Serious health needs on rise, nursing director tells School Committee

You’re a seventh grader at Ottoson, feeling uneasy in class, and you don’t know why. Was it the kooky look that girl in the front row gave you?

Dr. Franchi

You think: “Why does that look make me want to hurt myself?”

This is just one terror among the trials of being 13, and you head for the school nurse.

The director of nursing for the Arlington public schools has told the School Committee that she is seeing “serious health needs that we did not see two years ago.”

Dr. Susan Franchi said Thursday, April 9, that the rise in visits to the nurse throughout the town is particularly dramatic at Ottoson. “We really need another nurse at the school,” she said.

The chart accompanying this story shows the increases for all of the nine schools in a three-year period: Between 2013 and 2015, visits rose by 10,446, or 39 percent.

Visits to nurse at Ottoson

At just Ottoson, visits — which the presentation calls “encounters” — look this way in the last three years (September through early April):

2012-2013: 2,910, including 73 related to mental health;

2013-2014: 3,319, including 35 related to mental health; and

2014-2015: 5,402, including 192 related to mental health

Information in the charts presented defines mental health as encounters related to stress, anxiety and specific behavior.

A breakdown of mental-health numbers from 2014-15 at Ottoson shows:

• 23 hospitalizations;

• 40 students refusing to attend school;

• Increased incidence of self-injury called “cutting”; and

• Increased incidence of students reporting suicidal thoughts.

Accompanying this breakdown were these examples:

• Student A: 16 visits, 797 minutes in health clinic;

• Student B: 51 visits, 1,591 minutes in health clinic; and

• 119 students with fewer than 10 visits to health office, 3,078 visits.

Number of nurses to address issues

A presentation of these points about students visiting nurses included other numbers — how many nurses the public schools have to address these issues.

Franchi’s report says the annual school budget pays for nine full-time equivalents plus a nurse leader.

For students with serious medical conditions, there are two nurses (one full-time equivalent and one under agency contracted at about eight hours a week).

Other grants pay for about two full-time equivalents who work as permanent per diem with variability. A grant-funded pilot pays for one care coordinator, 0.8 full-time equivalent.

Putting these numbers in perspective are the recommended ratios of nurses to students.

The state Department of Mental Health guidelines call for one nurse for every 450 students. The National Association of School Nurses’ benchmark is more generous — one for 750.

The ratio of nurses paid for by the Arlington school budget is one to 1,277 students, a number that includes the Menotomy Preschool.

At Ottoson, the ratio is one to 1,105.

These ratios do not include the care coordinator or nurse leader.

The presentation included slides showing these reportable medical conditions:

• Asthma: approximately 185;

• Life-threatening allergies: 213; and

• Diabetes: 9.

Included are numbers of concussions districtwide:

• 2012-13: 20;

• 2013-14: 37; and

• 2014-15: 47.

Question about future

What does the future hold? The presentation makes some of these projections about impacts on resources:

• Increased student population;
• Increased health visits;

• Increased reporting to the state;

• Substantially increased mental health-related visits; and

• Numerous staffing issues related to employee absenteeism

• About the Menotomy Preschool, it says:

• No realistic nursing presence given nurse-to-student ratio;

• Greatly increased health-related acuity of the student population because of the services provided; and

• Would recommend a 0.5 nursing position for the preschool.

School Committee members had little to say about all of this information. Member William Hayner asked how an administration might determine the presence of a “sick building,” but he made no suggestion that Arlington has one.

This summary was published Wednesday, April 15, 2015.