DEPARTMENT OF EDUCATION

14 DE Admin. Code 220

Statutory Authority: 14 Delaware Code,

Section 220 (14 Del.C. §220)

Education Impact Analysis

Pursuant To

14 DEL.C. §122(d)

PROPOSED

805 The School Health Tuberculosis (TB) Control Program

A. Type of Regulatory Action Required

Amendment to Existing Regulation

B. Synopsis of Subject Matter of the Regulation

The Secretary of Education intends to amend regulation 805 The School Health Tuberculosis (TB) Control Program. The amendments change the requirement for school staff and new school enterers concerning the Mantoux tuberculin skin test.

School staff continue to be required to have the Mantoux tuberculin skin test within 12 months of employment and be assessed; but every five years thereafter the assessment will be done via the Department of Education TB Health Questionnaire for School Employees rather than a Mantoux tuberculin skin test as previously required.

All new school enterers shall show proof of Mantoux tuberculin skin test results from a test administered within the past 12 months or the results of a TB risk assessment questionnaire which may be administered by the school nurse and the definition of “new school enterers” has been changed.

Procedures for volunteers 2.0 and positive reactors 4.0 remain the same.

This regulation was advertised previously in the May 1,200 Register of Regulations, Volume 7 Issue 11. The regulation is being re-advertised because of a change in the last sentence in 3.1. It now states that a new school enterer shall also include any child who is re-enrolled in a Delaware public school following travel or residency of one month in a location or facility identified by the Delaware Division of Public Health as an area at risk for TB exposure. The amount of time referred to is now one month instead of six months.

C. Impact Criteria

1. Will the regulation help improve student achievement as measured against state achievement standards? The amended regulation addresses TB testing not achievement standards.

2. Will the regulation help ensure that all students receive an equitable education? The amended regulation addresses TB testing not equity issues.

3. Will the regulation help to ensure that all students’ health and safety are adequately protected? The amended regulation addresses TB testing which is a health and safety issue and the change from requiring a skin test to using a questionnaire is recommended by the Delaware Division of Public Health.

4. Will the regulation help to ensure that all students’ legal rights are respected? The amended regulation addresses TB testing not students’ legal rights.

5. Will the regulation preserve the necessary authority and flexibility of decision making at the local board and school level? The amended regulation will preserve the necessary authority and flexibility of decision making at the local board and school level.

6. Will the regulation place unnecessary reporting or administrative requirements or mandates upon decision makers at the local board and school levels? The amended regulation will add the process of administering the questionnaire but will substantially reduce the amount of actual testing.

7. Will the decision making authority and accountability for addressing the subject to be regulated be placed in the same entity? The decision making authority and accountability for addressing the subject to be regulated will remain in the same entity.

8. Will the regulation be consistent with and not an impediment to the implementation of other state educational policies, in particular to state educational policies addressing achievement in the core academic subjects of mathematics, science, language arts and social studies? The amended regulation will be consistent with and not an impediment to the implementation of other state educational policies, in particular to state educational policies addressing achievement in the core academic subjects of mathematics, science, language arts and social studies.

9. Is there a less burdensome method for addressing the purpose of the regulation? No, there is not a less burdensome method for addressing the purpose of the regulation than amending the regulation.

10. What is the cost to the State and to the local school boards of compliance with the regulation? There is no additional cost to the local school boards of compliance with the amended regulation.

805 The School Health Tuberculosis (TB) Control Program

1.0 School Employees, Substitutes, Student Teachers, and Contract Employees - All school employees, substitutes, student teachers, and contract employees (including bus drivers) shall receive the Mantoux tuberculin skin test or show proof of being tested in the past 12 months during the first 15 working days of employment.

1.1 Present employees, substitutes, and contract employees shall show proof of Mantoux tuberculin skin test results to the district designee by October 15, every fifth year of employment.

1.2 Student teachers need not be retested if they move from district to district as part of their student teaching assignments.

2.0 Volunteers - Volunteers, those persons who give their time to help others for no monetary reward and who share the same air space with students and staff on a regularly scheduled basis, shall complete the Delaware Department of Education’s Health Questionnaire for Volunteers in Public Schools prior to their assignment. Should the volunteer answer affirmatively to any of the questions, he/she must provide proof of a Mantoux tuberculin skin test in the past 12 months before beginning their assignment.

2.1 Volunteers shall complete the Delaware Department of Education’s Health Questionnaire for Volunteers in Public Schools every fifth year.

2.1.1 The district designee(s) shall collect and monitor the volunteer questionnaires. These questionnaires will be stored in the School Nurse’s office in a confidential manner.

3.0 Students - All new school enterers shall show proof of a Mantoux tuberculin skin test results within the past 12 months or follow the recommendations of the American Academy of Pediatrics (AAP). Health Care Providers must send documentation of the decisions. Multi- puncture skin tests will not be accepted. A school enterer is defined as any child between the ages of one year and 21 years entering or being admitted to a Delaware school district for the first time, including but not limited to, foreign exchange students, immigrants, students from other states and territories, and children entering from nonpublic schools.

3.1 School nurses shall record the results of the Mantoux tuberculin skin test in the School Health Record.

3.2 Tuberculin skin test requirements may be waived for children whose parent(s) or guardian(s) present a notarized document that tuberculin skin testing is against their religious beliefs.

4.0 Positive Reactors

4.1 Positive reactors (those currently identified and those with a history) need verification from a Health Care Provider or Division of Public Health indicating:

4.1.1 Skin test reaction recorded in millimeters.

4.1.2 Current disease status, i.e. contagious or non-contagious.

4.1.3 Current treatment, completion of preventive treatment for TB infection, or chemotherapy for TB disease.

4.1.4 Date when the individual may return to their school assignment without posing a risk to the school setting.

4.2 If documentation of the test is available, the known positive reactor need not have this tuberculin skin test but provide the above information related to disease status and treatment.

4.2.1 Verification from a Health Care Provider or Division of Public Health shall be required only once if treatment was completed successfully.

4.3 If documentation of the test is unavailable, the individual should be tested. If the individual refuses to be skin tested again, the individual shall provide from a Health Care Provider or the Division of Public Health information related to disease status and treatment.

4.4 Updated information regarding disease status and treatment shall be provided to the district designee by October 15 every fifth year if treatment was previously contraindicated, incomplete or unknown.

See 1 DE Reg. 1971 (6/1/98)

See 3 DE Reg. 440 (9/1/99)

805 The School Health Tuberculosis (TB)

Control Program

1.0 School Staff and Extended Services Personnel

1.1 Definition

“School Staff and Extended Services Personnel” means all persons hired as full or part time employees in a public school who are receiving compensation to work directly with students and staff. This includes, but is not limited to teachers, administrators, substitutes, contract employees, bus drivers and student teachers whether compensated or not.

1.2 Public school staff and extended services personnel shall provide the Mantoux tuberculin skin test results from a test administered within the past 12 months during the first 15 working days of employment.

1.2.1_ Student teachers need not be retested if they move from district to district as part of their student teaching assignments.

1.3 Every fifth year, by October 15th, public school staff and extended services personnel shall complete the Department of Education TB Health Questionnaire for School Employees and the questionnaire responses shall be retained in the individual’s personnel file.

1.3.1 If a public school staff member or extended services personnel staff member answers affirmatively to any of the questions, he/she shall provide proof of Mantoux tuberculin skin test results from a test administered in the past 6 months by October 30th.

2.0 Volunteers

2.1 Definition:

“Volunteers” mean those persons who give their time to help others for no monetary reward and who share the same air space with public school students and staff on a regularly scheduled basis.

2.2 Volunteers shall complete the Delaware Department of Education’s Health Questionnaire for Volunteers in Public Schools prior to their assignment and every fifth year thereafter.

2.2.1 If the volunteer answers affirmatively to any of the questions, he/she must provide proof of Mantoux tuberculin skin test results from a test administered in the past 12 months before beginning his/her assignment.

2.3 Each public school (s) shall collect and monitor these questionnaires and store them in the School Nurse’s office in a confidential manner.

3.0 Students

3.1 Definition:

“New School Enterer” means any child between the ages of one year and twenty one (21) years entering or being admitted to a Delaware public school for the first time, including but not limited to, foreign exchange students, immigrants, students from other states and territories, and children entering from nonpublic schools. For purposes of this regulation, “new school enterer” shall also include any child who is re-enrolled in a Delaware public school following travel or residency of one month in a location or facility identified by the Delaware Division of Public Health as an area at risk for TB exposure.

3.2 All new public school enterers shall show proof of Mantoux tuberculin skin test results from a test administered within the past 12 months or the results of a TB risk assessment questionnaire.

3.2.1 Health Care Providers must send documentation of the test results or the risk assessment. Multi-puncture skin test results will not be accepted.

3.2.2 Public school nurses who are trained in the use of the Department of Education TB Risk Assessment Questionnaire for Students may administer the questionnaire to parents, guardians or Relative Caregivers or to a school enterer who has reached the statutory age of majority (18) if the new enterer is in compliance with the other public school entry requirements for a current physical examination and up-to-date immunizations.

3.2.3 Public school nurses shall record the findings of the Department of Education TB Risk Assessment Questionnaire for Students and/or the results of the Mantoux tuberculin skin test in the School Health Record.

3.2.4 Tuberculin skin test requirements may be waived for public school children whose parent(s) or guardian(s) or Relative Caregiver(s) or a school enterer who has reached the statutory age of majority (18) presents a notarized document that tuberculin skin testing is against their religious beliefs.

4.0 Positive Reactors

4.1 Definition:

“Positive Reactor” means an individual currently identified as having TB or an individual with a history of TB.

4.2 Positive Reactors need verification from a Health Care Provider or the Division of Public Health indicating the:

4.2.1 Skin test reaction recorded in millimeters;

4.2.2 Current disease status, i.e. contagious or non-contagious;

4.2.3 Current treatment, completion of preventive treatment for TB infection, or chemotherapy for TB disease and;

4.2.4 Date when the individual may return to their school assignment without posing a risk to the school setting.

4.3 If documentation of the test is available, the known positive reactor need not have this tuberculin skin test but provide the information in 4.2.2 through 4.2.4 related to disease status and treatment.

4.3.1 Verification from a Health Care Provider or Division of Public Health shall be required only once if treatment was completed successfully.

4.3.2 If documentation of the test is unavailable, the individual should be re-tested or re-assessed. If the individual refuses to be skin tested again, the individual shall provide from a Health Care Provider or the Division of Public Health information related to disease status and treatment.

4.4 In the event the positive reactor shows any signs or symptoms of active TB infection, he/she must be excluded from school until all required medical verification is received by the school.

4.5 Updated information regarding disease status and treatment shall be provided to the public school by October 15 every fifth year if treatment was previously contraindicated, incomplete or unknown.

8 DE Reg. 38 (7/1/04)