Miners/Panther Valley School Health Index Module 5 School Health Services Question Title * 1. Thank you for taking the time to participate in the Panther Valley Healthy Schools survey. Please select the answer that best describes you. Student Parent/Guardian/Grandparent of a school aged child Faculty/Staff/Administration Community Member Other Question Title * 2. Does your school have a full-time registered school nurse responsible for health services all day, every day? Are an adequate number of full-time school nurses provided, based on the recommendation of at least one nurse per school? NOTE: More nurses are recommended if students have extensive nursing needs. Yes, we have a registered school nurse present all day every day We have a registered school nurse present most of the time each week We have a registered school nurse present some of the time each week, or we have an LPN or UAP (supervised by a school nurse) who is present at least some of the time each week No, we do not have a registered school nurse, LPN, or UAP present in our school, or we have an unsupervised LPN or UAP in our school Question Title * 3. Does your school provide the following school-based healthcare services, delivered by a school nurse or community healthcare organization (e.g., hospital, public health department, federally qualified health center)?* Pediatric healthcare* Dental care* Vision care Yes, our school provides all three of the school-based healthcare services Our school provides two of those school-based healthcare services Our school provides one of those school-based healthcare services Question Title * 4. Does the school nurse or other health services provider promote the health and safety of students and their families by addressing each of these topics?* promoting physical activity* promoting healthy eating* preventing tobacco or e-cigarette use* preventing alcohol or other drug use* preventing unintentional injuries* preventing violence and suicide* managing chronic health conditions* preventing HIV, other STD, and unintended pregnancy Yes, addresses all eight of these topics Addresses four to seven of these topics Addresses one to three of these topics Addresses none of these topics, or the school does not have a school nurse or other health services provider. Question Title * 5. Does the school nurse or other health services provider collaborate with other school staff to promote student health and safety in at least three ways?Examples of ways to collaborate include:* developing plans to address student health problems (e.g., individual health care plans, individual education plans, 504 plans, school team plans) * providing professional development* consulting with teachers/health educators to identify, revise or develop health-related curricula or units/lessons* developing and implementing school-wide and classroom activities* developing school improvement plans* establishing community systems with other school staff Yes, there is collaboration in at least six of these ways There is collaboration in three to five of these ways There is collaboration in one or two of these ways No, there is no collaboration, or the school does not have a school nurse or other health services provider Question Title * 6. Does your school implement a systematic approach (including the following components) for referring students, as needed, to appropriate school-or community-based health services?* Contact parents of students identified as potentially needing additional health services and recommend that the students be evaluated by their primary health care provider* Contact parents of students without a primary health care provider and give information about child health insurance programs and primary care providers* Referral information is distributed widely (e.g., through flyers, brochures, website, student handbook, health education class) so that students, staff, and families can learn about school and community services without having to contact school staff* Staff members are given clear guidance on referring students to school counseling, psychological and social services* Referral forms are easy for staff members to access, complete, submit and keep confidential* A designated staff person or interdisciplinary student supports team (e.g., school nurse, counselor) regularly reviews and sorts referral forms and conducts initial screening* With written parental permission, additional information (e.g., questionnaires, relevant records, brief testing) is gathered as necessary and in compliance with FERPA* Written consent is obtained, in compliance with HIPAA, to gather relevant records from other professionals or agencies, if applicable* A list is kept and regularly updated of youth-friendly referral providers along with basic information about each (e.g., cost, location, language, program features, previous client feedback)* Meetings are held with all relevant parties to discuss referral alternatives* Potential barriers (e.g., cost, location, transportation, stigma) and how to overcome them are discussed* Follow-up (e.g., via telephone, text messaging, email, personal contact) is conducted to evaluate the referral and gather feedback about the service* A status report is provided to the person who identified the problem, if applicable and in compliance with FERPA and/or HIPAA* Professional development is provided to all staff members about the referral process Yes, our school has a referral system that includes all of these components Our school has a referral system that includes many of these components Our school has a referral system that includes a few of these components Our school's referral system does not include any of these components, or our school does not have a referral system Question Title * 7. Does your school have a system for collecting student health information prior to school entry and every year thereafter? Is all pertinent information communicated in writing to all appropriate staff members? Yes, all pertinent information is systematically collected and communicated in writing to all appropriate staff members All pertinent information is systematically collected and communicated to some, but no all appropriate staff members Some pertinent information is collected and communicated to some staff members Pertinent information is not collected Question Title * 8. Does your school have access to and work with a consulting school health physician who assists with your school health programs? Yes, our school has access to a consulting school health physician and has worked with him/her within the past year Our school has access to a consulting school health physician through our state or local education or health agency and has worked with him/her within the past two years Our school has access to a consulting school health physician through our state or local education or health agency but has not worked with him/her within the past two years No, our school does not have access to a consulting school health physician Question Title * 9. Does the school nurse or other health services provider systematically collect information on unintentional injuries, incidents, and violence that occur on school property (including school buses) or that are associated with school-sponsored events? Is the information analyzed, consistently review, and acted upon as appropriate by school nurses and school policy-makers? Yes, information is collected, analyzed, and consistently reviewed by school nurses and school policy-makers Information is collected, analyzed, and occasionally reviewed by school nurses and school policy-makers Information is collected and analyzed but not reviewed by school nurses and school policy-makers Information is collected by not analyzed or reviewed, or information is not collected, or the school does not have a school nurse or other health services provider Question Title * 10. Does the school nurse or other health services provider have an emergency plan that includes all the components listed below for assessing, managing, and referring students and staff members suffering from a medical emergency (e.g., injury, severe asthma episode) to the appropriate level of care?* written instructions on contacting emergency service providers, with telephone numbers posted in prominent locations* list of health services and other staff and their assignments, including at least one qualified person who will assess the person(s) suffering from a medical emergency and manage immediate care; one person who will call emergency medical services (EMS); one person who will control students in the area; and one person who will direct EMS to the location of the person(s) suffering from a medical emergency. * plan for transporting and referring person(s) suffering from a medical emergency to care, including a protocol for situations in which staff members need to be with a student at a treatment center* system for contacting parents and appropriate staff members (e.g., a central file with daytime contact information for parents and guardians)* provisions for obtaining parental consent if referral for immediate treatment is required* copies of treatment and referral protocols available in first aid kits Yes, all of these components are part of the emergency plan All but one of these components are part of the emergency plan There is a plan, but it lacks more than one of these components The school does not have a plan Question Title * 11. Does the school nurse or other health services provider have a system for identifying and tracking students with chronic health conditions? Yes, there is a system to identify and track students with chronic health conditions Students are systematically identified, but not systematically tracked Students are identified only when an urgent need related to their condition arises at school No, there is no system for identifying or tracking students with chronic health conditions, or the school does not have a school nurse or other health services provider Question Title * 12. Does your school nurse facilitate or provide care coordination for students with poorly controlled chronic health conditions (e.g., asthma, diabetes, etc.)? Yes, care coordination is facilitated or provided to all students with poorly controlled chronic health conditions Care coordination is facilitated or provided to most students with poorly controlled chronic health conditions Care coordination is facilitated or provided to some students with poorly controlled chronic care conditions No, care coordination is not facilitated or provided to students with chronic health conditions Question Title * 13. Does your school use all of these methods to ensure students with chronic health conditions, such as asthma or food allergies, have immediate and reliable access to quick-relief medications (e.g., asthma inhalers or epinephrine auto-injectors) in school?* Allow students to carry and self-administer quick-relief medications with written permission from physician, parent/guardian, and school nurse* Ensure quick-relief medication is readily accessible, clearly labeled, and not accessible to other students* School nurse or other health care provider provides annual training to the appropriate staff on how to recognize acute symptoms such as those of allergic reactions or asthma, as well as the administration of quick relief medications. Yes, students are allowed to carry and self-administer quick-relief medications Quick-relief medication is readily accessible, clearly labeled, and not accessible to other student and someone trained to recognize acute or emergency symptoms and administer quick-relief medications is always present at the school Quick-relief medication is readily accessible, clearly labeled, and not accessible to other students or someone trained in administering quick-relief medications is always present at the school No, none of these methods are used Question Title * 14. Does your school offer disease-specific education at school for all students with known chronic health conditions? Yes, our school offers disease-specific education for students with known chronic health conditions Our school offers disease-specific education for students with chronic health conditions, but only offers education related to some chronic health conditions Our school offers disease-specific education for students with chronic health conditions, but only offers education related to a few chronic health conditions No, our school does not offer disease-specific education for students with known chronic health conditions Question Title * 15. Does your school have a plan to address food allergy management and prevention (e.g., Food Allergy Management and Prevention Plan) which includes the following priorities needed to manage food allergies in the school setting?* Ensure daily management of food allergies for individual children (e.g., identifying children with food allergies, a plan to manage and reduce risks of food allergy reactions)* Prepare for food allergy emergencies (e.g., easy to use communication systems, easy access to epinephrine auto-injectors, plans for contacting emergency medical services, identification of staff roles in emergencies)* Provide professional development on food allergies for staff (e.g., general training on food allergies for all staff, in-depth training for staff who have frequent contact with children with food allergies (including cafeteria/food service staff), specialized training for staff responsible for managing children with food allergies)* Education children and family members about food allergies (e.g., teach all children, all parents and families about food allergies)* Create and maintain a healthy and safe educational environment (e.g., limit exposure to food allergens, develop food-handling policies to prevent unintentional contact, make outside groups aware of food allergy policies and rules when they use school facilities, create a positive psychosocial climate) Yes, our school has a plan that includes all 5 priorities needed to manage food allergies in the school setting Our school has a plan that includes 3-4 priorities needed to manage food allergies in the school setting Our school has a plan that includes 1-2 priorities needed to manage food allergies in the school setting Our school does not have a plan to address food allergy management and prevention Question Title * 16. Does the school nurse or other health services provider take the following actions with students who use tobacco?* Provide a strong message regarding the importance of totally abstaining from tobacco use* Provide self-help materials* Provide, or provide referrals to, tobacco-use cessation counseling Yes, takes all three of these actions for students who use tobacco Takes two of these actions Takes one of these actions Takes none of these actions, or the school does not have a school nurse or other health services providers Question Title * 17. Does your school identify youth-friendly community-based health services providers and systematically link with them to provide sexual and reproductive health services to students? Yes, our school identifies youth-friendly community providers and systematically links with them to provide sexual and reproductive health services to students Our school systematically links with community providers to provide sexual and reproductive health services to students, but does not identify youth-friendly providers Our school refers students to community-based sexual and reproductive health services, but does not have a system for linking with these providers or identify youth-friendly providers No, our school does not link with or refer students to sexual and reproductive health services or identify youth-friendly community providers Question Title * 18. Thanks again for participating. Please provide any comments or feedback regarding any of the survey questions and/or suggestions on how to improve the health and wellness of Panther Valley. Done