In 2023, the Hawaii Keiki: Healthy & Ready to Learn Program was designated as an Edge Runner by the American Academy of Nursing. Edge Runners are evidence-based, nurse-designed models that demonstrate significant clinical, financial, community, and policy outcomes with proven sustainability and replicability. Each of these programs highlights nurses’ ingenuity and collaboration in developing new methods to provide care and promote health equity. Visit the American Academy of Nursing to view all Edge Runner profiles. Read the Hawaii Keiki Edge Runner press release.
Background & Goals
In 2014, the University of Hawaii at Manoa Nursing (UHM) and the Hawaii State Department of Education (HIDOE) partnered to create the Hawaii Keiki: Healthy and Ready to Learn program (Hawaii Keiki) to address the impact of health on student attendance and learning especially focused on the needs of Title 1 schools.
The Hawaii Keiki program was developed to provide access to no-cost school nursing services in Hawaii public schools. The program is enhancing and building school-based health services that screen for treatable health conditions; provide referral to primary health care and patient-centered medical home services; prevent and control communicable disease; and provide emergency care for illness or injury. Students succeed academically when they come to school healthy and ready to learn.
Program Description
The program’s five core goals are: (1) reduce preventable, health-related, chronic absenteeism while minimizing interruption to instructional time; (2) enhance wellness in the school environment and community; (3) promote optimal student health through preventive screening and effective services for chronic health conditions; (4) collaborate with community partners and organizations to provide coordinated school health programs, services, and resources; and (5) promote the nursing profession.
The program was designed to be flexible and agile to respond to emerging and ongoing student, school and community needs as well as funding availability. The Hawaii Keiki RNs and APRNs are a resource to the entire school community and lead the coordination of school health services as well as assistance in school wellness promotion and health career readiness. They collaborate with and make referrals to health systems and individual care providers. Students can walk into the Hawaii Keiki school clinic or be referred by a teacher/parent and have services provided regardless of insurance status. By utilizing technology such as telehealth, the program has expanded equitable care by using RNs to connect students to the Hawaii Keiki APRN for both physical and mental health needs. With the presence of dedicated nurses in school, it allows principals and teachers to focus on education rather than students’ health care.
Evidence of Success
The Hawaii Keiki: Healthy and Ready to Learn model has expanded access to healthcare and reduced health disparities for children and contributed to an emerging body of evidence on school health. During the COVID-19 pandemic, the Hawaii Keiki program continued to grow in size and scope to meet the needs of the students, community, and schools. When the state’s public schools closed during the pandemic, the program launched a hotline answered by Hawaii Keiki nurses to provide health advice, information on community services, as well as to conduct telehealth visits upon request.
School Nursing Services (in operation since 2014)
- Expanded from 59 schools served in 2014, to all 258 public schools across the state in 2023.
- 75% of students in 2022-2023 returned to class instead of being sent home after a visit to a Hawaii Keiki clinic.
- Grown from 4 nurses to approximately 160 registered nurses, advanced practice registered nurses, dental hygienists, dentists and health technicians in 2023.
- The program now offers: school nursing, telehealth, mental health services, dental services, health hotline, Vaccines for Children and recently expanded services to Hawaii Charter Schools.
- 82% of Hawaii public schools participated in the Hawaii Keiki Narcan/CPR training initiative to reduce potential opioid overdose on school campuses.
Dental Services (in operation since 2020)
- Provides no-cost dental screening focused on high-need schools and has received on-going grant funding from Hawaii Dental Service Foundation since 2019.
- Expanded services from 6 schools on one island in 2020, to 68 schools on three islands in 2023.
- 61% of students in 2022-2023 who received dental assessments received dental sealants.
Promotion of Health Professions
- Provides training and education for School Health Assistants (HIDOE employees) to increase their lifesaving and first-aid skills.
- Provides clinical experiences for University of Hawaii students from nursing, dental hygiene, pharmacy, sociology and psychology departments.
- Actively supports the HIDOE Career Pathways by engaging with high school student health academies and career fairs.