Glossary

School Health

Access to a Regular Source of Medical Care:  A measure of the family’s ability to access medical services in a timely manner and in a geographically acceptable location.  Measures determining access include location of the health care facility, hours of operation, and appropriateness of the level of care.  For the purposes of the School Health Services Program, acceptable documentation would be that the school nurse documents in the student health record the name of the physician or clinic as supplied by that child’s parent or responsible party. 

Activities:  Descriptive steps of a program utilizing its resources or inputs. 

Asthma Action Plan (AAP):  Because an asthma episode can be serious, any child who currently or within the past year has taken asthma medication at home or at school, warrants and should have in place an asthma action plan.  The plan should include triggers, early warning signs, how to treat episodes, medications used, management and self–management strategies, communication with the parent/guardian and or health care provider, when to use emergency measures, and guidelines for safe participation in physical education as well as field trips.  The student, parent/guardian, teachers, and healthcare providers should be included in the development process.  The plan is to be developed by a Registered Nurse and signed by the parent/guardian.

Barrier:  Something that acts to hinder or restrict a contractor’s ability to reach the projected short-term outcome.

Baseline:  As it pertains to this program, a baseline is the actual percent and number for a measure as of March 31 of the current contract year. 

Case Management:  Duties that include communication with families, students, other school staff, and community health care providers about a student health concern.  For children with special health care needs, case management involves the development of an Individualized Healthcare Plan (IHP) designed to maximize the student’s learning potential. The school nurse develops the IHP with input from the student, the student’s family, physician (when appropriate), and other school staff.

Consortium:  For the purpose of this School Health Services contract, a contract consisting of one agency designated as the Contractor (fiscal agent) and one or more collaborating agencies is called a consortium.  A Memorandum of Agreement between collaborating agencies must be submitted during contract application.  A fiscal agent must be designated.  The fiscal agent will be the administrator signing the contract.  During a contract year, if the fiscal agent changes, all collaborating agencies must sign a letter of agreement to transfer the fiscal responsibility for the contract to another responsible party.  A copy of that agreement must be sent to the Department.  If a collaborating agency desires to withdraw from a contract, a letter of explanation must be forwarded to the Department of Health and Senior Services.  Any deletion of school districts, or private and parochial schools in current contract will affect amount of funding available to current contractor.  Funding has been calculated on a per-student cost, and the funding follows the students.

Children with Special Health Care Needs:  Children meet this description of eligibility when they require health and related services at a type or amount beyond that generally required by children because they have or are at increased risk of chronic physical, developmental, behavioral, or emotional condition.  This is not limited to those who would meet the Department of Health and Senior Services, Bureau of Special Health Care Needs program eligibility criteria.  Examples:   Children who have or are suspected of having the following conditions:

• Chronic otitis media;
• Behavioral problems such as Attention Deficit Disorder (ADD);
• Learning disabilities;
• Delayed speech development;
• Weight for height inappropriate for age;
• Chronic infections;
• Asthma;
• Heart defects or conditions;
• Scoliosis;
• Diabetes;
• Seizures;
• Genetic conditions; and
• Other conditions which require health and related services at a type and amount beyond that required by children generally.

Chronic Conditions:  Any physical or mental condiditon that requires long term monitoring and/or management to control sysmptoms and to shape the course of the disease.  The term refers to any condition that meets the following criteria: 1) relative permanence; 2) lasts at least 6 months; 3) requires special training of the client or those who provide the client’s care; 4) is caused by a non reversible pathological alteration; 5) is usually not curable by short-term treatment; and 6) is often characterized by remission and exacerbations.

Completion Target date:  The date on which you plan to accomplish the activity outlined in a work plan in effort to meet or exceed the short-term goal percentage. 

Comprehensive Physical Exam (Well Child Checkup):  This is a preventive health examination of an apparently well child or adolescent. It is not an office visit when the child is ill or injured and needs to be treated. 

Coordinated School Health Program/framework (CSH):  A coordinated approach to school health enlists all the resources of a school and its community to improve student’s health and learning and organizes them so that they work together in a systematic way.  A coordinated school health program has eight components:

• Comprehensive school health education;
• Physical education;
• School health services;
• School nutrition services;
• School counseling, psychological and social services;
• Healthy school environment;
• School site health promotion for staff; and
• Family and community involvement.

Dental Exam vs. Dental Screening: 

• Dental Screening Program (school-based):  Dental screening is designed to detect early dental or oral health problems of children.  It provides baseline information so referrals and periodic evaluations may be made.  However, dental screening is not a replacement for a complete examination in a dentist’s office.  Inspections or screenings that can be done in a school setting include looking for the presence of dental caries (tooth decay), periodontal disease (inflammation of the gums and supporting structures), malocclusion (irregularity of the teeth and jaw), and trauma from oral injuries. 
  
  School Nurses using a tongue blade and adequate illumination (e.g., penlight) can detect tooth decay and gum problems (e.g., mild gingivitis) and refer the child to a dentist.  However, x-rays are necessary to detect interproximal caries in the early stages.

• Dental Exam:  A detailed, comprehensive oral assessment completed by a dentist under appropriate conditions for purposes of diagnosis and treatment.

Effective Skills-based Curriculum:  Curriculum that has been evaluated and demonstrated to show changes in behavioral intentions, e.g., programs evaluated by Centers for Disease Control (CDC), and acknowledged as “Programs that Work.”  Qualities of these programs include:

• Use of trained instructors;
• Presentation of basic, comprehensive and scientifically accurate information;
• Employment of multiple teaching strategies;
• Activities that address social pressures, including media, and presented over five or more classroom sessions;
• Reinforcement of clear and appropriate messages to strengthen individual values and group norms; and
• Involvement of more than single assemblies and guest speakers.

Emergency Action Plan (EAP):  For students who have the potential for a medical emergency during the school day, a plan must be developed to assist school personnel in recognizing and providing appropriate intervention during the crisis. The emergency plan can be part of the Individualized Healthcare Plan (IHP), or may be drafted separately from the IHP so that it can be readily shared with appropriate school personnel, e.g., classroom teacher, cafeteria director, coach, transportation personnel.  The Emergency Action Plan is to be developed by a Registered Nurse and renewed at a minimum annually.

External Fluoride Application:  Topical fluoride application utilizing fluoride varnish every six months or a liquid fluoride mouthrinse program weekly.

Healthcare Action Plan (HAP):  A plan individualized for a student with significant special needs and requiring specialized procedures.  The plan serves as a written agreement with the student’s parent/guardian, health care provider, and school personnel.  The plan outlines how the district intends to meet the individual student’s health care needs and is based upon the medical diagnosis.

Individualized Healthcare Plan (IHP):  This is a nursing care plan that has student-centered goals and objectives, and describes the nursing interventions designed to meet the student’s short and long-term goals.  IHPs are useful when the nurse is assisting the student to:

• Become better educated about their special health care need;
• Develop more self-care activities;
• Address health-related absenteeism; and
• Cope more effectively with their condition/disease.

The student, parent/guardian, and/or health care provider should be involved in the development of the IHP.  The IHP may be considered a contract between the student, the family and the nurse in order to accomplish specific outcomes for the student.  Not all students with a special health care need will require an IHP, only those with whom the nurse or an Unlicensed Assistive Personnel provides significant intervention, has health needs addressed on a daily basis, or as part of their Individualized Education Plan (IEP) or 504 plan.  Medications are a special health care need, but only those students requiring medication administration that cannot be delegated (oral meds that require nursing assessment before administration, or requiring alternative routes of administration, i.e., injectables) would require a written plan.

Infrastructure:  The basic facilities, equipment, and installations needed for the functioning of a system or organization.

Infrastructure Building:  Developing an underlying foundation or base for an organization (school district) evidenced by assessment and policy-making activities associated with School Health Advisory Council and School Health Index, program planning using best practices, evaluations using logic models and strengthened relationships with Local Public Health Agencies and community-based agencies.

Inputs:  Resources a program uses to achieve program objectives.  Examples are staff, volunteers, facilities, equipment, curricula, and money.  A program uses inputs to support activities.

Justification:  To demonstrate good reason for:  when the short-term outcome percentage is missed, comments describing the barriers encountered, and corrective actions planned in an effort to meet the projected outcome percentage.

Local Public Health Agency (LPHA):  Local county health department.

Medicaid Eligible:  “Medicaid eligible” is defined as “enrolled.”  Students in need of financial assistance for health care needs should be referred for Medicaid eligibility determination. 

Medical Home:  Primary and preventive health care that is accessible, continuous, comprehensive, family centered and coordinated, and directed by an appropriately trained and licensed health care professional.

Memorandum of Agreement (MOA):  A formal agreement between separate entities, of which one will be the lead agency (must be a local public school district or health department), to provide and receive services or funding for services, and ensuring participation in and reporting of required activities of the School Health Services program.

Outcome measures:  A measure of change-the difference from one point in time (usually before the intervention) to another point in time (usually following the intervention).  It is important for school nurses to identify what they do (nursing interventions) in response to various student conditions (nursing diagnoses) and to note the specific effects of those interventions (nursing outcomes).

Outcomes:  Benefits for participants during or after their involvement with a program.  Outcomes may relate to knowledge, skills, attitudes, values, behavior, condition, or status.

Output:  Products of a program’s activities, such as the number of classes taught, brochures distributed, or participants served.  A program’s outputs should lead to the desired outcomes for the program’s participants  (i.e. 324 completed student health inventories returned).

Persistent asthma:  Students who take daily asthma medication or have asthma symptoms two or more times a week.  Criteria for Adequately Controlled Asthma:

• Free from asthma symptoms (no coughing, wheezing, breathing difficulty, chest tightness, night wakening) or have only minor symptoms due to asthma;
• Go to school every day, unhampered by asthma;
• Participate fully in regular school activities;
• Have no bothersome side effects from medications;
• Have no emergency room or hospital visits for asthma;
• Have no missed class time for asthma-related interventions or missed class time is minimized.

Preventive Services:  Activities aimed at reducing the incidence of health problems or disease prevalence in the community, or the personal risk factors for such diseases or conditions.

Referral:  A component of the nursing process whereby, after a nursing assessment has been conducted and a nursing diagnosis made, the school nurse reaches a conclusion, and communicates this conclusion to the student and his or her parent/guardian to identify options for accessing the community health care system.  In making the referral, the school nurse determines whether or not services are accessible and acceptable to the student and family. The nurse considers distance, transportation, culture, language, previous health history, previous screening results, cost of care, and wait time and elicits past practices and satisfication with the needed service from the family.

Referral Completion:  Referral is determined as complete once the parent/guardian has entered the child into the health care system, i.e. child goes to an appointment and is evaluated by a health care provider, the child receives professional evaluation, and the problem is resolved to the extent possible.

School Health Advisory Council (SHAC):  A School Health Advisory Council (SHAC) is an on-going advisory group composed primarily of individuals selected from segments of the community. The group acts collectively in providing advice to the school district about aspects of the school health program. Generally, members of a SHAC are appointed by the school district to advise the school district. The School Health Services contract requires that one member of the SHAC must be from the local public health department.

School Health Index (SHI) for Asthma, Physical Activity, Healthy Eating, and a Tobacco-Free Use Prevention, and Safety Policies and Programs:  This is a self-assessment and planning guide developed by the Centers for Disease Control and Prevention (CDC) that will enable schools to:

• Identify the strengths and weaknesses of your school’s health promotion policies and programs;
• Develop an action plan for improving student health; and
• Involve teachers, parents, students and the community in improving school policies, programs, and services.

School Health Record:  According to Schwab and Gelfman (2001) in Legal Issues In School Health Services, the school health record is considered part of an educational record, and is maintained at school.

Services to non-public school age children:  As stated in HB564, health services offered to public school age children must be offered to non-public school age children within the jurisdiction of the School Health Services contractor.  Contractors are expected to document outreach efforts.  Examples of outreach efforts may include notification of services by newspaper articles, radio and/or television announcements, newsletters, flyers, SHAC meeting announcements, personal or telephone contacts.    

Severe Allergic Reaction:  An episode that may be triggered by an insect bite, drug allergy, food allergy or asthma that results in an anaphylaxis event that requires immediate life-saving actions.  Symptoms may include difficulty breathing, wheezing, throat tightness, tongue swelling, airway obstruction, difficulty speaking, fearful appearance, pale or dusky coloration.  Life-saving actions include calling 911 and use of epinephrine (auto injectible device) if available.

Special Health Care Need:  Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that required by children generally.

Supplanting:  The use of funds from this contract to fund activities that are already funded from another source, including local funding.  School Health Services contract funding cannot be used to pay for services required by federal or state laws, or pay for any services for a school-age child eligible for Medicaid.

Social Worker:  The School Health Services contract recognizes the definition from RSMo 337.604, as follows:

"Title of social worker, requirements to use title.

1.  No person shall hold himself or herself out to be a “social worker” unless such person has:

(1)  Received a baccalaureate or master degree in social work from an accredited social work program approved by the council on social work education;

(2)  Received a doctorate or Ph.D. in social work; or

(3)  A current baccalaureate or clinical social worker license as set forth in sections 337.600 to 337.689.

2.  No government entities, public or private agencies or organizations in the state shall us the title “social worker” or any form of the title for volunteer or employment positions or within contracts for services, documents, manuals, or reference material effective January 1, 2004, unless the volunteers or employees in those positions meet the criteria set forth in subdivision (8) of section 337.600 or subsection 1 of this section."

Social Worker Report:  Cumulative report of the efforts of all social workers employed by the School Health Services contractor which is to be completed and submitted on January 15 and June 15.

Technology Dependent:  Needing ventilators, oxygen, tracheostomy tubes, feeding tubes, etc to maintain or improve functional capabilities.

Warrant:  To justify or call for; deserve based on criteria provided in school health program guidelines.

Work Plan: A contractor's Work Plan establishes the short-term outcome as a percent and a number. The Work Plan describes the activities that will take place during the year including the person(s) responsible and the targeted date of completion to ensure the short-term outcome is accomplished.