The State School Mental Health Profile: Findings from 25 States

BACKGROUND

State-level leadership and conditions are instrumental to local and regional comprehensive school mental health system (CSMHS) quality, sustainability, and growth. However, systematic documentation of state-level school mental health (SMH) policy, infrastructure, funding, and practice is limited.

METHODS

Using a multi-phase, multi-method process, we developed the State School Mental Health Profile (State Profile) to offer a comprehensive landscape of state SMH efforts. State leaders in 25 states completed the State Profile once over a 3-year data collection period. Mixed methods results are reported in 8 domains.

RESULTS

State education agencies were reportedly most involved in SMH technical assistance, advocacy, leadership, funding, and service provision, with mental health agencies reported as second most involved. Nearly half of state respondents reported having a state-level SMH director or coordinator. Policies with the greatest perceived impact require implementation of and funding for SMH services and supports. Despite leveraging multiple sources of funding, most states emphasized lack of funding as a primary barrier to establishing CSMHSs. All states reported staffing shortages.

CONCLUSION

The State Profile can assist multi-agency state leadership teams to self-assess policy, infrastructure, and resources to support CSMHSs statewide. Findings point to areas of opportunity to advance equity across resource allocation, service provision, and policy development.

Case Management for Social Needs of Youth and Families in School-Based Health Centers

BACKGROUND

School-based health centers (SBHCs) are ideal settings to address social needs of youth and families. Case managers can play a vital role in social care interventions.

METHODS

We piloted a program to incorporate a Case Manager into the care team of 1 SBHC serving 2 local schools with over 900 students and their surrounding communities. This project's purpose was to evaluate program feasibility, utilization, and acceptability. Our mixed-methods evaluation included analyses of data from electronic health records, client satisfaction surveys, and staff interviews.

RESULTS

During the 6-month pilot, the Case Manager served 133 clients (about one third of all SBHC clients served) through 593 contacts. Most contacts included referrals to support services (90%) and 37% addressed newcomer immigrant adjustment. All 37 respondents to the satisfaction survey during the 3-month administration period (44% response rate) reported that the Case Manager made them feel comfortable asking for help; 95% reported getting the help they needed. The 7 SBHC staff interviewed shared many program benefits, including increased time for clinical services.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Inequities in children's health and educational achievement are influenced by structural factors. Results from our pilot program demonstrate that SBHCs may be well-positioned to deliver social care interventions and that case managers enhance the ability to deliver quality care.

CONCLUSIONS

School-based programs to address unmet social needs are critical to supporting learning and wellness for all youth. Robust studies are needed to further test the impacts of case management in SBHCs.

Withdrawal: Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19

Withdrawal: 'Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation and White Mountain Apache Tribe During COVID-19' by Shannon Archuleta MPH, Joshuaa D. Allison-Burbank PhD, Allison Ingalls MPH, Renae Begay MPH, Ryan Grass BS, Francene Larzelere PhD, Vanessa Begaye BS, Lacey Howe BS, Alicia Tsosie BS, Angelina Phoebe Keryte BA, Emily E. Haroz PhD, J Sch Health 2024, 10.1111/josh.13419. The above article, published online on 15 January 2024 in Wiley Online Library (https://onlinelibrary.wiley.com/doi/full/10.1111/josh.13419) has been withdrawn by agreement between the authors, the journal's Editor in Chief, Michael W. Long, the American School Health Association and Wiley Periodicals LLC. The withdrawal has been agreed because consent for publication from one of the tribes participating in the study was pending at the time of publication.

The impact of COVID-19 on school nursing: A qualitative survey of stressors faced by school nurses

BACKGROUND

As students returned to school, school nurses were responsible for infection control, communication, and the preparation of supplies and facilities. School nurses in the Pacific Northwest US demonstrated a higher prevalence of mental health symptoms in the years since the pandemic began, suggesting that their experience may have been unique.

OBJECTIVE

This study aimed to explore the stressors of school nurses in the Pacific Northwest at two time points.

DESIGN

This study is a qualitative, descriptive analysis of anonymous survey responses collected in June of 2021 (n = 333) and between October and December 2021 (n = 284).

SAMPLE

Self-identifying school nurses working in K-12 schools in Washington State were invited to participate.

MEASUREMENTS

Participants completed open-ended survey questions designed to elicit their experiences during the pandemic.

RESULTS

Four themes emerged from the data: (1) isolation from administration and the school community, (2) COVID-19-related workload, (3) disorganized and inconsistent communication, and (4) concern for students, themselves, and others.

CONCLUSIONS

School nurses played a vital public health role during the pandemic. However, their effectiveness may not have been fully utilized and sometimes undermined. Lastly, our findings highlight the difficulties encountered in implementing the changing scientific and public health guidance during the pandemic.

Parents' Participation in School Health Examinations for Their Adolescent Children in Finland

Engaging parents in school health examinations can promote adolescents' well-being. We examined parents' participation in universal school health examinations in Finland reported by adolescents in school surveys (14 to 16-year-olds, N = 58,232). Further we studied variation between service providers and schools, and student and school-level factors in participation. National data were analyzed using multilevel logistic regression models. Less than half of the adolescents reported parents' participation. The variation between service providers and schools was large. Non-participation was associated with mother's low education, students' immigrant background, daily health complaints, heavy drinking, and discussion difficulties with parents. Boys and those who did not live with both mother and father had a higher risk for parents' non-participation. Adolescents with a long-term illness or being bullied reported participation more often. Inviting parents and the school health nurse resource were not associated with participation. Our results raise the question of barriers to participation in health examinations.

Kids First: A Multicomponent Onboarding for Practitioner Students in a School-Based Health Center

School-Based Health Centers (SBHCs) often serve vulnerable populations who have been exposed to adverse childhood experiences (ACEs) which have been tied to an increase in adult health risk factors. At an urban SBHC serving adolescent students, 75% of patients reported three or more ACEs. This SBHC also had multiple practitioner students. A multicomponent onboarding was created to implement the Patient Interaction Standard of Care, addressing the SBHC model, adolescent care, and ACEs. Practitioner students that completed the onboarding demonstrated 97% adherence to the Patient Interaction Standard of Care "Always" or "Most of the Time." By onboarding frequent practitioner students, care provided to this vulnerable patient population was more consistently aligned to evidenced-based care appropriate for the SBHC model, adolescent care, and ACEs. This demonstrates the importance of mandatory onboarding completion compliance and further implementation across other SBCHs.

Substance Use Screening, Brief Intervention, and Referral to Treatment in Urban Settings: Barriers and Facilitators to Implementation With Minoritized Youth

BACKGROUND

Substance use in minoritized youth is associated with negative long-term health and life outcomes. The present study explores perspectives of school stakeholders at urban minority-serving schools regarding integration of an evidence-based intervention, screening, brief intervention, and referral to treatment (SBIRT) into existing school prevention models.

METHODS

Twenty-two participants were interviewed using the Consolidated Framework for Implementation Research to identify barriers and facilitators to SBIRT implementation. Qualitative data were transcribed, coded, and analyzed.

RESULTS

Four major themes related to barriers to SBIRT implementation included: lack of training, unclear role expectations, student confidentiality, and punitive school climates. The 3 major facilitators included: the feasibility of the intervention, its fit within multi-tiered systems of support, and the districts increasing collaboration with community mental health providers. These major themes along with other minor themes are discussed.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

SBIRT implementation within low-income, minority-serving schools may reduce substance use disparities among minoritized youth, improving health and life outcomes. Recommendations addressed training, school climate, and student engagement, highlighting a collaborative and supportive approach involving all stakeholders.

CONCLUSIONS

While SBIRT implementation has barriers and facilitators, overall, school staff were optimistic about implementation. In light of these findings, additional research should embed SBIRT in these settings.

Development of a School Health Policy Implementation Survey: A Delphi Study

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n  =  378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n  =  64) of questions. The remaining 15.8% (n  =  12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.

Examination of Social Determinants of Health, District Health Needs, School Nurse Caseload, and Academic Outcomes in Washington State

The purpose of this study was to examine associations between caseload, social determinants, health needs, students meeting grade-level English and Math standards, and attendance. Data from the Washington State Open Data Portal and Report Card were combined with District Health Assessment data from 264 school districts. Analyses of variance and linear stepwise regression analyses were conducted. Key findings indicate significant differences in English and Math outcomes by caseloads, with higher caseload districts have lower percentages of students meeting English and Math standards, but not attendance. Caseload is a significant predictor of students meeting English and Math standards, after controlling for social determinants and district health needs. Findings point to the complexity of school nursing work and builds a foundation to guide future nursing research. Large prospective studies that allow for comprehensive measurement of structure, process and outcomes variables are needed to advance school nursing research.

A Qualitative Exploration of School Nurse Continuing Education Needs

Continuing education (CE) can help school nurses achieve the unique competencies required for the challenges of an academic health setting. A comprehensive understanding of school nurse learning needs is necessary to guide CE development. The purpose of this study was to describe school nurse perceptions of their learning needs according to the Framework for 21st Century School Nursing Practice ™. The researchers analyzed data from 24 interviews with practicing school nurses using descriptive coding to identify perceived learning needs. Learning needs relevant to all areas of the framework were identified, with clinical judgment and team development emerging as priority areas for CE. These results illuminate school nurse perceptions of their own learning needs and can help guide the development of meaningful CE opportunities.

Data Submission: HOW the Power of One Creates the Power of Many

This article is the third and final article in a series exploring the WHAT, WHY, and HOW of data collection and data utilization. The final step, the HOW of data submission, provides discussion and guidance in contributing your data to the collective voice, including submitting data from the school, district, state, and national levels. Submitting individual school nursing data enriches the bigger story and increases the awareness and meaningfulness of school health data, the role of the school nurse as an integral member of the school community, and the connections of student health and academic outcomes. This article will also explore how to submit your school health data and the opportunities to submit it to district, state, or national levels, including to the National School Health Data Set: Every Student Counts! (ESC!).

The Teddy Bear Clinic: Engaging School-Aged Children in Health Education

This article describes the use of play therapy in a school-based health clinic on an American Indian Reservation. The project used the play therapy model, a nursing intervention focused on using play materials in a therapeutic manner as a form of communication and self-expression for children, enhancing the development of social, emotional, and behavioral skills through the nursing process. The purpose of the Teddy Bear Clinic was to establish relationships among non-Native student nurses and Native American children and their community on a Northern Plains Indian Reservation. A discussion of the potential benefits addresses opportunities for school nurses and student nurses to enhance their understanding of children's perceptions of the health care clinic and the effects of historical trauma on the health and wellbeing of Native American children while offering an opportunity for young children to engage in the health care setting in a fun way, without fear or discomfort is provided.

Fostering Belonging Beyond the Health Office Through Inclusive Language

A sense of belonging in school is fostered when students feel included. School nurses can establish an inclusive school atmosphere where students feel safe, supported, accepted, and valued. The language choices of school nurses play a key role in fostering such an environment. Through consciously using language that promotes respect, acceptance, justice, and equity, nurses can support student well-being. Nurses may be using embedded terminologies and outdated language that promotes exclusion but can learn and model inclusive language practices such as cultural humility, calling in, and respecting pronouns. Making intentional choices to embrace and employ these practices is imperative to supporting student health today.

The Red Square: A Healthcare Sterile Cockpit to Reduce Medication Errors

Medication administration is one of many duties and responsibilities of school nurses and involves both scheduled and as-needed (prn) medications. When administering medications, school nurses also experience unscheduled student health room visits, as well as interruptions such as staff member inquiries, miscellaneous phone calls, and occasional safety drills, to name a few. These distractions, inherent to the school nursing position, can lead to medication errors and pose a risk to students. This article describes the concept of a health care sterile cockpit (red square) and a school district's use of innovation in the health room to improve medication safety and reduce errors. Other benefits of implementing the red square will be discussed.

Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii

BACKGROUND

Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics.

METHODS

Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey.

RESULTS

Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses.

CONCLUSION

Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

Legal Issues 101: Documentation and School Records

This article is part of a series of articles titled "Legal Issues 101" addressing some common questions and misconceptions around the law and school health. Nursing documentation, a recording of interactions between a nurse and a patient, is a vital part of nursing care. Timely, thorough documentation allows for patient safety, risk reduction, continuity of care, and the availability of data for work process analysis. In the school setting, nursing documentation encompasses a record of student treatment in the health office as well as communication with parents, school team members, and healthcare providers. Student health records are intersected by educational and health privacy laws, which can create confusion around record management. The purpose of this article is to clarify frequently asked questions related to health office documentation.

The Role of the School Nurse in Addressing Climate-Associated Illnesses: Air Quality

Climate change is having an unprecedented influence on human health. Children's allergies and respiratory problems are increasing because of rising pollen levels and air pollution. School nurses are well positioned to prevent and treat allergies, asthma, and other respiratory conditions. Due to their consistent presence with the school setting, nurses can promote health, wellness, and academic productivity by addressing poor indoor and outdoor air quality. The purpose of this article is to increase understanding of how air quality affects the health of school-age children and to provide school nurses with primary, secondary, and tertiary prevention strategies for ensuring clean and healthy learning environments. This is the second in a series of articles aimed at raising awareness among school nurses about climate-associated illnesses and equipping them with the resources they need to protect students' health.

The Role of the School Nurse in the United States, United Kingdom, and Italy During the COVID-19 Pandemic: A Scoping Review

The school nurse has a crucial role in the United States and the United Kingdom and has their own expertise dedicated to school assistance for children, families, school staff, and the community. This study aims to identify the role and skills of the school nurse and understand the effects of COVID-19 on nursing skills in the following countries: The United States, the United Kingdom, and Italy. A Scoping Review was conducted following the JBI methodology for scoping reviews, following the PRISMA-ScR guidelines. Three databases were consulted: PubMed, Cinahl, and Scopus. In all, 58 studies met the eligibility criteria and were included. 93.1% of the studies were carried out in the United States, 5.2% in the United Kingdom, and 1.7% in Italy. 34.5% of the articles were published in 2020, 15.5% in 2021, 31% in 2022, and 19% in 2023. 22.4% of the studies included in the review concerned health promotion and education. Regarding the methodology of the studies, 41.5% of the studies were commentary papers, 15.5% were observational studies, and 12% were cross-sectional studies. Considering the effects of the school nurse in the United States and the United Kingdom, it is possible to reflect on how the systematic presence of a nurse could also have benefits in Italy.

Editorial: The need for more effective school-based youth mental health interventions

An important setting to detect youth mental health problems and provide interventions is the school context, but effective and affordable school-based interventions are scarce and implementation of the available evidence-based interventions is limited. In this editorial, we highlight three issues and propose a research agenda. First, we emphasize that many of the mental health interventions currently used in school settings lack a solid evidence base. Second, we outline that high-quality studies are needed to determine what works, for whom it works and under which circumstances. This includes insight into the most effective intervention elements, subgroups of students who profit more or less from these interventions, and the most effective modes of delivery. These questions should drive our research agenda on school-based mental health interventions. Finally, while answering these pivotal questions, a collaborative multidisciplinary effort should be made to implement school-based interventions with a solid evidence base, which involves, among others, studying how this can be done most effectively.

School Nurses' Experiences and Roles in Promoting and Administering the HPV Vaccine: A Systematic Review Using the Socioecological Framework

Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.

An Integrative Review of College Readiness Programs for Black High School Students; Opportunities for School Nurse Involvement

Education is associated with improved health outcomes. However, fewer non-Hispanic Black Americans earn high school diplomas, baccalaureate, or advanced degrees than White Americans, placing them at higher risk for poor health outcomes. Racial disparities in education have been linked to social injustice and structural racism. Through the Framework for the 21st Century School Nursing PracticeTM, school nurses can impact academic success and college readiness for Black youth. An integrative review of the literature was conducted to describe programs to promote college readiness for Black high school students and evaluate school nurse involvement. Findings of the eighteen unique studies included in this review were: programs included mostly female participants, and most yielded improvements in students' non-cognitive skills (i.e. sense of belonging/confidence) and college knowledge. None of the programs included school nurse involvement. School nurses can advocate for anti-racist college readiness programs with intentional, asset-based approaches to position youth for success in college.

Role of the School Nurse in Addressing Climate-Associated Illnesses of School-Age Children

Climate change is associated with global health emergencies. School-age children are particularly susceptible to the health effects associated with climate change. School nurses are uniquely positioned to address children's climate-associated illnesses. This article is the first in a series of articles that aims to inform existing knowledge gaps, raise awareness among school nurses, and equip school nurses with the skills they need to protect the health of school-age children. This series of articles will briefly discuss different aspects of the Impact of Climate Change on Human Health diagram, which was created by the Centers for Disease Control and Prevention.

Data Sharing: HOW to Tell Your Story

This is the second in a series of articles looking at school health data collection from identification of data points to utilizing data to share your story and submit your data to contribute to the National School Health Data Set: Every Student Counts! This article focuses on using data to share your story. Data storytelling versus data visualization will be discussed as well as HOW schools nurses can utilize easy access programs to support this process. Building on the first article in the series, the school nurse will not only identify the WHY and WHAT related to data collection but also HOW to link school health data to educational data to increase the audience of the story and follow data sharing regulations.

Deaths From Drug Overdoses What School Nurses Need to Know

Drug overdose deaths in pre-teen and adolescent students have risen over the past several years, causing increasing concerns in our society, along with concerns over the rise in availability of more counterfeit pills and illegally manufactured fentanyl. School nurses interface regularly with pre-teen and adolescent students and therefore are in a position to recognize students at risk for illicit drug use and provide important education to students, staff, parents, and the community. The purpose of this article is to briefly discuss risk factors for opioid misuse and to provide recommendations for interventions school nurses can use, including collaboration with other school and community leaders, to help prevent opioid overdose and death in pre-teen and adolescence.

Development of an Evidence-Based Employee Wellness Program

Workplaces can positively or negatively shape employee health and sense of well-being. Employees who feel well are more productive, engaged, and present at work. The effects of the COVID-19 pandemic added to an already stressed work environment for educators. Student success is dependent on educators who are healthy and present. Employee wellness programs have the potential to improve the well-being of employees and now, more than ever, should be a priority in schools. The purpose of this article is to provide the school nurse with evidence-based resources to assist in the creation and implementation of an employee wellness program in the school setting.

Doctor of Nursing Practice and Its Application to School Nursing

School nurses who are considering a terminal degree in nursing have two options, a Doctor of Nursing Practice (DNP) or a Doctor of Philosophy in Nursing (PhD). There are several factors for school nurses to consider when determining which terminal degree is best suited for them. This article focuses on the relevance of a DNP degree to school nursing, by first reviewing the evolution of DNP programs and then pivoting to discussions by three school nurses on why they chose this terminal degree and the projects completed during their courses of study. A main focus of a DNP project is to gather, analyze, synthesize, and translate research into practice, often operationalized as quality improvement (QI) in clinical settings. School nurses, practicing independently from other healthcare professionals while often managing large workloads, stand to benefit from obtaining or working with a nurse prepared at this level.

Action Plan and Model to Reduce Potential Opioid Overdose Deaths on K-12 Campuses

School communities are not immune to the alarming increase in opioid-related deaths occurring in the United States during the past decade. The purpose of this article is to share how a middle school in New York State, beginning in the late fall of 2022, successfully implemented a program to reduce the likelihood of opioid overdose deaths in their building through expansion of the accessibility of and education and training in use of naloxone, an opioid antagonist. The program is applicable for all K-12 campuses and follows the Model of Greater Awareness, Improved Training, and Increased Availability of and Accessibility to Intervention Devices, based on the steps successfully used for out-of-hospital cardiac arrest emergencies. Because opioid addiction does not discriminate, it is confidently projected that these targeted actions will proactively and positively reduce the likelihood of opioid overdose deaths in our school setting, including for students, faculty, staff, administrators, and visitors, when and should they occur.

The Impact of Distress, Personal Meaning & Training on the Delivery of Support to Grieving Students by School Nurses

Supporting grieving students is part of a school nurse's role which can provide meaning or special purpose in their career. This was verified by an online survey completed by 648 school nurse members of the National Association of School Nurses (NASN). A majority of respondents felt personal distress as a result of their work with grieving students which was predicted by a lack of access to work/community resources available and a lower level of educational background of the school nurse. Training to support grieving students and a higher level of educational background of the school nurse, however, appeared to predict a greater level of personal meaning found in school nurses' support of grieving students. Level of support by school leadership provided to school nurses in their support of grieving students was also found to be related to both the personal distress experienced and the personal meaning derived by school nurses.

What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households?

Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.

School Nurse Perspectives on Addressing Chronic Absenteeism

Chronic absenteeism is associated with poor health and educational outcomes. School nurses have great potential to address the health and educational needs that contribute to absenteeism. Through qualitative analysis of interviews with school nurses, we characterize their current role in reducing absenteeism and identify barriers 3 that limit their capacity to meet this goal, organized by the Framework for 21st Century School Nursing Practice. Interviewees (n = 23) identified actions perceived to reduce absenteeism aligned with domains of care coordination, leadership, quality improvement, and community and public health. Barriers perceived to limit the capacity of school nurses to address absenteeism were identified within these domains and ranged from student- and family-level to federal-level barriers. Specific healthcare system-level barriers included insufficient communication with community-based healthcare teams and the need for coordinated approaches across health and education sectors to address absenteeism. Strategic opportunities exist to address barriers to comprehensive school nursing practice and reduce absenteeism.

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.

Language Access for Families With Limited English Proficiency: Why Does It Matter?

This manuscript guides school nurses in addressing the unique needs of U.S. school-aged students and families with limited English proficiency (LEP). Owing to the increasing ethnic and racial diversity in U.S. K-12 schools, school nurses will likely encounter children and families with LEP. Students with LEP may be part of a family which immigrated to this country as permanent residents, are refugees, or asylum seekers. Some may be from migrant families who move throughout the region or country for work. School health services, including nursing services, may be the first and only health resource to which these children have consistent access. The availability and importance of language access services are highlighted, as well as tips for school nurses to advocate for language access resources, training for effective communication, understanding the legal landscape, and addressing cultural beliefs that influence health behaviors. Advocacy toward identifying the distinctive needs of families with LEP aims to help school nurses target equitable health outcomes.

Champions for School Health-An NASN Initiative to Increase Vaccine Confidence, Equity, and Uptake in COVID-19 and School-Required Vaccinations: Part 2

NASN, with generous funding from Kaiser Permanente (KP) and partnered with the Institute for Educational Leadership, developed and implemented the Champions for School Health (CSH) grant initiative. The CSH initiative awarded 54 Implementation Grants in two funding cycles in 2022, funding school districts and community-based organizations (CBOs) to increase access to the pediatric COVID-19 vaccine as well as school-required immunizations and to increase vaccine confidence among underserved populations in KP's footprint: California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia. These grantees administered a total of 17,630 COVID-19 vaccines to individuals ages 5 or older and 34,025 routine immunizations, of which 8,233 school-required vaccinations went to children of ages 5-11 years. Over 851,000 people were reached by vaccine education events in all nine KP markets. A notable takeaway from the project's results was the new partnerships created and the continuation of existing partnerships by the grantees. NASN's implementation of the CSH initiative and results provides a model and a source of critical data on how school health services and community-based organizations can partner to provide hyper-local responses to community/public health crises. This Part 2 article provides an overview of the key results of the project.

Common Skin Infections in High School Athletes and the Role of the School Nurse

Skin infections in high school athletes pose a risk of transmission to other student athletes. Therefore, it is important to promptly identify possible skin infections and refer them to the healthcare provider for treatment so athletes can return to play quickly and with little interruption to the team. Common skin infections include bacterial infections such as Streptococcus and Staphylococcus, viral infections such as herpes simplex and molluscum contagiosum, and fungal infections such as tinea corporis and capitis. The National Federation of State High School Associations provides guidance for the prevention of skin infections as well as return to play guidelines. The school nurse and high school athletic trainer are both healthcare professionals who play a role in preventing, identifying, monitoring, and caring for student athletes who contract skin infections.

Data Collection: Time to revisit the WHY, WHAT, and HOW

This is the first in a series of three articles looking at school health data collection from identification of data points to utilizing data to share your story and submitting your data to contribute to the National School Health Data Set: Every Student Counts! Many school nurses cringe at the mention of data collection. However, everything we do as school nurses is data driven. Every documented assessment, observation, and conversation provides the school nurse with data. The barriers often noted to participating in formal data collection efforts are time, workload, access to an electronic health record, and not understanding the WHY, WHAT, and HOW. The key to data collection is identifying the data already being collected and starting where you are. Data collection is not something new that you need to find a way to fit into your already busy schedule. WHAT do you currently collect? WHY are you collecting the data you have? HOW do you collect it? WHAT do you do with the data? These are all very important questions, but let's take a closer look at the WHY, WHAT, and HOW behind data collection.

Legal Issues 101: Malpractice and Licensure Discipline

This article is part of a series of articles titled "Legal Issues 101." The purpose of this series is to address common questions and misconceptions regarding the law and school health. Nurses frequently conflate malpractice or negligence with professional licensure discipline and it is important to understand the difference. To reduce liability exposure, school nurses must understand what their risks are and what they are not, for both civil lawsuits and for nursing board discipline.

Social Media Usage and Its Effects on the Psychological Health of Adolescents

Social media usage is ubiquitous among adolescents. Although social media may appeal to adolescents due to the ability to connect with peers and develop relationships, many teens also report feelings of exclusion or victimization associated with their social media use. High usage of social media may act as a forum for negative behaviors and psychological detriments. Awareness and understanding of how social media affects adolescents' psychological well-being will help parents and school staff better support teenagers and develop programs to improve coping skills and self-regulation of social media for adolescents.

Disparate discipline faced by black youth: The need for bias mitigation and school nursing impact to promote school connectedness

School connectedness is needed to improve youth mental health. Developing a school connection is more arduous for Black youth with a history of pervasive exclusionary discipline. This narrative review discusses academic and socioemotional consequences of school removals while highlighting disparities for Black youth. A comprehensive literature search was conducted, identifying relevant studies and publications using electronic databases; results from the last ten years were preferable but older references were included if deemed important. Recommendations for elevating the influence of school nursing has been included to help mitigate disparities and racial bias, considering historical discipline trends and rising mental health needs.