This notice is to inform you of the recent changes to the joint rule (Chapter 126/261), Immunization Requirements for School Children, (statutory authority, Title 20-A §6352). The Maine Department of Health and Human Services and Department of Education have revised the Maine School Immunization Requirements rule to now include meningococcal meningitis disease. These changes further align Maine’s immunization rules with current national recommendations to better protect the health of all Maine people. Meningococcal disease is a rare, but dangerous disease that strikes healthy young people without warning. It can affect all ages, but teens and young adults are at highest risk of getting the disease.

The following changes are effective for the 2018-2019 school year for all students attending a public or private school in the State of Maine:

• One dose of meningococcal vaccine MCV4 (serogroups A, C, W, and Y) is required for all students entering 7th grade.
• Two doses of meningococcal vaccine MCV4 are required for students entering 12th grade, with a minimum interval of 8 weeks between dose one and dose two. If the first dose of meningococcal vaccine was administered on or after the 16th birthday, a second dose is not required.

For your convenience, the Department has prepared a sample notification letter that your school may use to inform parents/guardians of the above changes to the immunization rule.

• Sample notification letter for parents

Additionally, the DHHS  has prepared a Frequently Asked Questions attached with more information. As a reminder, no student is permitted to be enrolled in or attend a public or private school in Maine without providing either a certificate of immunization or a written medical, religious or philosophical exemption for each required school entry vaccine.

• NEW 2018-2019 Maine School Entry Requirement for Meningococcal Vaccine

Please ensure all 7th and 12th grade student records are updated by the first day of the 2018-2019 school year for this new meningococcal meningitis requirement. If you have questions regarding this new meningococcal meningitis vaccine requirement, record keeping or immunization history reviews please contact Emily Poland, School Nurse Consultant at (207) 624-6688 or by email at Emily.Poland@maine.gov.

If you have immunization specific questions regarding vaccine schedules or validity of any doses given to a student, please contact the Maine Immunization Program at (207) 287-3746 or (800) 867-4775 or by email at ImmunizeME.DHHS@maine.gov.

This notice is to inform you of the recent changes to Chapter 45: Rule for Vision and Hearing Screening in Maine Schools. This rule outlines the standards and processes for periodic vision and hearing screenings. The purpose of a screening is to identify potential hearing or vision deficits among school age children and refer for further care. Updates to this rule reflect current national recommendations for hearing and vision screenings. The rule also clarifies techniques and acceptable research-based tools for schools to use.

This new requirement is in effect for the start of the school year 2018-19. Chapter 45 includes definitions, school nurse responsibility, general guidelines, vision screening schedule including distance and near acuity, alternative screening methods, and referral guidelines, hearing screening schedule and referral guidelines.  The complete rule can be reviewed at http://www.maine.gov/sos/cec/rules/05/chaps05.htm.

In brief, vision screening is required for preschool, kindergarten, and grades 1, 3, 5, 7, 9; hearing screening is required for preschool, kindergarten, and grades 1, 3, 5. The rule acknowledges that some children, because of their medical histories, have a higher rate of vision problems and may bypass routine screening at school to be directly referred to an eye specialist. The school nurse may determine which children should be referred directly.

The rule also clarifies which research-based tools are acceptable for screening. Particularly, using evidence-based instruments to screen for amblyopia risk factors and reduced vision risk factors may be used for certain school children in place of tests of visual acuity.

If you have questions about hearing and vision screening, please contact the Maine Department of Education School Nurse Consultant, Emily Poland at 624-6688 or emily.poland@maine.gov .

This memorandum is in response to queries from the field regarding PRN or discretionary medication administration in schools.

Registered nurses working as school nurses are in a unique place. Although they are school employees working under the rules and regulations of the local school board and State of Maine Department of Education, they are also licensed by the Department of Professional and Financial Regulation, Board of Nursing and therefore must follow the Nurse Practice Act and its rules. The registered nurse coordinates and oversees unlicensed personnel within a school to assign specific health tasks to be done and provides the training. Any unlicensed school staff who will administer medication must be trained by a registered nurse or physician before carrying out this task. It is the position of the Board of Nursing, that any task that requires a nursing assessment or judgment cannot be assigned to unlicensed personnel. When medication is not routine, such as with over-the-counter ibuprofen, for example, and the student’s response to the medication is less predictable, nursing oversight should be carefully considered. When evaluating if medication can be administered by an unlicensed staff, the school nurse should assess the situation and consider the following:

• The task should not inherently involve ongoing assessment, interpretation, or nursing judgment and decision making
• The school nurse should have the ability to provide adequate oversight of the unlicensed staff member’s medication administration tasks

It is recommended that schools take time to review their medication policies and procedures to ensure requirements from both the Board of Nursing and the Department of Education are being met. The following are resources that may assist your school in doing this:

Maine Board of Nursing Position Statement for School Nursing http://www.maine.gov/boardofnursing/practice/position-statements/school-nursing.html

Maine State Board of Nursing, Chapter 6 Regulations relating to coordination and oversight of patient care services by unlicensed health care assistive personnel. http://www.maine.gov/boardofnursing/docs/Chapter%206.pdf

Maine Department of Education, Chapter 40 Rule for Medication Administration in Maine schools. http://www.maine.gov/sos/cec/rules/05/chaps05.htm

Maine Department of Education, Decision Tree for Nurse Coordination and Oversight. http://www.maine.gov/doe/schoolhealth/manual/documents/nurse_decision_tree.pdf

Maine Department of Education, School Health Manual. Medication Administration in Schools Introduction http://www.maine.gov/doe/schoolhealth/manual/documents/intro_medication_administration_in_schools.pdf

For further information contact Emily Poland, School Nurse Consultant, Maine Department of Education at emily.poland@maine.gov.

The Maine Department of Education (DOE), as directed by Maine law Public Law 2015, Ch. 292 (LD 1180), An Act To Require Education in Public Preschool Programs and Elementary Schools Regarding Child Sexual Abuse, has developed a model policy for schools on child sexual abuse prevention education and response. The law (20-A MRSA §254, sub-§18) states that all school administrative units (SAUs) that operate schools with grades public preschool program through grade 5 shall adopt a written local policy for child sexual abuse prevention education and response that is consistent with the Maine DOE model policy located at www.maine.gov/doe/healthed/laws/ under Safety & Accident Prevention. The policy must include the following:

• Child sexual abuse response and reporting procedures;
• Child sexual abuse awareness training and prevention education for school personnel;
• Age-appropriate child sexual abuse prevention education for students;
• School response and reporting procedures for child sexual abuse; and
• Resources a victim of child sexual abuse or nonoffending caregivers of a victim of child sexual abuse may access for services and support.

Pursuant to this statute, school administrative units (SAUs) are required to develop a policy beginning in the 2017-18 school year. However, given the late release of the model policy, SAUs are expected to develop the policy on or before the beginning of the 2018-19 school year.

The Maine DOE and the Maine Coalition Against Sexual Assault (MECASA) are available to provide technical assistance in the writing and implementation of this policy that is intended to educate preschool through grade 5 children, as well as school personnel, families and community members in the prevention of and response to child sexual abuse. A web-based resource and trainings to support the implementation of this law are being developed by the MECASA with support from the Maine DOE. The website is expected to be launched this spring.

For more information on the new requirements contact Susan Berry, Maine DOE’s Health Education and Health Promotion Coordinator, at susan.berry@maine.gov.