Hawai‘i Keiki program designated as an American Academy of Nursing Edge Runner

The Hawai‘i Keiki: Healthy & Ready to Learn Program – a partnership with the University of Hawai‘i at Mānoa Nursing and the Hawai‘i State Department of Education – has been designated as an Edge Runner by the American Academy of Nursing.

Edge Runners are evidence-based, nurse-designed models that demonstrate significant clinical, financial, community and policy outcomes with proven sustainability and replicability. Each of these programs highlights nurses’ ingenuity and collaboration in developing new methods to provide care and promote health equity.

The program was developed in 2014 to address the impact of health on student attendance and learning, especially focused on the needs of Title 1 schools. Hawaiʻi Keiki enhances and builds school-based health services that screen for treatable health conditions; provide referral to primary health care and patient-centered medical home services; prevent and control communicable disease; and provide emergency care for illness or injury.

The program was designed to be flexible and agile to respond to emerging and ongoing student, school and community needs as well as funding availability. The Hawai‘i Keiki registered nurses and advanced practice registered nurses are a resource to the entire school community. They lead the coordination of school health services and assist in school wellness promotion and health careers readiness. Hawai‘i Keiki nurses collaborate with and make referrals to health systems and individual care providers.

By utilizing technology such as telehealth, Hawai‘i Keiki has expanded equitable access to care for physical and mental health needs. A Hawai‘i Keiki registered nurse can virtually connect a student to a Hawai‘i Keiki advanced practice registered nurse. With the presence of dedicated nurses in schools, it allows principals and teachers to focus on education rather than students’ health care.

The Hawai‘i Keiki: Healthy and Ready to Learn model has expanded access to health care and reduced health disparities for children and contributed to an emerging body of evidence on school health. During the COVID-19 pandemic, Hawai‘i Keiki continued to grow in size and scope to meet the needs of the students, community and schools. When the state’s public schools closed during the pandemic, the program launched a hotline answered by Hawai‘i Keiki nurses to provide health advice, information on community services as well as to conduct telehealth visits upon request.

School Nursing Services (in operation since 2014)

• Expanded from 59 schools to all 258 public schools across the state
• 75% of students in 2022–23 returned to class instead of being sent home after a visit to a Hawai‘i Keiki clinic
• Grown from four nurses to approximately 160 registered nurses, advanced practice registered nurses, dental hygienists, dentists and health technicians in 2023
• The program now offers: school nursing, telehealth, mental health services, dental services, health hotline, Vaccines for Children and recently expanded services to Hawai‘i Charter Schools
• 82% of Hawai‘i public schools participated in the Hawai‘i Keiki Narcan/CPR training initiative to reduce potential opioid overdose on school campuses

Dental Services (in operation since 2020)

• Provides no-cost dental screening focused on high-need schools and has received on-going grant funding from Hawai‘i Dental Service Foundation since 2019
• Expanded services from six schools on one island in 2020, to 68 schools on three islands in 2023
• 61% of students in 2022–23 who received dental assessments received dental sealants 

Promotion of Health Professions

• Provides training and education for School Health Assistants (HIDOE employees) to increase their lifesaving and first-aid skills
• Provides clinical experiences for UH students from nursing, dental hygiene, pharmacy, sociology and psychology departments 
• Actively supports the HIDOE Career Pathways by engaging with high school student health academies and career fairs

“The Academy is proud to designate unique and solution-oriented initiatives as Edge Runners. The diverse focus of Edge Runner models highlight the wide range of services, vital support, and team-based approaches that the nursing profession provides,” said American Academy of Nursing President Kenneth White. “The Hawai‘i Keiki: Healthy & Ready to Learn Program applies nurses as innovative change agents who are addressing a specific health care challenge.”