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New w Me Mexico xico Pu Public blic Ed Educat ucation ion De Depar artme tment nt Schoo hool l He Healt alth h Ed Education ucation In Inst stitut itute November ember 20 2019 19 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

Chronic Disease Management and Care Coordination in Schools Susan n Aco Acosta, a, B. B.S. RN State e Sch choo ool Health lth/St /Stat ate e Sch choo ool Nu Nurse Con onsul ultant tant New ew Mexi xico co Depar artme tment nt of of H Health th Office ce of of Sch choo ool and Ad Adol olesc scent ent Health lth 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org CA CARE RE CO COORD RDIN INATION TION INDIVIDUAL CASE MANAG AGEMENT

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org WORDS MATTER

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org CDC C definition nition of care coordin dination ation Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services www.ahrq.gov/research/findings/evidence-based-reports/caregaptp.html

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org CDC de defin init itio ion of care e coor ordi dinati tion on in in Schoo ools Care coordination in schools involves sch choo ool l nurses es organizing the care of students by sharing information and maintaining communication among those concerned with the needs and care of students with chronic health conditions

1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org Resources for Care Coordination https://www.cdc.gov/healthyschools/chronic_conditions/pdfs/2017_02_15-How-Schools-  Can-Students-with-CHC_Final_508.pdf https://www.cdc.gov/healthyschools/chronic_conditions/pdfs/2017_02_15-CHC-and-  Academic-Achievement_Final_508.pdf  https://www.cdc.gov/healthyschools/chronic_conditions/pdfs/2017_02_15-FactSheet- RoleOfSchoolNurses_FINAL_508.pdf  https://medicalhomeinfo.aap.org/tools-resources/Pages/Care-Coordination.aspx  https://schoolhealthteams.aap.org/public/content.cfm?m=11&id=11&startRow=1&mm=0 &parentMenuID=0  https://www.pathlms.com/nasn/courses/11191

CHRONIC CONDITIONS IN SCHOOLS SHEI 2019

CHRONIC CONDITIONS IN SCHOOLS- 18-19 SY • 43 43% of students had an identified medical diagnosis (N=138,996). • Top 4 medical diagnoses were: allergic disorders, asthma, ADD/ADHD, and eye disorders * . • 920 920 students had a diabetes diagnosis (Type I=708, Type II= 212) • 6,308 08 students had a mental health diagnosis. Source: 2018-19 Annual School Health Services Report Data

Top Four Diagnoses by School Year 160.00 140.00 120.00 Rate per 1,000 Students 100.00 80.00 60.00 40.00 20.00 0.00 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 Allergic disorders Asthma ADD/ADHD Eye disorders Source: 2018-19 Annual School Health Services Report Data

CHRONIC CONDITIONS IN SCHOOLS • 23% of all student visits were for care of chronic conditions during the 18-19 school year. • Asthma and diabetes care accounted for 55% of all medically complex procedures. • Top 3 prescription medications prescribed for students were asthma medications (42%), %), epinephrine (14%), %), and allergy medication (12%). %). Source: 2018-19 Annual School Health Services Report Data

Prescription Medications Asthma medication (41.5%) Epinephrine (13.6%) Allergy medication (12.4%) ADD/ADHD (10.7%) Diabetes (6.2%)* Other (5.9%)** Analgesics (4.7%) Antibiotics (2.0%) Mental health (1.8%)*** Cardiovascular (0.1%) * Diabetes includes insulin, glucagon, and oral diabetes medications. ** Other includes migraine includes medications, digestive aids and anticonvulsants. *** Mental health includes antidepressants and psychotropics. Source: 2018-19 Annual School Health Services Report Data

LEGISLATIVE UPDATES SHEI 2019

MEDICAL CANNABIS IN SCHOOLS • New Mexico joins Colorado, Delaware, Florida, Illinois, Maine, New Jersey, Pennsylvania, Washington and California (California’s law effective 1/1/2020) in having passed legislation allowing medical cannabis in the school setting. • There are variances in how each of these states has implemented their laws and rules regarding medical cannabis in schools.

MEDICAL CANNABIS: POLICIES & PROCEDURES Must allow the administration of medical cannabis, in accordance with the qualified student’s required treatment plan, by primary caregivers and/or designated school personnel. Must address the requirement that the administration of medical cannabis not disrupt the education environment and not cause medical cannabis exposure to other students  Schools may wish to designate a specific location for the safe administration of medical cannabis

MEDICAL CANNABIS: POLICIES & PROCEDURES Established by local school boards or governing bodies and shall establish the responsibilities of the qualified student’s primary caregiver in order for a qualified student to be administered medical cannabis in the school setting. • These responsibilities include providing:  A copy of the qualified student’s written certification signed by a certifying practitioner  A copy of the patient’s New Mexico Department of Health’s (NMDOH) issued ID card, which includes the name of the primary caregiver  A written treatment plan including dosage allotment and frequency

MEDICAL CANNABIS IN SCHOOLS • Medical cannabis in schools may only be in the form of a capsule, extract, or concentrate that may be safely divided into measurable doses and ingested through the mouth. • Individuals authorized to possess, store and administer medical cannabis to a qualified student may be primary caregivers (parents/legal guardians) and/or designated school personnel, excluding school nurses under current law.

MEDICAL CANNABIS: POLICIES & PROCEDURES The NMPED Safe and Healthy Schools Bureau website regularly updates training opportunities and other resources related to medical cannabis in the school setting. • Resources include:  Final Rule (6.12.10)  Medical Cannabis Policy Framework  Guidance for School Nurses Regarding Medical Cannabis  Sample Medical Cannabis Treatment Plan  HIPAA Authorization Form https://webnew.ped.state.nm.us/bureaus/safe-healthy-schools/medical-cannabis-in-schools/

STUDENT DIABETES MANAGEMENT ACT Rule Hearing for NMAC 6.12.11 held on October 25, 2019 Goal date for adoption: November 12, 2019 Requires annual comprehensive diabetes training for all school nurses and diabetes care personnel. A minimum of two school employees must be trained at each school attended by a student with diabetes. At least one diabetes care personnel must be available at the school in which a student with diabetes is attending. Requires annual training of staff with supervisory role during the school day, including bus drivers, in relation to recognition of symptoms and emergency response. End of year reporting to the NMPED is required by October 15 each year starting 2020.

Care Coordination in Schools for Students with Chronic Diseases Presented by NM School Health Advocates: Leslie Berry, BSN, RN Jennifer Downey, MPH, BSN, RN Marisa Pisana, BSN, RN Lynn Wheeler, MSN, RN, NCSN 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

Case Study Considering your role in the school, how would you manage the following? 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

Background It is mid-October and a 5 th grade student is enrolling in your school. His mother is in the office registering her son and tells the registrar he was recently diagnosed with type 1 diabetes. 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

Background A.J. knows how to do his finger-sticks to check his blood sugar. But he does not understand how to calculate his carbohydrates and insulin. He is on a sliding-scale for insulin and uses syringes. He is afraid to give himself the injections. A.J.’s parents are not very involved in his care. He is the first student with diabetes in your school since the new law has passed. 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org

Questions? • What else do you want to know? • What are your concerns and why? • What do you want to do first? 1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505 -827- 2613 • Fax: 505 -827- 2530 • nmhealth.org