There are many crossovers between the priorities to improve children’s health, together with the day-to-day work of school nurses, and the aims of a whole-school approach to promoting and supporting children’s mental health and wellbeing.The strategic role of school nurses to understand and track local need, to be aware of local services and support, and to be accountable for monitoring and feeding back on unmet need provides them with important opportunities to contribute to school planning, mental health improvement initiatives and to working with schools to influence commissioners.
In a recent survey, less than half of school nurses felt that children and young people knew about their service in schools, pointing to a need for better promotion and integration of work in schools.
School nurses work with children and young people aged 5 to 19 years old in both statutory and independent schools; health visitors have responsibility up to the age of five.
School nurses have a key role:
- Assessing the health needs of children, of school communities and of environmental risk factors (such as poverty, parental mental health problems etc.) in local communities.
- Delivering services to improve children and young people’s health and wellbeing and reducing child health inequalities. This can include:
- offering school drop-ins
- producing and reviewing health care plans for specific health needs (i.e. allergies, asthma etc.)?
- accepting referrals from school, children and families
- providing health education and information (sometimes as part of PSHE)
- delivering targeted interventions
- giving medical advice and providing liaison with GPs and other medical practitioners.
- Working closely with health visitors to support children’s transition into primary school and providing continuity of appropriate information transfer and support across primary to secondary transitions.
- Working with SEND leads, other education colleagues and multi-agency teams across health and social care – coordinating and supporting children with complex needs:
- signposting to other services
- influencing service planners and commissioners
- using research and audits to deliver an evidence-based service with clear outcomes, with evaluation as an integral part of the process.
School nurse priority areas
The Royal College of Nursing toolkit identifies six ‘high impact’ or priority areas of work – all of which are closely related to aspects of children’s mental health and wellbeing. These include building resilience, supporting emotional wellbeing, keeping children and young people safe and assisting children with ‘risky’ behaviours. Risky behaviour is defined as including children:
- who self-harm
- who avoid school and/or experience dips in attainment
- at risk of exploitation (e.g. staying out late or away from home, mixing with older peers)
- at risk of radicalisation
- with challenging behaviours and anger management problems.
School nurses can also advise on lifestyle challenges such as building healthy relationships, body image and eating problems, sleeping issues, age-appropriate sex education, substance use, active lifestyles etc. as well as on a range of other physical health problems (e.g. toilet training, long-term health conditions). They are also seen as having key opportunities to complete young carer statutory health assessments and to signpost and coordinate any necessary support for a child and their family.
School nurses: referral, roles and responsibilities
School nurses may identify children in need of services during a drop-in session. Referrals can also be received from teachers, parents, pupils and other professionals. Some school nursing teams have now set up a single gateway for managing referrals (single point of access) which has quickened referral processes. Find out if this system exists by searching online for school nurses in your area.
School nurses are tasked with responsibilities ranging from providing a service for all children to coordinating support for children with more complex needs. They also have a wider public health promotion and protection role in schools and in the community:
- Services for all children (universal): universal drop-in services or signposting to services.
- Services for children who need a little extra help (universal plus): school nurses are the key to the provision of early help for children who require extra services for additional health needs, emotional and mental health problems and sexual health.
- Service for children with complex needs (universal partnership plus): the school nurse will provide additional services to vulnerable children and families with specific problems requiring co-ordinated input from a range of professionals, including children with complex health needs and disabilities, and those involved in risk-taking behaviours and with mental health problems.
- Community public health role: school nurses have a wider community public health responsibility in local communities. This involves contributing to public health initiatives within schools and working with schools to help identify relevant health needs, ensuring services are provided in places accessible to children throughout the year and undertaking wider health promotion and protection activities through engaging and collaborating with other partners.
- Health checks in primary schools: school nurses also complete two standard health reviews as part of the Healthy Child Programme as a child enters and leaves a primary school setting.
How school nurses contribute to school planning
- School health profiles: as part of their core work, school nurses are responsible for completing a school health profile analysing the particular needs of children and families in the school based on local public health data, health and environmental risks. This data should provide a useful starting point for schools to use to assess the scale and nature of local risks and plan and coordinate support for children’s mental health and wellbeing. These health profiles could also inform primary school leadership team improvement plans.
- Mapping of services: as part of the action plan produced by school nurses to support local needs, they are required to ‘provide a comprehensive overview of services provided locally for children and young people’. This overview should provide a useful building block for schools to map and update local services.