WASHINGTON – Montgomery County invested $60,383 in 2001 in a Health Room Reporting System capable of logging every visit for every student in school health rooms across the county.
HERO contains the times, dates, locations, and types of illness at each visit, and school nurses can log 75 different complaints and more than a dozen interventions, from “ICE” to “911.”
But one component of HERO is not being utilized: the part that tracks some of the most serious health concerns among youth — substance abuse, physical abuse, neglect, pregnancy and sexual issues, among others. The lack of reporting data in those areas, other school districts and experts said, could leave the county with a void in information useful in combating these problems.
Montgomery County nurses and health technicians saw more than 40,000 students complaining of stomach aches last year. There were almost as many headaches, and 12,000 students saw the nurse for a sore throat, according to HERO data.
The HERO system logged 243,391 visits to health rooms in 2007-2008. With a Montgomery County Public School enrollment of more than 133,000, it averages about two visits per student each year.
As designed by Aspen Systems Corp., the HERO database includes a category of “nurse-referred problems,” from depression to sexually transmitted disease. Wade Bouton, business systems manager for the Montgomery County Health Department, said this category has never been used.
Instead, a monthly nurse’s report tallies the information separately from the powerful data analysis capability of HERO. This deliberate separation of information is occurring at a time when the national goal is to move toward better, more comprehensive data systems.
“We’re very interested in data collection,” said Martha Bergren, director of research for the National Association of School Nurses. “You need data to address problems.”
Montgomery County does try to capture some of the sensitive information gleaned from health room visits, but not in an analyzable database.
Judith Covich, Montgomery County director of School Health Services, verified that sensitive health room information is left out of the HERO system and that nurses compile the information in a less specific report with limited information.
“This data cannot be identified by visit, student, or any other factor,” Covich said by e-mail. “Nurses respond to each student’s unique needs confidentially, according to professional standards and federal, state and local regulations and guidelines.”
St. Mary’s County takes a different attitude toward collecting data on health issues. There, schools have tracked even the most sensitive health concerns for eight or nine years and have been able to offer targeted interventions in their schools, said Nancy Luginvill, the director of health services.
“We may devote more energy in one school or another,” Luginvill said, “and health issues can be linked to other data like suspensions or detentions, even drop-outs.”
Luginvill said the county protects student confidentiality and doesn’t target individual students as it monitors trends.
“It’s not that we go out and try to find kids who are using substances or not; it’s kids who are self-reporting into the health room,” Luginvill said.
A school nurse’s role has become more complex than simply to bandage a scraped knee and send a child back to class. In the 1980s a shift in community health views guided schools toward multi-dimensional health programs.
“We promote health practices in schools; we do vision and hearing screening; we screen children for diseases; we teach children how to maintain their health, eat properly, get enough exercise and enough sleep,” said Bergren.
Schools now offer counseling lessons on bullying, smoking cessation classes, and nurse consultations for pregnant teens. The theory is that children need to be healthy to learn.
Montgomery County Department of Health and Human Services, between grants and budget allotments, spent almost $19 million on school health programs last year; about $150 per child above the $14,000 the district spends to educate a student each year.
But assessing the effectiveness of health programs has not always been a priority. Bergren said that in Maryland there are 913 students in public schools for each school nurse employed.
“Given the realities of the typical school nurse’s job, that may not be able to happen,” Bergren said.
At the Boys and Girls Clubs of Greater Washington, they have been tracking pregnancy rates while offering prevention programs and assessing attitude changes.
However, they are sensitive to problems with data collection.
“There is a fine line between being too intrusive and being able to track information,” said Leah Lamb, chief development officer of the Boys and Girls Clubs of Greater Washington.
Counties are not required to report the sensitive information, according to Dr. Lee Woods, director of the Center of Maternal and Child Health for Maryland. The Maryland Department of Health and Mental Hygiene does not have a reporting requirement for school nurses.
The state only requires that schools report immunization compliance and vision/hearing screening data, said William Reinhard, spokesman for the Maryland State Department of Education.
As for health issues such as pregnancy or substance abuse, Reinhard said, “We do have an informal survey, but they’re not required to provide that information.”
To gather information on trends of high-risk youth behaviors, the state of Maryland uses a version of the Centers for Disease Control and Prevention Youth Risk Survey.
The survey is self-reported and anonymous, said Karen Hunter, senior CDC press officer. It helps depict a problem, but it isn’t useful when trying to measure specific programs.
At the Montgomery County School Health Division Bouton is unsure as to why the more sensitive data isn’t being tracked. In the meantime, he has created a simple database for the monthly nurse reports that used to be kept only on paper. He said the non-specific information has some limited use to county health officials.
“We hope,” Covich said, “to have a complete integrated data solution in the future.”