Designing School Health Services to Provide Multi-Tiered Systems of Support (MTSS) for All Students.

A system-level health equity lens is needed to meet the needs of today's students. School nurses stand at the intersection of health and education, poised to improve the health and academic outcomes for all children in collaboration with school health and education colleagues with a focus to reframe "learning and health losses" to "learning and health recovery." The Multi-Tiered System of Support is a familiar approach used in schools to address education equity for students. Working alongside educators, school nurses can demonstrate how including health in this framework augments reaching the goal of supporting student academic success.

Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy.

Atopic dermatitis (AD) and food allergies are more prevalent and more severe in people with skin of color than White individuals. The American College of Allergy, Asthma, and Immunology (ACAAI) sought to understand the effects of racial disparities among patients with skin of color with AD and food allergies. The ACAAI surveyed its members (N = 200 completed), conducted interviews with health care providers and advocacy leaders, and hosted a roundtable to explore the challenges of diagnosis and management of AD and food allergies in people with skin of color and to discuss potential solutions. Most of the survey respondents (68%) agreed that racial disparities make it difficult for people with skin of color to receive adequate treatment for AD and food allergies. The interviews and roundtable identified access to care, burden of costs, policies and infrastructure that limit access to safe foods and patient education, and inadequate research involving people with skin of color as obstacles to care. Proposed solutions included identifying ways to recruit more people with skin of color into clinical trials and medical school, educating health care providers about diagnosis and treating AD and food allergy in people with skin of color, improving access to safe foods, creating and disseminating culturally appropriate materials for patients, and working toward longer appointment times for patients who need them. Challenges in AD and food allergy in persons with skin of color were identified by the ACAAI members. Solutions to these challenges were proposed to inspire actions to mitigate racial disparities in AD and food allergy.

Notes From the Field: Diverse Partner Perspectives Improve the Usability and Equity Focus of Implementation Guides.

Context: School-based asthma programs (SBAPs) have improved health and educational disparities among youth with asthma. Design: To support scaling out effective SBAPs, our school partners identified a need for online implementation guides that are "always available," to meet the needs of school nurses' demanding schedules. School nurses play a key role in the adoption and implementation of SBAPs, so it is important to ensure the implementation guide would be highly usable and acceptable to them. Objective: Accordingly, our research team collaborated with human-centered design experts to identify the "user journeys" of school nurses and co-created our online implementation guide as a public-facing website with input from local and national school nurse partners. Main Results: In this perspectives article, our school nurse implementation partners and human-centered design experts reflect on challenges overcome in this process of developing a tailored implementation guide to school nurses and offer lessons from the field to others seeking to co-create implementation guides with community partners.

Using Local School Wellness Policies to Build a Culture of Health for Students With Chronic Health Conditions: The School Nurse Role.

Local school wellness policies (LWP) guide school districts' efforts to establish school environments that promote students' health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN's Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations' updated model wellness policy and NASN's supplemental wellness policy language to address management of students with chronic health conditions.

School Nurse-Led Care Coordination: Proceedings From the National Strategy to Action Roundtable.

This article describes the process for convening a national Roundtable that brought together multiple stakeholders to create a united vision and collaborative approach to care coordination for students with chronic health conditions and introduces the resulting published Translating Strategies into Actions to Improve Care Coordination for Students with Chronic Health Conditions white paper. Schools across the country are engaged to various degrees in addressing the health and academic success of students with chronic health conditions. Lack of a common definition of care coordination presents ongoing challenges to planning, implementing, and evaluating outcomes of care coordination for students with chronic health conditions. The Roundtable's overarching goal was to identify recommended actions for health and education leaders to implement a system to support care coordination at the school and district level. School nurses can use this description of the National Association of School Nurses' approach when convening community stakeholders to address common concerns related to student health and academic success. The Roundtable outcomes presented can be used by health and education leaders in schools and school districts to design, implement, and sustain system change to support care coordination as a strategy to manage chronic health conditions in school, recognizing the school nurse's central role.

Advocating for Oral Health Through Fluoridation.

Eight school nurses attended the American Academy of Pediatrics' Campaign for Dental Health meeting in March 2018, which focused on community water fluoridation programs. Because of aging infrastructure and antifluoridation community activists, some communities are considering stopping fluoridation programs. The benefits of water fluoridation have been demonstrated since the 1950s. School nurses can play a vital role in advocating for evidence-based fluoridation programs within their community. This article informs the school nurse on the benefits of water fluoridation for promoting community health and methods to advocate for those measures-key practice components of the leadership and community/public health principles of "Framework for 21st Century School Nursing Practice™."

The Mental Health Training Intervention for School Nurses and Other Health Providers in Schools.

School nurses encounter many students presenting with mental health needs. However, school nurses report that they need additional training and resources to be able to support student mental health. This study involved a multilevel, stakeholder-driven process to refine the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS), an in-service training and implementation support system for school health providers, including school nurses, to increase their competence in addressing student mental health concerns. Findings highlighted the importance of mental health content including assessment, common factors of positive therapeutic mental health interactions, common elements of evidence-based mental health practice, and resource and referral mapping. Additionally, multifaceted ongoing professional development processes were indicated. Study findings indicate that, with recommended modifications, the MH-TIPS holds promise as a feasible, useful intervention to support school nurse practice and ultimately impact student mental health and educational outcomes.

Increasing immunization rates through the immunization neighborhood recognizing school-located immunization programs.

Vaccines are considered one of the top 10 public health achievements in the United States; however, coverage rates for many of the recommended child and adolescent vaccines fall short of Healthy People 2020 goals. The vaccine delivery infrastructure in our country might be the most important limiting factor in achieving the vaccine uptake targets. Renewing the focus on schools for both vaccine delivery and vaccine promotion has the potential to augment other emerging alternate vaccination sites within the immunization neighborhood. School nurses are leading the way, and three national award winners are recognized for their immunization programming efforts. All school nurses can be immunization champions, advocating for the role of schools as key sites to promote the importance of vaccines in protecting the health and ensuring academic success of the students they serve.

How school nurses can benefit from immunization information systems: information exchange to keep students in school and ready to learn.

Recorded and retrievable information from state immunization information systems (IIS)--previously known as immunization registries--benefits schools, students, families, state and local immunization programs, and the medical home. The National Association of School Nurses (NASN), the National Association of County and City Health Officials (NACCHO), the Association of State and Territorial Health Officials (ASTHO), and the American Immunization Registry Association (AIRA) support state IIS as a way to facilitate immunization compliance, prevent immunization duplications, and sustain high immunization rates. There is much variability from state to state on who can access and/or input data into the IIS. School nurses need to know they can pick up the phone and contact their state IIS, and state IIS personnel need to know that school nurses desire full access to their state registry to view records and record vaccines administered and/or documented by families.

CDC update on pertussis surveillance and Tdap vaccine recommendations.

Pertussis is the most poorly controlled bacterial vaccine-preventable disease. Since the early 1980s there has been an increase in reported cases of pertussis. Multiple factors have likely contributed to the increase, including waning immunity, increased recognition, and changes in diagnostic testing and reporting. Of the four combination vaccines used to prevent diphtheria, tetanus, and pertussis, one dose of Tdap should be used to vaccinate preteens as well as teens and adults who have not yet received this booster dose. It is the position of NASN that immunizations, including the Tdap vaccine, are key to primary prevention of diseasefrom infancy through adulthood. The school nurse is in a critical position to create awareness and influence action-related national and state recommendations for the Tdap vaccine.

A collaborative approach to diabetes management: the choice made for Colorado schools.

Students with diabetes deserve a school nurse who can effectively manage the disease. Tensions between the school and families sometimes emerge when a child with diabetes goes to school. To resolve these tensions in Colorado, stakeholders collaborated to implement a statewide program to meet the needs of students with diabetes. Colorado school nursing leadership partnered with the National Association of School Nurses to adapt components of the Managing and Preventing Diabetes and Weight Gain Program (MAP), funded by the Centers for Disease Control and Prevention. The Healthy Learner Model for Chronic Condition Management, integral to MAP, provided guidance for the Colorado Collaborative to design the Diabetes Resource Nurse Program. The program supports the practicing school nurse, and facilitates collaboration between the family, school, and health care provider. This article describes how stakeholders in Colorado chose to collaborate when faced with rising tensions over how to best manage students with diabetes.

Diabetes management at school: application of the healthy learner model.

Every child with diabetes deserves a school nurse with the capacity to effectively manage the disease at school. The school nurse needs knowledge and skills to confidently provide care and communicate with health care providers and families. The Healthy Learner Model for Chronic Condition Management provided a framework to eliminate the disjointed approach to diabetes management at school, replacing it with a consistent, evidence-based approach. A diabetes resource nurse was a key component, providing support for the school nurse and collaboration between the school, community, family, and health care providers. Funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC), the National Association of School Nurses (NASN) chose five sites from across the country to implement this program-a project titled Managing and Preventing Diabetes and Weight Gain (MAP). This article describes the experience of two sites.