Improving School Health Screenings through Collaborative Efforts

The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade), a unit of the Florida Department of Health (DOH), is the county health department located in Miami, Florida. It provides population and community-based services to the county's 2.7 million residents and close to 16 million annual visitors. DOH-Miami-Dade represents the largest population and budget of the 67 county health departments in the State of Florida and is the second largest health department in terms of the number of employees. DOH-Miami-Dade currently employs approximately 775 staff and has an annual budget of more than $70 million

DOH-Miami-Dade is the lead agency providing core public health (PH) functions and essential services in the county as part of a complex PH system that includes hospitals, clinics, planning agencies, community-based organizations and others. PH is a fundamental element of the quality of life available to residents and visitors in Miami-Dade County and focuses on promoting and protecting community health through prevention and preparedness.

The DOH-Miami-Dade School Health Program is part of the public health system that provides basic school health services to children in all public schools. The services included within this program are: health appraisals, nursing assessments, child specific health trainings, health screenings; vision, scoliosis, hearing and growth and development. The overall goal of the school health program is to ensure that children are healthy in school and ready to learn. DOH-Miami-Dade collaborates with community partners in order to ensure that the mission and objectives of the program are achieved.

The primary focus of the Improving School Health Screening Through Collaborative Efforts practice is to increase the screening rates of students in mandated grades. The purpose of the practice is to ensure that a standardized process is developed and utilized by all school health providers to increase screening rates. The goals of the practice are to have at least 45% of the initial vision, hearing, scoliosis, growth and development screenings conducted by January 31st and at least 95% of the initial vision, hearing, scoliosis, growth and development screenings conducted by March 31st.

The practice was implemented in collaboration with community partners. Key stake holders meet to discuss the issues regarding the health screenings within all public schools which led to the development of a quality improvement project to address the issue. Health screenings calendar and assignment were created by all parties, and data was collected in a timely fashion and submitted to DOH-Miami-Dade.

DOH-Miami-Dade was the responsible agency to collect data from all stakeholders and report it to the State. The DOH-Miami-Dade School Health program communicated frequently with all parties to provide updates on progress toward the target as results were due to the Florida Department of Health School Health Program office by March 2018. In addition, the School Health Program partnered with Nicklaus Children's Hospital, a South Florida non-profit hospital exclusively for children, to provide screenings and provide telehealth services in 62 schools with Miami-Dade County.

As a result of the practice, significant improvements to health screenings were seen based on the increased communication and collaboration between key stakeholders in the community. Great strides were made by key stakeholders to improve the school health services provided and ensure adequate data collection.

The website for the Florida Department of Health in Miami-Dade County is http://miamidade.floridahealth.gov/.

Miami-Dade County Public Schools system is the fourth largest school district in the United States of America. There are approximately 392 schools with over 345,000 students. In addition, there are approximately 134 charter schools within Miami-Dade County. Charter schools are tuition-free public schools that are able to operate independently under an agreement as a charter” between a governing board and the public-school board. The total number of students in the mandated grades are as follow:

• Vision screening in kindergarten, 1st, 3rd and 6th grade = 102,660 students
  
• Hearing screening in kindergarten, 1st and 6th grade = 75,857 students
• Scoliosis screening in 6th grade = 27,354 students

Growth and Development with Body Mass Index screening in 1st, 3rd, 6th grade = 80,034 students

The target goals for all screenings was 95%. During the 2016-2017 school year, only 67.3% of students received vision screening, 17.4% received hearing screening, 53.5% received growth and development screening, and 20.7% received scoliosis screening in mandated grades. School screening is an important component of the school health program. Screenings provide a process that allows for the detection of health conditions that may negatively impact a child's success with learning. Health screening conducted at schools are not diagnostic: the intent is to identify abnormal screenings results. An abnormal screening result can indicate a potential or actual health program exists that requires follow up with a health care provider for diagnostic evaluation and treatment. The earlier a problem is diagnosed the greater probability the condition will be successfully treated. Screenings for vision, hearing, scoliosis, growth and development are mandated by the School Health Services Act, section 381.0056, F. S. and conducted on students in specific grade levels, at a minimum.

There is no available documentation of any other method being used to address this issue prior to 2016. It was during that time that the DOH-Miami-Dade School Health Program was reorganized, and steps were taken to implement the practice of collaborating with key stakeholders to improve school health screening. During the 2017- 2018 school year, the percent of students that received screenings significantly improved. Data shows that 78.7% of students received vision screening and 74.6% received hearing screening in mandated grades. The implementation of this project helped increase the screening rate by 11.4% for vision and 57.4% for hearing. The data further showed that 79.4% of students received growth and development and 71.5% received scoliosis screening in mandated grades. The implementation of this practice helped increase the screening rate by 26% for growth and development and 50.8% for scoliosis screening.

Actions attributed to the breakthrough include the use of the Plan-Do-Check-Act (PDCA) methodology to identify and understand the root problems in the collection and recording of data from the different providers. By using the four steps within the PDCA cycle, the DOH-Miami-Dade School Health Program was able to implement practical and effective solutions in a rigorous and methodical way. Once the School Health Program identified a potential solution, it was tested with a small-scale pilot project. The pilot project involved 62 public schools under the supervision of one provider. Data was gathered to assess whether the proposed changes achieved the desired outcome. Based on the pilot project, it was determined that the development of a health screening protocol was necessary or revisions to the current data submission protocol for school health service providers needed to be approved and implemented by August 15, 2017 through collaboration of all stakeholders. Data submission meetings were conducted monthly during the months of August 2017 through February 2018, meetings focused on data collection with the newly implemented process for reporting data, school health providers conducted health screenings in a timely manner and data was collected and recorded before the deadline