Vermont’s school health services infrastructure is truly a model for other states.  Only Vermont mandates school nurse staffing at the nationally recommended level of 1 nurse to 750 students or better.  Each school must have full-time coverage by either a school nurse or a trained associate, and each school must have a consulting physician.  Vermont meets 17 of 18 core policy standards and nine of 15 extra credit indicators.

Medication & Treatment

Medication Policies

Existing Vermont policy states that only the school nurse/associate school nurse, the student’s parent/guardian, or the school nurse’s trained designees may administer medication in the school setting.  However, a student may with training be such a designee.  School nurses are required to instruct and monitor students who, with a doctor’s order, are self-administering their medication in the school setting.  Prescription medications must be stored in a locked container unless the student is self-administering medication.

In order for any prescription medications to be administered at school, written orders from a physician must be provided, including the name of the drug, dosage, diagnosis, reason for giving and any further instructions; as well, written permission from the parent or guardian must be provided requesting that the school district comply with the physician’s order.  With these provisions, students may self-carry and self-administer asthma and allergy medications. 

School nurses are instructed to maintain extra epinephrine auto-injectors for cases of unknown allergy. 

Vermont is promoting the Coordinated School Health Program and has established a School Health Coordinating Council and a School Health Action Committee to evaluate school health programs and help schools implement the CSHP.  Although it is not mandatory that all schools adopt a CSHP program, 16 V.S.A. Chapter 5, §216 (Wellness Program) states, “all schools should strive toward incorporating a coordinated school health approach to enhance student health outcomes and academic achievement.”  It is suggested that the school nurse assume the role of facilitator of a school health team.

Identification and Reporting

School nurses are instructed to coordinate information with the student’s parents and physician, develop an Individual Health Care Plan including Emergency Plan, obtain needed medication from the parent, train staff, and document staff training for response to allergic emergency situations.  Additional suggested roles are to educate the school community about allergic reactions and treatment, collaborate with the school administration to develop preventative measures, and develop a protocol for incidents with unknown allergies. 

Nurses must identify and manage students with asthma or life-threatening allergies, and appropriate forms are provided for screening, maintaining records and developing individual care plans. 

Asthma and Allergy Management Policies

Act 158:  An Act Relating to Life-Threatening Chronic Allergies and Illnesses in Schools dictates appropriate policies and practices to be adopted by schools. 

An annual letter is sent from the Vermont Department of Health to all Vermont school boards, superintendents and principals with a list of the school’s responsibilities and legal authority, along with links to policies, guidelines and resources for serving students with life-threatening allergies and chronic illnesses, including asthma. 

Health Services Capacity

The Vermont Standards of Practice School Health Services Manual, available in full on the Vermont Department of Education Web site, explains in detail the student health services offered in Vermont schools, along with the required and suggested roles of the school nurse and associate school nurse. 

In Vermont, the ratio of school nurse-to-students must be 1:750 or better, and each school must have full-time coverage by either a school nurse or a trained associate.  Schools also have a consulting physician.  Each school must have a Health Services Coordinator, and the state has one as well.

Awareness

Continuing education training or staff development funding for school nurses is provided in accessing benefits for students with disabilities, administration of medications, case management for students with chronic health conditions, identification or school-based management of students with chronic health conditions, and teaching self-management of chronic health conditions such as asthma. 

School Environment

Indoor Air Quality

Vermont’s “Project Envision--Promoting Healthy School Environments” program was developed in response to passage of Act 125, which directs the Commissioners of Health, Education, and Buildings and General Services to develop an environmental health program for schools.  The program includes a model policy and procedures, creates a clearinghouse of information, provides technical assistance to schools and holds workshops for school personnel to improve school environments. 

The model policy was required to include a recommended maintenance schedule and checklist for maintenance of the heating and ventilation systems.   

Project Envision encourages schools to use the EPA’s Tools for Schools kit, which includes reduction of asthma triggers and implementation of best practices for asthma management.  Participation in Project Envision is voluntary; 102 schools were enrolled as of 2004.  IAQ and environmental procedures in participating schools are audited annually.

Act 125 also provides a model policy for Integrated Pest Management (IPM), which is recommended for all schools.  The policy restricts pesticide application in areas surrounding the schools, requires parental notification prior to pesticide applications, and requires that schools post signs notifying the community when pesticides are to be applied.

Outdoor Air Quality

Local efforts have begun to retrofit or replace diesel engine school buses, but there is no state-wide effort to do so. 

Proposed Rule 6001 limits the idling of school buses while waiting to board or exit students at school, and requires the State Board of Education to adopt rules implementing school bus idling limitations.  A letter urging school bus idling reduction and a package of information about the health hazards of bus exhaust has been distributed to school superintendents.  In addition, Act 48 of 2007 Section 2 permits school boards to limit idling on school grounds by vehicles other than school buses and required a model policy to be developed by the Department of Education by January 2008.

Tobacco Policies 

All Vermont schools prohibit tobacco use by anyone in school buildings, on school grounds or at school-sponsored functions.  Tobacco use prevention is required in the health education curriculum for all students as well as in staff development training.

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