In 2017–18, Florida’s pre-kindergarten through 12th grade student population numbered about 2.8 million students, residing in 67 counties that are geographically, socioeconomically and culturally diverse. Among this student population, there were 763,588 reported student health conditions, which included life-threatening allergies (41,409), asthma (198,413), cardiac conditions (14,563), diabetes (9,162), mental health conditions (25,420) and seizure disorders (21,189). Body mass index (BMI) screening results indicated that 363,621 (60.88 percent) of students were at a healthy weight, whereas, 205,359 (35.13 percent) had results at or above the 85th percentile (overweight and obese categories).

The Department’s School Health Program continued its statewide leadership to ensure the provision of health services and health education to children in all of Florida’s public and participating non-public schools. The program provided oversight and technical assistance to all 67 county School Health Programs, including county health departments, local education agencies, and their community partners, pursuant to Florida Statutes and Administrative Code.

Local county health departments, in collaboration with local education agencies and community partners, worked to ensure Florida’s pre-kindergarten through 12th grade students had access to health services that assess, protect, and promote their health and ability to achieve their individual potential. During 2017–18, the School Health Program performed 37 on-site programmatic monitoring visits, two vision service provider contract monitoring visits, and conducted four statewide programmatic conference calls.

The Department and the Florida Department of Education (DOE) partnered and promoted implementation of the Coordinated School Health approach in Florida public schools. The Bureau of Chronic Disease Prevention worked with DOE’s Office of Healthy Schools to support the Florida Partnership for Healthy Schools Healthy School District self-assessment and recognition program. As part of this collaboration, the School Health Program reviewed and scored the health services section of each county’s application. The Department and DOE's Bureau of Exceptional Education and Student Services collaborated on school entry immunization compliance activities and began planning for the development of an online training portal for registered school nurse trainings with continuing education that will launch in 2019.

In addition, the School Health Program continued to develop partnerships with the Florida School Health Association and the Florida Association of School Nurses and presented programmatic updates at their 2018 annual conferences. Also, the program continued its commitment to support the National Association of School Nurses (NASN) initiative, Every Student Counts, by preparing 2018–19 state-level data for a national standardized minimum dataset of key school health indicators.

Each year, the State Office’s School Health Services Program participates in monthly Walking School Bus events. During Walking School Bus events, adult volunteers ensure the safety of Florida students (kindergarten-12th grade) by walking them to school. This activity helps promote physical activity and wellness for students and Department staff alike.

Oral health is essential to general health and well-being. There is a strong correlation between poor oral health status and other systemic diseases, such as diabetes, heart disease, respiratory disease, stroke, and preterm and low-weight births. Tooth decay (dental caries) is a transmissible, infectious oral disease resulting from an imbalance of multiple risk factors and protective factors over time. Though the prevalence and severity of tooth decay has declined among school-aged children in recent years, it remains a significant problem in some populations, particularly among certain racial and ethnic groups and low-income children.

Dental caries (tooth decay) remain the most common preventable chronic infectious disease among young children and adolescents in the United States. Dental caries are five times more common than asthma. Nationally in 2016-2017, approximately 45.8 percent of youth age 2 to 19 had dental caries (untreated and treated decay) in their primary or permanent teeth. Among children age 6 to11, approximately 50.5 percent had dental caries and 15.3 percent had untreated decay, with rates for black and Hispanic children being higher than for white and Asian children. If dental decay is left untreated, it can cause pain and infection leading to problems with chewing, swallowing, speaking, and learning. These problems jeopardize children’s physical growth, self-esteem, and capacity to socialize.

Poor oral health is also associated with missing school and poor school performance. It is estimated that U.S. children miss more than 51 million school hours annually due to dental problems. Children with poor oral health are three times more likely to miss school and four times more likely to perform poorly when compared to their healthy counterparts. Additionally, parents miss on average 2.5 days from work per year due to their children’s dental problems.

A cost-effective way of preventing tooth decay are dental sealants. Dental sealants are thin protective coatings that adhere to the chewing surfaces of the back teeth (molars) and prevent the acid of leftover food particles from creating holes, or cavities, in the teeth. Dental sealants can prevent up to 80 percent of cavities and protect teeth for several years. While children with dental sealants have increased over time, low income children are 20 percent less likely to have them and are twice more likely to have untreated decay than high-income children. Barriers from receiving dental sealants or other dental care include the lack of access to dental services, dental care costs, and inadequate oral health literacy.

Oral health data are needed for ongoing surveillance, establishing the burden of oral health disease, and informing statewide programmatic planning efforts. To address the need for state level oral health surveillance data, the Department’s Public Health Dental Program (PHDP) has established a surveillance system for monitoring oral health status, risk factors, and access to dental services among various populations. The PHDP has completed surveillance projects on third grade children (2013-2014 and 2016-2017), Early Head Start and Head Start children (2014-2015 and 2017-2018), and older adults in congregate meal sites (2015-2016). The 2017-2018 Head Start children surveillance data is currently being analyzed and the PHDP will disseminate the results to its partners and the public.

Title V supported the continued development and enhancement of the Public Health Dental Program’s FLOSS Database. The two newest modules include the School-Based Sealant Program Module and the Oral Health Surveillance Module. The School-Based Sealant Program Module is used by all agencies and programs in Florida to enter aggregate data and information regarding their local programs on a yearly basis. The PHDP have collected data on the number of children served, schools visited, services provided, and other programmatic information during the 2016-2017 and 2017-2018 school years. The system is accessible by both internal and external partners and serves as the true statewide data warehouse for important public health dental measures for children. The Oral Health Surveillance Module is used to collect and validate data using the Basic Screening Survey Methodology, for populations such as preschool and school age children. The 2017-2018 Head Start Oral Health Screening Project used this new module for the first time to collect oral health indicators and consent form questions entered by external screeners in the field and then validated against paper records by PHDP staff. The PHDP will use the Oral Health Surveillance Module for the upcoming third grade and adolescent screening projects. Using the FLOSS database for this data collection and validation has reduced data entry errors and improved overall data quality. During SFY 2019-2020, Title V funding will continue to support development of the FLOSS database to improve functionality, enhance data quality and accuracy, and meet the dynamic business needs of the PHDP and FLOSS users.

The Department’s Public Health Dental Program released the Oral Health Status of Florida’s Third Grade Children 2016-2017 report.

Key Findings:

• Approximately one in four children (25.1 percent) had untreated decay.
  • The prevalence of untreated decay was highest for non-Hispanic black children (34.6 percent) and for children without any dental insurance (32.8 percent).
• Nearly half of children (45.5 percent) had dental caries (treated or untreated decay).

• More than half of children from schools with the highest percent of students enrolled in free/reduced lunch had caries experience (52.2 percent).
• Children reporting toothaches had the highest rate of dental caries experience (68.1 percent).

• Over a third of children (40.1 percent) had at least one dental sealant.
  • The prevalence of dental sealants was highest for children from schools with less than 25 percent of students enrolled in free/reduced lunch (52.5 percent).
• Early dental treatment need among Florida’s third grade population was 20.6 percent.
• Urgent dental treatment need among Florida’s third grade population was 3.0 percent.
• Children covered with private dental insurance had the lowest rate of each oral indicator of need and the highest rate of dental sealants compared to children who had Medicaid or no dental insurance.

Florida’s overall third grade population estimates are in alignment with the Healthy People 2020 goals related to the prevalence of untreated decay, dental caries, and dental sealants among children ages 6 to 9. (Table 1).

The Department works to make continued progress to improve access to preventive dental care for children in Florida. Continued collaborative partnerships with school-based dental programs to share information on evidence-based prevention and early intervention practices facilitates the promotion of oral disease prevention efforts starting in school-aged children.

To increase the percentage of parents who read to their young children, Title V funding was provided to county health departments through Schedule C and a statement of work, with an option to create a reading rich environment in waiting room areas such as a child’s reading table and chairs, a bookshelf, children’s books, etc. Funds were also available to establish a Reach Out and Read (ROR) program. ROR is an evidence-based early intervention model that encourages literacy and school readiness. ROR gives young children a foundation for success by incorporating books into pediatric care and encourages families to read aloud together. ROR medical providers encourage families to read aloud and engage with their infants, toddlers, and preschoolers every day. Additionally, medical providers give books to children at more than 10 well-child visits from infancy until they start school.

Literacy is a known factor impacting the social determinants of health. Healthy People 2020 includes school readiness and literacy in the early and middle childhood domains and objectives.

As recommended by the American Academy of Pediatrics, ROR incorporates early literacy into pediatric practice, equipping parents with tools and knowledge to ensure that their children are prepared to learn when they start school. Through this evidence-based intervention, parents learn new ways to stimulate their children’s literacy development, have more books in their home, and read to their children more. Parents are supported as their children’s first and most important teachers, and children are given a foundation for success.