Papakura High School
Enhanced School-Based Health Service
Sponsored by Sky City Community Trust
Quarter 4 report
1 April 2017 - 30 June 2017
Counties Manukau Health
19 Lambie Drive, Papatoetoe, Auckland 2104 | Private Bag 94052, Manukau City, Auckland 2241
T: +64 9 276 0000 | countiesmanukau.health.nz
Executive Summary
The work we’ve been funded to do:
· Additional nursing support for the most at-risk young people enrolled in the mainstream high school or Activity Centre (young people that have been removed from their mainstream school);
· Youth Worker (1 FTE);
· On-site GP clinic;
· Operational costs to support health services.
What we’ve achieved so far with our initiative:
· An increase in nursing provision, both in the mainstream high school and Activity Centre;
· An increase in the number of young people & whānau accessing the nursing service
· An increase in the number of young people & whānau accessing the GP service (skin infections, sore throats, respiratory, sexual & mental issues being the most common presenting issues);
· An increase in the number of young people accessing the youth worker for support and he then linking into the health and pastoral team for referral and follow up;
· Provision of a dedicated after-school programme to support young people with physical and mental health issues as well providing relief from often challenging whānau situations at home;
· Growing integration of a cohesive multi-disciplinary health team working together to support the needs of the young people.
Challenges we’ve experienced so far:
Health & social issues
· Increased awareness of the significant needs and complexity of the community where social deprivation is impacting on all aspects of young people’s lives;
Operational issues
· Transition of Health Team;
o New GP provider to commence Term 3; Quarter 1.
o New Guidance Counsellor to commence Term 3; Quarter 1.
Ensuring socialisation of new team members within the Health and School teams, as well as their understanding of the broader Kootuitui initiative (i.e., the digital technology and healthy homes components), and use of the appropriate IT systems and reporting mechanisms etc.
School & Community
· Both the School and Papakura community are incredibly supportive and appreciative of this service continuing into year 2; it will ensure the ongoing health needs and social support structures remain a priority for both young people and whānau.
1. Quarter 4 results (1 April 2017 - 30 June 2017)
Achievements
Nursing:
The winter term brings with it its seasonal adversities for the school nursing team to contend with. This term has already seen double the number of both sporting injuries and throat swabs than the previous term.
A commitment this term has been in undertaking opportunistic assessments of senior students (47 in total in years 12-13) to ensure they are enrolled with a GP, Dentist, assess any vision or hearing concerns, as well as discussing sexual health, contraception and any other general health concerns the students may have. This is a proactive step in ensuring these young people are engaged with their primary health services when they leave school but also are as healthy as they can be.
This quarter has seen a further increase in students accessing contraception, with more young women enquiring around long acting reversible contraceptives such as Jadelle implants or the Depo injection. This is really reinforcing the sexual health education that has been provided and the growing knowledge and health literacy young people are now having around their contraceptive choices and options. Additionally there have been no teen pregnancies recorded this term. In agreement with the health teachers the school nursing team will be providing sexual health education to all year 9 and 10 classes during next term.
In order to increase access and the range of means by which students can contact the nursing team, as of term 1 the nurses emails have been socialised with the students as a means of making appointments and obtaining support for their health concerns and follow up around treatment. Since this was initiated in term 1 over double the emails have been received from students this term, it is expected this will increase as a viable and secure option for young people.
The Wellness Centres Google Web Page has now been developed with student’s contribution to ensure it had a ‘youth friendly’ focus. The web page will contain information on the roles, responsibilities and contact details of the health team members as well as health promotion and health information. Once final sign off has been given by the school it will be launched for community access.
The after school programmes continue to engage, encourage, motivate and provide a safe haven for students. As a result of the programme’s success they have recently lost five members who have joined a sports team; this would not have happened without the confidence and the sense of value that the programme provides these young people.
Personal stories:
1) A young man in year 13 who has been smoking for 4 years came in seeking Nicotine Replacement Therapy to help him quit smoking. He had previously made attempts to give up but had never tried quitting using patches. Throughout term 2 we supplied him with patches and he made random visits in his own time to catch up. After 2 weeks he voiced that he had quit smoking since using the patches and said that although he felt like crap at the start he now felt great and proud to have stopped smoking. We continue to provide him with support.
2) One member of the afterschool programme previously came in with multiple large boils and was generally unclean and unkempt. We provided him with antibiotics for his boils and followed him up every day. Over the course of 2 weeks his boils slowly healed. We then spoke to him about hygiene and gave him supplies of soap, deodorant, socks and provided him with information on bleach baths. Over this term he has become a new young man, who takes care of his uniform and his general appearance and hygiene. He has also blossomed into a sports player with the group’s motivation, and has lost 9 kg of weight which he is very proud of.
3) A parent rang us after we had supported and treated their daughter at the Activity Centre. She thanked us for getting her seen by the GP and providing medication as taking time off work and money was a barrier to accessing a GP for their whānau .
Within this quarter 314 students (an increase of 68 more students seen than last quarter) were seen with a total of 890 visits, averaging around 2.8 visits per student. Consultations were predominantly for sore throats, skin infections, sports accidents and injuries. Senior health checks and smoking education have also been promoted this quarter. This quarter has also seen an increase in referrals, with 89 made (an increase of 9 from the previous quarter), these were made to either the students GP, the school GP or the onsite physio clinic. With the compliment of the GP service and the ability to provide prescriptions & medication it has been noted that often whānau are unable to cover the cost of their child’s prescriptions. These costs have been covered by the health clinic consumable budget but again does highlight that without this GP service there is a very real probability that these young people may not have been taken to see their GP let alone receive any treatment. The number of nursing interventions continues to grow each quarter since the commencement of the enhanced service on 1 July 2016.
Alternative Education Activity Centre:
The additional nursing hours at the Activity Centre (4 hours per week) continues to be well received and rewarding for both nurses and students alike. The school nurses have enjoyed working with the most vulnerable youths at the school and the students are now self-referring to both nurses and the GP.
Health programmes this quarter have focussed on personal hygiene, sexual health, dental care, sore throats and relationship advice. These sessions continue to be adapted by the nurses to ensure the needs of these students are met, due to the high turnover of students these sessions are repeated to ensure the messages are taken on board. A further focus on diabetes and healthy lifestyles has also led both students and tutors to participate in an individual health challenge of reducing their blood sugar levels, blood pressure and body measurements.
Within this quarter at the Activity Centre 15 students were seen with a total of 41 consultations, averaging 2.7 visits per student, 2 referrals were made. These consultations were predominantly for sore throats, sexual health and smoking cessation support. The number of nursing & GP interventions continues to grow since the commencement of the enhanced service on 1 July 2016.
GP:
The GP service continues to integrate well into the Wellness Team and school operating a two hour clinic on a Thursday. As noted by the attending GP there continues to be a high level of social deprivation at the school with difficult social situations for many, the top presenting issues for the students continues to be infections, mental health and sexual health issues.
This quarter has seen a consistent number of sexual health consults, with 5 young women having Jadelles (long acting reversible contraceptive) inserted at the GP practice. The GP practice continues to provide free care for students outside of the clinic hours, having treated several who have not previously attended the practice. The feedback from students and the nursing team continues to be very positive in regards to the attending GP (who also provides the Jadelle insertions), who has very much established herself within the school and Wellness Team.
This GP practice is also actively participating in the Counties Manukau Health Youth Friendly Quality Improvement Initiative, which focusses on improving access and responsiveness to youths and youth related health issues.
Within this quarter at the school 44 students were seen by the GP, an increase of 7 students from last quarter, with a total of 57 consultations, averaging 1.3 visits per student. These consultations were predominantly for skin infections such as boils and infected eczema and burns; ear problems, headaches, sore throats, ACC, respiratory, sexual & mental health issues. Three referrals were made within this term. Additionally HEADSS assessments (this is a robust psychosocial assessment covering Home life, Education, Activities, Drugs, Sexuality and Suicide) were conducted on a few students presenting with stress related illnesses or mental health and personal problems.
3 students visited the GP from the Activity Centre for sexual health issues and sore throats. The number of GP interventions continues to grow since the commencement of the enhanced service on 1 July 2016.
In addition, the GP:
· Has supported the nurses with standing orders[1] for treating skin infections and burns; urinary tract infections and STIs;
· Has provided another avenue for students and whānau to access mental health support and services, if they are reluctant to engage with secondary mental health services;
· Is available for advice and support for the nurses’ clinical decision making.
Unfortunately, at the end of this quarter we were notified that the GP provider will not continue to provide this service at the school citing concern around the contractual obligations and fulfilling them going forward into Year 2. We are currently under discussions with another local GP provider which looks promising for commencement at the start of term 3. Where necessary any clinics where a GP is unavailable will continue to operate with Counties Manukau Health Nurse Practitioner as the lead. This is a comprehensive role with the scope to provide prescriptions, medication, referrals to secondary services as well as being able to request laboratory and radiology tests, determining diagnosis and providing treatment plans. This is an ideal solution should there be a delay in the new GP provider commencing. The new GP provider will continue to offer all of the above services and we hope will transition seamlessly into the school setting.
Youth Worker:
The youth worker has integrated well into this role within the school working on a daily basis with the students, the health and pastoral team and the teaching staff. It is a role noted to require flexibility and sensitivity to meet the needs of the student as well as patience, required for building relationships and trust with students and whānau as well as developing links within the community.
Achievements for the Youth Worker:
· Term 2 has focussed on working with smaller groups of students through a variety of different Leadership and Teambuilding activities aiming to encourage self-confidence, connection and peer to peer support for students.
· A Year 10 ‘Connections’ group was established which met twice a week at Kevin Mealamu’s FIT60 Gym. Kevin led the boys through some great character and healthy living exercises and training. The term ended with Kevin and the students leading a year 9 PE class at the school.
· The Youth Health Council (YHC) has now been re-established made up of students, the youth worker and nursing staff meeting fortnightly to organise and run health promotion activities and projects at the school. The YHC has worked on promotional activities this term such as: Sign Language week, Youth week, World Smokefree day and Pink Shirt Day. The students organised fundraising activities and entertainment, which saw them raise $400 towards the Pink Shirt Day National Appeal.
· The New Student orientations that started in term 1 have continued with on-going support and follow up this term to those that still require it.
· On-going support for students with their visits to Specsavers, transport off-site to dental appointments, prescription pickups and home visits continues to play an important role in this position
· Ensuring that the health clinic environment is friendly and bright via mural art work. This has seen many students contribute and be involved in completing 4 different wall murals that now brighten up the whole area, making it a friendlier and a more welcoming place for students to gain the support and help they need.