1. Standardizing School- Community Health Practice: Developing Protocols and Guidelines for School Nursing Practice School Nurse Survival Training XIX BJC HealthCare July 27, 2016 Robin Wallin, DNP, RN, CPNP, NCSN Director of Health Services Parkway Schools, Chesterfield, Missouri

2. Presentation Objectives Understand the purpose, structure and development of school policies and how policies and regulations guide actions in schools. Identify three key resources to assist with the development of policies to support healthy and safe classrooms and school environments for students with food allergies. Describe best practices for engaging professional development and training on managing food allergies or other chronic illnesses in schools for school staff and partners.

3. Getting to Know You

4. Need – Food Allergies 4% of students are affected by food allergies, and the incidence is increasing 1,2 1 in 5 students with food allergies will have a reaction while at school 3,4 25% of severe food allergy reactions at school happen to students with no previous known food allergy 3,4 Source: CDC Food Allergy Tool Kit for Schools available at https://www.cdc.gov/healthyschoo ls/foodallergies/toolkit.htm https://www.cdc.gov/healthyschoo ls/foodallergies/toolkit.htm

5. Need - Diabetes 1.25M Americans including about 200,000 youth 40,000 people are diagnosed each year in U.S. Between 2001 and 2009 there was a 21% increase in the prevalence of Type 1 Diabetes in people under age 20 https://www.google.com/webhp?sourceid=chrome- instant&ion=1&espv=2&ie=UTF-8#q=type%201%20diabetes

6. Need - Asthma http://www.cdc.gov/asthma/asthmadata.htm

7. Asthma’s Impact on Attendance http://www.cdc.gov/asthma/asthma_stats/default.htm

8. Nuts and Bolts of School Policy CDC - Laws, mandates, regulations, standards, resolutions, and guidelines—provide a foundation for school district practices and procedures. (http://www.cdc.gov/healthyyouth/about/policy.htm)http://www.cdc.gov/healthyyouth/about/policy.htm School health policies “set expectations for students, parents, staff and administrators. They also help to provide consistency and continuity across the district and reflect laws and regulations.” (AAP, School Health Services Policy Development Guidance)

9. Characteristics of Sound School Health Policies (CDC) Inform, support, and direct individuals throughout the school system Reassure families, students, and school staff that safety and health protection measures are in place Provide legal protection for schools Help contain or prevent controversy Source: http://www.cdc.gov/healthyyouth/about/policy.htm

10. Policy Intersection Medication Administration Medication Storage Stock Epinephrine Cleaning and Sanitation Policies and Procedures Emergency Response Bullying Wellness Medication Administration Food Allergies

11. AAP Policy Development Guidance https://schoolhealthteams.aap.org/uploads/ckeditor/files/AAP_Guidebook_Final.pdf

12. Policy Components 1.Background or Purpose Statement 2.Definitions 3.Legal requirements or references 4.Body 5.Responsibilities and qualifications 6.Cross references or related policies 7.Authorizing information Source: https://schoolhealthteams.aap.org/uploads/ckeditor/files/aap%20policy%20guide%20FINAL.pdf

13. TEAMS Project Framework Form TeamIdentify IssuesDevelop Plan Strategy Phase Source: https://schoolhealthteams.aap.org/uploads/ckeditor/files/AAP_Guidebook_Final.pdf

14. TEAMS Project Framework Implement Plan and Monitor EvaluateSustain Implementation Phase Source: https://schoolhealthteams.aap.org/uploads/ckeditor/files/AAP_Guidebook_Final.pdf

15. Evaluation – How Do You Measure Impact? Process Evaluation documents the steps you took to bring about the intended change. What was done? By whom? How well? For whom? How many? Outcome Evaluation documents changes that that have occurred. Did we meet our objectives? What happened as a result of our initiative? Did it have the desired impact? Source: TEAMS School Health Services Improvement Guidebook, p. 66

16. Getting Started – Engage Stakeholders

17. CDC Parent Engagement Resources CDC’s Parent Engagement Web page: http://www.cdc.gov/ healthyyouth/adoles centhealth/parent_e ngagement.htm http://www.cdc.gov/ healthyyouth/adoles centhealth/parent_e ngagement.htm

18. Parent Engagement Parent engagement committee Action team for partnerships PTA/PTO Subgroup on the School Health team or wellness committee School Nurse

19. Parents for Healthy Schools Purpose: to develop resources for parents on school nutrition, physical activity/physical education, and chronic conditions Resources: Short PowerPoint presentation on the importance of a healthy school environment Parent idea sheets on a variety of topics Action guide on the process of engaging parents in promoting a healthy school environment http://www.cdc.gov/healthyschools/parentengagement/parentsforhealthyschools.htm

20. NSBA Policy Resource National School Boards Association. (2011). Safe at school and ready to learn. A comprehensive policy guide for protecting students with life- threatening food allergies.

21. 10 Essential Components of a Food Allergy Policy (NSBA) 1. Identification of students with food allergies and provision of school health services 2. Individual written management plans 3. Medication protocols, including storage, access and administration 4. Healthy school environments 5. Communication and confidentiality 6. Emergency response 7. Professional development and training for school personnel 8. Awareness education for students 9. Awareness education and resources for parents/caregivers 10. Monitoring and evaluation.

22. CDC Guidelines http://www.cdc.gov/HealthyYouth/foodallergies/

23. Food Allergy Management and Prevention Plan (FAMPP) 1.Ensure the daily management of food allergies in individual children. 2.Prepare for food allergy emergencies. 3.Provide professional development on food allergies for staff members. 4.Educate children and family members about food allergies. 5.Create and maintain a healthy and safe educational environments. (CDC, 2013, p. 15)

24. Guidelines Content Section 1- Food Allergy Management in Schools and Early Care and Education Programs Section 2 - Actions for School Boards and District Staff Section 3 - Actions for School Administrators and Staff Section 4 - Actions for Early Care and Education Administrators and Staff Section 5 - Federal Laws and Regulations Section 6 - Food Allergy Resources

25. CDC Tool Kit for Key School Audiences School superintendents School administrators Teachers and para-educators School nutrition professionals School mental health professionals School transportation staff (School nurses) https://www.cdc.gov/healthyschools/ foodallergies/toolkit.htm

26. Meeting Training Needs

27. Toolkit 6 audience-specific tip sheets 6 audience-specific customizable PowerPoint presentations 7 audience-specific podcasts Select Resources list for schools http://www.cdc.gov/healthyschools/foodallergies/toolkit.htm

28. School Guidelines for Managing Students with Food Allergies

29. Missouri Guidelines for Allergy Prevention and Response http://health.mo.gov/living/families/schoolhealth/pdf/ mo_allergy_manual.pdf

30. FAME Toolkit Children’s Hospital St. Louis Food Allergy Management and Education FAME is designed to: Provide schools with the components of a comprehensive school-based food allergy program to promote best practices Offer resources and materials to schools and families across the country on creating a safe, nurturing educational environment for children with food allergies Increase awareness that children with asthma and food allergies have an increased risk of anaphylaxis which is a rapid, severe allergic reaction. It can cause difficulty breathing, swelling, dizziness, and even death. http://www.stlouischildrens.org/health-resources/advocacy-outreach/food- allergy-management-and-education

31. Potential Barriers – Tips and Strategies

32. What Works Well – Tips and Strategies Involve key stakeholders Know your school environment Engage parents Use data Tell stories

33. Communication, Compliance and Enforcement Communicate using multiple formats that are audience specific Be proactive in communication efforts Engage administrators in compliance and enforcement

34. Interview with Katherine Park

35. Group Discussion: Asthma Break into groups of 3-4 Discuss the steps you would take to create a school asthma protocol

36. Sharing

37. The Power of One

38. Resources American Academy of Pediatrics (AAP), TEAMS School Health Services Improvement Guidebook. Available at https://schoolhealthteams.aap.org/uploads/ckeditor/files/AAP_Guideb ook_Final.pdf https://schoolhealthteams.aap.org/uploads/ckeditor/files/AAP_Guideb ook_Final.pdf Food Allergy Resource and Education (FARE) http://www.foodallergy.org/resources/schools http://www.foodallergy.org/resources/schools National Association of School Nurse (NASN), Food Allergy and Anaphylaxis Tool Kit. Available at http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis National School Boards Association, Safe at School and Ready to Learn Policy Guide. Available at http://www.nsba.org/services/school-board- leadership-services/food-allergiesschool-healthSafe at School and Ready to Learn Policy Guidehttp://www.nsba.org/services/school-board- leadership-services/food-allergiesschool-health Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Available at www.cdc.gov/healthyyouth/foodallergies/ www.cdc.gov/healthyyouth/foodallergies/

39. Questions? Robin Wallin rwallin@parkwayschools.net

40. 1 Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. 2008;10:1-8. 2 Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798-806.e13. 3 Nowak-Wegrzyn A, Conover-Walker MK, Wood RA. Food- allergic reactions in schools and preschools. Arch Pediatr Adolesc Med. 2001;155(7):790-795. 4 McIntyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005;116(5):1134-1140. References