The School Health Services Program will continue to fulfill statutory, regulatory, and FDOH mandates to ensure the provision of school health services to children in all of Florida’s public and participating nonpublic schools. County health departments, in cooperation with local education agencies and other partners, will work to ensure Florida’s 2.8 million pre-kindergarten through 12th grade students have access to health services that assess, protect, and promote their health and ability to learn.

School health services provided in all public schools include: nursing assessments; student health record reviews to ensure physical exam and immunization requirements meet statutory requirements; health services for chronic or complex health conditions requiring school-day management; first aid; medication administration; screening, referral and follow-up for vision, hearing, scoliosis and growth and development; preventive oral health programs; healthy lifestyle nursing interventions; emergency health services; health education classes; parent and staff consultations on student health issues; case management; and consultation for placement of students in exceptional student education programs. In addition, schools designated as Comprehensive or Full-Service schools by local programs receive additional services which address many social determinants of students’ health which impact educational achievement. County School Health Programs led by registered school nurses address health disparities and work to meet student and family needs every day (NASN, 2016).

The School Health Services program was awarded a one-million-dollar grant for the 2020-2021 school year under the Substance Abuse and Mental Health Services Administration (SAMHSA) to implement evidence trauma based mental health training in schools affected by Hurricane Michael including the counties: Jackson, Calhoun, Liberty, Bay, Gulf and Gadsden. The School Health Services Program  in collaboration with the National Center for School Mental Health at the College of Medicine of the University of Maryland provides  evidence-based curriculum. The effectiveness of the training will be evaluated by the SHAPE system, a program developed by the National Center for School Mental Health to determine the effectiveness of mental health services in schools. SAMHSA  has asked that Florida lead the regional monthly technical assistance calls and has asked the School Health Services program to extend their services to other counties, which they have already started by including Escambia County.

The FDOH’s School Health Services Program will continue to develop collaborative partnerships with the Florida Department of Education (DOE) Office of Healthy Schools, DOE Office of Safe Schools, Bureau of Exceptional Education and Student Services (BEESS), Florida Partnership for Healthy Schools. These partnerships promote implementation of the CDC’s Whole School, Whole Community, Whole Child (WSCC) model in Florida’s school districts and provide professional development for registered school nurses. The WSCC model is an evidence-based approach to advance the development of state, district, and school infrastructures which promote and maintain health and wellness for students, families, communities and school staff, and support student academic achievement. The School Health Advisory Committee (SHAC), a statutory requirement for each county School Health Program, is an important vehicle for counties to develop their WSCC models. However, gaining and maintaining SHAC representation from all 10 components of the WSCC model is an ongoing challenge for most county School Health Programs. The School Health Program will continue to address this need offering SHAC related updates and SHAC development content during its 2021-22 monthly conference calls. Also, SHAC development will continue to be a primary focus of school health liaisons during on-site program monitoring meetings with county School Health Program staff.

The School Health Services Program will continue to work with DOE to advance the Partnership’s Florida Healthy School District self- assessment and recognition program. In addition, the School Health Program will educate county school health programs on the requirements, application process and benefits of becoming a Florida Healthy District on at least one programmatic statewide conference call and during county School Health Services Program on-site program monitoring meetings during the 2021-22– school year. The School Health Services program will also partner with the Department of Education in developing a new Florida Healthy Schools website. These activities will support Objective 3 to increase the number of Florida school districts that apply for recognition as a Florida Healthy District for the 2021-22-application period.

The Florida Healthy School District Self-Assessment Tool was developed by experts from state agencies, school districts and community partners to assist school districts achieve the highest standards related to the CDC’s Coordinated School Health and WSCC models, based on district infrastructure, policy, programs, and practices identified from national and state guidelines, best practices and Florida Statutes. This planning tool helps school districts assess and determine current status and what they could do to remove health-related barriers to learning as they work towards recognition as a Florida Healthy District. Districts are encouraged to include school superintendents, school boards, school administrators, school nurses, component area experts, parents, and the SHAC in the assessment process.

The School Health Services Program will promote school nurses’ use of the Healthy Lifestyle Intervention by educating county School Health Programs about the Healthy Lifestyle Individualized Healthcare Plan and coding this service in the FDOH’s data system. This training will be provided on at least one programmatic statewide conference call and will be a focus of liaisons’ on-site program monitoring meetings with county School Health Program staff during the 2019–20 school year. These activities will support Objectives 1 and 2.

Challenges:

• Florida’s registered school nurse to student ratio is 1 to 2,476 (2019-2020); whereas the National Association of School Nurses (NASN), American Academy of Pediatrics and American Academy of Nursing recommend one professional registered school nurse for every school, all day, every day. Inadequate registered nursing staff limits the ability to organize and conduct health education classes, wellness promotion activities and additional registered nursing services such as Healthy Lifestyle Interventions.
• There are an estimated 331,182 children or 7.6 percent of Florida’s children under the age of 19 uninsured according to the United States Census Bureau Small Area Health Insurance Estimates (2018). For many students, the registered school nurse is the only licensed healthcare professional to which they have access, including for clinical guidance and support to practice a healthy lifestyle.
• The shift in community primary care services from county health departments to other healthcare providers, such as federally qualified health centers, presents challenges to ensuring students in need of follow-up care receive necessary services.
• School district prioritization of academic and standardized testing schedules presents ongoing challenges to including student health promotion activities during the school day, such as health education and additional initiatives to increase student physical activity.
• The School Health Services Program was limited to being able to educate and monitor counties due to the COVID-19 pandemic.

Title V funding has been consistently used to establish new School-Based Sealant Programs (S-BSPs) in Florida as well as expand existing sustainable programs to serve more children. These evidence-based programs increase access and reduce barriers to preventive dental care for low-income children in Title I schools, Early Head Start (EHS), Head Start (HS), Early Learning Coalition (ELC) centers, and Women Infant and Child (WIC) sites.   During SFY 2019-2020, the FDOH used Title V to provide funding for the expansion of twelve S-BSPs in counties with high unmet needs due a lack of dental providers, transportation barriers and low social economic factors influencing access to care. These expansion programs were Bay, Calhoun/Liberty, Charlotte, Clay, Hendry/Glades, Highlands, Jackson, Nassau, Orange, Polk, Wakulla and Walton. These S-BSPs provided preventive services to children in EHS, HS, WIC and ELC children. Final data reveal the twelve counties funded by Title V provided services to 9,606 children including 9,734 screenings/assessments, 10,861 dental sealants, 10,084 fluoride varnish applications, and 9,689 oral health instructions during SFY 2019-2020. For SFY 2020-2021, Title V funded eight counties to expand their programs to reach additional schools and children. These counties were Baker, Broward, Columbia, Leon, Okeechobee, Palm Beach, Pinellas and Putnam. Title V funding will continue to fund the expansion of existing programs for SFY 2021-2022. It is anticipated that ten existing programs will receive funding during SFY 2020-2021.

To promote S-BSPs to children and increase positive consent rates from parents, the PHDP produced and disseminated a postcard explaining dental sealants and their effectiveness in preventing tooth decay to each of the new programs, utilizing Title V funding. The postcards incorporate best practices for health literacy and implementation of healthy oral health behaviors in second and third grade children, the target population of the S-BSPs. The postcard encourages discussion of improved oral hygiene, specifically the benefits of dental sealants, between teachers, children and their parents or guardians. Along with the postcard, the PHDP purchased educational workbooks which align with statewide tests. These workbooks provide education on maintaining good oral health and encourage the discussion with parents on promoting oral hygiene in the home. The PHDP will continue to provide Florida S-BSPs with quality improvement and assurance guidance, technical assistance and training to ensure local program efficiencies and increased capacity of children served through these programs.
 

The MCH Section has also partnered with the Violence and Injury Prevention Section and Children's Medical Services to develop and implement a statewide comprehensive drowning prevention campaign.  Various media assets have been developed and will be distributed in the coming year.

The PHDP will continue to partner with other state agencies and not-for-profit organizations, such as Oral Health Florida, to plan and implement programs to benefit the oral health needs of children and families. The PHDP actively participates on various Oral Health Florida action teams (committees) and the leadership council to support initiatives to increase oral health services for children and families in Florida. In 2018 the PHDP received the Centers for Disease Control and Prevention’s (CDC) State Actions to Improve Oral Health Outcomes 5-year grant in support of oral health promotion and disease control. As part of the grant, the PHDP partnered with Oral Health Florida’s School Health Action Team to establish a Sealant Work Group for improving the sustainability of S-BSPs. The Sealant Work Group will address the quality of S-BSP services by facilitating meetings and conducting regional trainings to assist S-BSPs with improving their sustainability and increasing the number of children served and preventive services provided. The PHDP will also use the CDC Grant to potentially provide additional funding to seven S-BSPs to expand their reach and improve their programs. Working with county health department dental programs, federally qualified health centers, and local oral health coalitions across the state, preventive services will continue to be provided to low income children in Title I Schools, EHS, HS, ELC, and WIC sites. Providing services to children in school settings eliminates many barriers that impact access to dental care. S-BSPs are supported and enhanced by Title V funding and make it possible to reach high-risk children in need of dental services and improve dental outcomes for children in the state.

During the coming year, the PHDP will continue to increase statewide data capacity and serve as the state’s S-BSP data warehouse across all agencies through the FLOSS Database. Participation in the FLOSS database, especially for outside entities, will be encouraged through the Sealant Work Group of Oral Health Florida’s School Health Action Team. In addition, the PHDP  will be obtaining consent from schools to participate in the 2021-2022 Third Grade Oral Screening Project, which will collect data using FLOSS.

To increase the percentage of parents who read to their young children, Title V funding will continue to be available 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 may also be used to establish a Reach Out and Read (ROR) program.

In April 2018, Florida Children’s Council released a statewide report that finds current policies adversely impact Florida’s low-income families. With more than four million children and youth calling Florida home, and 45 percent of them living in economically struggling households, it is clear that many programs designed to help families become financially stable and self-sufficient fail to work. If children from low-income homes are to reach their full potential, there is a significant need toeliminate the current silos addressing adult-oriented and child-oriented programs separately. The report provides a roadmap of action to improve economic stability and child outcomes for families with young children in poverty.

Positive child and youth outcomes, financial stability for families, and economic vitality for businesses are interrelated goals. There is a clear need to rethink social service policy and align work-based solutions with child and family supports. These two-generational strategies provide a framework for developing systems that support strong child and youth outcomes within the context of family.

In Florida, many low-income households have working parents but they remain poor despite their efforts to progress toward economic prosperity. While accessing social services can provide needed financial supports for households, in many instances income eligibility requirements force parents to choose between wage increases and critical needs of children, such as child care. This reality has significant implications not only for the children and family, but also for employers and the economy.

Assisting parents to connect with opportunities to increase economic stability, increases their power to improve the likelihood of future success for their children.  There are systemic barriers that hinder a family’s ability to become economically self-sufficient and by strategically aligning systems of care, there is the opportunity to ensure that all children live in stable and nurturing environments.

Families with young children in poverty have different household survival budgets needs than individuals in poverty. Reforming social services for families with young children is timely and necessary. Aligning social services such as workforce development and child care can create the opportunity for a pathway to prosperity.

Florida is a vibrant and growing state that has its share of opportunities and challenges. To ensure that we secure paths to prosperity for all Floridians, especially the nearly one million kids living in poverty, we must focus on bold and broad strategies that consider two-generation approaches.

Another part of the solution is the FDOH’s continued support of the Florida’s Healthy Babies Initiative where Title V funding is allocated for county health departments to select one or more of the following projects to implement in their respective communities and previously discussed under the D.2 Budget:

• Title V funding will continue to be available to county health departments to establish a Reach Out and Read (ROR) program and/or create a reading rich environment in waiting room areas such as a child’s reading table and chairs, a bookshelf, and children’s books.
• Implement the Protocol for Assessing Community Excellence in Environmental Health (PACE EH) in communities of high need to assess neighborhood and community identified social determinants of health needs and provide action plans to address the top issues as defined by the communities.