From Haverhill to Sweden

Courtesy photoCathy Riccio, director of nursing services from Newburyport public schools; Rita Casper, director of nursing services from Andover public schools; Doreen Crowe, director of nursing services from Wilmington public schools; and Shanyn Toulouse, regional school nurse consultant from Haverhill public schools.

Three nursing directors and one regional school nurse consultant traveled to Sweden to present on "The Role of the School Nurse in Substance Use Prevention" at an international conference last month.

Knowing firsthand the impact school nurses have on students, the nurses combined their knowledge and experiences to generate a presentation that was widely received by those from all over the world in attendance.

Of the four women, two brought representation from the Merrimack Valley — Rita Casper, director of nursing services from Andover public schools, and Shanyn Toulouse, regional school nurse consultant from Haverhill public schools.

"In the region and throughout the state, we have had a problem with an opioid epidemic," Toulouse said. "Typically these things can start in early childhood if they're experimenting with substances."

At the conference, which included 170 school nurses from 24 countries, Toulouse discussed in the presentation the universal student screenings mandated in Gov. Charlie Baker's opioid legislation signed in 2016.

The bill requires schools to annually conduct verbal substance misuse screenings on all students in two grade levels. The first is conducted at the middle-school age — either seventh or eighth grade — and the second at the high school age.

Toulouse said the screenings, though different in some countries, are conducted internationally.

"The question is, 'How can you work on decreasing substance use disorders in our youth, and ultimately decreasing the amount of overdoses in our adult population?'" Toulouse said.

Doreen Crowe, director of nursing services from Wilmington public schools, was among the four that traveled to Sweden for the conference. She said the message given regarding the crucial role of school nurses in substance use prevention was widely received by those in attendance.

"School nurses are in a pivotal position to provide primary prevention to students," she said. "We are able to have conversations with our students that we normally wouldn't have, and we are in a really good position to talk with our students about substance abuse."

Crowe said the topic engaged nurses nationwide, many of whom have started to see a rise in overdose deaths. Specifically, a nurse from Australia and a nurse from Scotland stuck in Crowe's memory, as they both had a number of questions for the group and said they have seen an increase in overdose deaths in their countries.

Crowe credited Narcan, a drug which reverses overdoses and is accessible to the public, for the leveled-off opioid death rate across the state.

The Department of Public Health cited 2,100 opioid-related deaths in Massachusetts in 2016, the peak of the crisis which reverberated across the United States.

In 2018, the DPH estimated a 4% decrease in the rate of opioid-related deaths compared to 2016. In the first three months of 2019, the department said there are 135 confirmed opioid-related overdose deaths and estimated there will be an additional 325 to 400 deaths.

"We hope that we are making an effect," said Crowe, stressing the importance of intervening with children at an early age and informing them of the danger of substance use.

The group of four spent one week in Sweden for the conference, and their presentation topic stemmed from work they had all done on screening programs.

"Thinking internationally, we thought, 'What would be interesting to folks in other countries that would represent not only the U.S., but specifically work that school nurses have been doing in Massachusetts?'" she said.

Cathy Riccio, director of nursing services from Newburyport public schools, also traveled to the conference.

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