AISD Annual Report Executive Summary

Children’s/AISD
Student Health Services
School Health Advisory Council
April 6, 2016
Director
Sally Freeman, MSN, RN, NCSN
Medical Director
Stephen Pont, MD, MPH, FAAP
Quality Improvement Consultant
Susan Millea, PhD
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How Did AISD Partnership Begin?
• In 1995, AISD considered eliminating school nurses due to
economic challenges
• Hospital system & community voiced concerns regarding
increased ED visits & associated costs
• Innovative model in which non-profit hospital system
contracts with school district to provide student health
services began
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AISD Student Health Services
• Seton Healthcare Family contracts with Austin ISD for the
provision of student health services.
• Staff include medical director, nursing director, clinical
managers, school nurses, & school health assistants.
• Each campus has a Registered Nurse who functions as the
leader and coordinator of the student health services team.
• Additional support provided by nurse managers, nursing
director & medical director to promote health, wellness, &
safety.
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Student Health Services
Organizational Chart
Medical Director
Dr. Stephen Pont
Director
Sally Freeman
Nurse Educator
Detra Gentry
Assistant Director,
Comprehensive Health
Tracy Spinner, M. Ed
Department Assistant
Carley McCaw
Clinical Manager
Anne Cady
Clinical Manager
Jenifer Hernandez
Clinical Manager
Laura Cotton
21 Registered Nurses
21 School Health Assistants
21 Registered Nurses
21 School Health Assistants
21 Registered Nurses
21 School Health Assistants
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Acuity Methodology
• Annual analysis to determine number of Registered Nurse & School health
Assistant hours each campus will receive
• Schools have option to use local funds to increase Student Health Services
hours at their campus
• Criteria for acuity methodology:
– 30% School enrollment,
– 10% Economically Disadvantaged
– 30% Number of students with medical procedures, complex medical
conditions
– 15% Special needs classrooms (PPCD, Pre-K, SBS, PRS)
– 10% Illness, injury encounters from previous year
– 5%
Medication administration
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Multiyear Direct Health Contact Rate
Multiyear Direct Health Contact Rate per Student
Total Contacts SY 2014-15: 519,603
Total Enrollment SY 2014-15: 84,591
(Screenings, Immunization, Teaching, Ill/Injured Contacts,
Medication, Case Management)
1st Qtr
2nd Qtr
7.00
3rd Qtr
6.50
4th Qtr
6.00
5.50
5.00
SY 2009-10
SY 2010-11
SY 2011-12
SY 2012-13
SY 2013-14
SY 2014-15
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Return to Class Rate
Multiyear Comparison of Cumulative Outcomes for Students
Seen for Illness or Injury
% Return to Class
% Dismissed According to Protocol
% Dismissed Against Protocol
% Other, NOT Dismissed by SHS
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
2010-11
2011-12
2012-13
2013-14
2014-15
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Return to Class Rate
Proportion of All Dismissals Which were
Against Student Health Services Protocol
SY 2014-15 Count of Dismissals Against Protocol: 3526
20.0%
15.0%
10.0%
5.0%
0.0%
2010-11
2011-12
2012-13
2013-14
2014-15
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Prevention
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Prevention: Immunization
Percent of Campuses Achieving
95% Immunization Compliance
(Based on December DSHS Immunization Report)
100%
80%
40%
20%
0%
Data Unavailable
60%
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Reportable Communicable Diseases
Multiyear Trend of Vaccine Preventable
Communicable Diseases
Varicella (Chickenpox)
Pertussis
80
70
60
50
40
30
20
10
0
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
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Childhood Obesity: Cardiovascular
Middle School
SY 2007-08
Cardiovascular
42% HEALTH RISK
Source:
AISD Fitness tracking
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Childhood Obesity: Cardiovascular
Middle School
SY 2009-10
Cardiovascular
32% HEALTH RISK
Source:
AISD Fitness tracking
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Childhood Obesity: Cardiovascular
Middle School
SY 2013-14
Cardiovascular*
29% HEALTH RISK
SY 2014-15
33% HEALTH RISK
*metric changed from
SY 2009-10
Source:
AISD Fitness tracking
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Childhood Obesity: Body Mass Index (BMI)
Middle School
SY 2007-08
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
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Childhood Obesity: Body Mass Index (BMI)
Middle School
SY 2009-10
BMI
18% Overweight
15% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
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Childhood Obesity: Body Mass Index (BMI)
Middle School
SY 2007-08
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Middle School
SY 2013-14
BMI
17% Overweight
15% Obese
4% Severely Obese
36% HEALTH RISK
Middle School
SY 2014-15
BMI
17% Overweight
16% Obese
5% Severely Obese
38% HEALTH RISK
Source:
AISD Fitnesstracking
Source:
AISD Fitnesstracking
Source:
AISD Fitnesstracking
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Health Case Management
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Breathing Difficulty:
School Outcomes
Multiyear Return to Class Rate Following Breathing Difficulty
for Students With/Without Care Plan
Asthma Diagnosis with Care Plan
No Diagnosis/No Care Plan
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
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Breathing Difficulty:
Health Outcomes
Multiyear Health Outcomes
Following Breathing Difficulty for
Students with Asthma Diagnosis
and Care Plan
2010-11
2011-12
2013-14
2014-15
Multiyear Health Outcomes
Following Breathing Difficulty for
Students with No Asthma
Diagnosis/Care Plan
2012-13
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
2010-11
2011-12
2013-14
2014-15
2012-13
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
Medical
Referral
EMS Contact EMS Transport
Medical
Referral
EMS Contact EMS Transport
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Diabetes Case Management
Multiyear Trend of Total Diabetic
Health Contacts
Multiyear Trend of Diabetic
Health Contacts per Diagnosed
Student Receiving Case
Management
(SY 2014-15 N=133 Diabetic Students)
20000
200
16000
(SY 2014-15, 130 Diabetic Students)
16887
12000
150
8000
100
4000
50
0
0
130
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Student Pregnancy Rate
AISD Student Pregnancy Rate
per 1000 Females Enrolled Grades 9-12
50.0
40.0
44.8
40.6
37.4
32.1
30.0
21.6
24.4
20.0
10.0
0.0
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
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Middle School Pregnancy Count
Multiyear Trend of Middle School Pregnancies (Grades 6-8)
45
40
35
30
25
20
15
10
5
0
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
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Student Pregnancies by Trimester
Multiyear Trend of Student Pregnancies by Trimester at
Identification
% 1st Trimester
%2nd Trimester
% 3rd Trimester
Post Partum
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
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Health Incidents
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Health Incident Rate
• Lorem
ipsum Trend
dolorofsit amet,
Multiyear
Health Incidents
consectetur
adipiscing elit.
per 100 Students Enrolled
– Utof lorem
mauris,
tempus
Count
Incidents
SY 2014-15:
1272,sed
Student
Incidents:
1217
ante
non,
euismod
euismod
All Incident Reports
nunc.
Student Incident Reports
2.0
1.5
• In faucibus mattis commodo.
Quisque porta magna a
purus posuere, pretium
finibus augue dignissim.
1.0
0.5
0.0
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
An incident is typically an
illness or injury that does or
potentially could involve
emergency response
measures. Examples:
• Asthma attack that does not
respond to the care plan
• Playground fall resulting in a bone
fracture
• EMS is contacted whenever
medications such as diazepam or
epinephrine are administered
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Health Incidents: Illness v. Injury
Multiyear Comparison of Illness and Injury Incidents,
Count by Academic Level
2010-11
2011-12
*2012-13
2013-14
2014-15
600
500
400
300
200
100
0
Illness
Injury
All Elementary Schools
Illness
Injury
All Middle Schools (Gr. 6-8)
Illness
Injury
All High Schools
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Behavioral Health Incidents
Multiyear Count of Behavioral Health Incidents
by Academic Level and Type
2010-11
2011-12
*2012-13
2013-14
2014-15
355
305
255
205
155
105
55
5
Aggression
Injuries
Substance Abuse
All Elementary Schools
Aggression
Injuries
Substance Abuse
All Middle Schools
(Grades 6-8)
Aggression
Injuries
Substance Abuse
All High Schools
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% Health Incidents with Aggression
Multiyear Comparison of Injury Incidents Involving Aggression, as a
Percent of all Injury Incidents, by Academic Level
(SY 2014-15, Injuries=981, Aggression Injuries=465)
2008-09
2009-10
2010-11
2011-12
*2012-13
2013-14
2014-15
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
All Elementary Schools
All Middle Schools
(*Grades 6-8)
All High Schools
TOTAL
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Children’s Health Express
Calendar Year 2015
1,121 Health Encounters
70% Uninsured
30% Medicaid
Pregnant/Parenting
Students
Crockett
Travis
Lanier
Reagan
Eastside Memorial
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Customer Satisfaction
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Principal Satisfaction
Multiyear Comparison of Principal Satisfaction with RNs
(Percent of Maximum Value Using 5 Point Likert Scale)
SY 2014-15 N=41
SY 2010-11
SY 2011-12
SY 2012-13
SY 2013-14
2014-15
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Communication Works well with Treats students, Promotes a
Health room is
is complete,
school staff
staff, parents healthy and safe well organized
appropriate,
respectfully
lifestyle
timely
Same staff
person is
requested for
next year
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AISD Staff Satisfaction with Health Team
Multiyear Comparison of AISD Staff Satisfaction with Health Staff
(Percent of Max Value Using 5 Point Likert Scale, SY 2014-15 N=58)
SY 2010-11
SY 2011-12
SY 2012-13
SY 2013-14
2014-15
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
School RN
SHA
communicates communicates
well
well
RN provides
training
RN treats staff SHA treats staff I can depend on I can depend on
with dignity and with dignity and
my RN
my SHA
respect
respect
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AISD Staff Satisfaction with Training
Multiyear Comparison of AISD Staff Satisfaction with Quick Care
Training
(Percent of Max Value Using 3 Point Likert Scale, SY 2014-15 N=58)
SY 2009-10
SY 2010-11
SY 2011-12
SY 2012-13
SY 2013-14
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Content Relevant
Teaching Methods
Effective
Adequate time spent on Learning Center format
each topic
was effective
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2014-2015 Successes
– 12 Campus Based Counseling Referral Centers
– Sports physicals to 800+ students
– Kid Vision for Life Van
– Epi-pens in Schools Program
– Hospital based school at Dell Children’s
– Educational offering on Trauma Informed Care
– Ebola protocols & training
– Facilitate continuum of care for students with asthma, behavioral health and other
chronic health issues
– Gift of HealthTeacher
– 15 Nationally Certified School Nurses
– Sally Freeman presented overview of AISD Health Services to Healthy Schools Campaign
in Chicago, IL and annual National Association of School Nurses meeting
– Dr. Pont appointed inaugural faculty in the Pediatric Department of UT Austin/Dell
Medical School
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Value Add Benefits
• Consultation & guidance during communicable disease outbreak
such as H1N1
• EpiPens in Schools program
• Ongoing education & support to RNs & SHAs by pediatric medical
experts affiliated with Dell Children’s Medical Center
• Provide office space at Dell Children’s Medical Center for leadership
team
• Human resources support including hiring, licensure verification
• Immediate access to subspecialist consultation at Dell Children’s
Medical Center
• Annual AISD sports physicals for underserved athletes
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Next Steps
• Telemedicine
• Medicaid Delivery System Reform Incentive Payment (DSRIP)
• Campus Based Counseling Referral Centers (CBCRCs)
• Healthy Schools Flu Campaign Expansion to all AISD ES, MS
• Community Asthma Initiative
Questions?
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