Form 0920-1150 HPWS Survey (online)

Confidential

Healthcare Professionals Working in Schools Survey

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Form Approved
OMB Control No.: 0920-1150
Expiration date: 12/31/2019
___________________________________________________
We appreciate your time! The results from this survey will help us to better support you to prevent tickborne
diseases in your students.
This survey is being conducted by the New York State Emerging Infections Program and the Centers for Disease
Control and Prevention (CDC). Healthcare professionals working in schools in your state have been selected to
participate.
The topic of this survey is prevention of tick bites and tickborne disease in the school setting. The survey questions
will ask about your knowledge and school health practices as they relate to tickborne disease prevention.
This survey will take about 10 minutes. The survey is completely voluntary. You may decline to answer any question,
and you can stop the survey at any time. All of the information that you give will be anonymous.
If you have any questions about this survey or problems accessing the survey, please email us at
TickNet@health.ny.gov or call 518-473-4439. If you have any questions about your rights as a participant, please
contact the NYSDOH IRB coordinator Tony Watson at 518-474-8539 and reference NYSDOH Protocol #1375111-1
Please complete this survey by [DATE].
Please make sure you hit the "SUBMIT" button on the last page of the survey.
Thank you for helping us to prevent tick bites and tickborne disease in school-aged children!
___________________________________________________
Public reporting burden of this collection of information is estimated to average 10 minutes per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia
30333; ATTN: PRA 0920-1150

Eligibility Determination
Are you currently employed as a licensed healthcare
professional that provides health services or
consultation to students in a school setting?

Yes
No

Please answer the following questions based on your experience in the school setting. If you work in a school with
more than one healthcare professional, answers should be based upon on your own individual experience, not the
school setting as a whole.

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You chose "no." Please specify the reason:

You chose "other." Please specify:

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I am not currently employed
I am not a licensed healthcare professional
I do not provide health services or consultation
to students in a school setting
I provide mental health services and counseling
only
There is no licensed healthcare professional
employed at this school
Other

__________________________________

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Section I: General Demographics
This section contains questions that provide descriptive information about you and the school
setting in which you work.
What is your current healthcare license?

You chose "other." Please specify:

Certified Nursing Assistant/Certified Medical
Technician (CNA/CMT)
Licensed Practical Nurse (LPN)
Registered Nurse (RN)
Physician's Assistant (PA)
Nurse Practitioner (NP)
Physician (MD, DO)
Other

__________________________________

Are you employed at a school-based health center?

Yes
No

In total, how long have you worked as a healthcare
professional in a school setting as of the start of
the 2018/2019 school year?

Less than 1 year
1-5 years
6-15 years
16-30 years
More than 30 years

At how many school sites do you work?

Approximately how many hours do you work in a typical
workweek in the school setting?

__________________________________

__________________________________

What is the total number of students that you serve?

Less than 200 students
200-1,000 students
1,001-2,000 students
More than 2,000 students
Don't know

What student populations do you serve? (Check all
that apply)

Preschool/Pre-Kindergarten
Elementary (example: Kindergarten - 5th grade)
Middle/junior high (example: 6th - 8th grade)
High school (example: 9th - 12th grade)
Other

You chose "other." Please specify:

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Section II: Knowledge
This section contains questions to assess your current knowledge of ticks and Lyme disease,
since it is the most commonly reported tickborne disease in your state.
Which of the following images is the tick that can
carry Lyme disease? (select only one)
Don't know

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Section II: Knowledge, Continued
About how long does an infected tick need to be
attached to a person before transmission of the Lyme
disease bacteria can occur?

Less than one hour
1-24 hours
Greater than 24 hours
Don't know

How long does it take for erythema migrans (commonly
referred to as the "bull's eye rash") of Lyme
disease to develop after the bite of an infected
tick?

Within a few hours after a tick bite
Within 2 days after a tick bite
3 to 30 days after a tick bite
31 to 60 days after a tick bite
Don't know

What is the most common late stage symptom of Lyme
disease (months after tick bite)?

Swollen joint(s)
Confusion
Erythema migrans (commonly referred to as "bull's
eye rash")
Chest pain
Don't know

True or False: A child who has previously had Lyme
disease can get Lyme disease again if they are
bitten by another infected tick.

True
False
Don't know

True or False: In the case of a high-risk tick bite,
a single prophylactic dose of antibiotic can be used
to reduce the risk of acquiring Lyme disease.

True
False
Don't know

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Section III: Experiences and Practices
This section contains questions about your experiences and practices in your school setting
related to ticks and tickborne disease.
Since the start of the 2018/2019 school year, how
many times have you attended to a student for a
suspected tick-related issue?

None
1-5 times
6-15 times
16-30 times
31-50 times
More than 50 times

Does your school have a policy regarding the removal
of ticks from students?

Yes
No
Don't know

In your practice in the school setting, are you
allowed to remove attached ticks from students?

Yes
No
Don't know

Since the start of the 2018/2019 school year,
approximately how many ticks have you removed from
students?

None- I am not allowed to remove ticks from
students
None- no students presented with attached ticks
1-5 ticks
6-15 ticks
16-30 ticks
31- 50 ticks
More than 50 ticks
I don't know

In your practice in the school setting, how do you
remove an attached tick? (check all that apply)

Apply fingernail polish
Cover with a cotton ball soaked in rubbing alcohol
Grasp the mouthparts of the tick with fine tip
tweezers & gently pull it out
Smother the tick with petroleum jelly such as
Vaseline
I don't remove attached ticks
Other

You chose "other." Please specify:

What do you do for a student who has had a tick bite?
(check all that apply)

You chose "other." Please specify:

Do you attempt to identify ticks?

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Send the student home
Tell the student to be alert for fever and rash
Contact the parents/guardians
Contact the student's primary care provider
Offer educational resources on tick bite prevention
Recommend antibiotics to prevent Lyme disease
Recommend Lyme disease testing for the student
Recommend that the tick be tested for evidence of
infection
None of the above
Other

__________________________________
Yes
No

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You chose "yes." How do you go about identifying a
tick?

You chose "other." Please specify:

In your current role, have you given a presentation
on tickborne diseases at the school?

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Submit to a laboratory for identification
Ask a colleague
Contact the department of health
CDC website
Internet search engine (e.g. Google)
Tick ID card
Other

__________________________________
Yes
No
Does not apply to me

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Section IV: Prevention
This section contains questions about your recommendations to students to prevent tick bites
and resources provided to students.
Do you talk with individual students about their risk
for tick bites and ways to protect themselves from
being bitten?

Yes
No

Is this done by another staff member or individual at
the school?

Yes
No
Don't know

What do you recommend to students to prevent tick
bites? (Please check all that apply)

Use an EPA-registered insect repellent on skin or
clothes
Wear light colored clothes when outside in wooded
or grassy areas
Check for ticks, especially after being outdoors
Shower soon after being outdoors
Change clothes after being outdoors
Tumble dry clothes in the dryer for at least 10
minutes after coming in from outdoors
Avoid tick habitat (such as thick brush and tall
grass)
Wear clothing treated with permethrin
I do not provide recommendations to students to
prevent tick bites
Other

You chose "other." Please specify:

__________________________________

Do you routinely send home health-related educational
resources with students? (i.e. pamphlets, flyers,
informational booklets)

Yes
No
Does not apply to me

Do you send home tickborne disease-related
educational resources with students?

Yes
No
Does not apply to me

Do you know where you can obtain educational
resources for students on tick bite and tickborne
illness prevention? (i.e. pamphlets, flyers,
informational booklets)

Yes
No

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Section V: Attitudes and Perception
This section contains questions to assess your perception of risk for tickborne disease in your
student population and your degree of confidence in addressing concerns related to ticks and
tickborne disease.
How high do you believe the risk is for students in
your community for getting a tickborne disease?

No risk
Low risk
Medium risk
High risk

In general, I feel ____________ about my ability to
determine how long a tick has been attached to a
person.

Not at all confident
A little confident
Moderately confident
Very confident

In general, I feel ____________ about my ability to
remove a tick that is attached to a person.

Not at all confident
A little confident
Moderately confident
Very confident

In general, I feel ____________ about my ability to
recognize the symptoms of Lyme disease.

Not at all confident
A little confident
Moderately confident
Very confident

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Section VI: Resource Information
This section contains questions on where you obtain information and educational materials on
ticks and Lyme disease.
Are you familiar with the New York State Education
Department curriculum titled "Ticks and Tick-borne
Disease Resource Toolkit" that contains information
on tickborne disease prevention, including sample
education strategies?

Yes
No

Have you ever received specific education about
tickborne disease prevention for a school setting?

Yes
No
Don't know

Which of the following are your top three sources of
information about tickborne disease? (Please check
your top 3)

Professional societies (e.g. AAFP, AAP, IDSA, etc.)
Professional journals
Medical conferences
State or local health department
My school district
Federal organizations (e.g. CDC, NIH)
Television or radio
Newspapers or magazines
Friends and family
Professional colleague (e.g. other healthcare
professional in the school setting)
Other healthcare providers
Other

You chose "other." Please specify:

Which of the following are your top three online
sources for information about tickborne disease?
(Please check your top 3)

You chose "other." Please specify:

Which of the following resources about tick bites and
tickborne disease prevention would be helpful to you
in your school health services program? (check all
that apply)

You chose "other." Please specify:

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Online medical advising group (e.g. WebMD, Mayo
Clinic, Medscape)
Federal organizations (e.g. CDC, NIH)
State or local health department
Social media (e.g. Facebook, Twitter, etc.)
Google search (or other search engine)
Online blogs
YouTube
Lyme disease specialty website (e.g. ILADS, Lyme
Disease Association, etc.)
I don't use online sources for information about
tickborne disease
Other

__________________________________
Paper resources (informational pamphlets,
brochures, flyers, posters)
Online resources (PowerPoints, PDFs, audio/visual
web sessions)
Regular email updates
In-person meetings/trainings
Other

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Would continuing education credits increase your
willingness to participate in education for
tickborne disease prevention?

Yes
No
Does not apply to me

What, if any, barriers do you face in utilizing
educational resources on tick bite and tickborne
disease prevention? (Free text response)

__________________________________________

What would you like to learn about Lyme disease,
ticks, and/or tickborne diseases? (Free text
response)

__________________________________________

Is there anything else that you think we should know
about? (Free text response)

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Thank you for your time today! Your responses will help us learn how to better support you and your school in the
prevention of tickborne diseases. We would also be happy to provide you with FREE tick-borne disease educational
materials. If you are interested, please contact us at the following email: TickNET@health.ny.gov
If you would like to see answers to the survey and for more information about ticks and Lyme disease, please hit
submit!
Thank you!
New State Emerging Infections Program
Phone: 518-473-4439
Email: TickNet@health.ny.gov
Website: TickNet
You did not meet the eligibility criteria to complete this survey. Thank you for your time.
We would also be happy to provide you with FREE tick-borne disease educational materials. If you are interested,
please contact us at the following email: TickNET@health.ny.gov
If you would like more information about ticks and Lyme disease, please hit submit!
Thank you!
New State Emerging Infections Program
Phone: 518-473-4439
Email: TickNet@health.ny.gov
Website: TickNet

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