children’s/aisd student health services©2015 seton 1 children’s/aisd student health services...
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©2015 Seton 1
Children’s/AISD
Student Health Services
School Health Advisory Council
April 6, 2016
Director
Sally Freeman, MSN, RN, NCSN
Medical Director
Stephen Pont, MD, MPH, FAAP
Quality Improvement Consultant
Susan Millea, PhD
©2015 Seton 2
How Did AISD Partnership Begin?
• In 1995, AISD considered eliminating school nurses due to economic challenges
• Hospital system & community voiced concerns regarding increased ED visits & associated costs
• Innovative model in which non-profit hospital system contracts with school district to provide student health services began
©2015 Seton 3
AISD Student Health Services
• Seton Healthcare Family contracts with Austin ISD for the provision of student health services.
• Staff include medical director, nursing director, clinical managers, school nurses, & school health assistants.
• Each campus has a Registered Nurse who functions as the leader and coordinator of the student health services team.
• Additional support provided by nurse managers, nursing director & medical director to promote health, wellness, & safety.
©2015 Seton 4
Student Health Services
Organizational Chart
Department Assistant
Carley McCaw
Medical Director
Dr. Stephen Pont
Clinical Manager
Anne Cady
Clinical Manager
Jenifer Hernandez
21 Registered Nurses
21 School Health Assistants
Nurse Educator
Detra Gentry
Assistant Director,
Comprehensive Health
Tracy Spinner, M. Ed
Director
Sally Freeman
Clinical Manager
Laura Cotton
21 Registered Nurses
21 School Health Assistants
21 Registered Nurses
21 School Health Assistants
©2015 Seton 5
Acuity Methodology • Annual analysis to determine number of Registered Nurse & School health
Assistant hours each campus will receive
• Schools have option to use local funds to increase Student Health Services hours at their campus
• Criteria for acuity methodology:
– 30% School enrollment,
– 10% Economically Disadvantaged
– 30% Number of students with medical procedures, complex medical conditions
– 15% Special needs classrooms (PPCD, Pre-K, SBS, PRS)
– 10% Illness, injury encounters from previous year
– 5% Medication administration
©2015 Seton 6
Multiyear Direct Health Contact Rate
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
5.00
5.50
6.00
6.50
7.00
SY 2009-10 SY 2010-11 SY 2011-12 SY 2012-13 SY 2013-14 SY 2014-15
Multiyear Direct Health Contact Rate per Student Total Contacts SY 2014-15: 519,603
Total Enrollment SY 2014-15: 84,591 (Screenings, Immunization, Teaching, Ill/Injured Contacts,
Medication, Case Management)
©2015 Seton 7
Return to Class Rate
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Comparison of Cumulative Outcomes for Students Seen for Illness or Injury
% Return to Class % Dismissed According to Protocol
% Dismissed Against Protocol % Other, NOT Dismissed by SHS
©2015 Seton 8
Return to Class Rate
0.0%
5.0%
10.0%
15.0%
20.0%
2010-11 2011-12 2012-13 2013-14 2014-15
Proportion of All Dismissals Which were Against Student Health Services Protocol
SY 2014-15 Count of Dismissals Against Protocol: 3526
©2015 Seton 10
Prevention: Immunization
0%
20%
40%
60%
80%
100%
Percent of Campuses Achieving 95% Immunization Compliance
(Based on December DSHS Immunization Report)
Dat
a U
nav
aila
ble
©2015 Seton 11
Reportable Communicable Diseases
0
10
20
30
40
50
60
70
80
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Trend of Vaccine Preventable Communicable Diseases
Varicella (Chickenpox) Pertussis
©2015 Seton 12
Childhood Obesity: Cardiovascular
Middle School
SY 2007-08
Cardiovascular
42% HEALTH RISK
Source:
AISD Fitness tracking
©2015 Seton 13
Middle School
SY 2009-10
Cardiovascular
32% HEALTH RISK
Source:
AISD Fitness tracking
Childhood Obesity: Cardiovascular
©2015 Seton 14
Middle School
SY 2013-14
Cardiovascular*
29% HEALTH RISK
SY 2014-15
33% HEALTH RISK
*metric changed from
SY 2009-10
Source:
AISD Fitness tracking
Childhood Obesity: Cardiovascular
©2015 Seton 15
Childhood Obesity: Body Mass Index (BMI)
Middle School
SY 2007-08
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
©2015 Seton 16
Middle School
SY 2009-10
BMI
18% Overweight
15% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
Childhood Obesity: Body Mass Index (BMI)
©2015 Seton 17
Middle School
SY 2014-15
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
Source:
AISD Fitnesstracking
Middle School
SY 2007-08
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Middle School
SY 2013-14
BMI
17% Overweight
15% Obese
4% Severely Obese
36% HEALTH RISK
Source:
AISD Fitnesstracking
Childhood Obesity: Body Mass Index (BMI)
©2015 Seton 19
Breathing Difficulty:
School Outcomes
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Return to Class Rate Following Breathing Difficulty for Students With/Without Care Plan
Asthma Diagnosis with Care Plan No Diagnosis/No Care Plan
©2015 Seton 20
Breathing Difficulty:
Health Outcomes
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
MedicalReferral
EMS Contact EMS Transport
Multiyear Health Outcomes Following Breathing Difficulty for Students with Asthma Diagnosis
and Care Plan
2010-11 2011-12 2012-13
2013-14 2014-15
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
MedicalReferral
EMS Contact EMS Transport
Multiyear Health Outcomes Following Breathing Difficulty for
Students with No Asthma Diagnosis/Care Plan
2010-11 2011-12 2012-13
2013-14 2014-15
©2015 Seton 21
Diabetes Case Management
130
0
50
100
150
200
Multiyear Trend of Diabetic Health Contacts per Diagnosed
Student Receiving Case Management
(SY 2014-15, 130 Diabetic Students)
16887
0
4000
8000
12000
16000
20000
Multiyear Trend of Total Diabetic Health Contacts
(SY 2014-15 N=133 Diabetic Students)
©2015 Seton 22
Student Pregnancy Rate
40.6
44.8
37.4
32.1
21.6 24.4
0.0
10.0
20.0
30.0
40.0
50.0
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
AISD Student Pregnancy Rate per 1000 Females Enrolled Grades 9-12
©2015 Seton 23
Middle School Pregnancy Count
0
5
10
15
20
25
30
35
40
45
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Trend of Middle School Pregnancies (Grades 6-8)
©2015 Seton 24
Student Pregnancies by Trimester
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Trend of Student Pregnancies by Trimester at Identification
% 1st Trimester %2nd Trimester % 3rd Trimester Post Partum
©2015 Seton 26
Health Incident Rate
• Lorem ipsum dolor sit amet, consectetur adipiscing elit.
– Ut lorem mauris, tempus sed ante non, euismod euismod nunc.
• In faucibus mattis commodo. Quisque porta magna a purus posuere, pretium finibus augue dignissim.
An incident is typically an illness or injury that does or
potentially could involve emergency response measures. Examples:
• Asthma attack that does not respond to the care plan
• Playground fall resulting in a bone fracture
• EMS is contacted whenever medications such as diazepam or epinephrine are administered
0.0
0.5
1.0
1.5
2.0
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Multiyear Trend of Health Incidents
per 100 Students Enrolled Count of Incidents SY 2014-15: 1272,
Student Incidents: 1217
All Incident Reports
Student Incident Reports
©2015 Seton 27
Health Incidents: Illness v. Injury
0
100
200
300
400
500
600
Illness Injury Illness Injury Illness Injury
All Elementary Schools All Middle Schools (Gr. 6-8) All High Schools
Multiyear Comparison of Illness and Injury Incidents, Count by Academic Level
2010-11 2011-12 *2012-13 2013-14 2014-15
©2015 Seton 28
Behavioral Health Incidents
5
55
105
155
205
255
305
355
AggressionInjuries
Substance Abuse AggressionInjuries
Substance Abuse AggressionInjuries
Substance Abuse
All Elementary Schools All Middle Schools(Grades 6-8)
All High Schools
Multiyear Count of Behavioral Health Incidents by Academic Level and Type
2010-11 2011-12 *2012-13 2013-14 2014-15
©2015 Seton 29
% Health Incidents with Aggression
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
All Elementary Schools All Middle Schools(*Grades 6-8)
All High Schools TOTAL
Multiyear Comparison of Injury Incidents Involving Aggression, as a Percent of all Injury Incidents, by Academic Level
(SY 2014-15, Injuries=981, Aggression Injuries=465)
2008-09 2009-10 2010-11 2011-12 *2012-13 2013-14 2014-15
©2015 Seton 30
Children’s Health Express
Calendar Year 2015
1,121 Health Encounters
70% Uninsured
30% Medicaid
Pregnant/Parenting
Students
Crockett
Travis
Lanier
Reagan
Eastside Memorial
©2015 Seton 32
Principal Satisfaction
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Communicationis complete,appropriate,
timely
Works well withschool staff
Treats students,staff, parentsrespectfully
Promotes ahealthy and safe
lifestyle
Health room iswell organized
Same staffperson is
requested fornext year
Multiyear Comparison of Principal Satisfaction with RNs (Percent of Maximum Value Using 5 Point Likert Scale)
SY 2014-15 N=41
SY 2010-11 SY 2011-12 SY 2012-13 SY 2013-14 2014-15
©2015 Seton 33
AISD Staff Satisfaction with Health Team
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
School RNcommunicates
well
SHAcommunicates
well
RN providestraining
RN treats staffwith dignity and
respect
SHA treats staffwith dignity and
respect
I can depend onmy RN
I can depend onmy SHA
Multiyear Comparison of AISD Staff Satisfaction with Health Staff (Percent of Max Value Using 5 Point Likert Scale, SY 2014-15 N=58)
SY 2010-11 SY 2011-12 SY 2012-13 SY 2013-14 2014-15
©2015 Seton 34
AISD Staff Satisfaction with Training
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Content Relevant Teaching MethodsEffective
Adequate time spent oneach topic
Learning Center formatwas effective
Multiyear Comparison of AISD Staff Satisfaction with Quick Care Training
(Percent of Max Value Using 3 Point Likert Scale, SY 2014-15 N=58)
SY 2009-10 SY 2010-11 SY 2011-12 SY 2012-13 SY 2013-14
©2015 Seton 35
2014-2015 Successes – 12 Campus Based Counseling Referral Centers
– Sports physicals to 800+ students
– Kid Vision for Life Van
– Epi-pens in Schools Program
– Hospital based school at Dell Children’s
– Educational offering on Trauma Informed Care
– Ebola protocols & training
– Facilitate continuum of care for students with asthma, behavioral health and other chronic health issues
– Gift of HealthTeacher
– 15 Nationally Certified School Nurses
– Sally Freeman presented overview of AISD Health Services to Healthy Schools Campaign in Chicago, IL and annual National Association of School Nurses meeting
– Dr. Pont appointed inaugural faculty in the Pediatric Department of UT Austin/Dell Medical School
©2015 Seton 36
Value Add Benefits • Consultation & guidance during communicable disease outbreak
such as H1N1
• EpiPens in Schools program
• Ongoing education & support to RNs & SHAs by pediatric medical experts affiliated with Dell Children’s Medical Center
• Provide office space at Dell Children’s Medical Center for leadership team
• Human resources support including hiring, licensure verification
• Immediate access to subspecialist consultation at Dell Children’s Medical Center
• Annual AISD sports physicals for underserved athletes