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Teaming Up: School Counselor & School Nurse
Collaboration
Paige Schillig Ed. S., LPC & Jennie Olson BSN, RN
During this presentation, we will cover...
❏ School Nurse & School Counselor History❏ School Counselor and School Nurse Collaboration Model❏ Multi-Tiered, Multi-Domained Systems of Supports (MTMDSS) Overview❏ MTMDSS Tiers (Collaboration Steps 3 & 4)❏ School Counselor + School Nurse Collaboration
School Nurse & School Counselor History
Lina Rogers, 1902
School Nurse History
Start of School Nursing• Lina Rogers
• 1902: One month experiment where Lina Rogers, RN provided nursing services in the school setting
• 10,000 to 1 ratio• Drastic drop in absenteeism
• Interventions• Band aid fixes (small bites, cuts, etc.)• Disabilities (vision, hearing)• Contagious conditions (educate hygiene &
prevention)• Barriers (provided food, clothing)
• Within 6 months, absenteeism fell by 90%• School board agreed to supply funds for 27 nurses. • Close to 400 nurses in schools of NYC by 1914
THEN
School Nurse History
• Recommended Student to School Nurse Ratio: 1:750 (National Association for School Nurses)
• Mental Health concerns occupy up to 35% of school nurses’ time (Cogan & Kiefner, 2019)
NOW
School Counselor History
Start of School Counseling• Jesse B. Davis
• Late 1800s & early 1900s: 1st to implement a systematic guidance program in the schools
• Detroit & Grand Rapids public schools• 1960s began shift from primary focus of careers to
include personal & social concerns• 1998: first systemic meta-analysis of school
counseling was published with outcome research• 2014-15: 1:347 average Missouri student to school
counselor ratio
THEN
School Counselor History
• Recommended Student to School Counselor Ratio: 1:250 (American School Counselor Association)NOW
School Nurse & School Counselor
Collaboration Model
School Nurse & School Counselor Collaboration Model
(Tuttle, Yordy, Appling, & Hanley, 2018)
School Nurse & School Counselor Collaboration Model: Step 1
Step 1: Mutual Understanding of Professional Role in School Setting● Schedule an initial meeting to discuss
○ Professional training○ Job roles and parameters○ Areas to provide support to school, staff, and students○ Mandated reporting ○ Identify areas of collaboration
School Nurse & School Counselor Collaboration Model: Step 2
Step 2: Respect for Ethical Considerations ● Discuss ethical guidelines and limitations of sharing during collaboration
○ ASCA ethical standards○ NASN code of ethics
■ HIPAA■ FERPA
○ Maintain confidentiality
School Nurse & School Counselor Collaboration Model: Step 3
Step 3: Establishing Guidelines for Collaboration● Identify how the school counselor and school nurse can work together to best
support all students● Know when nursing initiatives are on calendar (ie-vision, hearing)● Distinguish between each role in certain situations
School Nurse & School Counselor Collaboration Model: Step 4
Step 4: Ongoing Communication and Consultation● Ensures continuity of care
○ Assess progress over time○ Maintain professional boundaries○ Prevents disruption of services to student
● Create intentional plan for ongoing communication and consultation which includes an action plan for follow up
Multi-Tiered, Multi-Domained
Systems of Support (MTMDSS)
Multi-Tiered, Multi-Domained Systems of Support
(Hatch, Triplett, Duarte, & Gomez, 2019)
MTMDSS Overview
Tier 1: Core Program (Universal Supports; 100% of students)● District Core Curriculum● Individual Student Planning 6-12● District/Schoolwide Programs and Activities
Tier 2: Targeted Interventions (Some Students; 20% of students)● Small Groups/Individual/Referral to Resources● Consultation/Collaboration
Tier 3: Intensive Interventions (Few Students; 5-10% of students)● Referral to Resources● Individual Counseling
Common Goals & Framework
Common Goals & Framework
Positively Influence● Attendance● Behaviors (discipline)● Academics
MTMDSS Tiers within Collaboration Steps 3 & 4
MTMDSS Tier 1 within Collaboration Model
District Core Curriculum● School Nurse
○ Role of Health Educator○ Develop & promote health program initiatives
■ Healthy eating■ Hygiene■ Alcohol & Drugs■ Vaping■ Dental health
● School Counselor○ GLEs
MTMDSS Tier 1 within Collaboration Model
Individual Student Planning● School Nurse
○ Technical Centers● School Counselor
○ Middle School■ Career Clusters & Paths
○ High School■ Registration■ Senior Interviews
MTMDSS Tier 1 within Collaboration Model
District/Schoolwide Programs and Activities● School Nurse
○ Screenings■ Hearing■ Vision■ Scoliosis
● School Counselor○ Screenings & Prevention
■ Suicide■ Bullying
● Crisis & Disaster Plans
MTMDSS Tier 1 within Collaboration Model
Advisory Committee● School Nurses are required to have an Advisory Committee as a part of a
“Coordinated School Health Program” ● Consider having School Nurse as part of Counseling School Advisory and vice
versa
MTMDSS Tier 1 within Collaboration Model
Utilize School Nurse Data ● Youth Risk Behavior Survey (DESE, odd years, 9-12)
○ Tobacco use○ Unhealthy physical activity○ Alcohol and other drug use○ Sexual behaviors○ Behaviors that may result in intentioinal injuries (violence & suicide) and
unintentional injuries (motor vehicle crashes)● School Health Index tool
○ Similar info as above
MTMDSS Tier 1 within Collaboration Model
Utilize School Nurse Data (continued)● Department of Health & Senior Services local/county & state data
○ https://health.mo.gov/living/families/schoolhealth/pdf/SHCNSurveyForm.pdf
MTMDSS Tier 2 within Collaboration Model
Group Counseling/Activities● School Nurse● School Counselor
○ Small Groups■ Mental health specific: depression, anxiety, etc.■ Anger management■ Conflict resolution■ Impulse control
Consultation & Collaboration● School Nurse● School Counselor
MTMDSS Tier 3 within Collaboration Model
Referral to Resources● School Nurse
○ Resource Coordinator■ Chronic Illnesses■ Food Scarcity■ Dental Services■ Vision Services
● School Counselor○ Resources
■ Therapy■ Psychiatry■ Substance Abuse Services
MTMDSS Tier 3 within Collaboration Model
Individual Counseling/Activities● School Nurse: Advocate & Mentor
○ Teenage pregnancy○ Abuse/neglect○ Chronic clinic visits○ Anxiety○ Hygiene○ Educational planning
■ Homebound services■ 504 accommodations■ Schedules & changes
● School Counselor: Counseling○ Mental health concerns○ Reentry into school setting○ Interdisciplinary team
■ Scheduled weekly check-ins with interdisciplinary team to discuss students who have been identified as needing additional support
■ Gauge student referrals, visits, and questionable incidents
School Nurse + School Counselor
Improvements in…● Physical health● Mental health● Additional data needed:
○ Attendance○ Behaviors (discipline)○ Academics
References
American School Counselor Association, & National Association for College Admission Counseling. (2015). State-by-state student-to-counselor ratio report 10-year trends. Retrieved from https://www.schoolcounselor.org/asca/media/asca/Publications/ratioreport.pdf.
“ASCA Ethical Standards for School Counselors.” American School Counselor Association, 2016. https://www.schoolcounselor.org/asca/media/asca/Ethics/EthicalStandards2016.pdf.
Cogan, R., & Kiefner, J. (2019). Complementary collaborators: school counselors and school nurses. ASCA School Counselor, 57(1).
Hanink, E. (n.d.). Lina Rogers, the first school nurse providing healthcare to keep kids in school. Retrieved from https://www.workingnurse.com/articles/lina-rogers-the-first-school-nurse.
Hatch, T., Triplett, W., Duarte, D., & Gomez, V. (2019). Hatching results for secondary school counseling: implementing core curriculum, individual student planning, and other tier one activities. Thousand Oaks, CA: Corwin.
Maughan, E., & Troup, K. D. (2011). The Integration of Counseling and Nursing Services into Schools. The Journal of School Nursing, 27(4), 293–303. doi: 10.1177/1059840511407778 Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1059840511407778?journalCode=jsnb
Missouri Department of Elementary and Secondary Education. (2014, June). Manual for School Health Programs. Retrieved from https://health.mo.gov/living/families/schoolhealth/pdf/ManualForSchoolHealth.pdf.
“National Association of School Nurses Code of Ethics.” National Association of School Nurses, June 28, 2016. https://www.nasn.org/nasn-resources/professional-topics/codeofethics.
Pope, M. (2009). Jesse Buttrick Davis (1871-1955): Pioneer of Vocational Guidance in the Schools. The Career Development Quarterly, 57(3), 248–258. doi: 10.1002/j.2161-0045.2009.tb00110.x Retrieved from https://eric.ed.gov/?id=EJ863872
Sloop, K. (2014, December 17). The reality of school nurse-to-student ratios In independent schools. Retrieved from https://web.magnushealth.com/insights/school-nurse-to-student-ratios-in-independent-schools.
Tuttle, M., Yordy, M., Appling, B., & Hanley, E. (2018). School counselor and school nurse collaboration: partnering for K-12 student success. Journal of School Counseling, 16(4). Retrieved from https://eric.ed.gov/?id=EJ1181068
