Revised Spinal Screening Program Rules




Chapter 37. Maternal and Infant Health Services Subchapter G. Spinal Screening Program Amendments §§37.141 - 37.152 

The Executive Commissioner of the Health and Human Services Commission (commission) on behalf of the Department of State Health Services (department) adopts amendments to §§37.141-37.152 concerning the minimum standards for detection of abnormal spinal curvature in certain school-age children attending public and private schools. The sections are adopted without changes to the proposed text as published in the April 11, 2008 issue of the Texas Register (33 TexReg 2903) and, therefore, the sections will not be republished.


The amendments are necessary to comply with Health and Safety Code, Chapter 37, which requires the department to provide training to screeners for the detection of abnormal spinal curvature and the collection of screening data.

Government Code, §2001.039, requires that each state agency review and consider for readoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act).  Sections 37.141 - 37.152 have been reviewed, and the department has determined that reasons for adopting the sections continue to exist because rules on this subject are needed.


The department, on behalf of the commission, did not receive any comments regarding the proposed amendments during the comment period.

§37.141. Purpose. The purpose of these rules is to implement the requirements of Health and Safety Code, Chapter 37, concerning the detection of abnormal spinal curvature in children.

§37.142. Definitions. The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise. 

  • Abnormal spinal curvature--An anatomic, structural deviation from the normal spinal curve, such as scoliosis or kyphosis.
  •  Child's health record--The official individual student health record(s) maintained by a school for a child.
  • Conflict of interest--The use of the screening process for solicitation of follow-up services which enable the individual, his/her immediate family members or professional associates to benefit financially, or earn favors or free publicity as a result of the screening process.
  • Department--The Department of State Health Services.
  • Forward-bend test--A screening procedure approved by the department to determine whether a child may have an abnormal spinal curvature.
  • Health practitioner--A licensed professional who has completed a course of study in physical assessment and who is appropriately licensed under state law, including physicians, chiropractors, physical therapists, and registered nurses.
  • Non-health practitioner--A person who may or may not have a health background, or whose training has not included physical assessment skills and techniques, which generally includes teachers, coaches, athletic trainers, licensed vocational nurses, health assistants, parents, and volunteers.
  • Professional examination--An evaluation performed by a health practitioner licensed under state law and whose expertise addresses the diagnostic needs of the individual identified as having a possible spinal deformity.
  • School--An educational institution that admits children who are between five-21 years of age, which includes an individual school campus.
  • Screener--An adult, non-student who performs the spinal screening test in a school setting. Screeners may be health practitioners who are licensed under state law or non-health practitioners who have successfully completed a department-approved course in spinal screening.
  • Screener certification--Department-approved training which qualifies the individual to receive a certificate stating that the person may perform spinal screening.
  • Screener recertification--A department-approved review course for screeners to extend their certification for an additional five years.
  • Screening--The forward-bend test, which is used for the determination of the need for a professional examination to diagnose a spinal deformity.
  • Trainer certification--A department-approved course which qualifies the individual to receive a certificate stating the person may teach the screener certification course.
  • Trainer--Individuals, including department staff and those health practitioners appropriately licensed under state law, who have successfully completed the department approved trainer certification course, and have at least two years of experience conducting spinal screening in a school-setting.

§37.143. Stages of the Department's Authorization. The department, in cooperation and coordination with the Texas Education Agency and other department bureaus, divisions or programs serving school-age children, shall develop, implement, and administer a program for the detection of abnormal spinal curvature in children. The program shall be known as the Department of State Health Services Spinal Screening Program, and is authorized to: 

  • provide certification training for spinal screening to non-health practitioners through the Regional Education Service Centers and other locations; 
  • approve spinal screener certification, screener recertification, and trainer certification programs, including approval of trainers for these training programs;
  • establish the standard spinal screening tests and referral criteria; 
  • coordinate spinal screening activities of school districts, private schools, state agencies, volunteer organizations, and other entities to prevent duplication;
  • monitor the quality of spinal screening activities in Texas;
  • issue reporting forms;
  • provide educational and other materials to assist local spinal screening activities; and
  • keep a roster of approved trainers and screeners who have become certified under these sections.

§37.144. Certification Training for Non-health Practitioners. The department shall monitor the quality of spinal screener training activities under the following guidelines. 

  • The department shall provide screener certification for non-health practitioners.
  • The screener certification of non-health practitioners shall be by department staff or department-approved trainers. 
  • The spinal screening course shall include: 
    • definition of abnormal spinal curvature; 
    • causes, consequences, and management of abnormal spinal curvature; 
    • procedure for performing the forward-bend test; 
    • notification of screening results and follow-up procedures; 
    • spinal screening program standards and responsibilities; and
    • the reporting of statistical data. 
  • Department staff or department-approved trainers shall issue a certificate to an individual who successfully completes a department-approved spinal screener certification. The certificate will indicate that the screener is approved by the department to perform spinal screening for a period of five years. 
  • The certificate described in paragraph (4) of this section will be renewable upon successful completion of a department-approved screener recertification.

§37.145.  Approval of Certification Courses and Trainers. 

  • In order to become an approved trainer, a health practitioner must be appropriately licensed under state law and successfully complete the department-approved trainer certification course consisting of a minimum of four hours of instruction by department staff that includes: 
    • legal requirements in spinal screening; 
    • workshop outline and materials to be used; 
    • an update on the latest advances in the management of spinal deformity; 
    • spinal screening program requirements; 
    • approaches to spinal screening training; and 
    • the role of the different health practitioners in spinal screening. 
  • The individual must have a minimum of two years of school spinal-screening experience. 
  • A certificate verifying trainer status will be issued upon successful completion of the requirements stated in subsections (a) and (b) of this section. 
  • In order to maintain trainer status, the individual must successfully complete each updated continuing education course provided by the program upon notification of the availability of such a course. 
  • All screener certification, screener recertification, and trainer certification workshops must be approved by the department prior to the training session. The criteria which the department will consider for approval are submission of: 
    • department's request for spinal screening training workshop form; and 
    • verification by the department that the trainer conducting the workshop is department- certified.

Once approved, the department may provide instructional materials, as they are available, to the approved instructors.

§37.146.  Termination of Screener or Trainer Participation. 

  • Approval of a trainer may be suspended or terminated if the trainer: 
    • fails to follow the department's rules for screener certification; 
    • fails to maintain instructor status by participating in the continuing education courses provided by the department; 
    • makes unethical referrals, i.e., referrals that could indicate a conflict of interest on the part of the instructor; or 
    • violates the Family Educational Rights and Privacy Act of 1974, 20 United States Code §1232g, et seq. 
  • The department may suspend or terminate a screener’s approval if the screener: 
    • fails to maintain screener certification; 
    • fails to screen according to department rules; 
    • fails to report screening results according to department rules; 
    • makes unethical referrals, i.e., referrals that would indicate a conflict of interest on the part of the screener; or 
    • violates the Family Educational Rights and Privacy Act of 1974, 20 United States Code §1232g, et seq. 
  • Before the department suspends or terminates an individual's participation in the program, the department will give the individual the opportunity for a hearing in accordance with §§1.51-1.55 of this title (relating to Fair Hearing Procedures).

§37.147. Standards for Spinal Screening Testing. The department and school districts, private schools, state agencies, volunteer organizations, and other entities performing spinal screening shall adhere to the following standards. 

    • The basic spinal screening test, known as the forward-bend test, shall be used to screen children for abnormal spinal curvature. A description of the test is available from the Department of State Health Services, Health Screening and Case Management Unit, MC 1938, P.O. 149347, Austin, Texas 78714-9347.
    • In order to avoid over-referrals, children failing the initial screening shall be rescreened using the forward-bend test prior to parental notification of the possible presence of an abnormal spinal curvature.

§37.148.  Responsibilities of Public and Private Schools. 

      • All children in grades six and nine attending public and private schools shall be screened for abnormal spinal curvature before the end of the school year. The screening requirements may also be met by a professional examination as defined in §37.142 of this title (relating to Definitions). 
      • The screening requirement for children entering grade six or nine may be met if the child has been screened for spinal deformities during the previous year. Schools may implement a program that includes screening in grades five and eight in lieu of grades six and nine. 
      • New students enrolling in grades scheduled for screening (i.e., grades six and nine or five and eight) who have no record of having received their scheduled screening(s) shall be screened the year they enroll.  Schools may offer a student enrolling in grades 10, 11, or 12 the opportunity for spinal screening if the student has no record of having been screened previously. 
      • The chief administrator of each school shall ensure that every child complies with the state- mandated spinal screening requirements or submits an affidavit of exemption. An affidavit shall be signed by the child's parent, managing conservator, or guardian that spinal screening conflicts with the tenets and practices of a recognized church or religious denomination of which the child is an adherent or a member. This affidavit shall be submitted to the school's chief administrator on or before the day of the screening procedure each year the screening is performed, to meet the requirements of the Act. A copy of this affidavit shall be filed in the child's health record. 
      • A parent, managing conservator, or guardian who declines participation in the spinal screening provided by the school must submit to the school's chief administrator documentation of a professional examination which includes the results of a forward-bend test. This documentation must be submitted to the school during the school year the student is scheduled for screening, or, if the professional exam is obtained during the following summer, at the beginning of the following school year. 
      • If the spinal screening test indicates that a child may have an abnormal spinal curvature, the individual performing the test shall fill out a report on a form prescribed by the department. The chief administrator of the school shall retain one copy of such report and send the original to the parent(s), managing conservator, or guardian of the child screened. The form shall contain information regarding the results of the screening and shall be accompanied by a letter advising the parent, managing conservator or guardian of his/her responsibility to select an appropriate health practitioner for the examination. 
      • A copy of the previously mentioned report shall be filed at the child's school and an entry shall be made in the child's health record. The original is returned with the final diagnosis and the plans for treatment, as indicated.
      • The chief administrator of each school shall monitor the referral process and encourage a professional exam, and may provide information about services to families without insurance or unable to afford private care. These services may include but are not limited to Medicaid, Children's Health Insurance Plan, Children with Special Health Care Needs, or local resources.
      • A list of children who failed the spinal screening test may be kept to assist in determining whether a professional examination has occurred.
      • Proof of screening shall be provided by an entry in the child's health record stating that the child has undergone screening tests that meet the standards outlined in these sections. Such an entry shall also include the results of screening.
      • Personnel performing screening may maintain a list of children screened for spinal deformities as proof of screening.
      • In cases when a professional examination was performed in lieu of the required screening test, the date, results, name, and title of the professional performing the exam shall be entered in the child's health record.
      • The chief administrator of each school shall ensure that each individual complies with the screening requirements in these sections.
      • Each school shall submit to the department an annual report of spinal screening performed during the school year no later than June 30 of the reporting year. The report shall be submitted by the chief administrator of each school district as specified on a form issued by the department.
      • The child's health record shall be acceptable as proof of screening if such record contains entries of screening results. In such a case, the original or a true and correct copy of that record may be transferred between schools and shall be honored by the governing body of the school upon transfer of a student from another school in Texas or another school within the United States.

§37.149. Responsibilities of Parent, Managing Conservator, or Guardian.  When screening indicates possible abnormal spinal curvature, the child's parent, managing conservator, or guardian is responsible for securing the services of a qualified health practitioner to perform a professional examination to diagnose the problem.

§37.150.  Further Responsibilities of the Department. 

  • Quality assurance activities. 
    • In order to monitor the quality of spinal screening services, department personnel may enter schools during normal hours and inspect records maintained on children subject to screening in each school for the purpose of ascertaining statistical information, and may directly observe the spinal screening process.
    • The department shall compile records and statistics from all spinal screening activities reported to this program in order to collect data concerning the quality of the diagnostic outcomes of children with possible abnormal spinal curvature.
  • Coordination and cooperation. The department shall encourage coordination and cooperation among entities in areas where more than one entity provides spinal screening so that the efforts of each entity are complementary, rather than duplicative.

§37.151.  Confidentiality of Information.  The department shall maintain the confidentiality of all information concerning those individuals screened, to the extent permitted by law.

§37.152.  Nondiscrimination Statement.  No person shall be excluded from participation, be denied benefits, or be otherwise subjected to discrimination in the Department of State Health Services Spinal Screening Program on the grounds of race, color, national origin, sex, creed, handicap, or age.

Last updated April 07, 2014