management through the following:  Review of Pre-K and Kindergarten physicals  Review of Health and Emergency Locator Cards, & Registration Forms  Case-finding in the health room  Compiling “Health Concerns List”  Participating in Intervention/ Student Services Management Team Meetings  Follow up on student, staff, or parental referrals of health/psychosocial and attendance concerns.  Review of Daily Attendance Bulletin

 Increased participation in activities &/or sports  Improved relationships, acceptance by others  Decreased anxiety, depression  Increased sense of well being and safety  Increased knowledge of support services and community resources  Decreased/ceased tobacco use  Decreased risk taking behaviors  Improved nutrition, healthy weight Case Management Outcomes!! Improving Quality Of Life

Helpful Hints For: Collecting Case Management Outcome Data  Record the number of health room visits  Review of suspensions and other disciplinary referrals  Review of grades  Review of attendance bulletins  Follow up with student  Follow up with parents, teachers, school support staff and medical providers  Evaluate student/school staff’s increase in level of knowledge regarding health needs of student

Completed Outcomes Data Form Age: 18 Grade: 12 OUTCOMES Gender: Female Before Case Management (CM) School: Southside High After 3 months or more CM Nurse: G Sample Absences (# of days per _____ months) 16 days/8 mo;9days d/t hospitalizations 7 d/t trip to Korea; 9 absences coded medically fragile; 7 remain unexcused Yes 7 Planned absences d/t trip unchanged Academics (EOGs, grades, teacher report) 1 F Calculus; 1D Eng; 4 A’s; 1B Eng C; Calculus A! Art not sure, may drop a grade Yes Behavior problem No ISS/OSS; Conflicts with Art teacher, miscommunication re assignments No Behavior problems Increased frequency of communication with art teacher and guidance counselor clarified assignments leading to work completion None Needed Health or health compliance Type 1 DM, Hospitalization x1d/t extreme elevated BG; HgbA1C 13, regular MD visits q 3 mos; sporadic adherence to diet, no reg exercise Improved dietary intake especially decrease hi cal snacks, increase sm frqnt meals; exercise 40 min 5 x/wk, Hgb A1c 10 at last MD visit 4/06 Yes Quality of life per students LTG to attend college; misses family in Korea; has friends at SMHS; dislikes adjustment to Type 1 DM Articulates plan to enroll CPCC Fall 06 then pharmacy school UNC. Keeps book of photos fr recent trip to Korea Manages reg BG cks and insulin injections at school with minimal supv. MD plans pump in 1 mo. Yes Quality of life per adult Confusion re significance Type 1 DM on long term behavior change and anxiety re” doing the right thing for DM” Positive adjustment to Type 1 DM: adheres to reg BG cks/insulin injections and dietary changes; keeps MD appts; began regular exercise regimen Yes

3 year Case Management Outcomes Data Number of students case managed Improved attendance Improved behavior Improved academic performance Improved quality of life Improved in health compliance Improved in one or more areas %27%29%59%63%92% %21%19%54%No data74% %21%29%60%69%84% 3 Yr Average %23%25.7%57.7%66% (2yrs) 83.3%