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Executive Summary

The Hawaii Keiki Program (HK) was established to enhance and build 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.

As SARS-CoV-2 (COVID-19) spread to global pandemic levels in 2020-21, schools were identified as potential sites for community transmission of COVID-19 between children, teachers, and staff.  As the only statewide school-based provider of health services, HK expanded in order to provide the on campus presence of a registered nurse (RN), a trusted health resource, to provide timely information, support, and updates to improve the health safety and increase the capacity and confidence of the school community.

While providing this unique response to COVID-19, the Hawaii Keiki Program continued its 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 and organizations to provide coordinated school health programs, services and resources

2020-21 Activity and Impact Highlights

COVID Response

Hawaii Keiki’s focus for the 2020-21 school year was supporting DOE administration and staff on return to learning strategies with increased support to schools in implementing guidelines contained in the Health and Safety Handbook. Nurses provided consultation to DOE administration and staff on COVID-19 and plans for reopening schools to in-person learning. Activities supporting DOE efforts to mitigate the spread of COVID-19 while bringing students back to campus included:

  • Established isolation areas in all schools for students who presented with any symptoms and were awaiting pick-up
  • Hired an additional 14 RNs, one per Complex Area, to support schools in COVID education, mitigation efforts, and tracing of cases as well as clinical support for students
  • Continued operating the HK Health “Hotline” and Telehealth Program during school hours to answer health questions and refer families and DOE staff to appropriate resources
  • Offered telehealth appointments with APRNs to assist in meeting student health needs during this period of diminished access to primary care services
  • Initiated virtual visits utilizing technology (TytoCare) to connect RNs with APRNs and provide more students access to higher levels of care in the health room
  • Created multiple Powtoon videos on health topics to support healthy school campuses
  • Assisted DOH and DOE in the implementation of ICATT (Increasing Community Access to Testing) pilot for school-based COVID-19 testing within the Pearl City-Waipahu and FKK Complex Areas
  • Assisted DOH and Health Partners with COVID-19 vaccination Points of Dispensing for DOE staff, parents and students
  • Assisted 217 schools of 14 complex areas and conducted 486 school readiness support visits
  • Assisted with the development of 27 COVID-19 school contingency plans for medically fragile students
  • Provided assistance to schools for 279 of COVID-19 response cases and 976 COVID response case contacts
  • Volunteered for 10 COVID-19 vaccine clinics

Reducing Health-Related Chronic Absenteeism and Minimize Interruption to Instructional Time

Health Room Services, Reporting, and Support[1]

  • 51% (n=12,070) parents provided consent for their child to receive Hawaii Keiki services[2]
  • Provided training on usage of electronic health records system (HOA) to 45 new School Health Assistants (SHAs)
  • 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
  • Supported DOE administration with planning and assessment of implementing the Health Module of Infinite Campus, an integrated student information and learning management system
  • Launched 13 new school-based health rooms staffed with RNs and 1 room with an APRN to provide assessment and medical treatment for health conditions increasing the statewide total Hawaii Keiki sites to 35 during the 2020-2021 school year
  • Launched Telehealth TytoCare technology to 3 RN run sites which connected students to APRN level services through technology and RN coordination

Enhancing Wellness in the School Environment and Community

  • Provided support to 15 Complex Areas and served 257 schools with population-focused school health services
  • Provided education to students, families and DOE staff on various topics, including: Adequate Sleep, Asthma Management, COVID-19, CPR/AED Programs, Diabetes Management, EPI-Pen, Fitness/Nutrition/Wellness, Food Allergies, Hand Hygiene, Healthcare Utilization (Well Child and Sick Visits), Medication Administration Training, Seizures, and Social Media/Screen-Time
  • Nurses and HK staff participated in the DOE Coordinated School Health meetings
  • Nurses provided support and assistance in SHA HealthOffice Anywhere® (HOA) refresher training
  • Nurses educated students, families and DOE Staff on COVID mitigation strategies, school specific COVID preventive strategies, COVID testing and education on the COVID vaccination

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

  • Partnered with Project Vision, Air National Guard, Vision to Learn, Lions Sight, SFAS, Times Pharmacy and Lions Club to provide hearing screening and vision screening for complex area students

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

[2] The consent rate for this school is lower than previous years due to addition of the new schools and not having all students on site due to the COVID-19 pandemic. The consent rate for HK schools continuing from the previous school year is 68%.

  • HK-Hawaii Dental Service (HDS) dental sealant team provided 193 oral assessments and applied 406 sealants to 123 2nd and 3rd grade students in 14 Title I schools

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
  • Nurses supported their complex area SHAs on electronic health record entry though the Health Office Anywhere (HOA) system
  • Nurses supported SHAs by providing education and ongoing support through utilization of the health hotline
  • Nurses supported the PHN, completing IEPs and other duties allowing for PHNs to perform essential contact tracing and other COVID public health duties

Our relationship within the University of Hawaii at Manoa Nancy Atmospera-Walch School of Nursing and partnership with Hawaii Department of Education, mandates we actively pursue our commitment to promoting professional school nursing practice and high-quality primary care services. We strive to elevate our practice and guide those pursuing a degree within nursing to positively impact our four core goals.  During the 2020-21 school year, Hawaii Keiki nurses demonstrated this commitment with following achievements:

  • Nurses completed 4 hours of training “Nursing During Pandemics COVID-19”
  • Nurses completed the Johns Hopkins Contact Tracing Course
  • One APRN completed her Doctorate of Nursing Practice (DNP) degree with a project titled “Addressing Health Disparities in LGBTQ Youth through Professional Development of Middle School Educators”. Her project was selected for the Dean’s Scholarly Project Award at UH Manoa Nursing
  • Two staff members were chosen to present at the annual conference of the National Association of School Nurses
  • One RN completed her Master of Science in Nursing degree with a project “The Importance of Self-Care: Implementation of a Wellness Program for School Nurses.” She was selected to present a poster at the National Association of School Nurses
  • One RN completed a Master of Science in Nursing degree and passed the certification exam for Family Nurse Practitioners
  • Our Dental Hygienist was selected to present a poster titled “Implementation of Virtual Oral Health Sessions for Head Start Families” at the American Dental Hygienists Association
  • Four APRNs are actively pursuing their DNP with projects supporting high-quality health services in schools
  • One APRN was selected for a DNP Postdoctoral Fellowship at the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare at Ohio State University
  • One APRN was selected to the National Nurse-Led Consortium’s Vaccine Confidence Advisory Committee
  • Nurses collaborated with Health Academy Faculty and supported students with an interest in pursuing a career within healthcare

2021-22 Planning

The positive impact of Hawaii Keiki was validated by the request for additional on-campus school support over the summer in order to prepare for the 2021-22 school year as well as ongoing support utilizing the health hotline and telehealth to serve students and families remotely. Hawaii Keiki leadership used this opportunity to seek additional funding for the 2021-22 school year to support initiatives that will address health disparities created or magnified by the COVID-19 pandemic including reduced childhood immunization rates and increased behavioral health needs.

To obtain a copy of the full report, please contact the Hawaii Keiki Program at hikeiki@hawaii.edu.

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