SD29 - Findings and Recommendations of the Blue Ribbon Commission on School Health


Executive Summary:
INTRODUCTION

This study was conducted during 1995 in response to Senate Joint Resolution No. 155 Requesting the Governor to establish a Blue Ribbon Commission on School Health to collaborate in developing, implementing, and evaluating school health programs (1994). This request was initiated by Senator L. Louise Lucas, responding to the need to protect the health and well-being of all children and ensure that each has the opportunity to grow and develop to his or her potential. The Commission was appointed in July 1994 and had a summit meeting in December 1994. It was at this summit meeting that the recommendations to the General Assembly were completed and ratified. Refer to Appendix A for Senate Joint Resolution No. 155.

The Blue Ribbon Commission on School Health recommended that school health programs in Virginia be studied in depth during 1995. The Commission prepared a workplan that outlined the course of action for this study, and that workplan is contained in Senate Document No. 48, "Developing, Implementing and Evaluating School Health Programs" (1995). For the purpose of this study a school health program is composed of the following nine components: (1) health education, (2) health services, (3) healthful school environment, (4) parent/community involvement, (5) counseling, (6) psychological and social services, (7) nutrition services, (8) physical education, and (9) health promotion for staff.

OBJECTIVES OF THE STUDY

• Identify existing state school health programs

• Analyze existing state school health programs

• Evaluate the performance of school health programs

• Identify and address issues of specific groups of stakeholders

• Formulate the needs of stakeholders

SOURCES OF INFORMATION

• Survey of personnel from selected state and nonprofit agencies

• Existing school health statues and regulations

• Position and policy statements about school health adopted by the Virginia Congress of Parents and Teachers

• Information from the Virginia Department for Rights of Virginians with Disabilities about school health issues from the perspective of parents of children with disabilities

• Survey of selected elementary, middle, and secondary schools

• Information from 1994 school health advisory board reports

• Five public hearings

MAJOR ISSUES AND FINDINGS OF STUDY

• The primary objective of state school health programs is to support instruction and to help students become successful learners and achieve high academic standards.

• There are limited data available on the total cost of each component of a school health program.

• All school divisions offer some portion of a school health program. Furthermore, the school survey revealed little difference in the success of school health programs in schools throughout the Commonwealth.

• School health advisory boards can serve as excellent vehicles for involving parents and the community in the improvement of school health programs; however, there is inconsistent utilization of school health advisory boards in the Commonwealth.

• Concerns exist regarding the management of children with special health care needs in the school setting. These concerns include the qualifications of personnel responsible for specialized health care procedures including administration of medications, liability of schools and individuals, and local policies that create barriers to self-care of children.

• Concerns exist regarding improving physical education, grades K-12.

• Although funding of school health services was identified as a concern at all public hearings, a comprehensive analysis of alternative funding sources was beyond the scope of this study.

Commission members were urged to review the recommendations of Senate Document No.5, "Report on the Needs of Medically Fragile Students" (1995) and were advised that many issues and concerns raised by stakeholders can be addressed effectively by implementing the recommendations contained therein.

RECOMMENDATIONS

• School superintendents should recognize the importance of school health advisory boards as a means of parent and community involvement and of assisting with the development of school health policies and the evaluation of school health programs.

• The Department of Education, in collaboration with the Department of Health, should provide periodic training and technical assistance to school health advisory board members and school health administrators to assist them in strengthening the boards' effectiveness in localities.

• Recommendations 1-6 and 8 of Senate Document No.5, "Report on the Needs of Medically Fragile Students" (1995), should be implemented:

* School divisions should develop a "health service plan" for each student who is a medically fragile child as defined by Senate Document No.5 (1995).

* Local school divisions should develop policies that address the provision of services to students who are medically fragile, including staff selection and training and roles and responsibilities.

* Local school divisions should develop policies to address the emergency medical needs of students, including those who are medically fragile.

* The local school health advisory board, required by § 22.1-275.1 of the Code of Virginia, should take an active role in assisting school divisions in developing policies related to children who are medically fragile.

* School divisions should provide periodic in-service or opportunities for school staff to attend programs to increase staff awareness and understanding of the general health issues faced by schools and the needs of students who are medically fragile.

* For risk management purposes, school divisions should document school health services provided to all students, including those who are medically fragile.

* School divisions should review and evaluate their policies and procedures relative to Section 504 of the Rehabilitation Act of 1973.

• Students with special health care needs and chronic illnesses should have their medical care managed at school by a professional nurse in collaboration with the child's parents and primary health care provider.

• The Virginia Board of Nursing's efforts to address delegation of nursing services in the school setting to unlicensed assistive personnel while ensuring that the professional nurse retains authority for nursing assessment, nursing evaluation, and nursing judgment should be supported.

• The Department of Health, in collaboration with the Department of Education, should distribute guidelines to assist qualified personnel in the assessment and ongoing management of students with specialized health care needs in the school setting. Such guidelines should be sent to all public and private schools in the Commonwealth.

• School divisions should require that specialized health care procedures be provided by licensed health care professionals or by personnel who have received training from persons qualified to provide such training and are certified or licensed to perform the procedure being taught.

• School divisions are encouraged to devote a portion of their professional development resources to assist staff in developing skills and strategies for working with parents and increasing parental involvement in the planning and implementation of school health programs.

• School divisions are encouraged to review physical education, grades K-12, and determine ways by which the program could be improved.

• The Department of Medical Assistance Services' studies on Virginia managed care Medicaid programs -- MEDALLION II and OPTIONS -- should include the impact of these programs on school health services.

• The Department of Medical Assistance Services should study the appropriateness and feasibility of contracting for school health services, including school nursing services, especially in medically underserved areas or health manpower shortage areas.

• School divisions, especially those in medically underserved areas, are encouraged to develop public-private contracts (e.g., HMO -- Health Maintenance Organization, CHIP -- Comprehensive Health investment Project of Virginia) which include formal reimbursement for school health services (e.g., school nursing services) provided by qualified personnel.