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San Jose Unified currently has a ratio of only one nurse to 2,055students, only about one-third the federally recommended level of 1 to 750,according to Don Iglesias, superintendent of the San Jose Unified SchoolDistrict. Yet school nurses increasingly are called upon to provide highlycomplex care, including assisting in chronic disease management.
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"Children who come to school with poorly managed asthma or diabetes,dental pain or behavioral issues are not able to perform at their best levelacademically," Iglesias said. "Our nurses are overwhelmed. We appreciate thewillingness of Packard Children's and the Lucile Packard Foundation forChildren's Health to help us address this immediate issue and develop a modelfor longer term solutions."
The project is designed to help children succeed in school by improvingtheir access to primary care and prevention services, and by establishing a"medical home" for students who do not have a regular health care provider. Inaddition to four school nurses, the grant also includes funding for a nursepractitioner based at School Health Clinics of Santa Clara County. The nursepractitioner will consult with the school nurses; assist in creating careplans for children with chronic problems; offer primary care; and referpatients to other healthcare professionals.
Research has shown that children who have a medical home where theyreceive ongoing health services fare better overall, but the cost ofdeveloping a health center at every school can initially seem prohibitive,said David Alexander, MD, president and CEO of the Lucile Packard Foundationfor Children's Health.
"With this project, we hope to demonstrate that a network of school nurseswho are formally linked to a clinic serving multiple schools is acost-effective model for getting children the care they need to succeed inschool," Alexander said.
Almost 5,000 students in the San Jose Unified District -- 18 percent --are diagnosed with chronic health problems. Nurses typically are responsiblefor three or four schools, and the increasing caseloads of chronic medicalproblems have reduced time for routine health screenings and health education.
Children with chronic conditions are absent more frequently, which notonly creates additional learning challenges for the student but also reducesstate reimbursement to schools, which is based on average daily attendance.
The project, which the hospital and the foundation will fund equally, willmaintain the nurses for five years in four schools: Hoover and Burnett Academymiddle schools, and Empire Gardens and Anne Darling elementary schools. Allcurrently are covered by part-time nurses. The schools were chosen becausethey have a high percentage of students living in poverty; substantialenrollments of children who do not have access to regular health care; andproximity to the School Health Clinics at San Jose High Academy and WashingtonElementary School. The clinics can provide services from physicians, physicianassistants, nurses, a dietitian, and a health educator.
Researchers from the Stanford University School of Medicine will evaluatethe project, analyzing measures such as access to ongoing health services,management of chronic problems and school attendance.
"As the children's hospital for Santa Clara County, we currently see manychildren from San Jose," said Christopher Dawes, president and CEO at PackardChildren's. "Our goal is to help these children be well and stay well
