February 11, 2014
“We know that students need to be healthy to learn. School nurses play a vital role in making sure children are healthy and ready to learn.” -- Arne Duncan, Secretary, U.S. Department of Education.
During the first 85 days of the 2013-2014 school year:
- 18,123 visits, students and staff, to the school nurse for illness, injury and other health related issues;
- 4605 medications and treatments have been administered;
- 8498 screenings for height, weight, vision, hearing, scoliosis, and pediculosis;
- 85 % of all students have been seen at least once for a health related matter, not including screening, and returned to class and learning 91% of the time;
- 4971 parent/guardian communications regarding student health of their child.
- 801 students in grades 1-4 received weekly fluoride treatments to strengthen their teeth and prevent cavities.
What isn’t evidenced by the above numbers:
- Instructing staff regarding EpiPen administration and Blood Borne Pathogens;
- Organizing Flu clinics for staff;
- Developing health lessons for first graders, Health Bear Lessons;
- Developing Health Care/Emergency Plans for students with significant health issues;
- Preparing referrals and follow-up care plans for students who fail the vision and hearing screenings;
- Ensuring a 99% compliance rate for immunizations;
- Monitoring follow-up care plans for students who have sustained a concussion;
- Contacts with community local physicians and community resources;
- Meetings with school resource offices and school-based IST and coordination teams;
- Participating in medical 504 meetings;
- Meetings with guidance and adjustment counselors to assist in the development of behavior management plans that address issues of self-injurious behavior, metal health, eating disorders, suicidal ideation and or attempts;
- Creating SMART goals and professional development activities;
- Providing counseling for students who have experienced recent/historical loss and or trauma;
- Connecting underinsured families with community resources (Lions Club, etc.);
- Collaborating with the Falmouth Service Center, Katelyn’s Closet and other community resources for families in need;
- Welcoming students who are not in medical need but emotional need;
- Attending to the medical needs of school visitors and/or family members;
- Organizing medical necessities and training for students and staff members for field trips.
As a registered nurse with over 27 years of varied experience in both big and small hospitals as well community health nursing even I was surprised at how much a school nurse does when I began as my position in this district. I am happy to give insight to our community regarding the work we do and the impact we as nurses have on the students.
The records show that I have had 2447 visits so far this year. This includes 472 unduplicated students or 87% of the students. I have had 411 visits for injuries and 893 visits for illness. I have had to administer an Epi-pen and call EMS for an anaphylactic reaction to nuts. I have had 12 students with concussions who have required coordination with their teachers and physicians for orders to be allowed to come to health office for rests so that they may stay in school and reduce amount of missed class time. I have administered 728 doses of medication and performed 302 treatments which include blood sugar testing for our diabetic students, auscultating lung sounds and measuring oxygen levels on our asthmatic students. I have 595 visits under the category of Management. This is where I record phone calls and emails to and from parents, or physicians and community resources. It also includes guidance coordination meetings which I attend along with our admin and school resource officer where we work as a team to come up with a plan to best assist our students with various issues reach their highest potential. Under the category “Other Health” I have had 608 visits. This would include students who have emotional issues and may have cut themselves, or need a place to decompress; students who have had to be screened for substance use/abuse; students who have participated in the “Ice Challenge” or “Eraser Challenge” whereby they have (at the urging or dare of others) injured themselves purposefully.
I have also had 74 visits from staff members for issues of injuries or illness or blood pressure checks. In addition to staff visits I have also done epi-pen training with Team leader teachers for field trips; organized a flu clinic with the VNA for staff and their families to which 55 adults and 11 children from my school were immunized.
As the school nurse I must also ensure that students comply with State Of MA immunization requirements and vision, postural and BMI screenings. At the start of the year there were over 180 students not in compliance for immunizations. I have done 620 screenings with the help of my assistant which include the state mandated vision and scoliosis, as well as lice checks.
As a school nurse I need to maintain my RN license but also become certified as a school nurse. I have to follow the same evaluation system as the teachers and come up with SMART goals. To that end I have developed my own web page as part of the Lawrence School page. I hope to increase communication between the health office and families as well as be a resource of pertinent information. My role as the school nurse encompasses both health and educational goals. There is a recognized relationship between health and learning. It is a team effort and I am proud to be one of the dedicated nurses of Falmouth Public Schools. Middle School Nurse
I could review all the numbers with you but I do not think that paints the picture of what the school nurse does. But for the record the health office my school has had 2,543 visits year to date.
This includes 629 students treated for injury and 957 assessments for illness. I have called 911 twice this year one for a neck injury on the playground and the other for anaphylactic reaction to nuts. I have
administered 721 medications thus far this school year and performed 90 “treatments” which includes checking blood glucose levels, auscultating lungs and monitoring oxygen levels. We have performed 1,051 screenings for vision, hearing, heights and weights and my favorite “lice checks”. I have 647 visits under the “management” category which include calls/emails to and from parents, doctors, community resources and the weekly guidance and crisis meeting which I attend. So far this year I have seen 530 unduplicated students which means 88% of the students have visited the health office this school year.
I feel being the school nurse is so much more than “the numbers” and the day to day office visits. I would like to share some of the things that I have been involved in recently:
- Sitting quietly and holding the hand of a student who has lost her dad in an accident this summer. She had just started her menses and was having a hard time;
- Making a phone call to the Lions club for a student who had a prescription change in their glasses but insurance wouldn’t pay for the new pair;
- Writing a letter home to the mom of a student of a foreign country on how to sign up for Rec Basketball for her son who is struggling to “fit in”;
- Working with Katelyn's closet, a charitable organization, to provide winter clothing for twin students at my school;
- Empathizing with the “upset parent” who spent her whole weekend dealing with lice;
- Counseled and listened to the staff member who was having an “anxiety attack” while at school;
- Being that friendly face for the special needs boy who likes to come for some crackers every day and can spend a minute having a conversation with him.
These are just a few quick thoughts on what being part of the TEAM that provide an awesome experience to the students in this school. I am proud to be the school nurse in the Falmouth Public Schools and as you can see it is so much more than “the numbers”. Middle School Nurse
From 09/01/13 to 01/17/14 I’ve seen 2,183 visitors to the health office. Injury visits: 636; Illness visits: 1142; Management (this is generally medication-related): 452; Other (phone calls, developing care plans, etc.): 471.
During the course of the week, I see an average of 150 students. There have been occasions that I’ve seen 60-90 visitors in a day due to classroom screenings for hearing, vision, heights and weights; or classroom head lice screenings. I conduct thorough assessments on each visitor, depending on their complaint. A sample of the students’ needs include grand mal and absence seizures, brain tumor, diabetes, severe asthma, as well as flu and colds, vomiting, playground injuries, dental problems, sore throats, stomach aches, strep throat assessment, burns, cuts, scrapes, head injuries, incontinence, and psychological distress. I also assess for possible abuse and neglect and follow-up and report as mandated. I call parents after most visits to ensure proper follow-up. I also collaborate with other staff members on a myriad of student health issues. I attend IEP and medical 504 meetings (a meeting held to make accommodations for students with serious medical needs), as well as professional development and nurse’s meetings. I dispense 8 psychotropic medications a day, and additional as-needed medications (asthma inhaler/steroid med via nebulizer, for example), and take part in PTO/school-wide activities. I also develop health care plans for medically fragile students and instruct staff on these
medical conditions, as well as Epi-Pen training. I also assess and act accordingly in true medical emergencies. I prepare first aid kits with student’s medications for field trips, and prepare @ 140 doses of fluoride/week. I attend the 4th grade Canal Bike Trip for management of health conditions or emergencies.
I research, organize and take part in a wide variety of staff and student wellness programs. These include the dental clinic, Body Walk, 4th grade Mother-Daughter Tea (puberty talk), flu shot clinic, Health E. Bear 1st grade health lessons, the health station on field day, mentor nursing students, yoga class for staff, health screening clinic for staff, write the monthly health news for the parent newsletter, Nutrition Detectives Program, and educate the students about healthy snacks on National Healthy Food day. I visit classrooms frequently to speak about cold and flu prevention. I attend meetings at admin as the building’s Health and Safety representative, and take part in the preschool assessments three times a year at the administration building. I am developing a nurse’s website for my school which will include pertinent medical information, as well as current “events” in health issues.
At the beginning of each school year, I ensure that all new incoming preschool and kindergarten students are compliant in immunizations and physicals, and input all of this information, with my aide’s help. We conduct health screenings on all students in the school and follow-up any “failed screenings”. I take part in kindergarten registration every year. I also conduct the “dreaded classroom lice screenings”, and educate parents and staff on prevention and treatment. Since I started at EF, the “lice problem” has decreased significantly.
I conduct state-mandated surveys regarding immunization compliance for all new kindergarten and preschool students, asthma surveys, and health condition surveys. I also prepare information packets about serious allergies in the classroom and send letters to parents regarding these allergies and proper birthday snacks.
I hope this helps to give you an idea of the week in the life of the EF school nurse!
Elementary School Nurse
A speech pathologist in the public schools addresses students with the following needs:
Receptive and expressive language skills (weaknesses in vocabulary, concepts and grammar) which may impact oral and written expression;
- Articulation- difficulties producing speech sounds that impact a student’s ability to make effective progress in school;
- Augmentative communication- Some children are not able to speak at all and need help learning other ways to communicate, we devise augmentative communication systems;
- Social communication – how students interact with others;
- Voice – how we sound when we speak (pitch, volume, quality, resonance);
- Stuttering - fluency of speech;
- Cognitive communication- thinking and memory which includes problems with long term or short term memory, attention, problem solving or staying organized;
- Feeding and swallowing also called dysphagia- how well we chew and swallow food and liquid. (Medically complex children who enter the school system may have these types of needs.)
- Conduct both formal and informal screenings as needed. Informally, observe students in their classrooms to determine if they need further speech and language testing. Formally, participate in the annual Kindergarten screenings;
- Conduct initial and re/evaluations of speech and language skills (these are new referrals or students that are currently on my caseload) and generate a written report to be presented at a Team meeting with the parents;
- Participate in the determination of eligibility;
- Collaborate in the development of IEPs.
- Attend IEP meetings for all students on my caseload annually or as often as requested by the Team including the parents;
- Provide a combination of services including one on one and small group therapy;
- Provide assistance with children who are at risk for communication and learning problems in the classroom;
- Determine if a child needs specialized instruction called response to intervention or RTI. I work with students who qualify for RTI within the classroom or in pull out sessions.
- Ensure that communication goals support student’s learning and social skills in accordance with the Massachusetts state standards;
- Facilitate social groups for children in need of explicit instruction and practice with social skills.
- Monitor and report data on student progress;
- Research best practices;
- Develop and create materials for each therapy session;
- Provide students with home programs to work on skills at home;
- Implementation of student behavior programs and implement skills which I have learned in the Crisis Prevention Intervention program which may include restraints or transporting a student in crisis.
- Consult to classroom teachers in accordance to IEP’s (most students on IEP’s have 5-10 minutes of consultation time per week) as well as informal consultation with regard to students not on my caseload;
- Attend Instructional Support Team meetings as part of the pre-referral process, provide teachers with suggestions for the classroom to improve student performance, or determine if a special education referral should be made;
- Collaborate closely with special education teachers and teaching assistants for students who are part of the Therapeutic Intervention Program to address carryover of communication skills in the classroom
Provide referrals/consult with outside agencies or write letters for parents to bring to doctors regarding speech language concerns;
- Develop home programs for students;
- Communicate with parents through emails, phone conversations, and in-person or through communication notebooks;
- Maintain the website for families to access to increase carryover and support at home.
- Engage in professional development activities to meet state and national certification requirements;
- Document and report on the Medicaid website after each speech and language session for students who qualify for this reimbursement;
- Present at staff meetings or with new staff at the start of the school year to educate them about working with students who have autism;
- Perform daily/weekly bus and or recess duties;
- Participate in meetings once a week before school to address the needs of students in the TIP program;
- Participate in bi-monthly meetings with TIP staff and administration to discuss individual students and program needs;
- Consult with Board Certified Behavior Analysts (BCBA) regarding individual students and program needs;
- Participate in staff meetings and grade level meetings;
- Meet with the school nurse regarding students who do not pass their hearing screenings.
As a speech-language pathologist at an elementary school, my position primarily consists of providing speech therapy to students and evaluating students to determine if they present with delayed or disordered communication skills. I am privileged work with 33 children in preschool through grade four. I am responsible for: evaluating students to determine their communication needs, writing evaluation reports, developing and maintaining an ever-evolving schedule as new students with communication needs are identified or move into district, developing therapy plans, preparing materials for therapy, preparing preschool phonemic awareness lessons, writing informational phonemic awareness letters for parents to support their children at home, writing preschool center-themed newsletters to provide parent/school connection to the preschool curriculum, keeping up-to-date on the newest research and best, research-based practices in my field, learning and utilizing technology to support my students’ communication needs, collecting data during therapy, writing detailed progress notes for each student for each grading period, consulting with teachers and staff, attending meetings for students on Individual Education Programs (IEPs) for speech services, attending meetings for students who I have evaluated, attending Instructional Support Team (IST) meetings as part of the testing pre-referral process, informally assessing students as part of the IST process, writing IEPs, reporting eligible services for Medicaid Billing, attending staff and departmental meetings, carrying out daily, building-based duties, attending courses and earning continuing education units (CEUs) in the field of speech-language pathology to maintain my
Massachusetts Licensure as a Speech-Language Pathologist and my national Certificate of Clinical Competence from the American Speech-Language Hearing Association (ASHA), as well as earning professional development points (PDPS) to maintain my Massachusetts Teaching Certificate.
I begin each morning by prepping materials for therapy and reviewing my meeting schedule for the day. I work in the two preschool classrooms for a total of two hours each morning, providing individualized therapy to 10 children in an inclusive setting. I also teach whole-group lessons on phonemic awareness in each preschool classroom, and provide consultation to the preschool teachers and teacher assistants. After my preschool sessions, I work with K-4 students in small, pull-out groups in half hour blocks of time. The groups are typically made up of 3-4 students. I work with several K-4 students in inclusive settings, as well. The students I work with have varied speech-language needs, with differing levels of severity. Some students have speech production issues such as articulation disorders, phonological processing delays, or fluency (stuttering) disorders; other students may present with receptive language, expressive language, or pragmatic language disorders. Elementary Speech Language Pathologist
School Adjustment Counselors
- Provide short- and long-term counseling to students and address social emotional, familial and mental health issues;
- Investigate bullying claims;
- Meet with families, collateral contacts, juvenile probation department, DCF;
- Conduct mediations;
- Connect families to the Falmouth Service Center;
- Assist parents with health insurance applications (Mass Health);
- Consult with teachers/guidance/administrators regarding students;
- Provide direct services based on individual IEPs, provide documentation, monthly Medicaid billing;
- Participate in IEP, Coordination, IST meetings;
- Provide appropriate community referrals;
- Conduct preliminary crisis intervention and arrange assessments by the PAT or DMH as deemed appropriate;
- Facilitate re-entry meetings for students returning from hospitalizations or crisis team assessments;
- Co-ordinate the delivery of educational services for hospitalized students;
- File 51As on behalf of the school teams;
- Conduct staff training around 51As as mandated by the state;
- Act as the Supervisor of Attendance;
- Adhere to the new CRA law and create and implement plans for students with attendance issues;
- Provide home visits;
- Take time samples;
- Contribute to the development of BIPs;
- Facilitate the mentor process;
- Chair 504 meetings;
- In 2013-2014 Elementary Adjustment Counselors assisted a total of 109 families (total of 265 children) during the holiday;
- Facilitate “Girls Circle”, Alternative Ed and “Stinkin’ Thinkin’” groups as schedule allows;
- Facilitate lunch bunch and social skills groups.
School Adjustment Counselors are licensed clinicians in the building servicing students with acute and chronic mental health diagnoses. We are working with students and their families to build alliances and connect them to community support for long term care. We are helping the faculty understand how these serious mental health concerns manifest themselves in the classroom and how they will impact learning. We are working with Guidance to create academic success plans and providing the clinical perspective to teaching students with these high risk needs.
Secondary Adjustment Counselor
- Complete psychological assessments for initial and reevaluations;
- Evaluate “at-risk” students and make appropriate referrals to PAT, DMH, ER;
- Manage plans for students with social emotional disabilities and/or executive function deficits;
- Provide both individual and group counseling;
- Present testing results in IEP meetings;
- Review findings with teachers, parents, and students;
- Consult with special and general education teachers regarding students in their classrooms;
- Complete Functional Behavioral Assessments;
- Develop and monitor BIPs;
- Complete OOD evaluations on Falmouth students;
- Consult with collaborative agencies to maintain consistency of services;
- Facilitate/attend IST meetings;
- Provide classroom support and intervention.
Much of my average week entails evaluation of students who are referred for special education testing and then finding and recommendations up in detailed reports. This process is conducted for the purpose of diagnosing (or ruling out) disabilities and for making recommendations to the “Team” (which includes parents, teachers, evaluators, and administrators) regarding supports, services, accommodations, modifications, and programming that might best help the child make effective progress in the least restrictive environment. This process involves more than testing and writing—it also entails parent and teacher interviews, observations, record reviews, etc.
A fair amount of time is also spent in Team meetings, during which the evaluation results and reports (described above) are reviewed and summarized for parents and staff.
Currently, my role also includes conducting the psychological evaluations at the preschool level. In addition to behavior and/or social-emotional concerns, the school psychologist tends to take the lead role in assessing for delays in cognition and for autism spectrum disorders. Evaluating these students often entails traveling to children’s homes, preschools, and daycare settings.
One of the elementary schools in which I currently work contains the district-wide program for children with social-emotional disabilities. As the school psychologist, I consult to the program staff regarding these students. I am also on call to respond to crises in this program. Although this may not be a something I have to do every single week, it is something that I tend to spend a good deal of time doing between the start and end of the school year.
Much of our work as school psychologist also entails regular education support, most notably for student who are “at risk” either academically or behaviorally. We are members of the buildings’ instructional support teams (IST) that meets weekly on children (usually general education students) who are presenting with academic, social-emotional, behavioral, or other concerns. ISTs usually assess the data available, recommend interventions, and then reconvene to assess the students’ responses to these interventions.
Finally, school psychologists try to help out in less formal ways during the day and throughout the school. This may entail going to lunch and talking with students, having students come to eat lunch with us, by going out to recess, etc. Elementary School Psychologist
The majority of my time is spend on completing assessments (testing, writing, reporting out). Regularly attend special education TEAM meetings. I provide direct services to students including individual and group counseling. I also provide consultation to teachers and parents. Another significant part of my week is responding to acute emotional and mental health issues. In response to these needs I work collaboratively with the counselors and administration to help connect families with community based mental health services. I also participate in coordinating the Instructional Support Team to identify and develop interventions for students who may be struggling in the general education curriculum. I regularly attend the weekly guidance/coordination meetings. I have also spent some time in the classroom teaching students about brain development, executive functions and study skills. Middle School Psychologist
Primary concern is safety in school, maximize participation and promote independent functional mobility. Modifications and accommodations are provided and monitored to promote student success.
Students that we see include those with developmental delays, genetic disorders, Down Syndrome, Autism, Coordination Disabilities, Cerebral Palsey, Muscular Dystrophy-Duschennes, Blind and deaf students, Anxiety Disorders, Congenital Cardiac and musculo-skeletal abnormalities, Respiratory concerns-Asthma, Seizure Disorders, Mitochondrial Disease.
- Perform PK through FHS evaluations, observations, screenings, meetings;
- Perform out of district evaluations (CCC, RFK School, home and private pre-school);
- Provide direct service and consult to caseload (45-50 students/year);
- Review and write IEP’s;
- Provide alternative motor activities to TIP program;
- Consult to Adapted PE at LAW and FHS, and to staff as needed;
- Provide teaching to TA’s regarding safety and motor function in school (i.e. how to guard on stairs, cues for participation in PE, and travel throughout the school setting);
- Parent communication provided on student progress;
- Prepare and maintain progress notes for caseload;
- Medicaid billing for direct service.
- Develop, implement, and coordinate Occupational Therapy services;
- Use a Response to Intervention model to perform district wide screenings;
- Perform evaluations to assess visual and fine motor skills, self-regulation skills, prevocational; skills, vocational skills, independent living skills, assistive technology;
- Create Individualized Education Programs (IEP) specific to the student, write progress notes, data collection, 504 Accommodation plans, District Curriculum Accommodation Plans;
- Educational planning: create accommodations for the classroom and MCAS testing, create Individualized Education Program goals and objectives to support student growth, provide consultative support to all specialized programs (TIPP, MALC, SLC, Integrated programs, Transition Program);
- Transition planning: as part of the high school transition program provide prevocational and vocational training, independent livings skills, social skills, community development, in addition provide transition planning between grades, programs and schools;
- Therapeutic intervention: provide direct services to students with visual and fine motor delays to access the curriculum, build self-regulation skills, organization skills, and sensory motor development;
- Collaborate with families and other service providers (Physical Therapists, Speech Therapists, Psychologists, Adjustment Counselors, Job coaches, Administrators, Teachers, Specialists, Community agencies);
- Review outcomes and modify intervention programs, clinical reasoning and professional judgment are essential to ensuring the safety of students and protecting liability of the school system and therapists;
Occupational Therapy Service and Delivery:
- Provide targeted, evidence-based therapeutic intervention to facilitate student participation within the school environment
- Format of services: direct services outside the classroom, direct services in the classroom, job coaching in the community, consultative services to the (classroom teacher, special education teacher, TAs, specialists)
Other related duties:
- Support general education through informal consultation, screenings, classroom accommodations, staff trainings;
- Ongoing consultation and support to TAs that work in the specialized programs (MALC, TIPP, Integrated classroom, High School program);
- Member of the Instructional Support Team;
- Member of the Preschool Screening Team;
- As a department, present 5-7 in-service trainings a year (to staff as well as the community);
- Provide summer services to prevent substantial regression;
- Provide summer transitional services for students turning 18 years to develop daily living skills and vocational pursuits;
- Provide assistive technology services; evaluation, consultation and direct service support;
- Develop and continue to modify data collection procedures related to goals and objectives;
- Submit Medicaid billing for reimbursement;
- Provide three month long internship programs for occupational therapy students from local colleges;
Occupational Therapy independent initiatives:
- Initiated and implemented the Zones of Regulation curriculum (self-regulation skills) in the general education and special education classrooms in the preschools, elementary schools, middle school, and high school along with specialized programs (MALC, SLC, TIPP, Integrated classrooms, High School Transition program);
- Applied for and received a grant to create fine motor kits in the regular education kindergarten classrooms;
- Applied for and received a grant to build sensory motor strategies and tools in two first grade classrooms to promote self-regulation skills;
- Applied for and received a grant for Educational Game systems to promote fine motor skills
- Applied for and received funding for assistive technology device to promote continuity between home and school;
- Applied for and received a grant for speech to text software;
- Revised occupational therapy evaluation to reflect school participation.
Professional Growth and Ethics:
- Participate in continuing education for professional development to ensure practice is consistent with best practice and to meet MA licensure requirements.
- Use professional literature, evidence based research, and continuing education content to make practice decision.
First thing each morning, we all need to prepare for daily direct student treatment sessions. We consult with classroom teachers and staff before students arrive and arrange schedules for treatment that are the least disruptive to the student learning. Treatment is provided to students outside of the regular education classroom and is designed according to specific IEP goals and objectives based on evaluation of needs. Therapy is also provided, when indicated, in the general education classroom in accordance with individual IEPs. Occupational Therapist