Coordination of Care Coordination of Care Vision and Hearing Referral Vision and Hearing Referral

DPAS 2 Component 5 Growth GoalsDPAS 2 Component 5 Growth Goals

Indicator 3 and 4Indicator 3 and 4

Susan Hoffmann MSN, RN, NCSNSusan Hoffmann MSN, RN, NCSN

School nurses provide quality health School nurses provide quality health care and intervene with actual and care and intervene with actual and

potential health problemspotential health problems

School nursing interventions School nursing interventions impact the student’s health & impact the student’s health & well-beingwell-being

• Optimal student health Optimal student health

impacts the student’s ability to impacts the student’s ability to learnlearn

• Hearing and vision are critical to Hearing and vision are critical to academic successacademic success

The school nurse coordinates The school nurse coordinates care delivery…care delivery…

Students referred Students referred from vision or from vision or hearing hearing screeningscreening

Will be seen by a Will be seen by a healthcare healthcare providerprovider

Why would a school nurse Why would a school nurse would want to choose this would want to choose this indicator?indicator?2.0 Regulation2.0 Regulation:

Vision and Hearing Screening

2.1.1 Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year.

2.1.1.1 In addition to the screening requirements in 2.1.1, screening shall also

be provided to new enterers, students referred by a teacher or an administrator, and students considered for special education.

2.1.1.1.1 Driver education students shall have a vision screening within a year prior to their in car driving hours.

2.1.2 The school nurse shall record the results on the Delaware School Health Record Form and shall notify the parent, guardian or Relative Caregiver or

the student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC 11434a) if the student has a suspected problem.

Which students should have a Which students should have a vision screening?vision screening?

• Grades kindergarten, grades 2, 4, 7 and Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each hearing screening by January 15th of each school year. school year.

• New enterersNew enterers• Those being considered for special educationThose being considered for special education• Teacher referralsTeacher referrals• Driver education students shall have a vision Driver education students shall have a vision

screening within a year prior to their in car screening within a year prior to their in car driving hours. driving hours.

Mandated hearing Mandated hearing screeningsscreenings• Grades kindergarten, Grades kindergarten, grades 2, 4, 7

and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year.

• New enterersNew enterers• Those being considered for special Those being considered for special

educationeducation• Teacher referralsTeacher referrals

What type of tests should be What type of tests should be used?used?

• First time screeningFirst time screening

• Routine screeningsRoutine screenings

• Referral criteriaReferral criteria

How to choose a cohort:How to choose a cohort:

• Include the entire school and should Include the entire school and should not be broken into smaller cohorts not be broken into smaller cohorts

• Screening Completion Rate from Screening Completion Rate from previous year compared to current previous year compared to current yearyear

• There must be a minimum of 10 There must be a minimum of 10 students referred in the previous year students referred in the previous year

How to get a baselineHow to get a baseline

• Cognos Report Cognos Report

Standard DOE Public Reports > Standard DOE Public Reports > Medical Reports > Annual Reports > Medical Reports > Annual Reports > Incomplete Referrals CurrentIncomplete Referrals Current

• Consider using percentage of a Consider using percentage of a comparable cohort of schoolscomparable cohort of schools

Calculate the baselineCalculate the baseline

• Determine the Vision Screening Determine the Vision Screening Referral Completion Referral Completion

• Divide the Number of Completions Divide the Number of Completions by the Number of Referrals to by the Number of Referrals to determine the percentage of determine the percentage of Completions. Completions.

Do the math…..Do the math…..

# of Completions# of Completions = percentage = percentage completecomplete

Total # referredTotal # referred

Example:Example:

25 complete 25 complete = .50 (50%)= .50 (50%)

50 referred 50 referred

How to calculate the growth How to calculate the growth

FY12 State FY12 State Hearing Hearing Screening Referral Completion Screening Referral Completion RatesRates

                              STATEWIDE:               53%STATEWIDE:               53%                              GRADES PreK – 2:     53%GRADES PreK – 2:     53%                              GRADES 3 – 5:             38%GRADES 3 – 5:             38%                              GRADES 6 – 8:             21%GRADES 6 – 8:             21%                              GRADES 9 – 12:          46%GRADES 9 – 12:          46%  FY12 State FY12 State VisionVision Screening Referral Completion Screening Referral Completion

RatesRates                              STATEWIDE:               38%STATEWIDE:               38%                              GRADES PreK – 2:     42%GRADES PreK – 2:     42%                              GRADES 3 – 5:             34%GRADES 3 – 5:             34%                              GRADES 6 – 8:             29%GRADES 6 – 8:             29%                              GRADES 9 – 12:          44%GRADES 9 – 12:          44%

Target goal –Close the gapTarget goal –Close the gap

Between baseline percentages by 50% Between baseline percentages by 50%

or other agreed upon %or other agreed upon %

Set the growth measureSet the growth measure

If previous year’s percentage is If previous year’s percentage is less less thanthan the state or district the state or district completion percentagecompletion percentage

Set a goal to Set a goal to close the percentageclose the percentage difference by 50% difference by 50%

Or percentage agreed upon with Or percentage agreed upon with administratoradministrator

Setting the growth goal if:Setting the growth goal if:

Nurse is new school nursingNurse is new school nursing

Nurse is new to the schoolNurse is new to the school

OrOr if the school has changed student if the school has changed student configuration (by adding or subtracting grades configuration (by adding or subtracting grades or cohorts of students)or cohorts of students)

Targeted goal district or Targeted goal district or state percentage minus state percentage minus 5%. 5%.

Examples:Examples:Percentage at end of previous

school year

Percentage at end of current

school year (state or district)

Difference between

percentages (school – state/distri

ct)

Minimal growth (50% of the

difference if it was a negative

difference, i.e., the state/district was higher than the

school)

Targeted Goal (previous year’s percentage plus

the minimal growth)

School #1 40% 60% (state)

- 20% 10% 50%

School #2 75% 60% +15% 0 75%

School #3 50% 42% (district)

85% (state)

*-35%

17.5% 67.5%

School #4(new nurse)

No data (nurse

was not in a

school)

42% (district)

85% (state)

n/a n/a 42% - 5% = 38% **

A completed referral can be A completed referral can be documented if:documented if:

– A healthcare provider’s note is receivedA healthcare provider’s note is received– The student has new glassesThe student has new glasses– The healthcare provider’s office will The healthcare provider’s office will

verbally confirm a visitverbally confirm a visit– The parent/guardian confirms a visit The parent/guardian confirms a visit – A re-screening by the school nurse A re-screening by the school nurse

indicates there is no need for a referralindicates there is no need for a referral

A completed referral can NOT A completed referral can NOT be documented be documented

• based on the number of contacts the based on the number of contacts the nurse makesnurse makes

• For example, the nurse may have For example, the nurse may have made multiple interventions without made multiple interventions without success but this is not a completed success but this is not a completed referral. referral.

Strategies for ensuring Strategies for ensuring growthgrowth

Identify the root cause for non-Identify the root cause for non-completioncompletion

Review DocumentationReview Documentation• What codes to use (Is the coding correct?)What codes to use (Is the coding correct?)

• Document better in the futureDocument better in the future

• So you can use the data next yearSo you can use the data next year

• Were all REFERRAL Completions? Were all REFERRAL Completions?

• Check with the student to ascertain if the Check with the student to ascertain if the referral was completed but not reported to referral was completed but not reported to the school nurse. the school nurse.

• A doctor’s note is not required for the A doctor’s note is not required for the school nurse to document completion. school nurse to document completion.

Did the referral letter ever Did the referral letter ever make it home? make it home?

Send home with child along with other Send home with child along with other important papers, like the report card or a important papers, like the report card or a daily communication bookdaily communication book

Send letter via certified mailSend letter via certified mailSend the letter under that principal’s Send the letter under that principal’s

signaturesignatureConsult with the student’s teacher (Best way Consult with the student’s teacher (Best way

to communicate with the family?)to communicate with the family?)Print on brightly colored paperPrint on brightly colored paperCall before sending the letterCall before sending the letter

Strategies for successStrategies for successGet supportGet support• Communicate with parent/ guardian and staff on Communicate with parent/ guardian and staff on

the impact of diminished vision on student the impact of diminished vision on student performance and well-being (newsletters, global performance and well-being (newsletters, global calls…)calls…)

• Meet with parent/guardian and staffMeet with parent/guardian and staff– Schedule a parent/guardian conferenceSchedule a parent/guardian conference– Participate in Parent/Teacher Conference eventParticipate in Parent/Teacher Conference event

• Work with the IEP or student assistance teamWork with the IEP or student assistance team• Engage the studentEngage the student• Work with the student’s teacher(s), staff, Work with the student’s teacher(s), staff,

counselor, administration, and outside agenciescounselor, administration, and outside agencies• Social worker may be an asset with home visits or Social worker may be an asset with home visits or

connecting with the familyconnecting with the family

Address barriers to care Address barriers to care providersproviders

– Transportation may need to be provided Transportation may need to be provided – Financial needsFinancial needs– Available resources:Available resources:

VSP vouchers member benefit of VSP vouchers member benefit of DSNA/NASNDSNA/NASN

State vision programState vision program Medicaid/Delaware Healthy children’s Medicaid/Delaware Healthy children’s

programprogram Lion’s clubLion’s club

Some activities could actually Some activities could actually be the same for multiple be the same for multiple measures measures

Questions ????Questions ????

ResourcesResources• Selekman, J.School Nursing: A Comprehensive Selekman, J.School Nursing: A Comprehensive

Text. Philadelphia: F.A. Davis.Text. Philadelphia: F.A. Davis.• www.nasn.orgwww.nasn.org• http://http://nasn.org/ToolsResources/Visionnasn.org/ToolsResources/VisionDelaware technical assistance manualDelaware technical assistance manual• http://www.doe.k12.de.us/infosuites/schools/filhttp://www.doe.k12.de.us/infosuites/schools/fil

es/de_schoolnursemanual_b1.pdfes/de_schoolnursemanual_b1.pdfThe Role of the School Nurse (2011) The Role of the School Nurse (2011)

http://nasn.org/PolicyAdvocacy/PositionPapershttp://nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/87/Role-of-the-School-Nurseabid/462/ArticleId/87/Role-of-the-School-Nurse-Revised-2011-Revised-2011

• www.dsna.orgwww.dsna.org