Getting Started: Understanding School Health Services Program Requirements

1. Getting Started: Understanding School Health Services Program Requirements Karen Erwin, RN, MSN Education School Nurse Consultant July, 2014

2. What are the laws ? • Federal law: IDEA – 34 CFR 300.34 (13) • Section 504 of the Rehabilitation Act 1973 HIPAA FERPA • State laws: KRS 156.502 KRS 314.021 All other federal (CFR), state laws (KRS) and administrative regulations (KAR) compliment these Listing of all laws on health services delivery available in KDE Health Services Reference Guide (2012) http://education.ky.gov/districts/SHS/Pages/Health-Services-Reference-Guide.aspx

3. Statues and Regulations • Statutes are laws that mandate a requirement or compliance Ex: KRS 156.160 requires written standards for school entrance: physical exam, vision exam, dental exam, immunizations, etc. • Administrative Regulations describe the way a statute (law) will be implemented Ex. 702 KAR 1:160 School Health Services describes when student must have physical exam, vision and dental exams, immunizations, forms to be used and how these records will be kept at school

4. How a bill becomes law • Bill introduced into House or Senate and assigned to a committee • Committee determines whether bill will pass out of committee or not • If passed out of committee, voted on by first legislative chamber (House or Senate) • If passed, goes to other chamber (House or Senate) • If both chambers vote to pass bill, goes to Governor to be signed into law

5. KY Education Laws/Regulations • Statutes (laws) describe role of the local school board, student enrollment requirements, attendance requirements and school health services administration • Regulations provide more information regarding the implementation and compliance of the statutes

6. KRS 156.502 • Is a Kentucky Education statute (law) • Requires school districts to provide any necessary health service to student who needs the health service to attend school or a school sponsored function • Does not specify how school district is to provide the service, only says they must provide it ( gives flexibility to school district)

7. KRS 156.502 • Defines school health services as • Administration of medications • Operation or maintenance of health care through use of medical equipment • Administration of a clinical procedure • Does not include ER meds or first aid

8. KRS 156.502 • Only RN, APRN or MD may delegate a health service to unlicensed school personnel • Delegated health service must be something that is within the RN, APRN or MD scope of practice to delegate • Provides exemption from liability for unlicensed school personnel if trained and delegated according to KRS 156.502

9. 702 KAR 1:160 School Health Services • Administrative Regulation • Describes health exams and forms necessary for employment or to enroll in school: 1. School employee physical exam 2. Student preventative physical exam 3. Immunizations 4. Vision exam 5. Dental exam or dental screening

10. 702 KAR 1:160 School Health Services • Mandates use of provided standardized training materials in training of unlicensed school personnel who are delegated to administer a school health service (medications or a procedure) • References requirements for school health room

11. 702 KAR 1:160 School Health Services • Describes health records to be kept (student cumulative record)and how records may be stored 1. Student Cumulative Folder (paper file) “green card” 2. Electronically via KY Student Information System (KSIS-Infinite Campus)

12. KY Public Health Laws and Regulations • Promote health and prevent disease • Statutes include: 1. Immunization Requirements 2. Immunization Exemptions 3. Closing of school for epidemic

13. KY Public Health Laws and Regulations • Regulations include: 1. Immunization Schedule 2. Immunization Reporting 3. School Sanitation and first aid requirements

14. School Nursing Laws • KY Board of Nursing is the licensing agency and determines the scope of nursing practice, including in the school setting • Statues describe the scope of practice for APRN, RN and LPN • Regulations describe implementation of scope of practice

15. School Nursing Laws • Unlicensed school personnel do not have a “scope of practice” and must be supervised • School nurses must know state’s nursing laws, nursing scope of practice, as well as education laws on providing school health services!

16. Local School Policy and Procedures • School Policy- a document that states how the school district will implement a statute and/or regulation • Provide support and directs protocols or procedures • Policies may protect schools, employees and/or students • School districts may subscribe to KY School Board Association (KSBA) policy writing service. Service provides template which district can “tweak”

17. Protocols/Procedures-step by step actions on implementing the related policy; may not require local board approval • Local school board policy/procedure must comply with the state’s stature (KRS) and/or administrative regulation (KAR) • Local Site Based Councils must comply with school board policy

18. Forms Standardized Kentucky School Forms • Preventative physical exam • Vision exam • Dental screening or Dental Exam • Immunization form • KY Sports Physical (KHSAA) School District Forms • Student Health History • Authorization for treatment

19. Contracted School Health Services • Some school district contract with an outside provider (LHD) for school health services • School district policies and procedures that have been established by the local school board of education govern all activities and staff that operate on all school properties • Contract between the school district and contracting agency needs to include language for compliance with school policies, procedures and school forms

20. Important People to Know • Superintendent- “CEO” for school district • Assistant Superintendent/Deputy Superintendent- Assists in district operations • Director of Pupil Personnel(DPP)- involved with student attendance, truancy, day to day operations of school district • District Health Coordinator-Responsible for oversight of all school health services, including necessary services for school sponsored functions

21. Important People to Know • School Principal- Building level school administrator • School Nurse – RN may be assigned to perform daily school nursing services, or may serve as role of School Health Coordinator. School nurse may also be an LPN, but must be supervised by an RN

22. Important People to Know • Community stakeholders – local health departments, hospitals, physician offices • FRYSC- Family Resource Youth Service Center Director

23. Important People to Know • School Health Technician- (2014) an unlicensed school employee hired for the purpose of assisting the RN in the administration of school health services and has completed all the training requirements per KRS 156.502 • Unlicensed school personnel- school employee who consents to be trained and delegated to provide a health service per KRS 156.502

24. Things to Remember • Schools must provide health services for student to be able to attend school or school sponsored function • KDE’s Health Services Webpage excellent resource for forms, laws, resource manuals, etc. http://education.ky.gov/districts/SHS/Pages/default.aspx

26. Resources • KDE Health Services Reference Guide http://education.ky.gov/districts/SHS/Pages/Health-Services-Reference-Guide.aspx • School District Policies & Procedures available at local school district central office (KSBA policy manual code for Students (09) • Kentucky Board of Nursing http://www.kbn.ky.gov/ • National Association for School Nurses (NASN) http://www.nasn.org/

27. Contact Information • Karen Erwin, KDE School Nurse Consultant Karen.Erwin@education.ky.gov • Sandi Clark, KY DPH School Health Nurse Consultant SandiK.Clark@ky.gov