THE YANKALILLA PILOT

The Yankalilla Healthy Heads - Without Headlice pilot promoted and tested a whole-of-community approach to headlice management by including parents, schools, children’s centres, community health centres, local government Environmental Health Officers (EHOs), local GPs, pharmacists and hairdressers.

The program components initially included an information package about treatment techniques, roles and responsibilities, a video for schools, children’s centres and local council on effective headlice treatment, and the support of a District steering committee to guide the program. These resources were tested and refined throughout the pilot program.

The program was launched early in the school year of 2002, and evaluated after six months.

STEERING COMMITTEE MEETINGS

The first meeting of the pilot Healthy Heads committee included representatives from Yankalilla District Council, local primary schools, the local Children’s Centre, the regional community health service, and the local pharmacist. Representatives from City of Onkaparinga, Department of Education and Children’s Services (DECS), and Department of Health (DH) also participated.

A working group was formed, made up of a teacher from Yankalilla Area School, an employee of the local pharmacist, the Yankalilla Council EHO, a representative from the Southern Fleurieu Health Service and an officer from DH. Working group meetings were held monthly. On two occasions larger meetings were organised to include representatives from each school and the Children’s Centre.

Committee members indicated several issues that they would like to address. These included:

• Establishment of a practical and consistent generic headlice management policy that maximises the control of headlice
• Addressing misinformation by using ongoing education of parents and families as a management tool
• The importance of increased collaboration and contribution of other health agencies and schools and children’s centres in the community
• Special care and advice required to help the small proportion of families experiencing ongoing difficulties with infestation
• Promotion of the wet-combing checking and treatment technique
• Ensuring that GPs take the issue seriously
• Workshops or parent sessions to show people how to check and treat
• Small specimens of headlice as a teaching resource
• The potential for a school or local council headlice educator to demonstrate headlice treatment methods, conduct occasional checks to demonstrate the presence of headlice in the community, and assist individual families experiencing difficulties (Return to top)

RESOURCES

A ‘Headlice and Nits’ fact sheet was distributed to each family at each school and children’s centre in the District through newsletter mail outs. A Healthy Heads video was provided to the council, the Children’s Centre and each school, to determine the most effective method of getting this resource out into the community. Survey sheets were provided for people to fill out after watching the video. The booklets were distributed for comment to local schools, hairdressers, pharmacists and general practitioners.

Discussions with DECS and DH Multicultural and Equity Strategies Unit showed that the fact sheet might benefit from revision. A pictorial version is easier to understand by people from non-English speaking backgrounds and those who have reading difficulties.

The video was well received by all viewers, and was an effective resource for helping families experiencing treatment difficulties. It was particularly well-used by families at the Children’s Centre, which was probably due to the Centre offering the video package to every newly enrolling family.

An updated and expanded version of the South Australian Health Commission Guideline, Headlice - A Guide to their Natural History and Management (1992) was circulated to stakeholders such as DECS, Divisions of General Practice, Pharmacy Guild, Pharmaceutical Society, and Child and Youth Health. The general response was that this is an excellent tool for health professionals and others who seek a more in-depth understanding of headlice biology and management. (Return to top)

HEADLICE POLICIES

The Victorian Department of Human Services has developed a “parent-managed headlice program”, and it was strongly felt by members of the committee that the South Australian program should provide a similar “Sample School/Centre Strategy”. The South Australian version has been significantly modified from the Victorian original after consultation with DECS. Parents become most frustrated when their children become reinfested shortly after treatment. This can be due to incomplete treatment (i.e. not repeating chemical treatment in seven to 10 days) resulting in self-reinfestation, or reinfestation from untreated contacts at school or childcare, within the family, or outside contacts. It is important not to assume that someone within the school or children’s centre is the source of reinfestation, or single out a particular family or group of people because of perceived ongoing infestation.

A flowchart - from school (or children’s centre) to EHO and on to community health services or Family and Youth Services social workers - is being developed to help address the issue of families not managing to treat their children successfully due to social, economic or other issues. (Return to top)

SCHOOL-BASED HEADLICE SCREENING

Accredited training for volunteers and prevalence surveys were proposed, but not tested due to time constraints and unresolved issues concerning privacy and duty-of-care. The development of a guideline for conducting headlice prevalence checks/screening is ongoing and will be available in the near future.

There was considerable dissatisfaction expressed initially about the committee’s decision not to actively support school-based headlice screening. The pros and cons relating to the use of nurses and/or parent volunteers and schools taking on this responsibility, and alternatives to headlice screening, were discussed at school governing council meetings.

School-based headlice screening:

• can take away from student curriculum time
• is potentially intrusive of student privacy
• takes over family rights and responsibilities
• conveys the message that headlice management is a school issue rather than a household and wider community responsibility

In a small school (< 100 students) ongoing headlice monitoring may be easier and more effective than in a large school. While the committee did not wish to stop school communities in their area from implementing screening programs, it is important to ensure schools are aware of associated issues which require careful consideration and planning.

There is no requirement for any school to undertake headlice screening, however if school staff were to undertake such a program, they would need to ensure:

• active, informed written consent of the parents

• active, informed verbal consent, at the time, from each student

• respect for privacy and confidentiality

• understanding by everyone involved of the screening’s limited potential success and impact (i.e. not all cases are guaranteed to be identified successfully and school-based screening alone cannot be considered an adequate community response)

If volunteer parents were to undertake this role, school management would need to consider:

• selection of volunteers, ensuring all child protection issues were addressed

• training of volunteers in the checking process and in appropriate ways to ensure student confidentiality, privacy, dignity and respect

• responsibility for quality of the process - this would lie with the person who provided the training, for example, a local council EHO

• overall duty of care for students – unless specifically addressed by the consent form duty of care would remain with teaching staff, so teacher supervision would be required at all times

• issues of informed consent for parents/guardians and students - this would include clearly explaining who the volunteers were, how they had been trained, how they were being supervised and the scope and limits of their responsibility

• utilising the services of someone covered by a professional code of ethics, such as a pharmacist or hairdresser, in preference to using parent volunteers

In addition, a school should:

• develop a generic/blanket consent form for headlice screening which parents/caregivers and students sign at the start of each school year

• respect the wishes of parents/families and children who elect not to participate in school headlice screening

• give a letter to all children involved in a headlice screening to help maintain confidentiality

• include teachers and other school staff in screening.

Some local councils offer headlice screening on a cost-recovery basis. Screening is generally undertaken by a registered nurse, and is run in conjunction with an educational program. (Return to top)

HEADLICE RECORDS

It is recommended that schools and children’s centres collect and keep records of suspected/confirmed cases, to help detect periods of increased infestation and evaluate the success of management and educational programs.

Management of school or centre headlice records can be as simple as keeping a log of the number of letters sent home to families, either on a computer spreadsheet, or in a notebook dedicated for this purpose. This information can then be interpreted and summarised at the end of each term, to help guide future headlice management.

OTHER HEADLICE MANAGEMENT ISSUES

To reduce the impact of headlice on individual students, it is recommended that schools keep children with suspected or confirmed headlice in class rather than in the school office or corridor, until their parent/carer can pick them up. Likelihood of transmission can be minimised through non-group activities.

COMMUNITY HEADLICE TREATMENT DEMONSTRATIONS

Demonstrations of wet-combing for detection and treatment of headlice were proposed, however it was felt that many parents would not make the time to attend an evening session dedicated to headlice. The preferred approach is to incorporate brief presentations conducted by the local council EHO on headlice treatment and control into school induction sessions, when further contacts and resources could be identified.

RECOMMENDATIONS FOR COMMUNITIES

• Establish a support link with DH

• Set up a Healthy Heads committee, with members drawn from parent groups, local council, community health centres, the local medical centre, pharmacy and hairdresser

• Attempt to integrate with existing Occupational Health, Safety & Welfare structures. For example, OHS&W representatives from each stakeholder group could be approached to form the committee; school or centre OHS&W committees may nominate a headlice contact person

• In consultation with School Governing Councils in the area, evaluate or prepare a generic school headlice policy and establish a protocol for dealing with a single case and persistent cases, and circulate throughout the school community

• Set up strategies for increasing people's capacity to treat and manage headlice such as:

- organising cheap combs

- organising information sessions

- active promotion of the video resource within the community, and

- incorporating an evaluation mechanism e.g. keeping a spreadsheet of headlice letters sent to
  parents and/or complaints to the council. (Return to top)

SUMMARY AND RECOMMENDATION

DH officers were involved throughout the formation and functioning of the Yankalilla Healthy Heads committee for the duration of the pilot, providing over 800 updated fact sheets and five videos for distribution, and introducing examples from interstate programs and points raised by DECS for discussion. Working group members were proactive in taking on tasks such as ensuring the distribution of fact sheets, and the Yankalilla Council EHO chaired all meetings for the duration of the pilot.

DH officers gained much insight through supporting and being involved in the Yankalilla Healthy Heads committee, and are happy to provide advice on setting up similar committees in other areas.

Recommended actions for DH include:

• Promote and support the formation of community headlice committees

• Encourage schools to nominate a staff member from the school’s standing OHS&W committee as a contact officer, providing:

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