11 Health Services State Questionnaire

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxx

Health Services
State Questionnaire

10 January 2011

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-74, Atlanta, GA 30333; Attention PRA (0920-0445).

Health Services
State Questionnaire

Questions

State Assistance to Districts and Schools 1–3

Funding/Medicaid 4–5

Collaboration 6–7

Evaluation 8

Reporting Requirements 9–10

Professional Development 11–14

School-Based Health Centers 15–17

Health Services Coordinator 18–28

THIS QUESTIONNAIRE WILL BE ADMINISTERED USING WEB-BASED INTERVIEW TECHNOLOGY. AS THE RESPONDENT TYPES RESPONSES TO THE QUESTIONS INTO THE COMPUTER, THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE.

For the purposes of this questionnaire, “elementary school” refers to a school that contains any of grades K–5. “Middle school” refers to a school that contains any of grades 6–8. Some jurisdictions may refer to these schools as “junior high schools.” “High school” refers to a school that contains any of grades 10–12. Some jurisdictions may refer to these schools as “senior high schools.”

The first questions ask about state assistance to districts and schools.

1. During the past 2 years, did your state develop, revise, or assist in developing model policies, policy guidance, or other materials to inform district or school policy on each of the following topics?

Yes No

1. HIV infection or AIDS, including procedures for
   HIV-infected school staff and students 1 2

2. Severe food or other allergies 1 2

3. Chronic health conditions, such as asthma or diabetes,
   including chronic disease management, recognizing and
   responding to severe symptoms, or reducing triggers 1 2

4. Infectious disease prevention, including foodborne

illnesses and flu prevention 1 2

5. Sending and keeping students home from school
   when they are sick 1 2

6. Closing school or dismissing students when the percentage
   of absent students or staff reaches a specified level 1 2

7. Student health records 1 2

8. Immunization requirements and exemptions 1 2

9. Tuberculosis testing 1 2

10. Screening for health-related conditions, such as hearing
    or vision problems 1 2

11. Screening for student weight status using
    body mass index (BMI) 1 2

12. Procedures for administering student medication 1 2

13. Linking students to community healthcare providers 1 2

2. During the past 2 years, did your state distribute to district or school staff model policies, policy guidance, or other materials to inform district or school policy on each of the following topics?

Yes No

1. HIV infection or AIDS, including procedures for
   HIV-infected school staff and students 1 2

2. Severe food or other allergies 1 2

3. Chronic health conditions, such as asthma or diabetes,
   including chronic disease management, recognizing and
   responding to severe symptoms, or reducing triggers 1 2

4. Infectious disease prevention, including foodborne illness
   and flu prevention 1 2

5. Sending and keeping students home from school
   when they are sick 1 2

6. Closing school or dismissing students when the percentage
   of absent students or staff reaches a specified level 1 2

7. Student health records 1 2

8. Immunization requirements and exemptions 1 2

9. Tuberculosis testing 1 2

10. Screening for health-related conditions, such as hearing
    or vision problems 1 2

11. Screening for student weight status using
    body mass index (BMI) 1 2

12. Procedures for administering student medication 1 2

13. Linking students to community healthcare providers 1 2

The next questions ask about technical assistance your state may have provided to district or school staff. Technical assistance refers to tailored guidance to meet the specific needs of the district or school that may be provided through phone, e-mail, Internet, or in-person meetings.

3. During the past 12 months, has your state provided technical assistance to district or school staff on…

Yes No

1. HIV infection or AIDS, including procedures for
   HIV-infected school staff and students? 1 2

2. Severe food or other allergies? 1 2

3. Chronic health conditions, such as asthma or diabetes,
   including chronic disease management, recognizing and
   responding to severe symptoms, or reducing triggers? 1 2

4. Infectious disease prevention, including foodborne illness
   and flu prevention? 1 2

5. Sending and keeping students home from school
   when they are sick? 1 2

6. Closing school or dismissing students when the percentage
   of absent students or staff reaches a specified level? 1 2

7. Student health records? 1 2

8. Immunization requirements and exemptions? 1 2

9. Tuberculosis testing? 1 2

10. Screening for health-related conditions, such as hearing
    or vision problems? 1 2

11. Screening for student weight status using
    body mass index (BMI)? 1 2

12. Procedures for administering student medication? 1 2

13. Linking students to community healthcare providers? 1 2

14. Establishing a school-located vaccination clinic? 1 2

15. Establishing an electronic system to track student visits
    to the school nurse? 1 2

16. Establishing an electronic system to track
    why students are absent? 1 2

17. Medicaid administrative claiming? 1 2

(Q3 continued)

Yes No

18. Medicaid billing practices? 1 2

19. State Children’s Health Insurance Program (SCHIP)
    billing practices? 1 2

20. Private insurance billing practices? 1 2

21. Applying for grants to obtain funding for school
    health services? 1 2

The next question asks about funding for standard school health services in your state. For the purposes of this question, “standard” means services offered to all students.

4. In your state, how are standard health services for students funded?
   MARK ALL THAT APPLY

State budget 1

School district budgets 2

Medicaid 3

State Children’s Health Insurance
Program (SCHIP) 4

Private insurance 5

Public grants 6

Private grants 7

Other 8

The next question asks about schools in your state that serve as Medicaid providers by providing health services to students.

5. In your state, do any schools serve as Medicaid providers by providing standard health services to students?

Yes 1

No 2

The next questions ask about collaboration among health services staff and other staff in your state.

6. During the past 12 months, have state-level health services staff worked on school health services activities with state-level…

State does
not have staff
Yes No in this area

1. Health education staff? 1 2 3

2. Physical education staff? 1 2 3

3. Child nutrition or nutrition services staff? 1 2 3

4. Mental health or social services staff? 1 2 3

7. During the past 12 months, have state-level health services staff worked on school health services activities with staff or members from…

State does not
have this agency
Yes No or organization

1. The state health department? 1 2 3

2. The state mental health or social
   services agency? 1 2 3

3. The state child welfare agency? 1 2 3

4. The state juvenile justice department? 1 2 3

5. A state-level school nurses’ association
   or organization? 1 2 3

6. A state-level physicians’ organization,
   such as the American Academy
   of Pediatrics? 1 2 3

7. A state-level dental association
   or organization? 1 2 3

8. A state-level health organization, such as
   the American Heart Association or the
   American Red Cross? 1 2 3

9. A state-level school health committee,
   council, or team? 1 2 3

(Q7 continued)

10. Colleges or universities? 1 2 3

11. Businesses? 1 2

The next questions ask about different aspects of school health services programs that the state might have evaluated during the past two years.

8. During the past two years, has the state evaluated…

Yes No

1. School health services programs? 1 2

2. School health services policies? 1 2

3. School health services professional development
   or in-service programs? 1 2

4. Student use of school health services? 1 2

5. Student or family satisfaction with school health services? 1 2

The next questions ask about information that might be reported to a state agency.

9. Do districts or schools in your state report the following types of information to your state education agency or state health department?

Yes No

1. Student injury report data. 1 2

2. Student immunization data 1 2

3. Student weight status data, such as body mass index (BMI) 1 2

4. Notifiable diseases 1 2

10. In your state, are there consequences for districts or schools that fail to comply with immunization requirements?

Yes 1

No 2

The next questions ask about professional development that may have been offered to school nurses during the past two years. This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

11. During the past two years, has your state provided funding for or offered professional development to school nurses on…

Yes No

1. First aid? 1 2

2. Cardiopulmonary resuscitation (CPR)? 1 2

3. Administration of medications? 1 2

4. Seasonal influenza vaccine? 1 2

5. Immunizations other than seasonal influenza? 1 2

6. Identification or school-based management
   of acute illnesses? 1 2

7. Identification or school-based management
   of chronic health conditions, such as asthma or diabetes? 1 2

8. Tracking of students with chronic health conditions? 1 2

9. Case management for students with chronic health
   conditions, such as asthma or diabetes? 1 2

10. Case management for students with disabilities? 1 2

11. Sports physicals? 1 2

12. Oral health problems? 1 2

13. Administration of topical fluorides, such as mouthrinses,
    varnish, or supplements? 1 2

14. Dental sealants? 1 2

15. Prenatal care? 1 2

16. Identification or treatment of sexually transmitted
    diseases (STDs)? 1 2

17. Contraceptives? 1 2

18. Infectious disease prevention, for example hand hygiene
    or food safety? 1 2

12. During the past two years, has your state provided funding for or offered professional development to school nurses on…

Yes No

1. Nutrition and dietary behavior counseling? 1 2

2. Physical activity and fitness counseling? 1 2

3. Pregnancy prevention? 1 2

4. Human immunodeficiency virus (HIV) prevention? 1 2

5. Other sexually transmitted disease (STD) prevention? 1 2

6. Suicide prevention? 1 2

7. Tobacco use prevention? 1 2

8. Alcohol or other drug use prevention? 1 2

9. Violence prevention, for example bullying, fighting,
   or dating violence prevention? 1 2

10. Injury prevention and safety counseling? 1 2

13. During the past two years, has your state provided funding for or offered professional development to school nurses on…

Yes No

1. Teaching self-management of chronic health conditions,
   such as asthma or diabetes? 1 2

2. Referrals for chronic health conditions, such as asthma
   or diabetes? 1 2

3. Tobacco use cessation? 1 2

4. Alcohol or other drug use treatment? 1 2

5. Counseling after a natural disaster or other emergency
   or crisis situation? 1 2

6. Crisis intervention for personal problems? 1 2

7. Emergency preparedness? 1 2

8. Identification of emotional or behavioral disorders,
   such as anxiety, depression, or ADHD? 1 2

9. Counseling for emotional or behavioral disorders,
   such as anxiety, depression, or ADHD? 1 2

(Q13 continued)

Yes No

10. Stress management? 1 2

11. Weight management? 1 2

12. Eating disorders treatment? 1 2

13. HIV counseling, testing, and referral? 1 2

14. Identification of or referral for physical, sexual,
    or emotional abuse? 1 2

15. Identification of or referral for students
    with family problems, such as parental divorce,
    substance abuse, or violence? 1 2

16. After-school programs for students,
    such as supervised recreation? 1 2

17. Child care options for teen mothers? 1 2

18. Services specifically for gay, lesbian,
    or bisexual students? 1 2

19. Enrolling in WIC or accessing food stamps or food banks? 1 2

20. Securing temporary or permanent housing? 1 2

21. Enrolling in Medicaid or SCHIP? 1 2

22. Accessing benefits for students with disabilities? 1 2

23. Job readiness skills programs? 1 2

24. Infectious disease outbreak detection and response? 1 2

25. Federal laws that protect the privacy of student health
    information, for example HIPAA or FERPA? 1 2

26. Accurately measuring student height and weight? 1 2

27. Calculating student weight status using
    body mass index (BMI)? 1 2

The next question asks about professional development for teachers, administrators, and school staff other than school nurses.

14. During the past two years, has your state provided funding for or offered professional development to any teachers, administrators, or other school staff on…

Yes No

1. CPR or use of automated external defibrillator (AED)
   equipment? 1 2

2. HIV infection or AIDS, including procedures
   for HIV-infected school staff and students? 1 2

3. Severe food or other allergies? 1 2

4. Chronic health conditions, such as asthma or diabetes,
   including chronic disease management, recognizing and
   responding to severe symptoms, or reducing triggers? 1 2

5. Infectious disease prevention, such as hand hygiene
   or food safety? 1 2

The following questions ask about health services offered at school-based health centers—that is, health centers on school property where enrolled students can receive primary care, including diagnostic and treatment services. These services are usually provided by a nurse practitioner or physician’s assistant. Some school-based health centers offer mental health and social services, which are usually provided by a psychologist, social worker, or other mental health or social services professional. In answering these questions, please do not include traveling or mobile health centers.

15. Currently, how many school-based health centers offer health services to students in your state?

School-based health centers

16. Currently, how many school-based health centers offer mental health or social services to students in your state?

School-based health centers

IF Q15 AND Q16 ARE BOTH 0, SKIP TO THE INTRODUCTION TO Q18.

17. In your state, how are school-based health center services for students funded?
    MARK ALL THAT APPLY

State budget 1

School district budgets 2

Medicaid 3

State Children’s Health Insurance
Program (SCHIP) 4

Private insurance 5

Public grants 6

Private grants 7

Other 8

18. Currently, does someone in your state oversee or coordinate school health services?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this interview.

19. Are you this person?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this interview.

20. Who do you work for?
    MARK ALL THAT APPLY

State education agency 1

State public health agency 2

Other 3

The last set of questions asks about your educational background.

21. Do you have an undergraduate degree?

Yes 1

No 2 SKIP TO Q27

22. What did you major in?
    MARK ALL THAT APPLY

Nursing 1

Education 2

Other (Specify) 3

23. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q25

24. What did you minor in?
    MARK ALL THAT APPLY

Nursing 1

Education 2

Other (Specify) 3

25. Do you have a graduate degree?

Yes 1

No 2 SKIP TO Q27

26. In what area or areas was your graduate work?
    MARK ALL THAT APPLY

Nursing 1

Education 2

Other (Specify) 3

27. Do you have…

Yes No

1. An LPN’s license? 1 2

2. An RN’s license? 1 2

3. A CNP’s license? 1 2

28. Do you have…

Yes No N/A

1. A national school nurse certification
   from the National Board of Certification
   for School Nurses? 1 2

2. A state school nurse certification? 1 2 3

Thank you very much for taking the time to participate in this study.

If you would like more information about this study or would like clarification of any questions in this questionnaire, please call 800-287-1815.

Health Services State Questionnaire—Public Use Version