A collaborative project was developed between an urban district’s alternative schools and a university college of nursing to address low immunization and physical examination rates among students. At baseline, seven alternative school campuses had 72.6% (ranging from 59% to 80%) of the 1306 students (ages 13-16 years) enrolled for academic risk also subject to suspension for noncompliance with required immunizations and/or physical examinations. An estimated 95% of the students were uninsured.

A formal partnership agreement for a service learning project outlined duties and responsibilities of each entity. A faith-based organization provided funding with the objective of increasing access to care for uninsured youth.

In the first efforts, 25 students from two schools had appointments to be transported to the university department of pediatrics for services including assessments by supervised nurse practitioner students.  The nursing students had an opportunity to practice skills in history taking and risk reduction education. Half the school students were absent; most absentees indicated “fear of hospitals and shots.”

In phase two, providers visited the schools to deliver the exams on one day. The school nurse administered immunizations. In addition to the physicals, students were informed about risk behaviors and could speak with the provider. Within confidentiality guidelines, parents were contacted about necessary referrals.  Most students participated (60 of 69) but lack of signed parental consent precluded the others.

Phase three added the use of community workers to make home visits to secure parental consent. These workers assured undocumented parents that their children could be served. All students scheduled were seen. The project included student-selected incentives, i.e., raffle items and pizza lunch. 

By the end of the first school year, the rate of non-completion dropped to 13% (with a wide variation from two percent to over 36% among the schools).  Absences and lack of parent consent forms accounted for those not in compliance. A total of 853 students (65% of total enrollment) had been seen. Arrangements were made to include signed consent forms in the registration process for the following school year.

(Glow K and Sperhac A. J Sch Health 2003;73(10):395-398)

Comment:  This project has classic elements of a nursing service learning project. The article did not indicate what changes were made that resulted in the school nurse administering immunizations nor the proportion of students needing only the required physical.  States differ greatly on requiring a physical for school attendance.--J.O.