children’s/aisd student health services©2015 seton 1 children’s/aisd student health services...

©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





©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 9

Prevention

©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:



©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:



©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:



©2015 Seton 17

Middle School

SY 2014-15

BMI

17% Overweight

16% Obese

5% Severely Obese

38% HEALTH RISK

Source:


Source:


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:



©2015 Seton 18

Health Case Management

©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 25

Health Incidents

©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

©2015 Seton 37

Next Steps

• Telemedicine

• Medicaid Delivery System Reform Incentive Payment (DSRIP)

• Campus Based Counseling Referral Centers (CBCRCs)

• Healthy Schools Flu Campaign Expansion to all AISD ES, MS

• Community Asthma Initiative

Questions?

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