Refocused school nurse role: early adopter evaluation summary

1. Background

The school health service is a universally accessible service provided to children and young people, aged 5-19 years and their families. Historically the school nursing role has played a significant part within this service. Models, roles and skill mix have varied greatly across Scotland and have encompassed; direct interventions with pupils in schools, a teaching and education focused role and a wider public health and community function. The publication of CEL 13 (2013) ^[1] aimed to redefine this role to focus on delivering consistent and more efficient services to meet current needs of the 5-19 Scottish population. The work to re-focus the School Nurse ( SN) role has been undertaken by a national Steering Group commissioned by CNO/ SEND. As part of this work detailed consideration was given to the epidemiology and wider needs of the 5-19 population across Scotland. It was then proposed what the unique and specific contribution and potential contribution could and should be of a nursing role supporting school aged children.

Since September 2015, two health boards, Dumfries and Galloway (D&G) and Perth and Kinross (P&K) in Tayside have been piloting the refocused role, including the role of the wider school health team, and associated re-design requirements. These early adopter sites are seeking to provide learning and guidance to support further roll out of the service.

The overarching aim of the refocus is to ensure that the SN role and service going forward delivers safe, effective and person-centred care based on the principles of Getting It Right for Every Child ( GIRFEC) national practice model.

It is proposed the future SN role will comprise two main elements:

1. Responsibility/leadership for children and families with additional healthcare needs:

Following pre-school review of children with an additional Health Plan Indicator ( HPI) at four years of age and handover from the Health Visitor, the SN will re-assess those families and children requiring on-going support. Following re-assessment, SNs will agree those children and families requiring additional support, intervention or home visit in discussion with the Named Person.

2. Focused and targeted interventions with vulnerable population groups:

It is proposed that the wider school health service remains a universally accessible service but the SN role will be more focused and targeted. School Nurses will be required to adopt the Getting It Right for Every Child National Practice Model to assess the health and well-being needs of children and young people in conjunction with the Named Person (education) role and other partners providing the health assessment component to the Child's Plan. The future role will have greater emphasis on home visiting and addressing wider policy and public health priorities, interagency working and partnerships with education and justice. In response to the available evidence base, policy direction and priorities, it was proposed that the role will be focused on nine priority areas:

• Mental health and well-being
• Substance misuse
• Child protection
• Domestic abuse
• Looked After Children
• Homeless children and families
• Children known to or at risk of involvement in the Youth Justice System
• Young Carers
• Transition points

As part of the review, it is proposed that some previous duties of school nurses may be more appropriately addressed through existing health improvement services and through the delivery of the health and well-being component of the Curriculum for Excellence.

Role of the wider school health team

The composition of the wider school health teams consisting of staff nurses, support workers, health improvement leads, social work and education link workers are likely to differ in individual Boards. However, it is proposed that they provide the universal service for all school aged children and families. This will consist of four main elements:

• Immunisation
• Screening such as height, weight, BMI. At present this takes place at P1 and sometimes P7. Following introduction of the Health Visitor review at 4 years of age the P1 screening will be reviewed. In the early adopter sites P1 assessment will be done by the wider school health team.
• Additional work commissioned by the SN
• Weekly Health Zones