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2. SHIELD will submit your responses and/or questions in batches on Wednesday and Fridays

West (Hampden, Hampshire)

Northeast

Metrowest

Boston

Central

Southeast

Universal & Tier 1 Strategies:

• Posters highlighting the benefits of school to be displayed at Back to School Night

• Summarize Attendance Policies for principal's family newsletters

Universal & Tier 1 Strategies:

• Nurses are members of attendance teams/committees.

• Promotion of healthy habits, importance of attendance through interactions, posters, bulletin boards and newsletters.

• Creating a welcoming and safe environment for all students

Universal & Tier 1 Strategies:

• Develop and impairment lessons that incorporate videos, games and hands on activities to make learning about nutrition more engaging

• Provide teachers with training/resources

• Engage families – involve families to reinforce healthy habits at home

• Address cultural/socioeconomic barriers by exploring resources to ensure access to healthy food options

• Promote critical thinking – teach students to evaluate food choices, distinguish facts from misinformation, and understand the impact of their choices in the long term.

Universal & Tier 1 Strategies:

• Collaborate with students and families in order to decrease the number of students who are chronically absent and/or consistently tardy during the school year.

• For Excused Absences due to illness, the nurses will follow the process below:

  School nurse will call the parent/guardian after three consecutive absences. If a parent/guardian reports the absences are related to a new illness/diagnosis, the parent/guardian will provide a provider letter directly to the school nurse. After school nurse review/approval, the letter will be shared with the building Data Specialist for entry into the student’s attendance record. The school nurse will use discretion if a provider letter is required for a student with a known medical condition.

Universal & Tier 1 Strategies:

• Nurses work with admin to track attendance

• Nurses communicate with parents/guardians about student's attendance on a daily basis

• Nurses work with providers to ensure all necessary medications/treatments have the necessary documentation and are available to the students with need

Universal & Tier 1 Strategies:

• As a district we have reminded families of when students must stay home due to illness and when they can attend.

• Screening data closely for illness and reaching out to families as needed for additional support.

Universal & Tier 1 Strategies:

• Review absences and identify known reasons

• Discuss known CA cases with school based student support team

Universal & Tier 1 Strategies:

• 3 community flu clinics with public health

• collaborate with our town doctor regarding absent notes

• communicate with families and educate families on sick policy

Universal & Tier 1 Strategies:

• Our district calls families after every absence if no one has contacted the school with an explanation. Letters are sent home if a student misses 10 days of school, a meeting is held with the family and a plan is developed. However, there is no uniform way that nurses are involved - it varies by school. In addition, the codes in ASPEN are vague and don't necessarily indicate if a student is out for medical reasons. Our first step is to meet with the attendance supervisors to discuss a more holistic, systematic approach.

Universal & Tier 1 Strategies:

• Running a report in our SIS every week to identify any student missing 3 days in a row of school. The school nurse will reach out to these families to address concerns and reasons for absence. Quarterly reports on who has missed 10% of school in one quarter and doing outreach to these families.

Universal & Tier 1 Strategies:

• The WPS district has chosen screening referrals as our quality improvement project: Year 2.

  We have chosen this QI topic because last year we were unable to meet even 50% of our projected goals of screening, detecting, referring and follow up with our student vision and hearing screenings. We addressed the obstacles and made improvement plans.

  Our Tier 1 Improvement plan to address increased referral follow up and intervention is as follows:

  Hired more per diem nurses over the summer.

  Weekly newsletters to parents educating on importance of early screening, early detection and referral and earlier interventions to help academic performance

  Per Diem orientation over 3-5 days, including vision/ hearing screenings.

  Dates on Calendar in Late September for each school- 2 per diems per day and 3 dates for each elementary school. 4 days for middle school and 3 days for High School screenings. NL assisted with triage if 2 per diems not available. (RN screened )

  Goal 100 % screenings completed by Thanksgiving Break Nov 23.

  Google form with referral results due by Dec 1st

  Booked 20/20 vision bus - using grant funds, and award money in district. Top 3 schools with most disparities chosen. 20 students/ day.

Universal & Tier 1 Strategies:

• Attendance tracking and monitoring by the Dean of Attendance.

• Educate parents and students about the effects of chronic absenteeism by adding a section about attendance on the Health Services Website

Universal & Tier 1 Strategies:

• Nurses are members of the attendance teams/committees.

• We have guidelines when a student should stay home on our school website under health services.

• Nurses communicate with parents on a regular basis regarding students who will be out due to illness, appointments, surgery, etc.

• Our schools send a robo call home daily to all parents of students who are absent that day.

• Our nurses work with healthcare providers to ensure that students are able to get their treatments and medications during the school day.

• Our nurses and district administration conduct regular attendance reports on students who are chronically absent.

• Creating safe and welcoming health offices for all students and staff.

Universal & Tier 1 Strategies:

• Discuss policies with parents and teachers and leadership

• Investigating why students may be absent

Tier 2 Strategies:

• Identify students at risk through attendance data, health screenings, discussion with staff students who they may be concerned about

• Being involved in team meetings (where teachers and leadership have meetings to discuss students) to see if I may have a medical presence and assist with a collaborative approach

Universal & Tier 1 Strategies:

• Meet with the principles and review the policy, current attendance tools, get input on best practices, try to develop a common tool for all schools, don’t increase work for staff, but make attendance tracking more seamless, coordinate communication with school and caregivers.

• The data collection would be incorporated into the actual tool for attendance tracking.

• The ECC and elementary attendance tracking tool appears to be the preferred method because it allows for seeing trends and for teachers, administrative staff, and nursing to add comments directly on the form that is shared. This tool will allow us to eliminate emails for communicating on when and why students are absent and if caregivers were contacted.

• The results of the small study show that there is an increase in information with all staff related to individual student absences. There is also a mechanism to follow tardiness, and when students are out for excused reasons.

Tier 2 Strategies:

• A primary nurse plan for a school nurse would focus on proactively assessing students' health needs or chronic absenteeism, managing chronic conditions, collaborating with parents and healthcare providers, and developing individualized healthcare plans (IHPs) for students with complex medical needs.

Universal & Tier 1 Strategies:

• Illness and attendance guidance is shared on the district website and in newsletters, provided in multiple languages.

• Unexcused absence notification letters are sent after five unexcused absences per term to reinforce attendance expectations and offer support.

• Nurses run immunization compliance reports in SNAP and contact families using the Language Line and translated materials.

• District nurses collaborate with the public health nurse to help families schedule required immunization appointments.

• Nurses collaborate with Family and Community Engagement to assist families in signing up for health insurance and accessing free vaccination clinics.

• Information is provided to families regarding primary care practices accepting patients and resources to assist with signing up for health insurance.

Universal & Tier 1 Strategies:

• At least once a year, I got into each kindergarten classroom (and additional grades when requested) to demonstrate proper hand hygiene, how to correctly blow a nose, and how both contribute to the spread of germs in the school community. In doing so, I am promoting good health habits. Parents are also notified of this demonstration so they may continue and encourage these behaviors at home.

Tier 2 Strategies:

• We track attendance through our school's EHR. If a student is absent and we have no notification an email will go out from the Health Services office inquiring why the student is absent.

Universal & Tier 1 Strategies:

• Nurses are members of the attendance teams/committees

• We have guidelines when a student should stay home on our school website under health services

• Nurses communicate with parents on a regular basis regarding students who will be out due to illness, appointments, surgery, etc

• Our schools send a robo call home daily to all parents of students who are absent that day

• Our nurses work with healthcare providers to ensure that students are able to get their treatments and medications during the school day

• Our nurses and district administration conduct regular attendance reports on students who are chronically absent

• Creating safe and welcoming health offices for all students and staff

Tier 2 Strategies:

• Currently conducting Individual behavioral/mental health check-in at health office- however we could do a better job at this

• Educate teaching staff about chronic health conditions (triggers, when to send a student to the nurse, etc)

• Targeted small group education to students and caregivers to build skills to understand physical and behavioral/mental health

Universal & Tier 1 Strategies:

• We are in year 2 of the unmet healthcare needs CQI: tier 1 is healthcare information at registration, nurse providing medical clearance at the time of registration and screening of ELL students for unmet healthcare needs

• We are in year 1 of the chronic absenteeism CQI: we are collecting information about how absences are tracked by each school and how the school based team is intervening with CA. I am presenting to school committee next week about chronic absenteeism and nurse cqi project.

Tier 2 Strategies:

• unmet healthcare needs year 2: intervention by family outreach nurse for students who have unmet healthcare needs or missing vaccines. She is working with public health to get students without health insurance vaccinated and providing information about health care for all to assist with the application for MA health. Intervention at the time of preregistration to have nurse review medical records and intervene earlier to assist with unmet health care needs/assisting with getting vaccines and physical for school entry. This has helped students be able to start school sooner.

• CA year 1: We pulled lists of chronically absent students and nurses identified reasons for the absences if known. This information was shared with central office, school based teams and next week I will present to school committee.

• 292 students who were Chronically Absent at 30 days of school 24-25

  Unknown 36%

  Illness 37.7%

  Multiple reasons 9.2%

  Travel 7.5%

  Surgery 2.4

  Mental Health Hospitalization 1.7%

  Injury 1.7%

  45 day Placement 1.7%

  Avoidance 1.4%

  Medical Hospitalization 0.3%

  Family Hardship (work, lack of transportation, family illness/surgery) 0.3%

Universal & Tier 1 Strategies:

• Nursing attends weekly meetings that review weekly attendance concerns.

• Guidelines for when to say home on health services website.

• Phone calls home inquiring absence reasons.

Universal & Tier 1 Strategies:

• Promoting meaningful connections/relationships between students and school staff

• Maintaining a welcoming school environment

Tier 2 Strategies:

• Reaching out to the families of students identified as chronically absent to learn more about the reasons for the absences

Universal & Tier 1 Strategies:

• August 2024- Reach out to per diem nurses to encourage BU SHIELD's screening training and create a Google doc for per diem availability for Sept- October- Nov- for screenings.

  August - Sept- Hire and orient new sub nurses to district.

  Schedule 2 RN for each elementary (5 total) for 3 days.

  Schedule 2 RN for High School x 2 days.

  Schedule 2 RN for Middle school over 4 days- Screen 1 team/ day. Call students down on a schedule. Give passes.

  Create doc for students absent, and one for students who need rescreen. Pick dates.

  Meet with Health Department for Flu clinic dates. Schedule secondary larger schools for Flu Clinic first (early Oct) then start scheduling screenings.

  Schedule elementary school screenings early Oct prior to Flu clinics.

Tier 2 Strategies:

• Use the CSHS grant funds to book the 20/20 onsite vision bus and additional award money received in 2024.

  Book 3 days (1 school a day- 20 referrals each day). We picked 2 elementary schools with biggest health disparities (ELL, Financial) and the Middle school. We referred 54 students and they received free eye exams. 41 students received a free pair of warby parker glasses and those with masshealth received 2 free glasses.

Universal & Tier 1 Strategies:

• Vision screening referrals:

  -students will be screened by December 1 to allow nurses adequate time to reach out to parents and guardians

  -screening dates and an explanation of why we do vision screening is provided in every school's newsletter as well as in the "welcome letter" sent at the start of the year

  -letters are sent home again (via Talking Points) a week before screening to encourage participation

  -screening dates are planned in cooperation with school administrators to maximize attendance and to avoid religious holidays or other factors that might affect participation

  -nurses chose to work on increasing referral return rates as a group goal

Tier 2 Strategies:

• when students fail a vision screening, parents/guardians receive a letter in their home language, usually the same day. Nurses follow up with a phone call and a Talking Points message to make sure parents are aware and to offer assistance

• student data is analyzed to identify any barriers to accessing care such as homelessness, ELL status, family needs or health insurance issues.

• nurses involve the homeless liaison, social worker, family liaison and/or health coordinator as needed

• nurses meet monthly to discuss strategies that work (or don't) and to assess progress

• partnership with local ophthalmologist ensures that students can get low cost glasses if needed due to social barriers

Universal & Tier 1 Strategies:

• Work at town flu clinics

• Plan mobile dental clinics

• Nurses attend weekly or biweekly students at risk meetings

• City Connects screenings

Universal & Tier 1 Strategies:

• Attend weekly or biweekly Student At Risk sessions

• Call chronically absent students

Tier 2 Strategies:

• Identify all students with IHPs

• Analyse absenteeism for this cohort

• Contact families to discuss potential health or other barriers

Tier 3 Strategies:

• create a more targeted IHP if necessary

• Do more frequent check in with student

• connect family to resources

Tier 2 Strategies:

• Collaborate with the Attendance Task force, which consists of building administrators and key ancillary support, to review chronic absenteeism accountability targets on a monthly basis.

Universal & Tier 1 Strategies:

• Tier 1 nursing strategies include family engagement, monitoring of attendance data, attendance awareness.

Tier 2 Strategies:

• Tier 2 nursing strategies include case management utilizing the RN Case Manager, home visits and family outreach, and support plans created in collaboration with a multidisciplinary team.

Tier 3 Strategies:

• Tier 3 strategies which will be ongoing include monitoring of student weekly attendance, adjusting interventions as appropriate and including students (age-dependent) and families in plans.

Universal & Tier 1 Strategies:

• To increase attendance, staff must understand chronic absenteeism is missing significant time regardless of the reason. This shared understanding will enable us to collaborate effectively on targeted attendance strategies.

• Reinforcing the Importance of Attendance: Consistent communication and collaboration with families reinforce the importance of regular attendance for the student's academic, social, and emotional development.

Tier 2 Strategies:

• Proactive Family Outreach: School nurses will initiate outreach to families following student absences due to illness, providing support, resources, and addressing potential barriers to return.

• Data-Driven Absence Tracking: Nurses will track the reported reasons for chronic absenteeism to identify patterns, contributing valuable insights for targeted interventions and support strategies discussed within the interdisciplinary student support team.

• Collaborative Attendance Review: School nurses will actively participate in student support meetings, contributing their unique perspective on health-related attendance factors and collaborating with the interdisciplinary team to develop comprehensive plans for students experiencing chronic absenteeism.

Tier 3 Strategies:

• For students with persistent chronic absenteeism, school nurses, counselors and administrators will collaboratively develop and implement individualized "Attendance Works" absence plans with families. These plans will establish clear structures, define responsibilities, and outline accountability measures to actively support the student's return to consistent school attendance.

Universal & Tier 1 Strategies:

• Nurses are members of the attendance teams/committees

• We have guidelines when a student should stay home on our school website under health services

• Nurses communicate with parents on a regular basis regarding students who will be out due to illness, appointments, surgery, etc

• Our schools send a robo call home daily to all parents of students who are absent that day.

• Our nurses work with healthcare providers to ensure that students are able to get their treatments and medications during the school day.

• Our nurses and district administration conduct regular attendance reports on students who are chronically absent.

• Creating safe and welcoming health offices for all students and staff.

Tier 2 Strategies:

• Currently conducting Individual behavioral/mental health check-in at health office- however we could do a better job at this

• Educate teaching staff about chronic health conditions (triggers, when to send a student to the nurse, etc)

• Targeted small group education to students and caregivers to build skills to understand physical and behavioral/mental health

Tier 3 Strategies:

• Conduct more frequent check-ins

• Connect families to resources or wrap-around coordinators, if possible