The Texas Guide to School Health Programs

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Crayon drawing of children in front of school As of May 2009, the Forward and Table of Contents, Chapters 1, 2, 3 and 7 have been revised. The chapters were re-formatted into stand alone modules and updated with the most current information on each topic. Revisions started in 2009 for modules 4 through 6 and the remaining modules will follow. In the meantime, the science and protocols in the current chapters are still appropriate.

To access the information in this guide:
Click on the title of the module or chapter where the topic of interest is located. Then, navigate through the text until you locate the page where the information appears. Module/chapter titles are underlined.

INTRODUCTION AND CONTENTS (106 kb)

FOREWORD iv
ACKNOWLEDGMENTS v
PREFACE vii
WHO SHOULD USE THIS Guide vii
WHAT THIS GUIDE INCLUDES viii
TABLE OF CONTENTS ix

1. MODULE 1:  INTRODUCTION TO SCHOOL HEALTH PROGRAMS (297 kb)

    History of School Health 3
    History of School Health Activities in Texas 3
    Describing the Components of a School Health Program 4
    Assumptions for School Health Services 6
    The Health Needs of School-Aged Children 6
    The Health Status of Children in Texas Schools 9
    Types of Health Services Available in Texas 9
    Health Services for Special Needs Children 11
    The Legal Environment for School Health Services 13
    Conclusions and Recommendations from Report of the School Health Task Force 16
    Developing a Program 17
    Planning 18
    Infrastructure 19
    Infrastructure at the State Level 21
    Infrastructure at the District or Community Level 22
    Infrastructure at the School Level 25
    Needs Assessment 25
    Identification of a Model 26
    Financing a School Health Program 27
    Federal Funding 27
    Fiscal Issues in Texas 28
    Collaboration Within the School System 31
    Collaborative Partnerships Outside the School 32
    Evaluation 33
    References 36

2. MODULE 2:  SCHOOL NURSING PRACTICE (197 kb)

    School Nursing Practice/Standards of Care 3
    Standards of Practice 3
    Standards of Professional Performance 4
    Establishing a School Health Team 5
    Position Descriptions/Roles/Relationships 5
    Relationship with School-Based Health Centers 13
    Communicating With Parents 16
    Culturally Effective Care 17
    Communication – Practical Advice 18
    School Health Resources 18
    References 25

3. MODULE 3:  SCHOOL HEALTH SERVICES (1,846 kb)

    Consent to Health Services 3
    Access to Student Records 5
    Access by Parents 5
    Access by Certain School Staff 6
    School Entrance Physical Examination Requirements 6
    Requirements for Enrollment 6
    Immunizations 7
    Population-Based Screening Programs: State Mandated 7
    Annual Report 7
    Vision Screening 9
    Hearing Screening 11
    Spinal Screening 15
    Acanthosis Nigricans Screening 21
    Dyslexia Screening 21
    Population-Based Screening Programs: Best Practice 23
    Height and Weight 23
    Body Mass Index 24
    Blood Pressure 26
    Oral Health and Dental Screening 27
    EPSDT/Medicaid/Texas Health Steps 28
    Speech and Language 30
    Fine and Gross Motor Screening 36
    Evaluation of Normal Development 37
    Exhibits 39
    CDC Growth Chart (77 kb) 39
    Girls Stature-for-age & Weight-for-age percentiles (546 kb) 40
    Boys Stature-for-age & Weight-for-age percentiles (539 kb) 41
    References 45

4. IMMUNIZATIONS (341 kb) 111

    Immunization Requirements 113
    Background Information 113
    Ask the Experts: General Vaccine Questions, VISs, Thimerosal 120
    Minimum Requirements 129
    Texas Vaccines For Children Program 131
    Exemptions 132
    Serologic Confirmation of Immunity 132
    Medical Contraindications 133
    Exemptions for Religious Conflicts 133
    Exemptions for Service in Armed Forces 134
    Authorization/Consent 134
    Liability 134
    Procedure 135
    Adverse Events Reporting 135
    Documentation 136
    School Records 136
    Acceptable Documents of Immunizations 136
    Vaccine Registry 137
    Relevant Exhibits 138
    Vaccine Information Statements 150
      Chicken Pox (Spanish) (1.1 mb) 150
      Chicken Pox (English) (724 kb)153
      Diphtheria, tetanus & pertussis (Spanish) (1.2 mb) 156
      Diphtheria, tetanus & pertussis (English) (757 kb) 159
      Hepatitis A (Spanish) (828 kb) 162
      Hepatitis A (English) (765 kb) 165
      Hepatitis B (Spanish) (876 kb) 168
      Hepatitis B (English) (795 kb) 171
      Haemophilus Influenzae Type B (Hib) (Spanish) (827 kb) 174
      Haemophilus Influenzae Type B (Hib) (English) (1.2 mb) 177
      Measles, Mumps & Rubella (Spanish) (951 kb) 180
      Measles, Mumps & Rubella (English) (790 kb) 183
      Pneumococcal Conjugate (Spanish) (797 kb) 186
      Pneumococcal Conjugate (English) (743 kb) 189
      Polio (Spanish) (949 kb) 192
      Polio (English) (821 kb) 195
      Tetanus and Diphtheria (Spanish) (794 kb) 198
      Tetanus and Diphtheria (English) (691 kb) 201

5. MEDICATION ADMINISTRATION (1.3 mb) 205

    Guidelines for Administering Medications in Schools 207
    Overview 207
    Texas Education Code Provisions 207
    Liability 209
    Nursing Practice Considerations 210
    Relationship with Other Healthcare Providers 211
    Guidelines for Administering Medications 211
    Procedures for Administering Medications 216
    Errors and Omissions in Medication Administration and Recording 222
    Special Topic: Medication Administration off of School Grounds (Field Trip/Event) 227
    Special Topic: Herbal and Dietary Supplements 231
    Special Topic: Use of Emergency Medication in Schools 233
    Emergency Injectable Epinephrine in the School Setting 233
    Special Topic: Psychotropic Medications in Schools 235
    Antidepressants 236
    Antianxiety Medications 237
    Mood Stabilizers 237
    Stimulants 238
    Special Topic: Medication for Diabetes (Type 1 and 2) in Schools 240
    Oxygen Administration in Schools 244
    Relevant Exhibits 251
      Skills Checklist for Medication Administration (415 kb) 251
      Sample Parental Consent/Provider Authorization 252
      Letter to Parent Advising of Texas Medication Law (w/Nurse) 253
      Letter to Parent Advising of Texas Medication Law (w/oNurse) 254
      Refusal to Administer Medication Letter (to Parents) 255
      Administrative Regulation for Administration of Medications at School 256
      Parental Permission to Administer Prescription
      or Non-Prescription Meds 258
      Sample Provider Authorization Form (17 kb) 259
      Sample Medication Log 260
      Sample Incident / Error Reporting Form 262
      Sample Medication Administration Plan 263
      Sample Wall Poster “5 Rights of Medication Administration” 264
      Sample Product Insert - Epipen 265
      Sample Insulin Pump 266
      Additional Resources 267

6. MENTAL HEALTH IN SCHOOLS (198 kb) 269

    Counseling, Psychological and Social Services 271
    Overview 271
    The Counselor 272
    The Psychologist 274
    The Nurse 277
    The Teacher 278
    Mental Health in Schools 280
    New Roles for School Nurses 281
    Screening: A Note of Caution 284
    Interviewing: Exploring the Problem with Student/Family 289
    Understand the Nature and Scope of Problems 290
    Psychosocial Guidance and Support 293
    Psychosocial Counseling 294
    Mental, Emotional and Behavior Disorders in Children and Adolescents 296
    Mental, Emotional and Behavior Problems 297
    Counseling, Psychological and Social Services: Special Populations 300
    Children with Special Health Care Needs 300
    “At risk” Youth/Suicide 301
    Eating Disorders 303
    Substance Abuse 307
    Family Crisis/Divorce 309
    Homosexuality/Alternative Sexual Orientation 309
    Violent Relationships 310
    School Violence 312
    NASN Position Statement: Role of the School Nurse in Violence Prevention 313
    Legislation 314
    Primary Prevention: Principles of Prevention and Early Warning Signs 315
    Conflict Resolution 319
    Relevant Exhibits 322

7. MODULE 7:  Treatments and Care Plans (175 kb)

Special Education: Children with Special Health Care Needs 3

Individuals with Disabilities Education Act  3
Section 504  4
Americans with Disabilities Act  6
Related Services  6
Scope of Related Services  6
Individualized Education Program  7
Timeline for Major Legislation Related to Children with Special Health Care Needs in
School Based Settings  7
The Role of the School in the Individualized Health Care Plan Process  8
The Role of the School Nurse in the Individualized Health Care Plan Process  10
 

Children with Disabilities  12

Eligibility  12
Types of Disabilities  13
The School’s Role  16
The Educational Environment:  Inclusion  18
 

Children Requiring Special Health Care Procedures  19

Procedures Performed in School Settings  20
Steps for Procedures Performed in Schools  21
Learning Disabilities  22
Role of the School and the Nurse in the Assessment of learning Disabilities  26
Learning Disability and the Law  32
Increased Services, Equal Opportunity  33
Public Agency Support  33
 

Children with Chronic Illnesses  34

Allergies  34
Asthma  37
Diabetes  42
Seizure Disorders  45
 

References  52

8. COMMUNICABLE DISEASE CONTROL (1.5 mb) 443

    Communicable Diseases 445
    NASN Position Statement: Infectious Disease 445
    Universal Precautions 446
    Overview 446
    Handwashing 447
    Ways to Avoid Contact with Body Fluids 448
    Disposal of Infectious Waste 448
    Accidental Exposure 450
    Reportable Conditions 451
    Reportable Disease Table 453
    Selected Communicable Diseases 456
    Impetigo 456
    Hepatitis A 457
    Influenza 458
    Meningitis 459
    Varicella (Chicken Pox) 461
    Tuberculosis 463
    Pediculosis 465
    Tinea Capitis (Ringworm of the Scalp) 467
    Exclusion from School 467
    Relevant Tables and Exhibits 470
      Dermatology: Common Childhood Diseases Associated with Rashes (21 kb) 470
      Hepatitis Chart (17 kb) 473
      Communicable Disease Chart for Schools and Child-care Centers (1.4 mb) 475
    References (29 kb) 481
    TB Addendum

9. EMERGENCY CARE (159 kb) 483

    Emergency Procedures 485
    The Law 486
    The School's Role 488
    Step One: Emergency Prevention and Risk Reduction 488
    Step Two: Emergency Readiness 490
    Step Three: Communication 496
    Emergency Procedures: Allergic Reaction 497
    The School's Role 498
    Common Types of Allergic Reactions and Strategies to Reduce Allergic Responses 502
    Emergency Procedures: Heat-Related Illnesses 509
    Prevention 509
    Temperature Overload 510
    Hot Weather Emergencies 510
    Emergency Procedures: Cardiac Arrest 514
    Causes of Cardiac Death in Children and Adolescents 514
    Risks for Sudden Cardiac Death in Schools 515
    Treatment of Sudden Cardiac Arrest 515
    The Law 518
    Out-of-Hospital Do Not Resuscitate Orders 519
    Legal Background 520
    Honoring a DNR Order 521
    DNR Order Record-Keeping 523
    Secondary Prevention: Crisis Management and Responding to School Violence 523
    The Emergency Response Plan 523
    The Emergency Response Team 525
    Intervention During a Crisis 526
    The Role of the School Nurse 527
    Other Resources for Critical Incident Response Plans 528
    Relevant Exhibits 537
      Emergency Categorization Chart (40 kb) 537
      General Emergency Guidelines 538
      Legal Discussion Regarding Standing Delegation Orders 539
      Helpful Resources 541
      Suggestions for School First Aid Supplies 544
      Sample Universal Precautions Guidelines 545
      Sample Emergency Care Plan (Allergy) (353 kb) 547
      TDH Out-of-Hospital DNR Order Form and Instructions (962 kb) 549

10. OTHER SCHOOL HEALTH SERVICES (153 kb) 553

    Case Management 555
    Child Abuse 558
    Operational Definitions of Abuse 559
    Reasons for Abuse and Neglect 559
    Assessing for Signs of Abuse and Neglect 563
    Referrals to Child Protective Services 577
    Child Protective Services 577
    Referrals to Other Health Care Providers 588
    Primary Health Care Providers 589
    Emotional 591
    Nursing Liaison Services to Homebound Students 599
    Home Visits 602

11. REFUGEE, MIGRANT AND IMMIGRANT HEALTH (64 kb) 613

    Refugee, Migrant and Immigrant Health 615
    Refugees 615
    Immigrants 615
    Mexican/Hispanic and Latin American Immigrants 618
    Cuban Refugees and Immigrants 621
    Iraqi Refugees 621
    Somali Refugees 622
    Sudanese Refugees 624
    Bosnian Refugees 625
    Vietnamese Immigrants 626
    Indian Immigrants 628
    Migrants 630

12. HEALTH EDUCATION (7 mb) 633

    Texas Essential Knowledge and Skills for Health Education 635
    Safety and Injury Prevention 635
    Substance Use and Abuse 642
    School Prevention Programs 643
    Alcohol Abuse 650
    Drug Abuse 652
    Tobacco Use 654
    CDC Guidelines for Preventing Tobacco Use and Addiction 659
    Abstinence-Based Education 667
    What is Abstinence? 667
    What is the Title V Abstinence Education Program? 668
    Texas Essential Knowledge and Skills for Health Education: Abstinence-Based Education 668
    Lifelong Healthy Eating 671
    School Nutrition Services 671
    CDC Guidelines: Promoting Lifelong Healthy Eating 673
    Physical Education 681
    CDC's Guidelines for School and Community Programs Promoting Lifelong Physical
    Activity 681
    How Much Physical Activity Do Young People Need? 682
    How You Can Help 685
    Skills to Target Each Year (Grade School, Middle School, High School) 687
    CDC Guidelines for Promoting Lifelong Physical Activity 691
    Preparticipation Physical Evaluation-Medical History 697
    Physicals 699
    Excerpt From AHA Medical/Scientific Statement: Cardiovascular Preparticipation Screening of Competitive Athletes 699
    Prevention of Anabolic Steroid Use 703

13. HEALTH PROMOTION FOR SCHOOL STAFF (21 kb) 713

    Staff Wellness Programs 715
    Relevant Exhibits 721
      Adult Immunization Schedule (628 kb) 721
      Helpful Resources (14 kb) 723
      Wellness Disease Prevention Resources: Tobacco (599 kb) 726
      Wellness Disease Prevention Resources: Violence (654 kb) 728
      Wellness Disease Prevention Resources: Environmental Health (603 kb) 730
      Wellness Disease Prevention Resources: Nutrition (761 kb) 732
      Wellness Disease Prevention Resources: Substance Abuse (388 kb) 734
      Wellness Disease Prevention Resources: Physical Activity (731 kb) 735
      Wellness Disease Prevention Resources: Cancer (697 kb) 737
      Wellness Disease Prevention Resources: Diabetes (751 kb) 739

14. HEALTHY SCHOOL ENVIRONMENT (131 kb) 741

    Healthy School Environment 743
    Indoor Air Quality 743
    Asbestos 753
    Mold 754
    Tobacco 756
    Pest Control in Schools 756
    Lighting at School 766
    Promoting Healthy Computer Use 767
    Protective Eyewear in Schools 770
    Animals in the Classroom 772
    School Building Requirements 773
    Safe Playgrounds 775
    Resources for School Facility Construction and Renovation 781
    Relevant Exhibit: EPA Tools for Schools Action Kit 787
      IAQ Backgrounder (2.3 mb)787
      Teacher's Classroom Checklist (2.4 mb) 793
      Administrative Staff Checklist (1.3 mb) 801
      Health Officer/School Nurse (935 kb) 805
      Ventilation Checklist & Log (1 mb) 808
      Explanatory Info for Ventilation Log Items (3.7 mb) 812
      Building Maintenance Checklist (1.8 mb) 824
      Food Service Checklist (857 kb) 830
      Waste Management Checklist (426 kb) 833
      Renovation and Repairs Checklist (3,108 kb) 835
      Walkthrough Inspection Checklist (1,116 kb) 845

15. PARENT AND COMMUNITY INVOLVEMENT (48 kb) 851

    Parent and Community Involvement 853
    Family and Community Involvement in Schools 853
    School Health Advisory Committees 857
    Parent Teacher Organizations 859
    Community Regulatory Organizations 860

APPENDIX A: Legal Appendix (350 kb) 867

INDEX (14 kb) 1053

INDEX OF EXHIBITS AND FORMS (12 kb)1059

Last updated August 06, 2014