Report Title:

Public Health Nursing; School Health System

Description:

Statutorily establishes the public health nursing services program within the Department of Health. Establishes a comprehensive school health system that promotes the healthy development of all students and a comprehensive school health program. Convenes a joint DOH and DOE planning committee to coordinate a phased implementation of the school health program. (SB740 HD1)

THE SENATE

S.B. NO.

740

TWENTY-SECOND LEGISLATURE, 2003

H.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to health.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

PART I

SECTION 1. The public health nursing services program was established by the department of health in 1923 to provide communicable disease control, infant welfare services, and nutrition services. Public health nursing services include home visitation to monitor and follow up on health conditions and conducting screening and assessments of children for early identification and intervention. The public health nursing services program continues to be prominently involved in the provision of services in the prevention and control of communicable diseases, immunization activities, and immediate response to epidemics and other catastrophic disasters and traumatic emergency events in the community.

Public health nurses have the clinical experience to monitor, anticipate, and respond to public health problems in communities regardless of the disease or threat. The program targets care coordination services to the most vulnerable population – special needs infants, toddlers, children, and elderly – and other populations who have difficulty accessing the health care system due to ever-changing societal challenges. The public health nursing services program has extensive experience in collaboration, coordination, transition, and family involvement in meeting the needs of vulnerable population.

The purpose of this part is to statutorily establish the public health nursing services program to recognize the roles and functions of the program in the delivery of direct clinical nursing services to the people of Hawaii.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§321-    Public health nursing services program. The department's public health nursing services program shall include the following:

(1) Mobilizing the department's nursing resources and responding to catastrophic and traumatic emergency events, including natural disasters (for example, tsunami, hurricane, and flooding) and biologic outbreak or exposure;

(2) Responding to communicable diseases and other public health outbreaks;

(3) Providing care coordination services to the most vulnerable populations of special needs infants, toddlers, and children with complex medical conditions, as well as the elderly and other populations who have difficulty accessing the health care system;

(4) Providing services that involve the family in collaboration and coordination with other agencies;

(5) Collaborating with the department of education and the Hawaii chapter of the American Academy of Pediatrics in the provision of school health services to address the medical and health conditions of students that affect their learning;

(6) Developing collaborative partnerships with individuals, families, communities, and providers to improve the health and safety of families and communities through assessment of community needs, establishment of priorities, and policy development;

(7) Providing health care services when no other resources are available in the community; and

(8) Collecting and evaluating data that address family and community needs to improve nursing and health services delivery to enhance the quality of life for families."

PART II

SECTION 3. Children and most adolescents are usually dependent on parents and caregivers for access to health care to maintain good health. When they become sick or are injured, most children and adolescents have access to a health care professional or service. However, too many children and adolescents in the United States, particularly those from poor families or in rural or isolated communities, are at risk for multiple health problems because they lack health insurance or access to a primary care provider. Indigent children may experience two to three times the usual incidence of certain medical conditions, many of which are preventable. Even those adolescents who have health insurance and a primary care provider do not readily seek medical care and their parents or caregivers find it difficult to maintain regular visits to the pediatrician or family doctor for their teenagers.

The most common health problems affecting children and adolescents today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, adolescents and pre-adolescents are now engaging more frequently in risky behaviors that may lead to health problems, including smoking, drinking alcohol, illegal drugs, and unsafe sex.

Since all children and adolescents are required to attend school, health services that are readily available at little or no cost would encourage students, especially adolescents, to access care or information at the earliest point of need. School-based health services will also provide access to mental health services in a non-threatening, non-labeling, and non-stigmatizing environment, since services would be provided as part of an array of services. School-based health services can play a strategic role in the delivery of school-based mental health assessments, day treatment, and mental health services as required by the Felix-Cayetano consent decree.

The legislature finds that the concept of school-based or school-linked services, which are enhanced by community agencies providing services at a school site, will facilitate school and community reforms to adopt a comprehensive, multi-faceted, and integrated approach necessary to prevent health problems. However, the legislature understands that developing a comprehensive and integrated approach requires more than outreach to link community resources, coordination of school-owned services, family resource centers, and full service schools. Meeting the needs of all students also requires community input and investment to identify and plan a continuum of school and community programs and services that is appropriate to the values of the community. Collaboration, communication, and cooperation among schools, parents, students, and community agencies and organizations are essential to establishing a successful school-based health system and over time, to ensure a seamless system of prevention, early intervention, and when necessary, care of every student in need.

The purpose of this part is to provide children and adolescents access to quality, affordable health care in an encouraging and non-threatening environment through a comprehensive school health program.

SECTION 4. (a) The department of health, with the cooperation of the department of education, shall establish a comprehensive school health program in conjunction with the department of education's comprehensive school support system. The program shall:

(1) Coordinate and integrate a range of community health and social services with components designed to:

(A) Facilitate development and learning; and

(B) Overcome barriers to regular school attendance;

(2) Integrate in-school resources;

(3) Enhance projects by integrating school and community resources, including increasing access to community programs and services by coordinating as many programs as feasible with the school to fill gaps in projects and services; and

(4) Use funds from but not limited to the following sources:

(A) Special education;

(B) Health insurance reimbursements for billable services;

(C) General funds;

(D) Federal funds; and

(E) Community resources, including community health centers, agencies, grants, donations, and volunteers.

(b) For purposes of this section, "enabling projects and services" means clusters of programmatic activities that address barriers to learning and enhance healthy development by:

(1) Enhancing classroom-based efforts to enable learning;

(2) Providing prescribed student and family assistance;

(3) Providing physical and mental health assessments and services;

(4) Responding to and preventing crises;

(5) Overcoming barriers to school attendance related to physical and mental health and family problems;

(6) Increasing home involvement in schooling;

(7) Supporting comprehensive school support services; and

(8) Supporting outreach for greater community involvement and support, including recruitment of volunteers.

(c) School-based health services shall be established through collaborative partnerships if general fund appropriations are not available.

SECTION 5. (a) The director of health, with the assistance of the superintendent of education, shall establish and operate a program, consisting of at least one comprehensive school health project in each of the seven school districts; provided that at least three projects shall be in the Honolulu district and two in the Hawaii district.

(b) Prior to the establishment and operation of a comprehensive school health project, the principal of the school and the school and community-based management council, in consultation with at least one health care professional, shall establish policy decisions related to the operation of the project, including but not limited to:

(1) How consent of a parent or parents will be provided;

(2) Ability to pay;

(3) Confidentiality of records;

(4) Financial responsibility;

(5) Limitation of actions; and

(6) Personnel.

(c) The comprehensive school health projects shall be student-centered and include the following components:

(1) Health education;

(2) Physical education;

(3) Health services;

(4) Nutrition services;

(5) Counseling, psychological, and social services;

(6) Healthy school environment;

(7) Health promotion for staff;

(8) Parent and community involvement; and

(9) Mental health assessments and services.

(d) The comprehensive school health projects shall be designed using the comprehensive school health program established in section 4 of this Act.

SECTION 6. There is established a joint department of health and department of education planning committee to plan and coordinate implementation of a comprehensive school health services and comprehensive school health program in conjunction with the comprehensive school support system.

The director of health and superintendent of education shall designate members of their respective departments to sit on the joint planning committee to carry out the purposes of this Act. The planning committee shall also include representation from mental health, medical, and dental providers, community health centers, the American Pediatric Society, Hawaii Chapter, Hawaii State Parent-Teacher Association, school-based or public health nurses, and school health aides.

SECTION 7. The director of health shall report to the legislature on the experience of each comprehensive school health project at least twenty days prior to the convening of the regular sessions of 2005 and 2006. The report shall include:

(1) The policies of each comprehensive school health project;

(2) The number of students served and the types of health services provided;

(3) The operating cost, including income collected through fees, monetary donations, private grants, and in-kind services;

(4) Quantifiable changes in high-risk behaviors among students receiving services;

(5) Benchmarks for physical and mental health and increases in positive outcomes for children and adolescents;

(5) Recommended changes to improve the program; and

(6) Any other information that the departments of health and education may determine to be necessary to assist the legislature in evaluating the efficacy, cost-effectiveness, and intangible merits of the program.

SECTION 8. The department of health shall work in collaboration with the Primary Care Association of Hawaii to apply for federal matching funds and grants and mechanisms to bill for reimbursable services provided by school-based health services to implement the provisions of this Act.

SECTION 9. There is appropriated out of the tobacco settlement special funds designated under section 328L-4, Hawaii Revised Statutes, the sum of $950,000 or so much thereof as may be necessary for fiscal year 2003-2004 for comprehensive school health projects. The sum of $100,000 of the money shall be allocated for existing and/or startup school-based health clinics for at least one school in each of the seven department of education school districts. The sum of $75,000 of the money shall be allocated for coordination and administration of the projects.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 10. This Act shall take effect upon its approval; provided that:

(1) Section 9 shall take effect on July 1, 2003; and

(2) Sections 3, 4, 5, 6, 7, and 8 shall be repealed on June 30, 2010.