1. Exploring Nurse Case Management& Student Learning
Lynn Nelson, RN, MSN, NCSN
Leslie Stahlnecker, RN, MS

2. Conflict of Interest Disclaimer
''The planners and presenters of this educational activity disclose that this presentation contains no conflict of interest."
Acknowledgements
Gayle Thronson, RN, MEd
Health Services Program Supervisor
WA Superintendent of Public Instruction
Kathleen O”Neill Sande
Institutional Education Program Supervisor

3. Nurse Case Management & Student Learning
Examine links between healthy students and academic success
Explore nurse case management and its ability to impact barriers to learning
Describe the WA State Health Services Project model and anticipated outcomes

4. What do we know about the Kids?
Increasing numbers of students with
Asthma (10%)
Anaphylactic allergies (food allergies – 8-10%)
Diabetes (0.26% of persons under 20)
Each of these needs an emergency care/action plan and individualized healthcare plan
20% of our youth have diagnosable mental health conditions 4

6. Academic Achievement and Health Do Healthy Kids Really Learn Better?

7. Key Findings of the Report
Health and education are linked
Every health risk can affect academic success
Interventions can narrow disparities
Health interventions can improve learning and health
Research Review: School-based Health Interventions and Academic Achievement

8. Unlucky 13
Severe asthma %
Obesity
Cigarette smoking
Feeling unsafe at school
Drinking soda pop
Marijuana use
Insufficient exercise
Feeling depressed
Excess TV watching
Alcohol use
No breakfast
Insufficient sleep
Insufficient fruit/vegetables 74.7

9. Healthy Students Learn Better

10. Which are Most Important Health Risks Related to Academic Problems?
Strongest associations
(approaching double risk)
Smoking, severe asthma, marijuana, no breakfast, depression
Moderate associations
(about 50% greater risk)
Obesity, soda pop, insufficient exercise, TV, alcohol, feeling unsafe at school
Weakest associations
(10-20% risk increase)
Insufficient fruit & vegetables, not enough sleep

11. Every Health Risk Makes a Difference

12. Healthier Kids Get Better Grades
Health and Education are linked
Every health risk can affect academic success
Interventions can narrow disparities
Health interventions can improve learning and health
Comprehensive programs are better
Findings included:
Health and education are linked. For students in middle and high school, health risks and academic risks affect each other. The report examines 13 key physical and mental health risk factors and analyzes the relationship between these health factors and the grades students report getting in school.
Every health risk can affect academic success. The more health risks students have, the less likely they will succeed in school or graduate on time. Each health risk that can be removed has the potential to positively influence academic behaviors.
Interventions can narrow disparities. In addition to facing academic challenges, Washington’s low-income students and students of color frequently have more health risks. Disparities in health may compound already existing disparities in academic achievement.
Health interventions can improve learning and health. The report highlights 11 evidence-based interventions for health and achievement, including such programs as handwashing, parent/teacher communication skills, and school breakfast programs.
Comprehensive programs are better. They address three key areas: 1) policies, procedures, and environments; 2) curriculum, instruction, and training; and 3) health services. Comprehensive programs that address these three areas are consistent with the Coordinated School Health approach developed by the Centers for Disease Control and Prevention.
Learn more at

13. Healthy Students Make Better Learners
Students need to:
be in school
be in class
have the social and emotional skills to engage in learning
and be ready to learn

14. Barriers to Achieving Educational Outcomes
Student not there (absent)
acute illness, infectious disease
chronic illness
parent fear of health problem in school
lack of family resources

15. Barriers
Student there, but not in class
in nurse’s office, sick
in principal’s office, misbehaving
in detention
in bathroom
hiding behind the gym

16. Barriers
Student there, but lacks social and emotional skills to engage in learning
hygiene issues
class avoidance
emotionally drained
attention-seeking behavior
inappropriate coping techniques

17. What Does a School Nurse Do?

18. Nurses Help Overcome Barriers
Identify and
Manage health issues so…
KIDS CAN BE IN SCHOOL

19. Nurses Help Overcome Barriers
Develop plans so that kids can safely participate in all school activities
KIDS REMAIN IN CLASS

20. Nurses Help Overcome Barriers
Screen for health problems and intervene so that: KIDS ARE READY TO LEARN

21. Title 1 Part D Health Services Project
Students with special health care needs are at a greater risk for academic failure
Opportunity to demonstrate impact of nursing case management on academic achievement

22. What is Title I, Part D?
Also called: Prevention and Intervention Programs for Children and Youth who are Neglected, Delinquent or At-Risk (N or D),
Provides financial assistance to
educational programs for youth in State-operated institutions or community day programs
local school districts' programs involving collaboration with locally-operated correctional facilities.

23. Goals of Title I, Part D The goals of Title I, Part D, are to:
improve educational services for children and youth who are N or D so they have the opportunity to meet challenging State academic content and achievement standards;
provide them with services to successfully transition from institutions to further schooling and/or employment; and
prevent at-risk youth from dropping out of school, and provide dropouts and children and youth returning from correctional facilities with a support system to ensure their continued education.

24. Washington State PROJECTS
Academic Support Services inside facility schools
Education Advocates in middle and high schools
Transition/Intervention Wrap-around Services in alternative schools
Health Services in Elementary & Middle schools
Kathleen Sande Institutional Education Program Supervisor
WA State Office of Superintendent of Public Instruction
Olympia, WA

25. PROVIDING ONE-ON-ONE SERVICES
Assisting Youth to:
Overcome barriers
Return to/stay in school
Improve attendance
Improve school coordination
Re-engage youth in schools
Parent engagement in schools
Locate viable employment

26. Providing Nurse Case Management Services to:
Address services to youth with complex or serious health conditions
Promote overall school health and safe school practices around health issues
Improve relationships with parents of youth with unmet health needs

27. Health Services for Elementary & Middle School Students
Targets:
Increase academic improvement
Increase engagement with education by addressing health concerns
Increase nursing time in rural areas
Address intensity and complexity of student needs

28. Case Management
….a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health care needs through communication and available resources to promote quality cost effective outcomes. (Case Management Society of America)

29. Title 1 Part D Health Services Project
Data driven student selection
Holistic assessment
Identify strengths and barriers
Prioritize interventions
Ongoing evaluation and modification of health plan

30. Criteria
Life-threatening conditions and chronic diseases
Attendance
Unmet health care needs
Absenteeism with accompanying health care needs

31. 9 elementary and 10 middle schools 12 nurses
Implementation
3 ESDs
11 districts
9 elementary and 10 middle schools
12 nurses
About 125 of students served to date

32. Anticipated Outcomes
Improved self-management of health conditions
Increased utilization of health care and educational resources
Decreased absenteeism
Increased math and reading scores

33. Other Benefits
Increased nursing skills set and broadened scope of practice
Better communication
Increased school awareness of the need to address student health
Increased parent participation

34. MAP Score Reading MAP Score Math MSP Reading MSP Math
Evaluation Plan
MAP Score Reading
MAP Score Math
MSP Reading
MSP Math
3 Year Attendance

35. Relationship of Absence & State Assessment Scores
Question #1: Of the students participating in the Nursing Education Support Program, do the state Reading and Math Scores differ significantly at the end of the year for those missing 17 or fewer compared to those missing 18 or more days?
Table: Independent T-Test* t df
Sig.
(2-tailed)
State Assessment
Absences N
Mean SD
SEM
Math
17 or Less 29
379
38.15
7.08
2.129 58
.037
18 or More 31
359
31.59
5.67
Reading
386
24.05
4.47
1.286
.204
378
23.25
4.18
* Equal variances were assumed

36. Program Participants School Day Absences (2009-2011)
Question #2: Did students participating in the program experience fewer days absent when looking at them across Baseline, Program Start, and Current Years?
Table: Paired Samples Statistics
Program Stage
Pairs
School Year
Mean N SD
SEM t df
Sig. (2-tailed)
Baseline
Pair 1
16.44 39
12.24
1.96
2.708 84
0.008
22.23
19.65
3.15
Program Start
Pair 2
21.37 85
16.52
1.79
-2.223 38
0.032
16.47
13.75
1.49
Current Year
Pair 3
16.03 37
11.69
1.92
2.229 36
11.26
12.85
2.11

37. MAP Math & Reading Scores (Pre to Post)
Question 3: During the initial Program Year were there statistically significant pre and post math and reading gains made by students in the program as measured by the Northwest Evaluation Association(NWEA) Measure of Academic Progress (MAP) assessment?
MAP Testing Paired T Samples Statistics
MAP Testing
Mean N SD
SEM t df
Sig.
(2-tailed)
Reading
Pre Test
206 49
19.69
2.81
Post Test
19.87
2.84
-0.012 48
0.991
Math
Pre-Test
214 50
22.35
3.16
Post-Test
216
21.68
3.07
-1.079
0.286

38. Current Year (2011-2012) MAP Math & Reading Scores (Pre to Post)
Question 4: During the Current Year, do students exhibit statistically significant pre and post math and reading gains as measured by the Northwest Evaluation Association(NWEA) Measure of Academic Progress (MAP) assessment?
MAP Testing Paired T Samples Statistics
 MAP Testing
Mean N SD
SEM t df
Sig.
(2-tailed)
Reading
Pre Test
197 65
25.35
3.14
Post Test
203
22.60
2.80
-3.995 64
.001
Math
206 68
27.93
3.39
212
27.09
3.29
-4.515 67

39. Limitations Small number of participants Short time period
No control or comparison group
No identification or measurement of other interventions
Difficulty replicating without dedicated funding

40. Conclusions Academic success is impacted by student health
Nursing Case Management is a nontraditional and promising use of Title 1 D funding
More information and further study needed to understand the full impact a school nurse case manager can make.

41. Further Study Larger sample of students
Consider variables like time of year, type of health concern, or demographics
Explore type and frequency of nursing interventions
Identify a comparison group

42. Implications for School Health
Many students are well served by traditional school nursing services
Some students need more intensive nursing interventions
Case management is a model to provide more intensive nursing supports
Given the opportunity, nurses can make a positive difference in student academic achievement

43. Implications for School Health
States can choose to use Title 1 Part D funding to support nurse case management
Individual students benefit both academically and in terms of health status
Increased nurse job satisfaction/decreased risk of professional burnout

44. References – Links:
Dilley, J. (2009) Research Review: School-based Health Interventions and Academic Achievement. Retrieved from
Bonaiuto, M. M. (2007). School nurse case management: Achieving health and educational outcomes. The Journal Of School Nursing, 23(4), doi: /
Engelke, M., Guttu, M., Warren, M. B., & Swanson, M. (2008). School nurse case management for children with chronic illness: Health, academic, and quality of life outcomes. The Journal Of School Nursing, 24(4), doi: /
Engelke, M., Guttu, M., & Warren, M. B. (2009). Defining, delivering, and documenting the outcomes of case management by school nurses. The Journal Of School Nursing, 25(6), doi: /
Office of the Superintendent of Public Instruction Health Services:
Office of the Superintendent of Public Instruction Institutional Education
Educational Service District 113, School Nurse Corps
Educational Service District 123 School Health Services

45. Contact Information
Lynn Nelson, RN, MSN, NCSN
Program Administrator, Health & Student Support
Educational Service District 113
Tumwater, WA
Phone: (360)
Leslie Stahlnecker, RN, MS School Health Services Administrator Educational Service District 123 Pasco, WA Phone: (509)