Schools must have written policies that define when and how often signed consent
is required to exchange information, the limits of information to be exchanged,
and terms of notification when this information is exchanged. In the course
of classroom discussions, private conversations with nurses, counselors, coaches,
and others, students often reveal personal information they do not want others
to know. Unless this information jeopardizes their safety or that of others
(e.g., suicidal thoughts, disclosure of sexual assault, expressions of harming
others), students should have the right to control whom at school is informed.
Confidentiality should include information about a pregnancy. The Code
of Ethics of the National Education Association stipulates that educators
"shall not disclose information about students obtained in the course of
professional service unless disclosure serves a compelling purpose or is required
Health agencies must handle personal health information under stipulations outlined
under a federal law known as the Health
Insurance Portability and Accountability Act (HIPAA). Although only some
school health records (e.g., records that derive from school-based health centers)
fall directly under HIPAA jurisdiction, all schools need to exchange information
with health providers, clinics, hospitals, and other entities required to adhere
to HIPAA. As such, "release of information" forms used by schools
to notify health agencies that student information is being sought must now
comply with HIPAA regulations if they are to serve their purpose. For example,
parents' consent to have their children's health information disclosed to schools
from a health agency should be revocable, explicitly limited to a defined duration
of time, and limited in its scope and range of use.
The handling of private information described in HIPAA can be very instructive
for schools. The flow of protected health information within the school system
needs to be carefully analyzed. School administrators and the school health
and safety team must review how items such as phone logs, records of students
visiting the school nurse, students visiting the school psychologist or counselor,
and lists of students with health problems are utilized and who has access to
them. This confidentiality applies to written, oral, and electronic forms of
information. Modifications to record-keeping may need to be made in order to
be sure that those who require information have access to it and that the information
is available only to those persons.
Under the Family
Education Rights and Privacy Act (FERPA) (28), parents have the right to access
all the records a school has on their children. In addition, with a few exceptions,
the school may not release student information outside the school without consent
of the parents. In cases where a student's safety is at risk (e.g., an abusive
family situation), school staff must inform external authorities (e.g., child
protective services). Schools that maintain health information about staff should
seek guidelines for maintaining confidentiality of this information, through
School Boards Association.
The training of health professionals often includes maintaining confidentiality
of clients' personal information. However, educators and other school staff
are often unaware of their responsibility to maintain confidentiality. Schools
need to train school staff and volunteers who have regular contact with students
or with student and staff records so that school policies are explicitly known.
Bergren MD. HIPAA hoopla: privacy and security of identifiable health information. Journal of School Nursing. 2001; 17(6):336-340.
Lewis KD, Bear BJ. Manual of School Health. 2nd ed, St. Louis MO: Saunders-Elsevier Science, 2002.
National Association of School Nurses. School Health Nurse's Role in Education: Privacy Standards for Student Health Records (issue brief). Scarborough, ME: National Association of School Nurses, 2002. Available at: http://22.214.171.124/briefs/hippa.htm.
National Education Association. NEA Handbook, 1991-1992. Washington, DC: National Education Association; 1991.
National Task Force on Confidential Student Health Information. Guidelines for Protecting Confidential Student Health Information. Kent, OH: American School Health Association, 2000.