DC Action's Testimony at the Public Hearing on the Public School Health Services Amendment Act of 2017
Testimony of Shana Bartley, Acting Executive Director
DC Action for Children
Public Hearing on the
B22-0027 Public School Health Services Amendment Act of 2017
Before the Committees on Education & Health
Council of the District of Columbia
March 23, 2017
Good afternoon, Chairman Grosso, Chairman Gray and members of the Committees on Education and Health. Thank you for the opportunity to testify on the proposed B22-0027 “Public Health Services Amendment Act of 2017.” My name is Shana Bartley, and I am acting executive director at DC Action for Children (DC Action).
For 25 years, DC Action has been the independent voice for children in the District. We provide data analysis and policy leadership on critical issues facing DC children and youth. We are also the home of DC KIDS COUNT, an online resource accessible to policymakers and community members alike that tracks key indicators of child well-being in the DC neighborhoods where children live learn and grow. We coordinate closely with District agencies, the public school system and service providers to share clear and actionable data and analysis.
In the second quarter of 2016, DC Action completed the School Health Needs Assessment (SHNA) on behalf of the DC Department of Health (DOH). In order to capture a thorough understanding of whether school health services are meeting the needs of students, we used both quantitative and qualitative analysis of utilization data from school nursing records, interviews with DC Agencies, school-based health center personnel and school leaders, and focus groups with students, parents and school nurses. As independent researchers, we gained many insights into school health services in the District; we have testified previously on the five recommendations to the Department of Health and other District agencies before at the public hearing on school health services in October of 2016. The full SHNA report may be found on our website. Our main takeaway—DC’s children have a variety of health needs and we need a school health program that can address those needs.
While we support the goals of this legislation, we do not believe that mandating a minimum of 40 hours of registered nursing coverage alone will improve outcomes for children. To see measurable improvements in children’s health in the District, we must implement a public health approach that embeds school health services in our pediatric system of care. School health providers are members of the health care team and must support care coordination and connections to medical homes. We were pleased to hear that DOH emphasized the importance of these two components by including care coordinators and health navigators in their new model. This approach puts the District at the forefront of innovation in school health services based on our conversations and survey of the school health services landscape around the country.
DC Action echoes many parents and other stakeholders’ sentiments in seeing the immense value of having nurses in schools. However, our research for the SHNA leads us to consider the vast range of public health components that encompass school health. According to the American Academy of Pediatrics, the role of the school includes critical components, “such as surveillance, chronic disease management, emergency preparedness, behavioral health assessment, ongoing health education, extensive case management, and much more.”
There is little doubt of the value and need for the level of skilled clinical care that RNs and LPNs provide in schools as over 13,000 DC students have asthma, and over 70% of all recorded special needs administrations by school nurses were for diabetic care. Given the need for high quality clinical care as well as public health functions, school nurses need the support of other trained health personnel to accomplish these goals. We spoke with school nurses and learned that their responsibilities are immense. A large portion of the school nurse’s day-to-day work, such as ensuring that all students have accurate and updated health forms or filing notes and other forms, is administrative in nature and takes time away from providing quality care to students.
In order to provide students with the highest level of care that best addresses their needs and connects them to primary care and medical homes in their communities, we feel that a RN’s hours in the school could be better leveraged if the legislation allows for school nurses to be supported by health professionals with less advanced skills such as certified nursing assistants. The utilization of certified nursing assistants would relieve a large share of the administrative burden from RNs so that they can better utilize their skilled expertise to provide high-quality care to students.
I would also like to take the opportunity to underscore two key findings and recommendations from our report that are key to the success of any model of school health services. First, the District needs a school advisory body to eliminate silos and improve collaboration across school health stakeholders. Second, there must be clearly defined roles and expectations of health professionals in schools. We feel that without incorporating these two recommendations, administrative and communication challenges with school health services will persist despite legislative efforts to increase mandatory coverage.
We envision a child-centered school health services program that ensures that every student in the District is healthy, safe and ready to learn. In order to achieve such positive health and education outcomes for all students, it is crucial that stakeholders across District agencies and other partner organizations authentically engage in clear, open and collaborative communication with one another. The Whole School, Whole Community, Whole Child (WSCC) model emphasizes the importance of this collaboration among stakeholders in health and education. Interviews for the SHNA revealed that leadership across school health services is not coordinated and that the roles and responsibilities of school health providers, especially those of the school nurse, are unclear for school leaders. In order to ensure that responsibilities are well-defined for all professionals working across sectors, our SHNA report recommends forming a school health advisory body that brings agencies and school leaders together at the same table. This body Not only would such a body facilitate the clarification of roles and responsibilities at the intra-school and inter-district level, but a school health advisory body would provide a space where advisory body members could openly share data, vet new ideas and collectively address pressure points in the system. Finally, a school health advisory body would also advance the objective the SHNA also identified in its recommendations section: facilitating continuous quality improvement processes for school health services. Such an advisory body could act as a forum where parents and others invested in school health could be invited to have their feedback heard and acted upon.
As enrollment in the District’s public education system continues to grow: the District of Columbia public education system served 85,403 children and youth between ages 3 and 18+ across two public education sectors and 19% of DC children and youth reported they were not in excellent or very good health, an increase from 17% in 2003, we affirm the chairmen’s call for ensuring all DC students have access to qualified health professionals in school.  Our SHNA report highlights that the school health services program is no one agency’s issue; it is our hope that all stakeholders involved authentically collaborate to determine what a child-centered school health services program that prioritizes quality services and improved health and education outcomes looks like and how it can be achieved in the District.
Thank you for the opportunity to testify today. We are happy to serve as a resource for the Committees on Education and Health in any way that we can.
 Role of the School Nurse in Providing School Health Services. (June 2016). American Academy of Pediatrics Council on School Health. Retrieved from: http://pediatrics.aappublications.org/content/137/6/e20160852
 Lessons Learned from the 2016 School Health Needs Assessment, 2016; p. 8. https://www.dcactionforchildren.org/sites/default/files/SHNA_Final_Report_9_2016.pdf
 Office of the State Superintendent of Education (2015). SY2014-15 enrollment audit. Retrieved from, http://osse.dc.gov/sites/default/files/dc/sites/osse/publication/attachments/Enrollment%20Audit_updated_2015_7_31.xlsx
 Data via National KIDS COUNT. Accessed at: http://datacenter.kidscount.org/data/tables/8824-children-who-are-not-in-excellent-or-very-good-health?loc=10&loct=3#detailed/3…