In 2020-2021, Florida’s pre-kindergarten through 12th grade student population fell to 2.77 million students distributed across 67 geographically, socioeconomically and culturally diverse school districts. Preliminary data from local school health programs shows 663,223 students with health conditions, which included 24,221 with severe (life threatening) allergies, 109,565 with asthma, 9,590 with cardiac conditions, 6,937 with diabetes, 26,135 with mental-behavioral health conditions, and 13,872 with seizure disorders. Results from 264,142 body mass index screenings reflect 153,083 (57.95%) students fell in the healthy weight range, 8,842 (3.35%) in the underweight range, 44,486 (16.84%) in the overweight range and 57,731 (21.86%) in the obese range.

The FDOH’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 2019-2020, the School Health Program performed 21 on- site programmatic monitoring visits, two vision service provider contract monitoring visits, and conducted four statewide programmatic conference calls.

The FDOH 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. For 2020 Florida Partnership for Healthy Schools recognized 51 existing, new and renewed districts as Florida’s Healthy School Districts 2020, 21 new school districts completed the self-assessment; previously recognized districts were given the option to extend their recognition for another  year due to COVID-19. The FDOH 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 launched 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 2019 annual conferences. Also, the program continued its commitment to support the National Association of School Nurses (NASN) initiative, Every Student Counts, by preparing 2020-202021 state-level data for a national standardized minimum dataset of key school health indicators.

Oral health is essential to general health and well-being.  Poor oral health status correlates with 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 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 impact children five times more than asthma. Nationally in 2015-2016, 45.8 percent of youth ages 2-19 experienced dental caries (untreated and treated decay) in their primary or permanent teeth. Among children ages 6-11, approximately 50.5 percent experienced dental caries and 15.3 percent suffered from untreated decay. Rates for  Black and Hispanic children being higher than for white and Asian children. If dental decay remains 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. Research 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. The objective is to reduce children receiving dental health service to 50.9 percent by 2026. 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 is 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 FDOH’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). In addition, PHDP worked with the Florida Dental Hygienists’ Association to evaluate previous surveillance projects among children using Title V to enhance the upcoming 2021-2022 Third Grade Project and 2022-2023 Adolescent Project.

Title V supported the continued development and enhancement of the Public Health Dental Program’s Florida’s Linked Oral Status System (FLOSS) Database which includes 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 providing services at schools in Florida to enter aggregate data and information regarding their local School-Based Sealant Programs on a yearly basis. The PHDP has collected data on the number of children served, schools visited, services provided, and other programmatic information during the 2016-2017, 2017-2018, 2018-2019, and 2019-2020 school years. The system is accessible by both the FDOH internal and non-FDOH 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 developed by the Association of State and Territorial Dental Directors, 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 dental hygienist 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 2020-2021, Title V funding has continued to support the 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.

Objective: By September 30, 2022, increase the number of school-based sealant programs (internal or external) completing annual reports in FLOSS from 51 programs (SFY 2019-2020) to 57 programs.

The FDOH’s Public Health Dental Program analyzed the 2017-2018 Head Start surveillance data and disseminated a report with the full results to our partners and the public.

Key Findings:

• Nearly one in four Head Start children aged 3-6 years (24.0%) had untreated decay.
• Non-Hispanic Black children (28.3%) had the highest prevalence of untreated decay.
• Approximately one third of Head Start children (34.3%) had dental caries (treated or untreated decay).
• Children aged 5-6 years (41.9%) had the highest rate of dental caries experience.
• One in five of Head Start children (20.8%) had an early dental treatment need.
• Uninsured children had a higher prevalence of untreated decay and a lower prevalence of treated decay than insured children (28.5% and 13.4% respectively).

Florida’s overall Head Start population estimates are above the Healthy People 2020 goals related to the prevalence of untreated decay and dental caries among children ages 3-5 years (Table 1). The oral health screenings did not capture dental sealants among Florida’s Head Start children because they do not have molars to be sealed.

The FDOH works to make continued progress to improve access to preventive dental care for children in Florida. Title V funding has been provided to county health departments through Schedule C to initiate and expand the provision of preventive services for children in Early Head Start, Head Start, Women Infant and Children (WIC), Early Learning Centers, and schools throughout Florida. Continued collaborative partnerships with School-Based Sealant programs to share information on evidence-based prevention and early intervention practices facilitates the promotion of oral disease prevention efforts starting in young 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. In 2020, 27.4 percent of parents read to their young children. The FDOH aims to increase the percentage of parents who read to their your children to 38.7 percent by 2026.

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.