Presentation Snapshots

North Carolina COVID-19 School Preparedness and Response

Ellen Essick, PhD, North Carolina Department of Public Instruction, and Jenifer Simone, MSN, RN, CPHN, NCSN, North Carolina Department of Health and Human Services Division of Public Health, shared strategies and successes from North Carolina for protecting vulnerable students and staff during the COVID-19 Public Health Emergency (PHE). They framed their work by noting that everyone becomes vulnerable during emergencies and that there is a spectrum of need. Specific initiatives in North Carolina highlighted as successful included establishing child care centers in schools for essential workers; providing coordinated, comprehensive guidance and professional development for schools; and delivering school meals to children and their families.

Key lessons that can be applied to future emergencies:

• Use an equity lens for all aspects of emergency response. For example, masking had to be handled differently at schools for the deaf where lipreading was an important aspect of communication.
• Identify vulnerable students through data and on-the-ground partners. In North Carolina, the statewide school information system was used to identify children with special healthcare needs and those in need of services such as school meals, as well as to ascertain which areas of the state may need extra resources and supplies. School nurses and social workers were also engaged to find students who needed assistance and determine strategies for supporting them.
• Maintain strong collaboration between the state/tribal health and education agencies. In North Carolina, the relationship and partnership between the two agencies was a strong driver of success.
• Increase the workforce to support the demands of PHE response, including hiring school nurses, school nurse extenders, and health department liaisons to communicate with schools.

School Nurses: The Key to Successful Emergency Preparedness

Elizabeth Clark, MSN, RN, NCSN, FNASN, National Association of School Nurses, discussed the critical role of school nurses during PHEs, drawing on surveys conducted during the COVID-19 PHE. During school closures, school nurses provided essential supports such as outreach to students at risk; helping to connect students with health care, medications, and meals; supporting chronic condition management; and providing information to families and community members. They used their understanding of both the health and education systems to assist with planning for school re-opening, interpreting guidance, educating staff and students on infection prevention and control measures, and partnering with public health. When schools re-opened, school nurses supported screening, contact tracing, and testing and organized immunization clinics for students and staff. Unfortunately, the increased workload took a toll, with nearly 45% reporting at least one adverse mental health condition.

Lessons learned for the future:

• Expand the school nurse workforce to provide every school access to the essential PHE planning, response, and recovery supports provided by school nurses.
• Ensure school nurses are included in decision-making from the start. Many districts failed to engage the expertise of their school nurses in planning and response.
• Recognize the role school nurses can play in providing mental health support for students and staff. Mental health needs have increased significantly, and school nurses have been under-utilized in responding to this need.
• Provide additional supports to school nurses during emergencies, including assistance with communications, more immediate access to Personal Protective Equipment (PPE), and increased staffing to support the workload.
• Improve electronic data systems so that school nurses have efficient systems for contact tracing and surveillance.

Walking in Two Worlds: Exploring the Roles and Experiences of State School Nurse Consultants During the COVID-19 Pandemic

Ruth Ellen Luehr, DNP, RN, LSN, NCSN, FNASN, National Association of State School Nurse Consultants, provided a presentation on the role of state school nurse consultants during PHEs based on the findings of an after-action review. State school nurse consultants bridge state health and education systems and foster an improved understanding between the two systems, build partnerships, and translate public health guidelines so they can be implemented in the school setting. They can reach every school in their state and serve as trusted messengers for school nurses. As with school nurses, state school nurse consultants experienced a high degree of trauma and stress during the COVID-19 PHE.

Key takeaways for future emergencies:

• Create a formal, established infrastructure to bring together public health and education at the state level. State school nurse consultants play a pivotal role in this infrastructure.
• Clearly define authority and responsibility for policymaking, guidance, and communication.
• Ensure clear, timely, consistent, and repeated communication in understandable language to school nurses, school administrators, and other partners.
• Provide additional support for the National Association of State School Nurse Consultants so the organization can continue its critical role of connecting and supporting state school nurse consultants.

Critical Opinion Data for Communication Strategy in Emergencies: Public Trust during COVID-19

Alyssa Boyea, MPH, CPH, Association of State and Territorial Health Officials and Gillian K. SteelFisher, PhD, MSc, Harvard Opinion Research Program provided information on a multi-year project to strengthen public health communications during the COVID-19 PHE. The project included 16 health opinion surveys, a learning community that used survey findings to help state

health agencies hone their emergency communications, and a collection of digital resources. Dr SteelFisher shared key survey findings that can be used to restore public trust and improve communications during future PHEs. The surveys found that most people have at least some trust in public health agencies for COVID-19 information, and that trust has been rebounding.

To continue to build trust, health agencies can:

• Focus on the “moveable middle”—those who are somewhat trusting. Those with no trust are less likely to change and will require a more targeted strategy.
• Emphasize science and research as threads of consistency when policies need to change, make effective mitigations available, provide clear recommendations, demonstrate that the flow of information goes from health organizations to elected officials and not the reverse, and aim for a non-partisan approach. At the local level, discuss how approaches are custom fit for the population and demonstrate how the agency provides direct services.
• Engage physicians or other trusted partners with direct connections to the community in co-presenting emergency communications.

Fostering Student Wellbeing through Culturally Responsive School Mental Health

Tiffany Beason, PhD, National Center for School Mental Health, discussed ways to foster student well-being and mental health. Dr Beason shared a wealth of resources to assist schools in better meeting the mental health needs of students, including a trauma-informed, resilience-oriented schools toolkit; psychological first aid for students and teachers; an assessment tool to guide improvements in comprehensive school mental health systems; and emergency communications guidance.

Strategies to address student mental health during and after PHEs:

• Implement comprehensive school mental health systems with multi-tiered systems of support that take a preventive approach and support children in building coping skills as well as responding to mental health needs.
• Create systems to promote equity, using data to understand and address disparities.
• Utilize a resilience promotion framework to help students bounce back from adversity experienced during and after PHEs and to prepare for future emergencies.

Kaiser Permanente Thriving Schools: Advancing School and District Resilience

Annie Reed, DrPH, MPP, discussed the work of Kaiser Permanente Thriving Schools to support staff mental health. Following the COVID-19 PHE, over half of teachers reported feelings of burnout, and 85% of principals are suffering from job-related stress. Marginalized communities are disproportionately affected by staff mental health challenges, and the looming fiscal cliff will exacerbate this problem. The presentation highlighted several of Thriving Schools’ successful initiatives, including Resilience in School Environments (RISE), which provides robust, no-cost resources to support student and staff resilience, and the National Healthy Schools Collaborative, which convened multiple partners to develop a playbook and 10-year roadmap for healthy schools.

Key strategies for the future:

• Align incentives and funding to elevate the interconnectedness of health and education and integrate health into the foundational strategy of schools, focusing on addressing school district priorities such as attendance.
• Invest in prevention and early intervention for teacher and staff well-being. Spending $1 on well-being can save $16 in absenteeism, health care, and other costs.
• Move beyond one-off classes and other “perks” and develop a culture in which school employees feel supported and comfortable expressing their authentic selves.
• Ensure governance processes are established between LEAs and public health agencies to support coordination and planning for PHEs.

Developing a High-Quality Emergency Operations Plan Using the Six-Step Planning Process

As a final presentation, Steven Harris shared guidance on emergency planning and resources from the US Department of Education Readiness and Emergency Management for Schools (REMS) Technical Assistance Center. He provided an overview of key principles for the planning process and walked through a six-step process for developing emergency operating procedures.

Key takeaways included:

• Ensure school, district, and state/tribal plans are aligned for consistency.
• Convene a collaborative planning team, which may include parents and students, state/tribal health and education agencies, state/tribal emergency management or school safety unit, insurance commissioner, and the state school nurse association. While this team may start as a working group, ideally it will be sustained over the long-term.
• Use a structured, scenario-based planning process and draw on existing, validated resources to assist with planning.
• Use tools such as RACI (Responsible, Accountable, Consulted, Informed) charts to document and track responsibilities.
• Practice the plan through exercises.