State of North Dakota, Department of Health

Report date
February 2020

What has been most instrumental to your progress?

CREA has implemented the following instrumental activities with positive results. These include but are not limited to: 1)Expansion of the Trauma Sensitive School (TSS) trainer capacity through Regional Training of Trainers events-- This provided educator professional development on behavioral/social emotional learning strategies and Trauma Sensitive Schools training.
2) Offering programs and services to schools that include the ND eCare School Health Program, School Counseling, Sources of Strength and Social and Emotional learning.--Providing access to behavioral health specialists to ensure student success, whether it be educational specialists, school counselors, social workers or therapists has been extremely beneficial. Each program offered and utilized by schools is a step towards filling gaps in behavioral and physical health needs of students. Schools that have had access to school nurses through the ND eCare School Health Program have witnessed the benefits and are providing testimony to their peers on the importance and need for addressing student health needs.
3) The ND eCare School Health Program has continued to act as a resource for school partners by providing an updated Community Resource Guide.-- This has provided school health and nutrition resources for schools in our region and beyond.

Schools that have had access to school nurses through the ND eCare School Health Program have witnessed the benefits and are providing testimony to their peers on the importance and need for addressing student health needs.

Key lessons learned

Capacity and relationship building of the eCare system in schools is critical for its success in the school. Schools that utilize the eNurses frequently build that relationship earlier with the nurses. The more use of the eNurse also allows for school personal and administrators to see first-hand the advantage and need for school nurse assistance with the health care needs for their students. We would provide an eNurse demonstration for school personnel to help them understand the effectiveness of a telemedicine visit and how we can provide a comprehensive student health assessment on camera.

Reflections on the community innovation process

Collaborative. The ND eCare program is truly a joint effort and partnership program. We would not be able to move forward with this program without the support from DoH and the Avera eNurse team. This partnership has worked well between the nurses in all organizations involved with the main goal to address unmet physical and behavioral health needs of students.

Progress toward an innovation

“With the expertise of a school nurse, rural schools are the ideal venue to reach and address the unmet physical and behavioral health needs of underserved families by providing access to care.” – MDEC Bush Prize Narrative Eliminating or reducing barriers to healthcare and; in this instance, the barrier of rural living and travel, or meeting the student where they are, bridges the transportation barrier for students in rural communities.
Using the data provided by Avera eCare, schools that utilize the eCare nurses understand the importance and need in having access to school nurses. Schools with students with chronic conditions like diabetes demonstrate the need of school nurses most prominently.

What it will take to reach an innovation?

See innovation above.

What's next?

Our goal is to come up with a fiscally affordable plan to be able to continue these services within the schools.

If you could do it all over again...

The one piece of learning that would have been beneficial to understand at the beginning of the grant is, “a lack of understanding exists when it comes to understanding whole child health – specifically, the close relationship between physical health, behavioral health, and educational outcomes.” Although this barrier is rightfully addressed in the narrative, the extent to which this barrier existed was not fully anticipated.

Rural North Dakota schools do not traditionally address individual student’s behavioral or physical health needs. Understanding the extent of this barrier would have allowed a different dialogue with school stakeholders regarding behavioral and physical health interventions. The dialogue needs to be mind changing in its views and provide the connection for school stakeholders in the relationship between meeting individual student’s physical and behavioral health needs and improved educational outcomes.