Introduction: Health

Both prevention and intervention should be taken into consideration when planning for the health and safety of students. Assessment, planning and intervention in a variety of health areas are linked closely with other sections in this tool kit:

·  They are based on effective use of data.

·  They are a critical part of a school-wide behavior system.

Health is an important variable to consider when assessing and designing individualized plans for immediate and ongoing student support. Identifying health concerns and implementing health care supports and related health education programs in school may eliminate or diminish the impact that these concerns have on student engagement and academic readiness.

Physical, social, emotional, mental and environmental health include[1]:

·  Systems for promoting healthy development and preventing problems

·  Early intervention system

·  Intensive intervention/crisis response

The table below forecasts the focus areas and tools in this section, and offers some practical tips for building leaders to implement in their schools.

Focus Areas

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Role of Building Leader(s)

Key Components of a School Health Program / ·  Engage staff, parents and community members in conversations about perceived gaps and needs in health services at your school.
·  Engage students (as appropriate) in conversations about perceived gaps and needs in the health services system at school.
·  Examine the health curriculum in your school to ensure that it is thorough, appropriate, and developmental.
·  Ensure system/protocol exists for confidentiality of medical records.
Resources Available in the School / ·  Be aware of resources available in school and make sure staff and students are fully aware as well.
·  Conduct the School Health Index to identify possible areas of focus for work.
Response Systems / ·  Make sure all staff is fully aware of district procedures pertaining to a health crisis.
·  Establish appropriate roles and responsibilities in a crisis.
Alcohol, Tobacco, and Drugs / ·  Establish roles and responsibilities to carry out procedures.
·  Become familiar with district’s procedures for addressing alcohol, tobacco, and other drug (ATOD) issues, and ensure staff are as well.

Focus Area: Key Components of a School Health Program

A coordinated school health program (CSHP) model consists of eight interactive components.

•  Health Education: A planned, sequential, K-12 curriculum that addresses the physical, mental, emotional and social dimensions of health. The curriculum is designed to motivate and assist students to maintain and improve their health, prevent disease, and reduce health-related risk behaviors. For more detailed information about comprehensive health education curricula go to www.cdc.gov/healthyyouth/CSHP/comprehensive_ed.htm.

•  Physical Education: A planned, sequential K-12 curriculum that provides cognitive content and learning experiences. Quality physical education should promote activities and sports that all students enjoy and can pursue throughout their lives.

•  Health Services: These services are designed to ensure access or referral to primary health care services or both, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems.

•  Nutrition Services: Access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students.

•  Counseling and Psychological Services: Services provided to improve students' mental, emotional, and social health. Organizational assessment and consultation skills of counselors and psychologists contribute not only to the health of students but also to the health of the school environment.

•  Healthy School Environment: Factors that influence the physical environment include the school building and the area surrounding it, any biological or chemical agents that are detrimental to health, and physical conditions such as temperature, noise, and lighting.

•  Health Promotion for Staff: These opportunities encourage school staff to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school's health program. Health promotion activities have improved productivity, decreased absenteeism, and reduced health insurance costs.

•  Family/Community Involvement: An integrated school, parent, and community approach for enhancing the health and well being of students. Schools actively solicit parent involvement and engage community resources and services to respond more effectively to the health-related needs of students.

Source: Centers for Disease Control (CDC).
Focus Area: Resources

Available in the School

“How do we know what district and community resources are available to help our students with health issues?”

In MPS, all schools have, or have access to, support staff in the building that helps address barriers to student learning. The licensed school nurse (LSN) is an important source of data and brings knowledge that can inform the problem solving process for students.

A grid at the end of this section provides an overview of essential questions for the LSN when specific health issues arise related to attendance and behavior.

Also, the Centers for Disease Control (CDC) offers a customized self-assessment health survey for schools at http://www.cdc.gov/HealthyYouth/SHI/paper.htm.

The CDC’s School Health Index (SHI) Self-Assessment and Planning Guide was developed in partnership with school administrators and staff, school health experts, parents, and national nongovernmental health and education agencies for the purpose of:

·  Enabling schools to identify strengths and weaknesses of health and safety policies and programs

·  Enabling schools to develop an action plan for improving student health, which can be incorporated into the School Improvement Plan

·  Engaging teachers, parents, students, and the community in promoting health-enhancing behaviors and better health

Completing the SHI is an important first step toward improving a school’s health promotion policies and practices.

There is growing recognition of the relationship between health and academic performance, and a school’s results from using the SHI can help include health promotion activities in the overall School Improvement Plan. The SHI has two activities that are to be completed by teams: the eight self-assessment modules and a planning for improvement process. The self-assessment process involves members of a school community coming together to discuss what the school is already doing to promote good health and to identify strengths and weaknesses. The SHI assesses the extent to which a school implements the types of policies and practices recommended by CDC in its research-based guidelines for school health and safety policies and programs.

After completing the self-assessment process, participants identify recommended actions a school can take to improve its performance in areas that received low scores. A simple process for prioritizing the various recommendations follows. Finally, participants complete the School Health Improvement Plan to list steps in planning the implementation of recommended actions.

Focus Area: Response Systems

“When we have students with health issues, how do we respond and who can we call?”

Mental Health and Crisis Response

There are district procedures in place to respond to mental health concerns and crises at the building level. For more information on the Crisis Consultation Team, review the Student Support Services website at http://www.mpls.k12.mn.us/.

For questions about social work and mental health services available to schools, contact the Office of Social Work in the Department of Student Services at 612-668-5432 / 612-668-5436 /612-668-5409.

A mandatory district-wide procedure is in place requiring involvement of a school’s pre-assessment team for school situations where there is suspected drug use (see pages 83–84). In addition, the procedures that schools must implement per Federal and State guidelines are included. This procedure mandates that students with ATOD concerns be referred to the schools’ pre-assessment team (may be the school’s problem solving, student support, or crisis response team) to address reports of chemical abuse problems and make recommendations for appropriate response.

c Using Data to Assess the Impact of Health Concerns

on Student Learning page 77

c Mental Health Crisis Assessment pages 78-79

c Mental Health Crisis Response Flowchart page 80

c Suspected Drug Use Protocol, Actue Use Procedure page 81

c Suspected Drug Use Procedure Flowchart page 82

c  Pre-Assessment Team Implementation Planner

for ATOD Use page 83

c Pre-Assessment Team Activity Log page 84

c Steps for Student Reentry Following Suspension for

Alcohol or Other Drug Possession, Use or Sale page 85

c Sample Letter for Student Suspension for

Alcohol, Tobacco, and Other Drugs (ATOD) page 86

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Concern Area

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Essential questions to ask the Licensed School Nurse

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Data Sources

Attendance

/ Does this student have any acute or chronic health concerns? / Annual health information form (AHI), Emergency Card, Electronic Pupil Health Record (EPHR), Health Office Logs,
Are there pregnancy or parenting issues for this student? / Teenage Pregnancy and Parenting and Prevention Services (TAPPP) data
Is student or family chemical use or abuse a concern? / Suspension data, Pre-assessment Team Data EPHR, Health Office Logs
Are there any mental health concerns? / EPHR, Health Office Logs, Crisis Team Logs
Does this student have any nutrition/eating concerns? / EPHR, free or reduced lunch list
Is this student experiencing sleep problems? / Health Office Logs, EPHR, Behavior Referrals
Does this student have health insurance? / AHI
Does this student have a primary care provider or clinic? / AHI, immunization status, EPHR
Is this student homeless or highly mobile? / Homeless or highly mobile data

Behavior

/ Does this student have any medical conditions, which may
impact behavior (may or may not be diagnosed)? / AHI, Emergency card, EPHR, Health office logs, health information on OCR worksheets 1, 2, 3
Has or is this student been on any medications?
What were the benefits and side effects? / Annual health information form, emergency card, Electronic pupil health record, Health office logs, emergency cards,
Is student or family chemical use or abuse a concern? / Suspension data, Pre-assessment Team Data
Has this student received other therapeutic interventions? / Annual health information form, emergency card, electronic pupil health record, Health office logs, emergency cards, health review form
Does this student have mental health concerns? / EPHR, Health Office Logs, Crisis Team logs

Other

/ Are there pregnancy or parenting issues for this student? / TAPPP data
Has there been a change in the number or type of school injuries? / Accident Reports

When problem solving with students who have behavior or attendance issues, it is important to get complete information.

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Mental health crisis assessment is available to all Minneapolis Public School students through an agreement with Behavioral Health Partners. A Mobile Mental Health Crisis Assessor conducts the assessment at the school. Following assessment, the Assessor authorizes the appropriate level of care, consistent with the family’s insurance, and including outpatient therapy, partial-hospitalization, day treatment, and hospitalization. The assessment requires written parental consent. The assessment is provided at no cost to the student or family, however treatment relies on insurance or fee-for-service.

Core student support staff in each school has been trained in the protocol for accessing the Assessor. Contact the School Social Worker to initiate a referral.

Criteria for Referring a Student for Mental Health Crisis Assessment

Prior to contacting the Assessor, it is important that the support staff at the school determine that the student meets at least one of the following criteria:

Psychiatric

Student displays signs and symptoms of psychosis making the child vulnerable in the community and at risk in the school. Symptoms may include acknowledging auditory/visual hallucinations, delusional thoughts, and/or paranoia. These may be accompanied by significant social withdrawal, suspiciousness, or pressured speech, grandiosity. Aggression may also present.

Emotional

• Signs of depression appear to interfere with the child’s ability to function in school; if left unattended may lead to further regression or to the risk of self harm. Signs of depression may include sleep disturbance, appetite disturbance, decrease in energy, social withdrawal, decline in academic and/or social functioning and tearfulness. Self-injurious behavior may include self-inflicted wounds (cuts, carving, burns etc.) and/or verbal or written statements indicating intention to harm self.

• Signs of emotional stability including euphoria, grandiosity, severe irritability, risk-taking behavior. This may be accompanied by aggressive behavior that is not typical for this child. Evidence of illicit substance use/abuse interfering with child’s functioning in the school setting, associated with one of the above. This evaluation is not a chemical health assessment. If a chemical health assessment is needed a referral should be made to an appropriate facility.

Behavioral

The child is behaviorally unregulated to such an extent that it is very difficult to be contained in school. Examples may include extreme distractibility such that redirection is ineffective and student is agitated, hyperactive, and unable to be contained within an appropriate educational setting. Referrals may be initiated if this is a new behavior and represents a notable change in behavior patterns for this student, other standard interventions have been attempted, and the child risks school disruption. If the student is under a clinician’s care, the parent and that clinician should be contacted rather than initiating a referral to the assessor.

Contraindication for Referral

Behavioral episodes, including those in which aggressive behavior is manifested, which are indications of oppositional/defiant behavior, criminal activity or gang activity, primarily in response to disciplinary action or enforcement of school expectations are not appropriate for referral.

Questions? Contact Minneapolis Public Schools Lead Social Worker, department of Student Support Services, at 612-668-5432.

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The Acute Use Procedure provides a consistent framework for school administrators and response teams to quickly act on concerns of possible student drug or alcohol use in school. This tool can be used proactively to inform students and families about what will happen if drug or alcohol use is suspected. It also can serve as a guide for student referrals to community based chemical health services.