Officials in tug of war on school nurses

Health department argues its ability to care for students is better

June 20, 2008|By John-John Williams IV | John-John Williams IV,SUN REPORTER

County officials tangled this week over a venerable institution: the school nurse program.

Members of the County Council and the school board argued about the prospect of the health department taking over the program from the school system, and how best to serve the health interests of students.

Councilman Calvin Ball got the discussion going by asking about the merits of turning over control of school nurses to the county health department, a model followed in several Maryland jurisdictions.

School Superintendent Sydney L. Cousin said he is "adamantly opposed" to the idea, as officials raised concerns about student privacy and control.

"The goals of the health department are in conflict with those of the school system," he said.

School officials pointed to their efforts to adhere to state-mandated immunization requirements last year and the completion of dental checkups as reasons for maintaining responsibility for the nursing program.

"We were able to call every individual student," said Donna Heller, coordinator of health services for county schools. "As a result we had the lowest exclusion rate in the state. In other counties where the health department had responsibility, they much higher exclusion rates than we did. We had the relationships with the families."

Health Commissioner Peter L. Beilenson favors transfer of responsibility to his department, saying the array of health department resources could be brought to bear for the benefit of school communities. Possibilities include expanding programs to address obesity, asthma and communicable diseases.

"We are health advisers to the school system," Beilenson said in an interview Wednesday. "I think it is nice to have a tie to public health."

Across Maryland, oversight of school nurses varies by jurisdiction. Most programs - 13 out of 24 - are managed by the school system. Nurses in 10 school systems, including Baltimore, are managed by the local health department. In Queen Anne's County, nurses are managed in a joint agreement between the health department and the school system.

"More school systems have taken over from health departments as [health departments] have had funding cuts," Heller said. "They are very different models. We have a coordinated school health model. We do a lot of teaming. We look at the needs of the students."

Beilenson, who was responsible for school system nurses in Baltimore when he was health commissioner there before coming to Howard, said transferring management of the county's nurses to the health department would "take a load off" the school system.

"Their primary mission is to provide a top-notch education, which they do," Beilenson said of school system leaders.

The county's nurses are part of the overall student support team, said schools spokeswoman Patti Caplan.

"There is a very integrated approach to student wellness," she said. "Where the health department's focus is providing information and increasing awareness, our focus is on the individual student and their health needs as it relates to academic success."

Howard has 42 nurses, which equates to about one for every two schools. The school system also has health assistants assigned to schools without nurses to pick up the slack.

School officials say confidentiality would be affected if a change was made. The health department is bound by Health Insurance Portability and Accountability Act of 1996, which requires stricter privacy guidelines than the Family Educational Rights and Privacy Act of 1974 (FERPA), which the school system follows.

If the health department oversees nurses, school system officials would be cut out of the loop, Heller said.

"FERPA allows us to share information on a need-to-know basis," Heller said. "That is very critical to the school staff."

Beilenson said privacy matters were not an issue when he was health commissioner in Baltimore.

"We never had a problem with the city," he said. "We would share information."

For now, it appears no change in the system is in the offing, mostly because the system works, Cousin said.

Cousin and Beilenson stressed that they have had a good working relationship. They pointed to initiatives that have been beneficial to students, such as the Healthy Schools Awards program, which was launched this year.

"We have the same goals - to provide the safe environment for our students and their families," Cousin said.

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