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School Nurses Key in Managing Chronic Health Conditions

More children with chronic health conditions (CHC) are attending school, and some of them struggle academically because of issues related to their health.

School-based case management provided by a school nurse is the most effective way to improve the academic success of these children. The school nurse coordinates and conducts assessment, planning, and implementation of individualized health care plans for safe and effective management of students with health conditions during the school day.

Over the past few decades the number of students with CHC in schools has increased for a variety of reasons. Many students who had been confined to therapeutic settings are now being educated in the local school district in the least restrictive environment. Their right of participation is protected by federal law, including the
Rehabilitation Act, Section 504 and the Individuals with Disabilities Educational Act [IDEA] of 2004.

As survival rates associated with chronic conditions in infants and children continue to increase and life expectancy increases, the health care and educational service needs of students will increase. Many children with CHC now are able to attend school and succeed due to critical support services, including those provided by school nurses. The school nurse is a key member of the educational team and is the one who is responsible for planning, implementing, and monitoring the health care plans for students with CHC.

Below is a video chronicling four students with life threatening health conditions and their need for school health management:

This video was produced for presentation to the Washington State Senate Health and Long-Term Care Committee of the Washington State Legislature. Source: Heron Cove Productions

School nurses evaluate students, often identifying conditions

Health care needs of students with chronic health conditions are complex and continuous. School nurses assist many children not served by the health care system and work to create access to health care for students and families. Students who may not have been identified as having a chronic condition prior to school entry are identified by school nurses who then coordinate evaluation and intervention services.

School nurses assist students in learning to manage chronic illness, increasing seat time in the classroom, decreasing student absenteeism, resulting in cost savings to the school district and an increase in the overall academic success of the student.

Source: Chronic Health Conditions Managed by School Nurses, National Association of School Nurses

Kids Learn Better in Healthy School Environment

Primary and secondary schools are responsible for providing a healthy and safe learning environment for schoolchildren in Washington State.

A healthy school environment keeps children’s minds alert and bodies strong. Poorly maintained school buildings can cause illness or make symptoms worse for children, teachers, and staff. This results in absences, missed schoolwork, and lower test scores. Schools that promote healthy environments can improve health and productivity for students and adults.

Middle school students in class.
Middle school students in class.

Washington State’s School Environmental Health and Safety Program works with local health jurisdictions, school districts, the Office of the Superintendent of Public Instruction, private schools, agencies and non-profits to promote incorporation of environmental health and safety into school facility design, operation, and maintenance. The program also provides support for implementation of the State Board of Health School Rule, Chapter 246-366 WAC.

Technical areas include controlling asthma triggers, science lab, art, and shop safety, hazardous waste management, injury prevention, playground safety, indoor air quality, ventilation, emergency response, communicable and vector-borne disease control, animals in schools, integrated pest management, cleaning and disinfection for health and safety, general safety, noise control, and lighting.

School Environmental Health Program Activities

— Work with, and provide technical assistance on school environmental health and safety issues to local health jurisdictions and school staff – including custodians, nurses, administrators, and maintenance and operations and risk managers.

— Provide interpretation and technical support on the State Board of Health School Rule (WAC 246-366), the K12 Health and Safety Guide, and the School Indoor Air Quality Best Practices Manual.

— Promote best practices through presentations, statewide committee participation, and work with school associations and state, local, and federal agencies.

— Available for phone and on-site consultation on school environmental health and safety issues, including indoor air quality.

— Available for presentations and trainings.

— Participate in the Department of Health and Office of the Superintendent of Public Instruction Coordinated School Health Program funded by the CDC.

Healthy Indoor Air is Important

— Over 1 million Washington children spend about 1300 hours in a school building each year.

— One half of U.S. schools have indoor environmental quality problems (Source: EPA).

— Children in classrooms with higher outdoor air ventilation rates tend to have higher scores on standard math and reading tests than children in poorly ventilated classrooms (Source: EPA).

— Poor indoor air quality not only can trigger asthma episodes in susceptible children but also can cause drowsiness, fatigue, lethargy, headache, inability to concentrate, and eye, nose, throat, and skin irritation – all of which compromise learning. (Source: School Health Policies and Practices Study).

— Indoor concentrations of pollutants are commonly three to five times higher than outdoor concentrations due to chemicals found in some conventional cleaning products, improper cleaning procedures, defective or ineffective climate control (HVAC) systems, interior finishes, exterior pollutant, personal care products and renovation projects (Source: EPA).

See resources provided by the School Environmental Health Program

Source: Washington State Department of Health

Healthy Youth Need PREP

WA PREP Intervention Partners educate youth ages 11-18 on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections.


The 2014-2015 Intervention Partners received funding to implement evidenced based interventions (EBIs) in Washington State communities. This includes HIV/AIDS and three adulthood preparation subjects subjects (Healthy Relationships, Parent-Child Communication, and Healthy Life Skills). WA PREP staff have provided specialized technical assistance and training to all Intervention Partners to build their capacity to implement EBIs.

The Washington State Personal Responsibility Education Program (WA PREP) is in its fourth year!

Currently, WA PREP has trained dozens of facilitators in eight EBIs:

Washington State Department of Health (DOH)

On August 17, 2010, Governor Gregoire designated DOH as the lead agency to apply for and administer WA PREP. To implement this grant, the department has collaborated with Cardea, Office of Superintendent of Public Instruction and the Department of Social and Health Services.


Cardea’s role within PREP will include training local educators in one of the five evidenced-based interventions that the community has chosen. Cardea will also provide training in supplemental topics and ongoing technical assistance, as needed to ensure that local educators have the knowledge and skills needed to implement their communities chosen curriculum effectively.

Washington State Department of Social and Health Services (DSHS)

DSHS is an integrated organization providing a range of services including behavioral health care, financial assistance, food assistance, juvenile justice, child welfare, aging, and development disability services. Their mission is to improve the safety and health of individuals, families and communities by providing leadership and establishing and participating in partnerships. DSHS is a strong partner in WA PREP because they believe that all of the vulnerable youth served today can become healthy empowered adults.

Office of Superintendent of Public Instruction (OSPI)

OSPI‘s HIV and Sexual Health Education Program within the Teaching and Learning Division provides leadership, technical assistance, resources and support to schools by promoting best practices in HIV/STD/Unintended pregnancy prevention and comprehensive sexual health education. Collaborating to implement WA PREP aligns with the overall goal of the HIV and Sexual Health program to ensure that all students have the necessary knowledge and skills for a safe and healthy life now, and in the future.

Learn more at

Students with Food Allergies Need Emergency Care Plan

A school health plan will identify the types of responsibilities, training and services required to keep your child’s environment safe and how to respond to an emergency, should one arise.

As a parent sending your child off to school for the first time, it is normal to experience a myriad of emotions. Although this can be a time of great anticipation and excitement, all parents have the usual concerns: Will my child like his new school? Will he like his teacher? Will he get on the right school bus? Will the program be one that allows him to grow and learn in a positive environment?

Food Allergies

As a parent of a child with food allergies, you have yet another dimension added to the anticipation and worries of sending a child off to school.

In addition to all of the usual concerns, you will worry about his health needs and safety. What will he eat? How will he be able to participate safely in classroom and cafeteria activities? Will my child get sick at school? Will the school be able to respond promptly to an emergency? Does the school have a full time school nurse? Will the school arrange for my child to be given medicines or special asthma treatments during the school day?

Concerns such as these are legitimate and understandable. You will have to “let go” of your child for the first time, and entrust your child’s health to staff with whom you are unfamiliar. You will have to trust that the school staff will learn to manage your child’s allergies safely, and learn how to respond to any emergency.

How will you ensure that they do it?

The key is to work with the school cooperatively and proactively to create a comprehensive school health care plan. A school health care plan will identify the types of responsibilities, training and services required to keep your child’s environment safe and how to respond to an emergency, should one arise.

The three most common plans used for food allergic children are known as Emergency Care Plans (ECP), Individualized Healthcare Plans (IHCP) and 504 Plans. When registering your child for school, be sure to make an appointment to meet with the school nurse and complete your child’s care plan.

Source: Kids With Food Allergies web site; Written by Lynda Mitchell, MA

Washington school nurse shares her story…

Documentary Reveals Success of Trauma-Informed Approach

Three years ago, the story about how Lincoln High School in Walla Walla, WA, tried a new approach to school discipline and saw suspensions drop 85% struck a nerve.

It went viral – twice — with more than 700,000 page views. Paper Tigers, a documentary that filmmaker James Redford did about the school — premiered on May 28, 2015 to a sold-out crowd at the Seattle International Film Festival. Hundreds of communities around the country are clamoring for screenings.

Paper Tigers captures the pain, the danger, the beauty, and the hopes of struggling teens—and the teachers armed with new science and fresh approaches that are changing their lives for the better.

After four years of implementing the new approach, Lincoln’s results were even more astounding: suspensions dropped 90%, there were no expulsions, and kids’ grades, test scores and graduation rates surged.

But many educators aren’t convinced. They ask: Can the teachers and staff at Lincoln explain what they did differently? Did it really help the kids who had the most problems – the most adverse experiences? Or is what happened at Lincoln High just a fluke? Can it be replicated in other schools?


Last year, Dr. Dario Longhi, a sociology researcher with long experience in measuring the effects of resilience-building practices in communities, set about answering those questions.

The results? Yes. Yes. No. And yes.

In case you don’t know Lincoln High School’s story, here’s a quick summary: In 2010, Jim Sporleder, then-principal of Lincoln High School, learned about the CDC-Kaiser Adverse Childhood Experiences (ACE) Study and the neurobiology of toxic stress at a workshop in Spokane, WA. The ACE Study showed a link between 10 types of childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence. The Children’s Resilience Initiative (CRI) organized a group of 30 people from Walla Walla, including Sporleder, to attend the workshop in Spokane. CRI is a community organization in Walla Walla that creates awareness about childhood adversity and encourages all sectors of the community – business, faith-based, corrections, law enforcement, education, etc. — to integrate trauma-informed and resilience-building practices.

Here’s what Sporleder learned:

Severe and chronic trauma (such as living with an alcoholic parent, or watching in terror as your mom gets beat up) causes toxic stress in kids. Toxic stress damages kid’s brains. When trauma launches kids into flight, fight or fright mode, they cannot learn. It is physiologically impossible.

They can also act out (fight) or withdraw (flight or fright) in school; they often have trouble trusting adults or getting along with their peers. They start coping with anxiety, depression, anger and frustration by drinking or doing other drugs, having dangerous sex, over-eating, engaging in violence or thrill sports, and even over-achieving.

Sporleder said he realized that he’d been doing “everything wrong” in disciplining kids, and decided to turn Lincoln High into a trauma-informed school. 

Learn more about the results of Sporleder’s efforts here.

Source: ACES Too High News


Healthy Youth Survey Helps Educators Address Students’ Needs

Recently released results show a connection between a student’s commitment to school, risky behaviors and academic performance.

Results from the Healthy Youth Survey help school staff, community members, and parents understand how youth perceive their school experience, and how better to help students succeed in school and life.

Healthy Youth Survey

Results of the 2014 Healthy Youth Survey were released in March 2015. In addition to substance and alcohol use, the survey collects information related to school commitment, opportunities for involvement in school-related activities, and the presence of a helpful adult in the school and community.

State Superintendent Randy Dorn said that more state money is needed to help students who don’t feel connected to school. “All students need to understand how important school is,” he said. “Part of that understanding is to have someone they can rely on when they need help. That support system is critical so that students don’t fall through the cracks and drop out.”

The survey results connect a lack of commitment to school with increased risky behaviors and decreased academic performance in key areas:

School Commitment
A student’s commitment to school is determined by responses to a number of questions, such as whether he/she enjoys school, is interested in school work, if they find school work meaningful and important and tries his/her best in school.

Statewide, about 62 percent of 10th-grade students are classified as having a high commitment to school. Of the 10th graders that had a high commitment to school:

  • 81 percent reported high grades (mostly A’s or B’s), (compared to 62 percent of students who reported a low commitment to school);
  • 11 percent reported using marijuana, (compared to 29 percent who had a low commitment); and
  • 13 percent reported drinking alcohol, (compared to 30 percent of those who had a low commitment).

Positive Social Opportunities in School
Positive social opportunities at school include participating in classroom discussions, extracurricular activities, decision making, and one-on-one conversations with teachers.

Of the 10th graders who reported that they have more school social opportunities:

  • 72 percent have a high commitment to school (compared to 42 percent of students reporting fewer opportunities);
  • 31 percent reported depressive feelings (compared to 47 percent of students reporting fewer opportunities);
  • 18 percent reported being bullied (compared to 29 percent of students reporting fewer opportunities);
  • 15 percent report using marijuana (compared to 24 percent of students reporting fewer opportunities); and
  • 17 percent use alcohol (compared to 25 percent of students reporting fewer opportunities).

Trusted Adults
About 74 percent of 10th graders reported that they can talk to adults in their community about something important. Of those students:

  • 66 percent have a high commitment to school (compared to 48 percent of students that do not feel they can talk to adults in their communities);
  • 18 percent reported drinking alcohol (compared to 25 percent of students that do not feel they can talk to adults in their communities); and
  • 16 percent reported using marijuana (compared to 24 percent of students that do not feel they can talk to adults in their communities).

About 23 percent of students reported that they do not have an adult at school to help them (or they weren’t sure). Of those students:

  • 28 percent reported drinking alcohol (compared to 19 percent of students that have an adult at school to help them) and  
  • 25 percent reported using marijuana (compared to 16 percent of students that have an adult at school to help them).

Andra Kelley-Batstone, a high school counselor in Olympia, noted that data from the Healthy Youth Survey help address students’ needs. “While it is perception data, we value any information and insight regarding how our students feel at school,” she said. “We know from research that those feelings impact their daily ability to fully focus on and engage in learning.

“At Olympia High School, we’ve developed a new mentor program and increased support for new student transition and other activities in response to the survey. That’s created a more inclusive school environment.”

About the HYS and Where to Access More Results
The Healthy Youth Survey, which is anonymous and voluntary, is administered in even years to 6th, 8th, 10th and 12th graders. In 2014, 220,000 Washington students from 986 schools participated. Data are available at

The survey is given by the Office of Superintendent of Public Instruction, the Department of Health, the Department of Social and Health Service’s Division of Behavioral Health and Recovery and the Washington State Liquor Control Board.

Source: OSPI

Washington Partners Fight to End Childhood Hunger

We have all heard it before – breakfast is the most important meal of the day, especially for children. Without a nutritious breakfast, kids are not fueled to start the day ready to learn.

Even though we know how important breakfast is, far too many kids in Washington are missing breakfast and starting the day hungry. Without that important first meal of the day, their chance to succeed at school is drastically reduced. Kids in Washington State are too hungry to learn.

In order to fight childhood hunger, we have school nutrition programs that provide nutritious meals to low-income children at a free or reduced price. However, while the school lunch program is reaching most eligible children, only 33% of eligible low-income students in Washington are eating school breakfast. This low participation rate puts our state at 41st – in the bottom 20 percent – among states in the number of low-income children who eat school breakfast.

Breakfast served at school helps fight hunder

One of the main reasons that eligible children aren’t eating school breakfast is that most school breakfast programs require kids to get to school early in order to eat. School bus schedules, friends on the playground, carpools, and social stigma all create real barriers to kids accessing breakfast at school.

The good news is there’s a solution: Breakfast After the Bell incorporates the most important meal into the school day and will ultimately increase achievement levels.

Breakfast After The Bell gives kids food where and when it matters most. By moving breakfast to after the bell and including it as part of the school day (just like lunch), breakfast participation increases. Schools that more effectively get their students a healthy breakfast find that kids do better academically in class, are better behaved, and have less visits to the nurse during the school day.

Watch this interview with two Washington State Elementary School principals about why they believe in serving school breakfast after the bell.

Click here to see progress of the bill to expand “Breakfast After the Bell” meal service for low-income students across the state.

Source: Breakfast After the Bell

Breakfast After the Bell Program Combats Obesity

See how programs like what they have at White Center Heights Elementary are aimed at fighting childhood obesity may end up in more schools.


Preventing Suicide: A Toolkit for High Schools

Suicide is the third leading cause of death among our nation’s teenagers. Every year, approximately one out of every 15 high school students reports attempting suicide.

Positive changes to the school climate and a student’s increased sense of connectedness to the school can result in improved academic achievement and healthy behaviors that foster a positive learning environment.

Learn how you can help

Download Preventing Suicide: A Toolkit for High Schools, developed by the Substance Abuse and Mental Health Services Administration (SAMSHA).

Substance Abuse and Mental Health Services Administration's Suicide Prevention Toolkit for High Schools

This FREE Toolkit assists high schools and school districts in designing and implementing strategies to prevent suicide and promote behavioral health. It includes tools to implement a multi-faceted suicide prevention program that responds to the needs and cultures of students and provides:

• Screening tools

• Information about warning signs and risk factors

• Parent education materials

• Research-based guidelines

• Resources to assist the whole community in its suicide prevention efforts that respond to the needs and cultures of high school students

• Practices to help identify students at risk of suicide

• Protocols to respond to suicide death

• Educational programs to engage youth in suicide prevention programs

• Recommended actions to increase parent and school community support for screening programs

Students helping students

See how students at Seattle’s Franklin High School implemented peer support through training by the Youth Suicide Prevention Program:


State youth suicide prevention plan updates

The Washington State Department of Health has been updating the youth suicide prevention plan – see the draft here.

Source: SAMSHA & KING5 Health Link

Mental Health Part of Overall Health at Seattle Schools

It used to be that students went to their school clinic to have their sore throat checked or get a vaccine. But many kids today have needs that go beyond physical health, whether it’s dealing with exposure to violence or having suicidal thoughts.

In response, a growing number of schools have started offering mental health services.

At Rainier Beach High School, Jen Kantor doesn’t always wait for students to come to her office. Sometimes she gets out and meets them where they are. Kantor is a therapist, a mental health counselor.

Jen Kantor has been mental health counselor at Rainier Beach High School for the past seven years. CREDIT KUOW PHOTO/RUBY DE LUNA
Jen Kantor has been mental health counselor at Rainier Beach High School for the past seven years. CREDIT KUOW PHOTO/RUBY DE LUNA

One afternoon she’s out in the hallway, trying to round up students for Girls’ Talk, enticing them with free lunch. The lunch time talk is confidential. Students can talk about whatever is on their minds. Today’s topic is race relations. Sometimes Kantor comes up with topics that might be relevant to them.  

“Right now we’re planning our groups for the rest of the year, focusing on domestic violence in relationships,” Kantor said. “There are some violence in teen relationships and we want to help kids know how to spot and identify things with regards to power and control in relationships.”

These lunch time talks take place twice a month. They’re part outreach, part prevention work. And they also let kids know Kantor’s office is always open to them. 

Keshia, 18, said mental health is just as important as physical health. For that, she appreciates having Kantor around. 

“If she wasn’t here, oh my gosh, I don’t know who I would talk to,” Keshia said. She declined to provide her last name. “For her to be here is a lot easier; everyone knows they have someone to talk to, they don’t have to hold it in, go home angry, come to school angry, and just have a bad attitude. Because some people don’t have someone to talk to at home or friends.” 

Kantor works for Group Health, and has been the counselor at Rainier Beach for the past seven years. She works with students on a range of problems, but issues of anxiety and depression come up a lot.

A Growing Trend

More and more schools are including mental health services as part of their health clinics. Often it’s a collaboration between public agencies and local health organizations.

For example, Seattle’s school-based clinics get funding from the city’s Families and Education Levy. Running the clinics is a collaboration between the school district, Seattle-King County Public Health and local health care providers.

Dixie Grunenfelder oversees behavioral health programs in public schools at the Office of State Public Instruction. “Schools have become much more sophisticated in identifying kids’ needs,” she said, “not just on the academic realm, but also on the behavior realm, things they might be struggling with.”

The state is keeping track. Every other year it conducts a survey to get an idea of students’ physical and mental wellbeing. This helps agencies gauge their needs.

Grunenfelder said that over the past few years the state has seen an increase in kids feeling depressed — especially among 10th and 12th graders.

Having a counselor onsite makes a difference she said. It increases the likelihood that kids follow through on a referral and get the services they need — and get right back to class.

Grunenfelder said it also sends an important message. “It sets a climate of, ‘this is a healthy environment,’” she said. “Having a mental health issue isn’t a bad thing; it’s not stigmatized. It’s not put away and sent away. It’s something we deal with.”

Read complete post here.

Source: KUOW News and Information, By Ruby De Luna 

Managing Asthma in the School Environment

Schools can play an important role in helping your child manage their asthma by providing support through an asthma action plan.

The asthma management plan should include school policies on the use of inhalers and medications, actions or emergency procedures staff should take when a student has an asthma attack, and student asthma action plans.

Washington State Law (RCW 28A.210.370) requires that in-service training on asthma be provided by all school districts for school personnel. “The Superintendent of Public Instruction and the Secretary of the Department of Health shall develop a uniform policy for all districts providing for the in-service training for school staff on the symptoms, treatment, and monitoring of students with asthma and on the additional observations that may be needed in different situations that may arise during the school day and during school-sponsored events. The policy shall include standards and skills that must be in place for in-service training of school staff.”

Student Asthma Action Plan

The student asthma action plan serves as an individual management plan for each student with asthma. It provides pertinent information to school officials on each student’s asthma condition. The asthma action plan should contain the student’s medical information, identified asthma triggers, actions to take, emergency procedures, and phone numbers. This action plan should be signed by the child’s physician. Afterwards, the physician, parent or caregiver, and the school each keep a copy of the student’s action plan.

Asthma Action Plan

Share Your Asthma Action Plan

Share your asthma action plan with all the adults who regularly interact with your child at school. These individuals might include:

  • Teachers, including music, art and physical education teachers
  • After-school caregivers
  • Bus drivers

These individuals need to know about your child’s asthma and how best to help keep your child’s symptoms under control.

Stay in touch

Has your action plan changed? Keep your physician, school nurse/health assistant and teachers informed of:

  • Changes in your child’s asthma symptoms or overall condition
  • Medication changes
  • Revisions to your child’s asthma action plan, including your contact information
  • Recent asthma flare-ups or attacks
  • Specific times when asthma triggers may be a greater risk for your child, such as changes in seasons or during times of increased anxiety/stress or physical activity

Be proactive in managing your child’s asthma at school. A team approach is key to keeping his or her asthma under control.

Learn more at the Puget Sound Asthma Coalition.

Source: American Lung Association