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Executive Summary

The Hawaii Keiki Program is enhancing and building school-based services to promote population-based health education and intervention; screen for treatable health conditions; provide referrals to and coordination with primary health care and patient-centered medical home services; prevent and control communicable diseases and other health problems, and provide emergency care for illness or injury.

The Hawaii Keiki Program has four core goals to support the Hawaii Department of Education (DOE):

  • reduce health-related chronic absenteeism and minimize interruption to instructional time
  • enhance wellness in the school environment and community
  • promote optimal student health through preventive screening and effective services for chronic health conditions
  • collaborate with community partners, organizations, and resources to provide coordinated school health programs and services

Number of Hawaii Keiki Nurses and Schools Served, 2014-15 to 2019-20

School Year HK Nurses on Staff Complex Areas Served Schools Served
2014-15 4 5 59
2015-16 6 6 89
2016-17 11 7 106
2017-18 17 13 225
2018-19 18 14 236
2019-20 21 15 256

2019-20 Health Room Services, Reporting, and Support

Hawaii Keiki nurses worked with DOE School Health Assistants (SHAs) in participating Hawaii Keiki schools to provide health services for students presenting to school health rooms. Nurses and SHAs documented visits to their health rooms in HealthOffice Anywhere® (HOA), the electronic school health record. Sixty four percent (N=11,525) of all parents in Hawaii Keiki schools provided consent for their child to receive Hawaii Keiki services. The following data on the 40,941 health room visits conducted by SHAs (80%) and Hawaii Keiki nurses (20%) during the 2019-20 school year for Hawaii Keiki schools was prepared from HOA data and minimally supplemented by paper documentation.

  • 54% of students visited the health room at least once during the school year [1]
    • 46% for illnesses (acute symptoms)
    • 29% for injuries (injuries during school activities)
    • 25% for health guidance (hygiene counseling, and provision of material and social/emotional support)
  • 165 cases of urgent or emergency medical needs, including 45 calls to 911 and 120 referrals for urgent medical care.
  • 85% of all health room visits resulted in students returning to class.

The number of keiki seeking health guidance increased from 17% in 2016-17 to 25% in 2019-20. The number of students returning to class remained approximately the same as prior years.

[1] School Health Assistants (SHA) at 4 schools received HOA training and/or were on extended leave for a period of the school year. Visits conducted by sub-SHAs were not logged in HOA, and thus data related to health room utilization was not included for those schools.

Response to COVID-19 and School Building Closures

Following the closing of school campuses and the transition to online learning, Hawaii Keiki Program launched a telephone consult “Hotline” and telehealth platform to provide access to much needed information and services to the DOE students. The telephone consult system provides an equitable way for families to experience continuity of care, receive advice and allows the option for a telehealth visit. The telephone consult and telehealth also allow for APRNs to assess and refer to the DOE school-based behavioral health team for counseling services for follow-up of high-risk children, especially those that are medically complex, as well as for prescription refills as applicable. With support from HMSA Foundation and CARES Act funds, the initiative continued throughout the summer and is now a continuing HK service to DOE students and families.

2019-20 Activity and Impact Highlights

Reducing Health-Related Chronic Absenteeism and Minimizing Interruptions to Instructional Time

  • Nurses provided 1,289 hours of non-clinical enabling services that helped to remove barriers to follow-up care such as case management, and health education
  • Nurses engaged with families and/or schools to address concerns for chronically absent students or students with known chronic medical conditions
  • Nurses coordinated with students’ primary care providers to provide treatment/care management
  • Nurses participated in case management meetings, attended IEPs and 504 meetings in addition to providing schools administrators, teacher, SHAs on various chronic disease (seizures, asthma, etc.)

Enhancing Wellness in the School Environment and Community

  • Provided support to 15 Complex Areas and served 256 schools with population-focused school health services
  • Nurses educated students and teachers on health topics, including: vaping , stroke prevention, “Hands-Only” Cardiopulmonary Resuscitation (CPR), hygiene, food allergies, sexual abuse/assault prevention, Automated External Defibrillator (AED) use, diabetes and seizures, puberty, mindfulness, nutrition, cold prevention, screen time and physical activity, and seizures
  • Nurses provided families at Complex Area schools with monthly health maintenance information delivered through school newsletters, blogs, websites, and educational displays posted in schools
  • Nurses and HK staff participated in the DOE Coordinated School Health meeting
  • Nurses provided education on immunizations, TB testing and consulted on the tracking of delinquent immunizations
  • Nurses provided support and assistance in SHA HOA Refresher training
  • Nurses provided consultation to DOE administration and staff on COVID-19 and plans for reopening schools
  • Nurses assisted in the creation of a HK Health “Hotline” and Telehealth Program when school closed due to COVID-19 and continued to staff the service through the end of summer

Promoting Optimal Student Health through Preventive Health Screening and Effective Services for Chronic Health Conditions

  • Partnered with Project Vision, Vision to Learn, Lions Sight, Lions Club, and DOH Stop Flu at School campaign to provide hearing screening, vision screening, and flu vaccinations for complex area students
  • 1,666 students received Body Mass Index (BMI) Screening
  • For 422 health room visits, students were screened for depression, in 6 HK schools.
  • HK-Hawaii Dental Service (HDS) dental sealant team provided 106 oral assessments and applied 172 sealants to 2nd grade students in six Title I schools

Health Room Services, Reporting, and Support [2]

  • 64% (n=11,525) parents provided consent for their child to receive Hawaii Keiki services
  • Conducted 8,024 health room visits for illness, injury, and health guidance, with 88% students returning to classes.
  • 4,834 visits to the health room included prescription administration
  • Supported the statewide e-school health records system by providing additional training support resulting in an increase in the number of schools utilizing the system and improving documentation
  • Launched a new school-based health center staffed with an APRN to provide assessment and medical treatment for health conditions for a total of 21 sites during the 2019-2020 school year
  • Average time in the health room was 18.5 minutes

[2] Health room statistics for this section only pertains to the care provided by HK nurses.

Collaborating with Community Partners, Organizations and Resources to Provide Coordinated School Health Programs and Services

  • Hawaii Keiki nurses and program staff supported school/community health and wellness initiatives and facilitated additional school-based resources through collaborations with stakeholders and community partners
  • Collaborated with American Lung Association and Maui United Way to apply for grant funding for Kicking Asthma and Open Airways program for asthma education in Maui schools
  • Nurses supported their complex area SHAs on electronic health record entry though the Health Office Anywhere (HOA) system
  • Hawaii Keiki nurse and program staff assisted in the successful launch of the HK-HDS dental sealant program

Promoting Professional School Nursing Practice and High-Quality Primary Care Services

  • Nurses completed training “Nursing During Pandemics COVID-19” and completed Modules 1-3
  • Nurses delivered multiple presentations to healthcare professionals, including at the 2019 DOE Leadership Institute, Community Panel for Nurses, and the National Association of Pediatric Nurse Practitioners Conference
  • Nurses provided nursing career presentations to middle and high school students across complex areas
  • Nurses collaborated with Health Academy Faculty and supported student with health projects and screenings in their schools

To obtain a copy of the full report, please contact the Hawaii Keiki Program at

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