School Absenteeism Surveillance Program: Evaluation Reportophla.pbworks.com/w/file/fetch/68176713/School Health Absenteeism... · School Absenteeism Surveillance Program: Evaluation

2012

Wellington-Dufferin-Guelph Public Health

Health Analytics, Melissa Horan

School Absenteeism Surveillance Program: Evaluation Report

School Health Absenteeism Program Evaluation Report Page 2

ACKNOWLEDGEMENTS

Authors

Lead Author

Melissa Horan Health Promotion Specialist, WDGPH

Dr. Lise Trotz-Williams Epidemiologist, WDGPH

Contributors

Mai Miner Program Assistant, WDGPH

Wellington-Dufferin-Guelph Public Health would like to thank our school board partners from the Upper

Grand District School Board and the Wellington Catholic District School Board for their permission to

conduct this work and for their help implementing this evaluation.

We would also like to thank the office coordinators and principals for their responses to this evaluation

and for the time they provide to supply information to the school absenteeism surveillance program.


TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................................................................................................................................. 2

TABLE OF CONTENTS ..................................................................................................................................................... 3

EXECUTIVE SUMMARY ................................................................................................................................................... 4

Evaluation Description .............................................................................................................................................. 4

Recommendations .................................................................................................................................................... 4

Next Steps ................................................................................................................................................................. 5

INTRODUCTION ............................................................................................................................................................. 6

Program History ........................................................................................................................................................ 6

Description of the School Health Monitoring System ............................................................................................... 7

School Orientation and Communication with Schools .............................................................................................. 7

EVALUATION OBJECTIVES AND METHODOLOGY ........................................................................................................... 8

SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM EVALUATION RESULTS ................................................................ 10

CHARACTERISTICS OF RESPONDENTS ..................................................................................................................... 10

PARTICIPATING SCHOOLS ................................................................................................................................... 10

NON-PARTICIPATING SCHOOLS .......................................................................................................................... 11

SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: PARTICIPATING SCHOOLS .................................... 12

SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: NON-PARTICIPATING SCHOOLS ........................... 19

KEY FINDINGS AND CONCLUSIONS .............................................................................................................................. 23

WEB-FORM .............................................................................................................................................................. 23

Recommendation #1 ........................................................................................................................................... 23

Recommendation #2 ........................................................................................................................................... 23

PROGRAM EMAILS, PHONE CALLS, AND YEAR-END REPORTS ................................................................................ 23

Recommendation #3 ........................................................................................................................................... 24

Recommendation #4 ........................................................................................................................................... 24

Recommendation #5 ........................................................................................................................................... 24

PROGRAM OVERALL ................................................................................................................................................ 24

Recommendation #6 ........................................................................................................................................... 24

Recommendation #7 ........................................................................................................................................... 24

TIME REQUIRED FOR PARTICIPATION IN THE PROGRAM ....................................................................................... 25

Recommendation #8 ........................................................................................................................................... 25

ADDITIONAL ANALYSIS ............................................................................................................................................ 25

Recommendation #9 ........................................................................................................................................... 25

NEXT STEPS .................................................................................................................................................................. 25


EXECUTIVE SUMMARY

Evaluation Description In winter of 2012, Wellington-Dufferin-Guelph Public Health conducted an evaluation of its School

Absenteeism Surveillance Program of secondary and elementary schools in both the Upper Grand

District School Board and the Wellington Catholic District School Board.

The goals of the school absenteeism surveillance program are:

To monitor and collect information about illness in the community, using school absenteeism as

a possible early indicator of illness in school-aged children in order to improve early detection of

outbreaks before they reach their peak level of infection (“syndromic surveillance”).

To utilize the information collected to identify unusual trends or clusters of illness within the

community, including enteric and/or respiratory illnesses.

To utilize school absenteeism data to target prevention strategies (i.e. proper coughing and

hand washing practices) and/or deploy treatment resources.

The goal of the evaluation was to answer the question “How can the delivery of Wellington-Dufferin-

Guelph Public Health’s School Absenteeism Surveillance Program be improved to better serve the needs

of schools and Wellington-Dufferin-Guelph Public Health (WDGPH)?”

To accomplish this goal, two separate surveys were designed for participating and non-participating

schools using Fluid Surveys software. Participants in the survey self-identified whether they belonged to

a participating or non-participating school and filled out the corresponding survey.

Recommendations As a result of analysis of the survey responses Public Health will consider implementing the following

changes to the program:

Public Health will investigate how to make the response emails and phone calls, and the year-

end report, more helpful to schools.

At the beginning of the 2012-2013 school year, principals will be asked to indicate whether they

would like to receive a customized report on their school’s attendance at the end of the school

year. Public Health will provide these reports based on interest.

Public Health will review their response protocol for the program to ensure that:

o The submitted data on illness from schools are closely examined prior to the

distribution of emails to schools with reported absenteeism rates of 10% or over. If a

school has indicated that most of their absenteeism is not due to illness, but rather class

trips or vacations, Public Health will not send the school an email.

o No more than one email a week is sent to a school with repeated daily absenteeism

rates of 10%.

Public Health will consider providing school boards, office coordinators and principals with more

information on syndromic surveillance and its importance in disease prevention. To make the


program more meaningful to schools, it may also be helpful to share any success stories that the

system has had to date in local schools, or examples of successes from other syndromic

surveillance systems in schools.

Since principals and office coordinators change schools frequently, it is important to inform

schools about the program and the processes involved on an annual basis. In order to ensure

that this is done, Public Health will consider sending the end-of-year reports directly to

principals of participating schools.

Public Health may contact schools that have ceased participation in the program to help

determine how to better support office coordinators with respect to the time required to

participate in the program.

To meet the needs of an effective syndromic surveillance system and to respect the time of

school office coordinators, Public Health will discuss the feasibility of making the following

changes to the web-form used for absenteeism reporting:

o Introducing an autofill function for the ‘total school population’ field

o Adding a field or fields that will allow schools to indicate whether increased

absenteeism is mainly due to illness or not, to the current optional fields reporting exact

number of students absent due to gastrointestinal, respiratory, and other illness.

o Removing the section on the web-form that asks office coordinators to report on staff

illnesses. Office coordinators have indicated that it is difficult to gather the reasons for

staff illness. Because of this and the low numbers of staff compared to students in

schools, it is difficult to use the numbers of staff absent for the purpose of syndromic

surveillance.

Next Steps Public Health also intends to take the following next steps:

Public Health will share the results of the evaluation with external stakeholders, including

the Upper Grand District School Board and the Wellington-Catholic District School Board

and principals and office coordinators from both school boards.

Public Health will share the results of the evaluation with relevant internal staff.

Public Health will, in consultation with the School Boards, and if feasible, implement the

changes listed above prior to or during the 2012-2013 school year.


INTRODUCTION

In winter, 2012, Wellington-Dufferin-Guelph Public Health conducted an evaluation of its School

Absenteeism Surveillance Program of secondary and elementary schools in both the Upper Grand

District School Board and the Wellington Catholic District School Board.

The goals of the school absenteeism surveillance program are:

To monitor and collect information about illness in the community, using school absenteeism as

a possible early indicator of illness in school-aged children, in order to improve early detection

of outbreaks before they reach their peak level of infection.

To utilize the information collected to identify unusual trends or clusters of illness within the

community, including enteric and/or respiratory illnesses.

To utilize school absenteeism data to target prevention strategies (i.e. proper coughing and

hand washing practices) and/or deploy treatment resources.

Program History Figure 1. A Historical Timelines of the School Absenteeism Surveillance Program

School Absenteeism Surveillance Program Timeline

Abbreviations WDGPH Wellington-Dufferin-Guelph Public Health UGDSB Upper Grand District School Board

WCDSB Wellington Catholic District School Board MOHLTC Ministry of Health and Long-Term Care

2002 2008

2002

2004

2002

2006

2002

2010

2002

2012 2002

2014 2002

SARS Outbreak Occurs

which resulted in the

recognition of a need

for increased

surveillance, including

early warning

systems. (2003)

(2003)

WDGPH pilots a Syndromic Surveillance

Project. 15 elementary schools from

UGDSB participate.

(January, 2008)

After the H1N1

pandemic,

participation in

the program

declines from

both school

boards, leaving

only 38 schools

from both school

boards

participating.

(2011)

WDGPH initiates an

evaluation to give schools

an opportunity to provide

feedback and suggest how

to make the program more

user-friendly.

(2012)

H1N1 Outbreak occurs. MOHLTC requests school absenteeism

data weekly from Public Health. WDGPH expands the Sentinel

Elementary School Health Monitoring Project. (Fall 2009)

67 UGDSB and 14 WCDSB schools participate in the newly

named School Absenteeism Surveillance Program in the 2009-

2010 school year. (Fall 2009 - 2010)


Description of the School Health Monitoring System Submission of absenteeism data by schools is done via a secure customized web form created by the

WDG Information Technology (IT) department. Upon submission, data from the schools is automatically

saved in a secure, Microsoft Access database.

Required fields on the form include:

Name of School

Total Student Population

Report Date

Completed by

Number of students absent due to all causes

Total number of staff expected

Number of staff absent

Optional fields include:

Number of students absent due to illness only

Number of students ill with mainly respiratory symptoms (e.g. fever, cough, runny nose, sore

throat)

Number of students ill with mainly gastrointestinal symptoms (e.g. diarrhea, vomiting, stomach

cramps)

Number of students ill with other symptoms or symptoms not reported (e.g. malaise, lethargy,

anything that does not fit into above categories)

The same database that was created for the pilot project was used for the expanded surveillance

system. The optional fields were created for the pilot project so the Health Unit could differentiate

between absenteeism due to symptoms of respiratory or enteric illness, and absence due to other

illnesses or reasons. However, when the expansion of the program occurred, the decision was made

that schools would only be asked to report on all cause absenteeism (i.e. absences for any reason) for

both students and teachers, to limit the time required by school staff to collate and submit the

information. However, many of the pilot schools and some other schools continue to report numbers

absent broken down by illness/other, and by syndrome (enteric vs. respiratory).

School Orientation and Communication with Schools In general, school office coordinators are responsible for collating student absenteeism information and

submitting it to the secure web form daily. Upon joining the program, schools are provided with an

orientation package that includes the following:

Access to the secure web-form to report absenteeism to Public Health

Hands on familiarization with the web form for data submission

A data-sharing agreement form to establish the commitment of the school and the specific

office coordinator-public health unit liaison


Summary reports of school absenteeism provided to the Upper Grand District School Board and

the Wellington-Catholic School Board at the end of the school year.

In addition, schools who wish to submit absenteeism information broken down by syndrome are

provided with:

A newsletter article for parents to familiarize them with the need to report their children’s

symptoms when reporting their absence for the day and to notify parents that the privacy of

their children would be protected

Voice mail script for the automated prompt message on the absenteeism reporting phone line

of each school to enhance the practice among parents of reporting their child’s symptoms

The database is then monitored daily by a public health unit program assistant. If more than 10% of

students from a school are absent, the program assistant sends the school principal and office

coordinator an alert email, asking the school to contact Public Health if the increased absenteeism is

related to illness. A list of schools with absenteeism rates over 10% is send daily by the program

assistant to the Control of Infectious Diseases team at Public Health. If over 20% of students are

absent at a school, a Public Health Nurse calls the school to investigate the alert, and may suggest

infection control measures to prevent illness.

At the end of each school year, a summary report is prepared for schools of each school board. This

report is sent to participating school boards, as well as principals and office coordinators of participating

schools. Individual school absenteeism data summaries are also made available to schools on request.

EVALUATION OBJECTIVES AND METHODOLOGY

The goal of the evaluation was to answer the question “How can the delivery of Wellington-Dufferin-

Guelph Public Health’s School Absenteeism Surveillance Program be improved to better serve the needs

of schools and Wellington-Dufferin-Guelph Public Health (WDGPH)?”

Based on this evaluation goal, several objectives were created. These objectives included:

To determine the perceived benefits and challenges of participating in the program

To determine the helpfulness and usefulness of the program’s features

To determine how Public Health can improve the program to better support schools

To identify any program processes that either support or impede involvement in the program

To gather feedback from both principals and office coordinators.

To gather feedback from both schools that participate in the program and schools that stopped

participating in the program.

To make changes to the program based on evaluation feedback

To accomplish these goals and objectives, two separate surveys were designed for participating and

non-participating schools using Fluid Surveys software. Survey participants self-identified whether they

belonged to a participating or non-participating school, and filled out the corresponding survey. Before


being launched, draft copies of both surveys were submitted to both the Upper Grand District School

Board and the Wellington Catholic District School Board for approval. The surveys were pre-tested by

five Health Promotion Specialists, one Epidemiologist, a Public Health Inspector and an Office

Coordinator from the Upper Grand District School Board to ensure the questions were understandable,

had face validity and could be accessed in the school environment. Following approval and pretesting,

the Upper Grand District School Board posted both surveys on the School Board’s conference systems

for principals and office coordinators, while Public Health emailed the surveys directly to principals from

the Wellington Catholic District School Board.


SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM EVALUATION

RESULTS

CHARACTERISTICS OF RESPONDENTS

PARTICIPATING SCHOOLS

For a school to be considered to be participating, Wellington-Dufferin-Guelph Public Health must have

received at least one data submission for the school absenteeism surveillance program, in the fall of

2011. Fifty-three schools from both the Upper Grand District School Board and the Wellington Catholic

District School Board met this

criterion. Assuming each

school has one principal and

one office coordinator that

contributes to the program,

the total number of responses

that could have been received

was 106. Thirty one responses

were received from both

principals and office

coordinators, which amounts

to a response rate of 29%.

For the survey of the

participating schools, the

majority of responses were received from elementary school office coordinators. Twenty-seven (87%)

of the 31 total responses were

from office coordinators, while

4 (13%) were from principals.

Of the surveys from office

coordinators, 85% were from

elementary schools and 15%

were from secondary schools.

Of the surveys received from

principals, 100% were from

elementary schools. (See Figure

2).

From the participating school

responses, 27 (87%) were from

the Upper Grand District

School Board (UGDSB) and 4

23 (85%)

4 (15)

27 (100%)

4 (100%) 0 (0%)

4 (100%)

27 (87%)

4 (13%)

31 (100%)

0

5

10

15

20

25

30

35

Off

ice

Co

ord

inat

ors

Pri

nci

pal

s

Tota

l

Off

ice

Co

ord

inat

ors

Pri

nci

pal

s

Tota

l

Off

ice

Co

ord

inat

ors

Pri

nci

pal

s

Tota

l

Elementary School Respondents

Secondary School Respondents

Total Respondents

# o

f re

spo

nd

en

ts

Figure 2. Participating Schools:Number of Survey Respondents by School Type and Job Title

23

4

27

4

0

4

27

4

31

0

5

10

15

20

25

30

35

UGDSB WCDSB Total UGDSB WCDSB Total UGDSB WCDSB Total

Office Coordinator Responses

Principal Responses Total Responses

# o

f re

spo

nd

en

ts

Figure 3. Participating Schools: Number of Survey Respondents by School Board and Job Title


(13%) were from the Wellington Catholic District School Board (WCDSB). All four of the respondents

from the Wellington Catholic District School Board were office coordinators, thus all feedback received

from principals will reflect the views of Upper Grand District School Board Principals only. (See Figure 3).

Concerning the length of time involved with the program, the majority of respondents 19 (62%) had

been involved with the program for over 2 years. Nine (29%) had been involved with the program for 1-

2 years and 3 (10%) had been involved for 6 months to 1 year.

NON-PARTICIPATING SCHOOLS

If Wellington-Dufferin-Guelph

Public Health has not received

a data submission to the school

absenteeism surveillance

program in the fall of 2011, the

school was considered to be

non-participating. Forty-one

schools from both the Upper

Grand District School Board

and the Wellington-Catholic

District School Board met this

criterion. Assuming each

school has one principal and

one office coordinator, the

total number of responses that

could have been received was

82. Seventeen responses were

received from both principals

and office coordinators, which

amounts to a response rate of

21%.

For the survey of the non-

participating schools, 16 (94%)

of the 17 total respondents

were office coordinators. Of

these 16 respondents, 14 (88%)

were from elementary schools and 2 (12%) were from secondary school. The one principal that

responded (6% of total respondents) was from an elementary school. (See Figure 4).

From the non-participating school responses, the majority, 16 (94%), were from the Upper Grand

District School Board. Of these responses, 15 (94%) were from office coordinators and 1 (6%) was from

a principal. The one (6%) response from the Wellington Catholic District School Board was from an

office coordinator. Additionally, when asked if the school currently participated in the program, 2

2 (12%)

12 (70%)

3 (18%)

0

5

10

15

Yes No No response

# o

f re

spo

nd

en

ts

Figure 5. Current Participation in the School Health Absenteeism Program, from Non-Participating Schools

14 (93%)

1 (7%)

15 (100%)

2 (100%) 0

2 (100%)

16 (94%)

1 (6%)

17 (100%)

0 2 4 6 8

10 12 14 16 18

Off

ice

Co

ord

inat

ors

Pri

nci

pal

s

Tota

l

Off

ice

Co

ord

inat

ors

Pri

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Tota

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Off

ice

Co

ord

inat

ors

Pri

nci

pal

s

Tota

l

Elementary School Respondents

Secondary School Respondents Total Respondents

# o

f re

spo

nd

en

ts

Figure 4. Non-Participating Schools: Number of Survey Respondents by School Type and Job Title


indicated they do currently participate. (See Figure 5), and one of these responses was from a principal.

Thus, their responses were excluded from the analysis, leaving 15 responses to analyze from office

coordinators only. Of the 15 responses, the majority 12 (80%) had participated in the program

previously. 3 (20%) were not sure if they had.

SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: PARTICIPATING

SCHOOLS Question: The time it takes to participate in the program is acceptable.

Eighty-five percent of all respondents from participating schools either agreed or strongly agreed that

the length of time required to participate in the program is acceptable.

Question: How easy is it to log into the program’s web-form? How easy is it to complete the

program’s web-form?

Ninety-six percent of office coordinators indicated that logging into the web-form was either easy or

very easy. 100% responded that completing the web-form was easy or very easy and that none of the

questions on the web-form were easy to understand.

0 1 0

10

16

0 0 0

12

15

0

5

10

15

20

not at all easy

not easy neutral easy very easy

# o

f re

spo

nse

s

level of agreement

Ease of logging into and ease of completing the program's web-form, level of agreement for participating schools

Ease of logging into the web-form

Ease of completing the web-form

0% 7%

0%

48% 37%

0%

20%

40%

60%

strongly disagree

disagree neutral agree strongly agree % o

f re

spo

nd

en

ts

response

Participating Schools Question: Is the time required to participate in the

program acceptable?


Question: Have you received an email from Public Health for having an absenteeism rate greater than

10%? Have you received a call from a Public Health Nurse or Public Health Inspector for having a

school absenteeism rate of greater than 20%? Have you received a copy of Public Health’s year-end

report on the School Absenteeism Surveillance Program?

Of the total sample of principals and office coordinators, the majority 23 (74%) recalled receiving an

email from Public Health. However, most of the respondents had not received a phone call from Public

Health for having an absenteeism rate over 20%. The majority 23 (74%) of respondents either did not

know or had not received a copy of the year-end report 27 (87%).

Question: Are the emails you received from Public Health when your school had an absenteeism rate

of greater than 10% helpful? Are the phone call(s) you received from Public Health when your school

had an absenteeism rate of greater than 20% helpful? Have you received a copy of Public Health’s

year-end report on the School Absenteeism Surveillance Program?

Seven (30%) of all respondents either strongly disagreed or disagreed that the emails were helpful and

an additional 10 (43%) were neutral. The majority of respondents 5 (80%) were neutral on the

helpfulness of the phone calls. Of the 4 possible respondents to the question on the helpfulness of the

year-end reports, 3 (75%) were neutral and 1 (25%) agreed. However, the responses to the questions

on the phone calls and year-end reports must be interpreted with caution, as the sample size was very

small.

23

6 2

5

23

3 4

15 12

0

5

10

15

20

25

Yes No I don't know

# o

f re

spo

nse

s

response options

Respondents from participating school that had received emails, phone calls and year-end reports from Public Health

# Receiving Email from Public Health

# Receiving Phone Call from Public Health # Receiving Year-end Report from Public Health

3 4

10

6

0 0 0

4

1 0 0 0

3 1 0

0

5

10

15

strongly disagree

disagree neutral agree strongly agree

# o

f re

spo

nse

s

Level of Agreement

Level of Agreement on the Helpfulness of Public Health's

Emails, Phone Calls and Year-end Reports, from Participating Schools

The Emails were helpful

The Phone Calls were Helpful

The Year-end Reports were Helpful


Question: The number of emails I receive from Public Health for the program are:

The majority of survey participants agreed that the number of emails received from Public Health was

‘just right’ 27 (90%).

Question: Would you be interested in receiving a separate year-end report on your specific school’s

absenteeism trends?

The majority of office coordinators 20 (74%) were not interested in receiving a separate year-end report

while half of principals were interested.

0 3 (10%)

27 (90%)

0

5

10

15

20

25

30

not enough too many just right

# o

f re

pso

nse

s

Level of Agreement

Acceptability of the Frequency of Emails from Public Health, from Participating Schools

7 (23%)

20 (65%)

2 (50%) 2(50%)

9 (29%)

22 (71%)

0

5

10

15

20

25

Yes No Yes No Yes No

Office Coordinators Principals Total

# o

f re

spo

nd

en

ts

Interest in receiving year-end report customized to the individual school level, participating schools


Question: On a scale of 1 to 5, please select your response to the following statement: “Preventing

disease at my school is important.”

Thirty-one (100%) respondents either agreed or strongly agreed that preventing disease in schools is

important.

Question: On a scale of 1 to 5, please select your response to the following statement: “Participating

in the School Absenteeism Surveillance Program could prevent disease at my school.”

Two (6%) respondents either agreed or strongly agreed that participating in the program helps prevent

diseases in schools, and 14 (45%) respondents were neutral.

4

9

13

1 0 0

2 1 1

0

4

11

14

2

0 0

2

4

6

8

10

12

14

16

strongly disagree


# o

f re

spo

nse

s

Level of agreement

Level of Agreement with the Statement "Participating in the Program Helps Prevent

Diseases in Schools."

Office Coordinators

Principals

Total

0 0 0

15

12

0 0 0 1 3

0

5

10

15

20

strongly disagree


# o

f re

spo

nse

s

Level of agreement

Preventing Disease in Schools is Important, participating schools

Office Coordinators

Principals


Question: On a scale of 1 to 5, please select your response to the following statement: “The Program

is helpful.”

Nearly half of all respondents were neutral on whether they perceived the program to be helpful, while

8 (29%) respondents disagreed, and 7 (23%) agreed with the statement.

Question: What do you think are the benefits to participating in the program?

The main perceived benefit of the program was that it “alerts Public Health of outbreaks” 26 (84%),

followed by “the program informs schools of absenteeism rates” 15 (48%), and “the program prevents

diseases from spreading in schools” 9 (29%).

0

7

14

5

1 0

1 1 2

0 0

8

15

7

1

0 2 4 6 8

10 12 14 16

strongly disagree


# o

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s

Level of agreement

Level of Agreement with the Statement "The Program is Helpful"

Office Coordinators

Principals

Total

15 (48%)

26 (84%)

9 (29%)

4 (13%) 1 (3%) 0 (0%)

4 (13%)

0

5

10

15

20

25

30

Informs schools of

absenteeism rates

Alerts Public Health of outbreaks

Prevents diseases from spreading in

schools

Education on disease

prevention from Public

Health

Year-end summary reports

Other (please specify)

I do not think there are

benefits to participating

in the program

# o

f re

spo

nse

s

Possible Benefits

Perceived Program Benefits of Principals and Office Coordinators from Participating Schools


Question: What do you find challenging about participating in the program?

The majority of respondents 18 (58%) indicated that participating in the program wasn’t challenging.

Challenges that were identified were time 9 (29%), having to report the same information to multiple

sources 3 (10%), and “other” 3 (10%). Some of the qualitative responses to the other option, included:

forgetting to do the reporting and not feeling like Public Health properly examines the absenteeism

rates, resulting in the school receiving emails when it has indicated that most of the students are on

vacation, rather than ill.

Question: How can Public Health better support schools in reporting absenteeism data to the

program?

Below is a summary of the responses:

Two responses indicated that an autofill function for the form that would self-populate the

fields that remain the same each time (for example, school name and size) would be helpful and

would save time.

Two responses noted that schools will indicate on the web-form that while there are a large

number of absences, most are due to vacation or schools trips. However, Public Health often

sends schools an email for having high absenteeism rates, despite the warning of students not

being absent due to illness. This can be frustration for office coordinators.

One respondent suggested a month-end summary report detailing the dates the school

reported absenteeism information.

One respondent noted that the program focuses mainly on gasto-intestinal and respiratory

illness; however, other health concerns may also be important (for example, chicken pox, eye

infections).

One respondent expressed confusion over the reasons for requesting staff absenteeism

information. The respondent noted that there is not a place on the form for information on the

9 (29%)

2 (84%) 0 (0%)

3 (10%) 3 (10%)

18 (58%)

0 2 4 6 8

10 12 14 16 18 20

Time Technical difficulties

Not enough support

from Public Health

Having to report the

same information to multiple

sources

Other I do not find participating

in the program to

be challenging

# o

f re

spo

nse

s

Possible Challenges

Perceived Program Challenges of Principals and Office Coordinators from Participating Schools


cause of staff absenteeism. It was expressed that office coordinators don’t always know the

details of staff illness.

Question: How can Public Health better support schools in preventing communicable diseases, other

than the school absenteeism surveillance program?

Responses include:

Distributing information via school newsletters or via the school board website on specific

problems or outbreaks that parents need to be aware of.

Sending out an information flyer to parents at the start of the school year stating the amount of

time children should stay at home until medications become active, as well as signs parents can

use to recognize illness.

Send out the newest information to schols so they can update their binders, particularly the

information on whether specific diseases need to be reported or not.

Have a Public Health Nurse visit the school regularly to discuss issues or health concerns.

Communicate with the schools via the Public Health Nurse assigned to the school.

Provide information sessions for staff and students on communicable diseases and prevention.


SCHOOL ABSENTEEISM SURVEILLANCE PROGRAM FEEDBACK: NON-

PARTICIPATING SCHOOLS Question: Why does your school no longer participate in the program? (Please check all that apply).

Overall, time for participation in the program did appear to be a factor, with 6 (50%) of respondents

indicating this as a reason for discontinuing participation in the program. Three (25%) did not see the

benefit of participating in the program. Seven (58%) chose the “other” option. Some of the qualitative

(other) responses include:

Four respondents indicated they either were not aware that the program was still continuing,

they forgot their password to log in, or participation “just did not happen this year.”

Two respondents noted that parents calling in to report their child’s illness often do not

indicate the kind of illness (respiratory or gastro-intestinal).

One school noted that it generally doesn’t have a lot of absences, thus they aren’t sure about

the purpose of reporting.

6 (50%)

3 (25%)

1 (8%)

7 (58%)

0

1

2

3

4

5

6

7

8

Time Did not see benefit to

participating in the program

Difficulty filling out the online

form


# o

f re

spo

nse

s

response options

Reasons for ceasing participation in the School Health Absenteeism Program


Question: Did your school ever receive an email from Public Health for having an absenteeism rate

greater than 10%? Did your school ever receive a phone call from a Public Health Nurse or Public

Health Inspector for having a school absenteeism rate greater than 20%? Have you ever received a

copy of Public Health’s year-end report on the School Absenteeism Surveillance Program for your

School Board?

The majority of respondents had not received an email (7 [58%]), phone call (10 [83%]), or year-end

report (10 [67%]) from Public Health.

The participants that had not previously received a copy of Public Health’s year-end report on school

absenteeism trends were asked if they would be interested in receiving a separate year-end report on

their specific school’s absenteeism trends. The majority (11 [73%]) responded no.

Question: On a scale of 1 to 5, please select your response to the following statement: “Preventing

disease at my school is important.”

The majority of respondents 12 (85%) either agreed or strongly agreed that preventing disease in

schools is important.

3

7

2 1

10

1 0

10

5

0

2

4

6

8

10

12

Yes No I don't know

# o

f re

spo

nse

s

response options

Non-participating Schools: Number that had received emails, phone calls and year-end reports from Public

Health

# Receiving Email from Public Health

# Receiving Phone Call from Public Health

# Receiving Year-end Report from Public Health

1 (7%) 0 (0%)

1 (7%)

10 (71%)

2 (14%)

0

2

4

6

8

10

12

Strongly disagree

Disagree Neutral Agree Strongly Agree

# o

f re

spo

nse

s

Level of agreement

Preventing Disease in Schools is Important, level of agreement from non-participating schools


Question: On a scale of 1 to 5, please select your response to the following statement: “Participating

in the School Absenteeism Surveillance Program could prevent disease at my school.”

The majority (10 [71%]) neither agreed nor disagreed with the statement while 3 (21%) strongly

disagreed or disagreed that participating in the program could prevent disease at their school.

Question: What do you think would be the benefits of participating in the Program?

Perceived benefits of participating in the program included: the program alerting Public Health of

outbreaks (10 [71%]), the program informing schools of absenteeism rates (2 [21%]), the program

preventing diseases from spreading in schools (2[14%]), education on disease prevention from Public

Health (2 [14%]), and the year-end summary reports (2 [14%]).

2 (14%) 1 (7%)

10 (71%)

1 (7%) 0

0

5

10

15

Strongly disagree

Disagree Neutral Agree Strongly Agree

# o

f re

spo

nse

s

Level of agreement

Level of Agreement with the Statement "Participating in the Program Helps Prevent

Diseases in Schools," Non-participating Schools

3 (21%)

10 (71%)

2 (14%) 2(14%) 12(14%) 1(7%)

2 (14%)

0

2

4

6

8

10

12

Informs schools of

absenteeism rates

Alerts Public Health of outbreaks

Prevents diseases

from spreading in

schools

Education on disease

prevention from Public

Health

Year-end summary reports


There would not be

benefits

# o

f re

spo

nse

s

Possible Benefits

Perceived Program Benefits from Non-Participating Schools


Question: What do you think would be challenging about participating in the Program?

Potential challenges to participating in the program included time (11[78%]), having to report the same

information to multiple sources (5 [35%]), technical difficulties (3 [21%]), and “there would not be any

challenges” (3 [21%]).

Question: How can Public Health better support schools in reporting absenteeism data to the

program?

Below is a summary of the responses:

Schools enter absences on a daily basis into “Maplewood.” There School Board could provide

the absenteeism data that Public Health is wanting from the Maplewood database.

The Upper Grand District School Board needs to recognize that reporting data to Public Health is

an additional duty that needs time to summarize and report.

Question: How can Public Health better support schools in preventing communicable diseases, other

than the school absenteeism surveillance program?

Responses include:

Making information on reportable disease more accessible on their website.

Coming to schools to teach about the importance of hand washing and/or suggesting to

teachers to have scheduled hand-washing times.

Producing monthly inserts for newletters, providing presentations by Public Health Nurses to

students and staff, and providing presentations to staff on P.D. days.

Informing the Public on how important it is for parents to communicate with the school.

11 (78%)

3 (21%)

0 (0%)

5 (35%)

0 (0%)

3 (21%)

0

2

4

6

8

10

12

Time Technical difficulties

Not enough support from Public Health

Having to report the

same information to multiple

sources

Other There would not be any challenges

# o

f re

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s

Possible Challenges

Perceived Program Challenges of Principals and Office Coordinators from Participating Schools


KEY FINDINGS AND CONCLUSIONS

WEB-FORM Survey respondents from participating schools overwhelmingly indicated that the secure web-form

for the program is easy to login to as well as to complete. Additionally, only one non-participating

school indicated that a reason for discontinuing with the program was due to the web-form.

Qualitative feedback related to the web-form indicated that the possibility of an autofill function

that would self-populate the fields that remain the same each time (for example, school name and

student population) would be helpful and would save time for office coordinators. Also, one

respondent expressed confusion over the reasons for requesting staff absenteeism information.

The respondent noted that there is no place on the form for information on the cause of staff

absenteeism. It was expressed that office coordinators do not always know the details of staff

illness.

Recommendation #1

It is recommended that Public Health look into the possibility of an autofill function; however, the

implementation of this feature is not crucial to the success of program.

Recommendation #2

Because the web-form doesn’t ask for the cause staff absences, Public Health should consider

removing the section on staff absenteeism from the web-form. Without information on illness type,

it is difficult to apply this information.

PROGRAM EMAILS, PHONE CALLS, AND YEAR-END REPORTS The majority of respondents from participating schools did recall receiving an email from Public

Health for having an absenteeism rate more than 10%, but most did not find the email to be helpful.

However, most respondents also indicated that the frequency of emails from Public Health for the

program was just right. A large percentage of respondents (likely those whose schools had not

exceeded the alert thresholds) did not recall receiving a phone call or year-end report from Public

Health and were therefore neutral on the helpfulness of these features.

From non-participating schools, most respondents did not recall receiving an email, phone call or

year-end report from Public Health. Overwhelmingly, office coordinators were not interested in

receiving a year-end report on their school’s absenteeism trends. However, some principals did

indicate an interest for this feature.

Qualitatively, two respondents appeared frustrated that they often receive emails from Public

Health in response to having a high absenteeism rate, even when they have noted in the web-form

that most students are absent due vacations or class trips, rather than being ill.


Recommendation #3

Concerning the helpfulness of the program’s features, Public Health may want to consider having

the schools or the school boards provide input on how to make these emails, phone call and year-

end report features more helpful to schools.

Recommendation #4

At the beginning of next year’s surveillance program, ask principals to indicate whether they would

like a customized report for their school at the end of the year, and provide these reports based on

interest.

Recommendation #5

Currently, Public Health automatically sends emails to all schools that have an absenteeism rate

equal to or greater than 10%. However, Public Health should revisit their response protocol to

ensure that any submitted data from schools on numbers of students ill are reviewed prior to the

distribution of emails. If a school has indicated that most of their absenteeism is not due to illness,

Public Health should not send the school an email. Additionally, Public Health should only send one

email to an individual school on having a high absenteeism rate each week to not overwhelm office

coordinators.

PROGRAM OVERALL Respondents from both participating and non-participating schools overwhelmingly indicated that

preventing disease in schools is important. However, the majority of survey participants from both

groups selected ‘neutral,’ ‘disagree’ or ‘strongly disagree’ for their response to the statement

“participating in the [school absenteeism surveillance] program helps prevent diseases in schools.”

Additionally, when asked about the benefits of the program, the majority of respondents indicated

that the main benefit is that it alerts Public Health of outbreaks. Few respondents indicated that it

prevents diseases from spreading in schools.

Effective syndromic surveillance of school absenteeism data requires regular data from the majority

of schools in order to be successful. If participants in the program do not feel the program could be

helpful in preventing disease, this puts the future of the program as risk, particularly since data

submission is not mandatory.

Recommendation #6

It is recommended that Public Health provide school boards, office coordinators and principals with

information on syndromic surveillance and its importance in disease prevention. It would also be

helpful to share any success stories that the system has had to date in local schools or examples of

successes from other syndromic surveillance systems in schools to make the program more

meaningful to participants.

Recommendation #7

Since principals and office coordinators change schools frequently, it is important to continue to

inform schools about the program and the processes involved on an annual basis.


TIME REQUIRED FOR PARTICIPATION IN THE PROGRAM Schools that continue to participate in the program felt that the length of time required to

participate in the program is acceptable; however, for schools that no longer participate in the

program, time was the main reason for ceasing participating in the program.

Recommendation #8

Public Health should contact schools that have ceased participation in the program to help

determine how to better support staff with respect to the time required for participation in the

program. Also contact some of the participating schools that do not feel the program takes a great

deal of time to see if they have any suggestions for non-participating schools.

ADDITIONAL ANALYSIS Public Health has noticed that many schools are not indicating the number of students absent due

to gastrointestinal, respiratory, or other symptoms on the web-form. For a syndromic surveillance

system to be truly effective, it is imperative to gather some information on the cause of

absenteeism, rather than simply the total number of students absent. However, Public Health

suspects that it is often quite difficult and time consuming for office coordinators to track and

gather all this information.

Recommendation #9

To meet the needs of an effective syndromic surveillance system and to respect the time of school

office coordinators, it is recommended that changes should be made to the program’s web-form. In

addition to the current optional fields for the reporting of the number of students away to

gastrointestinal, respiratory, and other illness, a field could be added for office coordinators to

indicate whether they feel any unusual absenteeism is due to illness, along with an associated

qualitative field where more details on illness could be provided.

NEXT STEPS

In response to the results of the evaluation, Public Health should take the following actions:

Public Health should share the results of the evaluation with external stakeholders,

including the Upper Grand District School Board and the Wellington Catholic District School

Board and principals and office coordinators from both school boards.

Public Health should share the results of the evaluation internally with the Communicable

Infectious Diseases (CID) program staff, the school health team, and the program assistants

involved with the program.

Public Health should consider all proposed recommendations and, in consultation with the

School Boards, implement them, if feasible, prior to or during the 2012-2013 school year.

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