Provisions included in House Joint Resolution (HJR) 43 of the 2002 General Assembly Session, as introduced, directed the Joint Commission on Health Care (JCHC) to study emergency medical and mental health services in public schools. Although HJR 43 was passed by indefinitely during the 2002 Session, a member of the Joint Commission agreed to include the study in the Commission's 2002 Workplan.

There are several relevant sections of the Code of Virginia that address the provision of emergency medical and mental health services in the public schools. These provisions include requirements under the following categories: standard support services; student health services; school nurse incentive grants program and fund; school health advisory boards; and school safety audits and school crisis and emergency management plans.

The delivery of emergency medical and mental health services is specific to an individual school and would be in accordance with the school's required written crisis and emergency management plan. Local school divisions oversee individual schools and provide guidance on policies and procedures governing emergency and crisis situations. Additional guidance is provided by the Department of Education (DOE) and the Department of Health (VDH). DOE and VDH provide resources to guide public schools in their implementation of crisis and emergency management plans and their delivery of emergency medical and mental health services. Additionally, both DOE and VDH provide training opportunities and staff support in the area of school health services.

There are a number of data collection efforts at VDH and DOE, but these efforts are unable to provide a comprehensive review of the delivery of emergency medical and mental health services. There are several areas in which data collection efforts could be expanded to obtain the needed information. The agencies (DOE, VDH, and the Department of Criminal Justice Services) involved in these efforts could work together to examine existing efforts, determine the additional information that should be collected, and how best to collect the information without duplicating current efforts.

With regard to staffing of nursing and mental health professionals, Virginia has a recommended guideline of one school nurse per 1000 students, but has no recommended guideline for psychologists. Representatives of the Virginia Association of School Nurses and the Virginia Academy of School Psychologists indicated their interest in per-pupil ratio guidelines. Their national counterparts recommend the following ratios:

• one school nurse per 750 students and
• one school psychologist per 1000 students.

JCHC staff examined current staffing ratios for school nurses and psychologists in the localities, but the staffing information collected by DOE was incomplete for the purposes of this study. Using the available data, JCHC staff estimated that there is a need for additional nurses and psychologists for the state to meet the suggested guidelines. DOE staff provided cost estimates associated with reaching the suggested ratios using a ratio methodology and netting out current funding for those positions. The estimated state funding would be $32.9 million and the local funding would be $27.0 million.

JCHC staff surveyed Kentucky, Maryland, North Carolina, South Carolina, West Virginia, and the District of Columbia regarding their per-pupil ratios for school nurses and psychologists. There is no required per-pupil ratio for either school nurses or psychologists for most of the surveyed states or for the District of Columbia.

Actions Taken by JCHC

Three policy options were offered for consideration regarding the provision of emergency medical and mental health services in public schools. Option IV was added at the December meeting of the Joint Commission. These policy options are listed on pages 33-34. A summary of public comments received regarding the proposed options are included in Appendix B.

JCHC took the following action with regard to the study Options:

• JCHC voted to accept Option IV, to include further study and analysis of issues related to emergency medical and mental health services in the public schools in the Joint Commission's 2003 workplan. This will include working with the Department of Education, the Department of Health, and the Virginia Center for School Safety to examine their data collection practices to improve and potentially consolidate them in an effort to provide comprehensive information on school health services.