Improving School Health Screenings through Collaborative Efforts

State: FL Type: Promising Practice Year: 2019

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

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

The project was a collaborative effort between DOH-Miami-Dade, the Miami-Dade County School District, Nicklaus Children's Hospital and participating partners funded by The Children's Trust. DOH-Miami-Dade and the above-mentioned organizations were responsible to conduct health screenings and submit the data to the School Health Program in a timely manner.  An Action Plan Matrix was created and followed to achieve the desired objective. Steps taken to implement the practice included:

  • Develop a list of names of key staff and partners
  • Establish the initial meeting date
  • Send out meeting invite through Outlook
  • Develop meeting agendas
  • Discuss goals and expectations
  • Develop screening process
  • Review the current data submission Protocol for School Health Service Providers”
  • Create a data submission tool
  • Request screening data monthly from school health providers
  • Conduct monthly data submission meetings

Discuss and share screenings results /outcomes with school health providers

All school health providers participated in the development and implementation of the practice which was implemented in June 2017. The practice is an ongoing process as school health providers continue to meet quarterly to ensure mandated health screenings services are provided to the students in specific grade levels, including referral and adequate follow up. There was no cost involved in the development and implementation of the practice. DOH-Miami-Dade served as the catalyst in bringing together community stakeholders. DOH-Miami-Dade's role in fostering collaboration aided in successfully enhancing the overall screening rate in Miami-Dade County. Data showed an increase among all mandated health screenings for vision (11.4%), hearing (57.4%), scoliosis (50.8%) and growth and development with body mass index (26%). In time, the collaborative is expected to reach the established target of 95% due to the active participation from a network of broad-based partners.

The purpose of this practice was to identify and ensure a standardized process is utilized by all school health providers in Miami- Dade County to increase screening rates. The objectives of the practice include:

  • Hold meetings to discuss project's purpose and vision
  • Ensure all community partners are participating in all school health meetings
  • Monitor and analyze health screenings data

Accomplish 95% goal for school health screenings

The objectives were developed during provider meetings. The School Health Services Act” and School Health Coding Manual were used as the foundation for these objectives. The overall arching goal of the project was to standardize the screening process among all providers. A data submission tool was created by DOH- Miami- Dade and shared with all providers in order to capture all screenings services rendered within Miami- Dade County Public Schools. Data from the shared tool was received monthly and entered in the Health Management System (HMS) within one week from the time it was received.

DOH-Miami-Dade's School Health Program was responsible for monitoring the data and sharing results with all providers. Data from the 2017-2018 School year showed that 80,801 students (78.7%) were screened for vision from a total population of 104,237. This result shows an increase of 11.4% in the vision screenings in comparison to 2016-2017 school year where 70,166 students (67.3%) were screened. The practice effectively addressed health screening issues and concerns, and a significant increase in screening rates was seen after the changes were implemented.

During the evaluation process and following PDCA methodology data was reviewed among all providers and  further modifications were made to the process. It was determined that most of the providers were not aware of the deadlines and processes related to the School Health Services Act, health screening process, and school health coding. Importantly, a data submission tool was created to avoid the possibility of data being duplicated. An additional area of improvement was also identified due to the practice. Screenings within the charter schools were not being conducted, and if performed, were not being reported. It was also determined that outreach to the charter schools needed to be implemented to collect, review, and report on the data.

DOH- Miami-Dade's definition of sustainability embraces the needs of conducting all four health screenings to students in the mandated grade level and relies on key partners to share ownership and responsibility to work towards the same goals.

To ensure the sustainability of the practice, the DOH-Miami-Dade School Health Program developed an operating procedure describing all the steps within the practice.

During the course of the implementation and evaluation of the practice, it was learned that school health services will not be effective without the active collaboration of key partners. DOH-Miami-Dade County, the Miami-Dade County School District and The Children's Trust are committed to continue working together to ensure that the 95% goal is met annually. The above-mentioned entities are invested in the maintenance of this practice and agreed to the following sustainability goals:

  • Health screenings will be conducted according to the School Health Services Plan, School Health Services Act, School Health Administrative Resource Manual 
  • Meet quarterly, at a date and time that will be agreed upon by school health providers and DOH-Miami-Dade, to discuss opportunities for improvement
  • Follow all recommendations based on QI/QA (quality improvement/ quality assurance) audits conducted by DOH-Miami-Dade
  • Conduct monthly data meetings to monitor health screenings process
  • key partners participate in the School Health Advisory Committee (SHAC)
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