Create and maintain a school climate and learning environment that is safe for, respectful of, friendly toward and responsive to persons of all racial, cultural, ethnic and socioeconomic groups; of all faiths, family structures, and sexual orientations and identities; and with any special health need, developmental delay, or disability. Such a climate and environment must apply to students, staff and families.

Schools that respect and promote the acceptance of diversities create environments that enhance the physical, emotional, and social health of students, faculty, and staff, and ultimately contribute to a better learning environment for students. Staff training is usually necessary to create such an inclusive environment.

Schools reflect the diversity of communities and their families. They have a unique opportunity to model tolerance, promote acceptance, and celebrate the contributions made by people from a variety of family structures, faiths; racial, ethnic, linguistic, and socioeconomic backgrounds; and sexual orientations and identities.

Families from diverse backgrounds sometimes do not feel included or engaged in school activities and in decision-making processes that influence all health and safety issues affecting their children. Efforts must be made to address language, economic, accessibility, and social barriers that inhibit full participation of students and their families in school activities.

Schools can work to accommodate different family situations in a variety of ways. Schools may:

• identify policies, practices, and curricula that promote acceptance of diversity. Any that may be interpreted as offensive or may be misunderstood by some groups must be addressed in a culturally competent and sensitive manner;
• hire staff who are culturally competent and speak languages of populations served by the school in order to interact with families of diverse backgrounds and increase their involvement with school matters;
• schedule parent-teacher meetings after work hours or via telephone and devise similar strategies to eliminate barriers to family involvement; and
• censure derogatory comments made to anyone else by students, staff or family members at school and do so consistently and immediately.

Appropriate training can help school staff increase communication between families and school personnel and create a family-friendly environment that will encourage family involvement. To accomplish this, provide staff and volunteers with training opportunities to develop cultural competency (see Appendix B).

Ensure that district health, mental health, food service, and safety policies and procedures are congruent with federal, state, and local regulations as well as with current case law concerning school health and safety.

The magnitude of case law concerning school health and safety provides evidence of the importance of policies and procedures that are consistent with laws and regulations. Keeping school health- and safety-related policies congruent with the law is one important way for schools to maintain a high standard of quality for matters related to the safety and health of students and staff.

State departments of health and education have a responsibility to ensure that local jurisdictions are aware of federal, state, and local laws, regulations, and legal actions that shape and modify local school health and safety policies and practices. Resources are available to schools and school districts that are designed to help identify areas of legal concern. Organizations sponsoring such resources include the National Association of State Boards of Education, Council of Chief State School Officers, National School Boards Association, and state and federal departments of education.

Up-to-date information about changes in federal law and regulations relevant to school health and safety are often available from federal agencies. These include: Department of Education (e.g., Office of Special Education and Rehabilitative Services, Office of Safe and Drug-Free Schools, Office for Civil Rights), Department of Health and Human Services (e.g., Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services), Department of Justice, Department of Agriculture (e.g., National School Lunch Program; School Breakfast Program regulations), Consumer Product Safety Commission, Department of Transportation, Environmental Protection Agency, and Department of Labor (including Occupational Safety and Health Administration).

Maintain confidentiality of students' and staff members' health and mental health information including both personal and family health data.

Students and members of the staff must believe that their right to confidentiality and privacy will be respected. Maintaining confidentiality is mandated by many states' laws and regulations.

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 by law."

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 the National 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.

Designate a "school health and safety coordinator" position at each school and at the district level. Individuals holding these positions should have the knowledge and skills necessary to integrate schools' health, mental health, and safety programs, to reach out to and involve families, and to collaborate with community agencies.

Having coordinators for health and safety at the district and school levels helps to coordinate and sustain activities that support students' health, safety, and academic achievement. Without a coordinator, situations may occur in which no one feels responsible for coordinating health and safety programs, or perhaps several people will do so independently. Administrative support and recognition are necessary to influence staff, change systems, and implement programs.

School and district health and safety coordinators develop and coordinate activities that support the health, mental health, and safety of students and their families. The role should enhance and complement the school health and safety team, as well as the roles of its members (e.g., school nurse, counselor, principal). At the district level and in large schools, coordination may be a full-time function. In small schools, coordination may only require release time from one class period. The salary should reflect the position's supervisory responsibilities. Delineate expected activities in a job description and assess them using performance evaluations. Define the scope of authority of the position. Activities differ in scope at the district and school levels. They may include:

• developing community resource listings (e.g., medical, dental, vision-related, mental health, and social services);
• assuring that offers from community agencies and professionals to provide schools with products or services are assessed and, if accepted, applied appropriately to school programs;
• helping teachers develop health- and safety-related activities that involve students' families and the community;
• acting as a liaison or representative to school and community partnerships;
• coordinating school health and safety teams, and serving as a resource for school and district health and safety advisory councils;
• coordinating efforts of school nurses, counselors and other staff members to identify and address primary causes of student absences, student injuries, and disease outbreaks;
• coordinating efforts to assess the school environment for contradictory health- and safety-related messages;
• identifying potential funding sources for supporting programs; and,
• evaluating and revising components of school health and safety programs, including coordination itself.

Highly motivated, well-informed individuals who have the confidence of the school and community at large are most effective. A small number of colleges, as well as the American Cancer Society, offer training programs designed to build coordinators' skills and to train them to take on leadership roles within their schools and districts.

Establish a school and/or district health and safety advisory council that is composed of diverse members of the school and community, including family members of students and student representatives.

Working jointly with stakeholders (of children's education, health, and safety) helps to promote a safe school environment that best nurtures the health and mental health of students. Community partners are more likely to assume responsibility for meeting goals and objectives that they help identify jointly and that reflect the community's concerns and issues than they will for goals and objectives determined independently by schools who subsequently seek community help.

In some school districts, each school may have an advisory council. In others, both schools and district or only the district will have an advisory council. Councils can be designed to address all components of a coordinated school health and safety program such as health and safety instruction, a healthful and safe school environment, health and mental health services, physical education, school counseling, food services, school site health promotion for faculty and staff, and integration of school and community programs. A council should advise staff members who are in positions to develop school health- and safety-related policies (e.g., school principal at the school level; superintendent and/or school board at the district level).

Councils can provide advice on a variety of health and safety issues. They can operate as advocates for students and families, provide support and advice concerning controversial health issues, advise on fiscal planning, as well as on evaluation, accountability and quality control. They can help school administrators and the school health and safety coordinator determine community needs, identify resources in the community, coordinate activities at school with those of other community agencies and organizations, improve communications between schools and the communities they serve, and recommend policy changes.

Family representatives and students on the advisory councils can help ensure that families and students are valued and that their interests are protected by school health and safety decisions. Seek diverse membership so that both genders are represented, there is geographic diversity, and the racial and ethnic groups of the community are well-represented. Welcome community representatives from youth organizations, government, service agencies (health-related and social services), justice and safety-related agencies (e.g., emergency medical services, fire, police), faith-based institutions, media, and business/industry. In addition to community members, a school health and safety council should include the school health and safety coordinator (Guideline 0-04) as well as school personnel who represent components of the school's (or district's) health and safety programs.

Establish and maintain a school health and safety team composed of selected school-employed staff and contractors responsible for planning and implementing various components of a school health and safety program.

The school health and safety team is a component of a systematic process that encourages collaboration, joint planning, and training among school staff who share responsibility for implementing general health and safety programs as well as students' individualized health and safety plans.

The school health and safety team is separate and different from an advisory council (See Guideline 0-05), although many staff may be members of both. Whereas the school or district advisory council recommends policy and programmatic issues to school or district administrators, it cannot determine the day-to-day processes required to implement programs at the school level. This is the role of the school health and safety team along with the school's health and safety coordinator (Guideline 0-04). Working with site administrators, team members can also ensure that everyone in the school community knows about the coordination and how to contribute. In addition to coordinating all components of health and safety programs at a school, the school's health and safety team coordinates how health- and safety-related accommodations for each student with special needs will be implemented once the Individualized Educational Program (IEP) team or other multidisciplinary student assistance team (Guideline 4-01) has determined necessary measures to take.

Members of a school health and safety team should include people with responsibility for a wide variety of health- and safety-related school services. Members may be representatives of school administration, nursing, social services, mental health and counseling assessment and services, physical education, health education, substance abuse prevention and intervention, food services, audiology, oral health, special education and special services (including personnel responsible for compliance with Individuals with Disabilities Education Act(PP-ii) and with Section 504 of the Rehabilitation Act), occupational therapy, physical therapy, speech and language therapy, medical consultation, school based health centers (where applicable), staff wellness, health promotion programs, transportation, security, and building maintenance.

Train all school staff on health and safety procedures so that they know what to do and whom to call at the outbreak of an urgent situation or emergency. Include training that prepares staff for urgent situations that may occur when there are students or staff with diabetes, asthma, seizures and allergic disorders.

When a physical, mental health or safety-related emergency occurs, quick action by those on the scene can often prevent further harm and avoid panic among students and staff witnessing the event. School health professionals and other school personnel who are designated as providers of first-aid are often not on the scene when such events initially occur. Therefore, all school staff, including administrators, educators, support staff (e.g., secretaries, custodial staff, bus drivers, cafeteria staff), and regular volunteers need to know how to respond to a variety of situations until professional help arrives.

Each school requires a minimum number of trained personnel who know how to provide rescue breathing, render first aid, and take other special precautions, such as immobilizing a victim's head and neck after an injury (Guideline 4-07). These people are often called "first responders". All staff members need to be trained so that they know who these designated staff are and how to summon their help.

Train all new employees and regular volunteers who have contact with students and then re-train them at least annually thereafter. In addition to being able to identify designated school-based first responders and how to summon them, teach immediate response techniques that can be applied until this help arrives. Develop this training in consultation with the school's health and safety coordinator and the health and safety team. Also consult with local emergency services providers (e.g., fire and emergency medical services, police). Immediate responses to a witnessed injury, mental health or emotional crisis (e.g., an immediate threat of physical violence), a severe allergic reaction, a fire, an explosion, a poisoning and an exposure to a hazardous material should be covered. All employees need to know how to handle body fluids safely and be aware of basic procedures to protect students and staff.

Develop collaborative relationships with service providers in the community, including providers of health, mental health and dental services, emergency services, hospitals, rehabilitation services, local health departments, social service agencies, youth service providers, child care and after-school programs. Written agreements should be established for specific contract-related services to schools.

Development of partnerships between schools and community service providers helps improve access to needed services, coordination of care, and consistency of programmatic approaches. Coordination helps to reduce duplication of services and miscommunication. A contract, a memorandum of agreement or a memorandum of understanding clarifies the nature of the collaborative relationship.

Schools exist within a community context, which can be of great support to the school's responsibility to provide a safe and healthy learning environment for students and to educate students. Schools should establish partnerships with community services that can provide health, mental health, and safety expertise as well as other support services. Schools are confronted with and need to address many complex issues (e.g., violence, suicide, complex health conditions, addictive behaviors) that require multifaceted skills that are not necessarily within the purview of teaching professionals or that can be dealt with comprehensively by school health professionals. As such, schools need to develop outside partnerships with agencies that can provide quality services for students, families and staff. In addition to community service providers listed above, many communities have other agencies (e.g., universities) that provide services to students and families.

Individual health, dental, and mental health care providers, hospitals, state and local health departments, community agencies, and school-based health centers often contract or establish agreements with schools to provide services and consultation on health and safety. A written contract or memorandum of agreement clarifies roles, responsibilities, and lines of authority. Written descriptions of the relationship help to reduce confusion and the potential for misunderstanding and conflict.

Involve students, families, staff, administrators, and school board members in development of school health and safety policies and communicate these policies to them. Provide necessary training to implement policies. Monitor and evaluate policies' implementation and impact.

New policies receive a broader base of support when those affected by them have had the opportunity to contribute to their development. There is a decreased likelihood that a policy will be misunderstood, poorly communicated, or misapplied when its dissemination is planned, people are trained to implement it, and its implementation is monitored to ensure uniform application and enforcement.

To help ensure broad support for school health- and safety-related policies, students, families, staff, administration, and the school board should contribute to their development and implementation. The school health and safety coordinator, working with the health and safety advisory council, may be helpful with coordinating community involvement. When families, school staff, and others affected by policies are left out of the policy development process, the rationale for a policy is more likely to be misunderstood, implementation challenges may multiply, and the policy is more likely to be ignored in practice.

All health- and safety-related policies should be available in writing. Communication can occur through a variety of modalities, including routine staff development opportunities, routine communication such as newsletters to staff and to families, pay slips, policy manuals given to all school employees upon hire (and annually thereafter), Internet-based formats, e-mail messages, or specially convened staff meetings. Those on the staff with direct responsibility for implementing a given policy require more communication and monitoring than other staff or families. For certain policies, all staff members need training. School policy makers at the local level must determine who needs specialized training on specific policies.

Schools and districts need to base plans for developing their coordinated health and safety programs on a thorough needs assessment of the health, mental health, and safety-related needs of students and staff as well as school and community assets and resources.

Proper planning of a coordinated school health and safety program is essential to meet identified needs of the population and to identify resources and services needed to implement the program. Only by assessing population characteristics, school policies, practices, and the school environment can schools be sure they are meeting the specific needs of their population and determine what additional policies, curricula, resources, and services are still required. Proper planning drives budget development, program implementation, and helps to assure inclusion of essential components.

Although students of a given age share many characteristics, unique aspects of a community and its students must be documented and taken into account when planning. Resource materials from the Centers for Disease Control and Prevention, as well as individuals with expertise in assessment and evaluation, can provide advice on this process - a process that is critically helpful to schools.

A group of people who know the community, or are familiar with its students, and that includes persons with expertise in conducting needs assessments as well as analysis and interpretation of data, should work together to gather and examine relevant information. This group may include teachers, administrators, other school health staff, community and public health professionals, medical professionals, clergy, family members, and students. Districts' school health and safety advisory councils (Guideline 0-05) might serve as such a group. The process of developing a needs assessment should include a plan to handle the information so that the process does not stigmatize a school or a student. A needs assessment might include student and community surveys, as well as information from focus groups of students and family members.

Surveying students for sensitive health and safety information (e.g., suicide ideation, sexual activity, substance use, child abuse, and domestic violence) can make community acceptance difficult to attain. Ironically, these are the very same issues that may most interfere with students' ability to learn.

Surveillance can also involve environmental scans looking for community assets and resources as well as toxins, potential safety hazards, inconsistent health and safety messages, and barriers to physical activity and to other health and safety enhancing practices. School nurses, hospitals, mental health providers, substance abuse prevention and treatment programs, and/or local health departments can provide information about health and safety concerns they encounter regularly. The information should not identify health and safety problems of specific students, but trends and students' highest risks, and risks relative to others their age.

Select and implement curricula, programs, and services that have scientific evidence for effectively reducing health risks or injuries, for improving health (including oral and mental health), safety, or academic outcomes, or for improving related knowledge, practices, and/or attitudes. For content areas that are new, emerging, or for which there are little data, choose curricula, programs, and services that utilize effective theories, practices, and/or principles.

Evidence of program effectiveness derived from research is an important criterion a school should use when selecting an intervention. Programs funded by the US Department of Education under Safe and Drug-Free Schools( 74) must adhere to "Principles of Effectiveness," which states that programs are to be "based on scientifically based research that provides evidence that the program to be used will reduce violence and illegal drug use."

Findings from evaluated school health programs are available, but just because a program has undergone evaluation does not guarantee that it is effective. Many effective strategies for health and safety education curricula are described in Guideline 2-05. Synthesis research helps to identify research-based characteristics of effectiveness for a number of components of school health and safety programs, but for many aspects of these programs, this research is not available. When no research exists to support one intervention over another, schools should consider characteristics of effective programs and services and then select or develop an intervention that is based on models with proven effectiveness (ie, best practices). When using untested interventions, the importance of including an evaluation component with the program is paramount.

Although many effective programs are narrow in scope, all chosen programs, curricula, and services should contribute to a district's or school's coordinated health and safety program.

Engage students' families and homes, service agencies, youth-serving organizations, local businesses, faith-based institutions, and other community resources to enhance school health, mental health, and safety programs.

Schools are one element in a community that can help families keep children safe and healthy as well as promote their learning and citizenship skills. As schools do not and should not have sole responsibility for students' health, mental health, and safety, the support of families and community agencies is essential for school programs.

Schools often have insufficient resources to provide a comprehensive and multifaceted continuum of interventions. By having direct contact with families and key informants in the community, schools are better able to identify barriers to student success and well-being and better equipped to develop solutions that overcome these barriers. Schools can enhance home-school links by sharing concerns with families and developing solutions that address students' unique needs.

In addition to the benefits for students' education and well-being, students' families, and school staff, there are reciprocal benefits for community agencies who partner with schools. Businesses, the justice system, community health and safety systems, and others may benefit from a healthier population. Community agencies and organizations that provide services to children and families often gain a more visible profile when they become partners with schools.

Examples of neighborhood stakeholders in student health and well-being are students themselves, as well as their families and teachers. Other school staff, community business owners, police, faith-based institutions, universities and colleges, local health departments, health and mental health service providers, dentists, emergency medical services, educators of first-aid, departments of health, justice, education and social services, and other agencies that serve families have stakes in the well-being of the student population and school staff. Communicate regularly with partners and potential partners in order to learn what each has to offer.

Conduct periodic and ongoing evaluation of coordinated school health and safety programs and their components. Include process evaluation and quality assurance, evaluation of programs' effectiveness (including performance measurements), and evaluation of programs' impact on the entire school population.

Program evaluation enables program improvement, appropriate allocation of resources, and objective support for continuation of effective programs. Routinely conducted evaluation of school health and safety policies, curricula, programs, and services can help decision makers determine if planned interventions are consistent with what students actually receive and demonstrate the effectiveness of these interventions. Information from a well-designed data collection system can help school administrators make decisions about policies, about maintaining or modifying programs, and about allocating future resources.

Most schools have only limited resources for evaluation. Partnerships with local community planning agencies, universities, foundations, and governments can sometimes augment school resources for planning and implementing an evaluation. Three levels of sophistication for evaluation are monitoring, assessment (more rigorous than monitoring with an additional focus on process measures), and applied research (experimental design and statistical data analysis). To conduct any level of evaluation, allocate adequate time, funds and other resources. Evaluate and collect data on all school programs designed to promote wellness or reduce illness, injuries, suicide, and violence (ie, all health-, mental health- and safety-related services and programs). Evaluation can include student outcomes and outcomes of programs on the school environment (e.g., a sense of community, a sense of safety). When schools use programs with preexisting evidence of effectiveness, evaluation can assess implementation effectiveness as well as relevance in the specific setting and for the specific population to which they are being applied. School administrators often choose to reserve the most sophisticated level of evaluation (applied research) for programs that are either new or cost- or time-intensive, until the program is proven effective.

"Process evaluations" of programs, curricula, policies, and services assess the effectiveness of implementation. Evaluation data can help decision makers modify and improve scrutinized programs and ascertain whether programs were efficient, in addition to being effective. Data can consist of administrative information already being collected (such as attendance, injuries, and health office visits) as well as data derived from new surveillance efforts. Examples of data to collect, analyze, and act upon are:

• student incident report forms that include cause, location and other characteristics of incidents of violence and of injuries.17 All schools should collect data on injuries and violence;
• logs of student visits (nature and number) to school health professionals (e.g., nurses);
• classroom behavior, referrals for disciplinary measures and specialized assistance, interpersonal functioning;
• attendance, timely completion of assignments, involvement in extracurricular activities, satisfaction with programs and services, progress toward long-term goals;
• individual families' basic needs and involvement in schooling;
• surveys of students, families, and staff for their awareness and satisfaction with programs and services; and
• frequency of "copy-cat" incidents after a suicide or suicide attempt.

Hire or contract with health, mental health, and safety related professionals who have completed the appropriate academic training for their field and are licensed, credentialed, or certified to provide the services and education for which they are responsible.

Appropriate academic training and formal credentialing and licensing can help assure the quality of the health, mental health, social, nutrition, dental, and safety services, and of the health education and physical education provided in schools.

Licensing, credentialing, and certification procedures vary by profession. Where licensure, credentialing, and certification are available, staff should be licensed, credentialed, and certified. In many cases, licensure is required, but certification is voluntary. In some cases, evidence of specialized training is desirable, such as specialized training with adolescents or in school settings. If it pertains to professionals' roles and functions at school, require training and experience in specific developmental stages of childhood and adolescence.

Certification and credentialing are often, but not exclusively, achieved through a national body. Licensure always occurs through the state. Districts interested in the availability of licensing for a profession by the state, or in the requirements of professional licensure, should contact their state professional licensing boards. A number of health- and safety-related professions are listed in Appendix C. Each is accompanied by contact information for a national certification body that is associated with the profession or with a national professional organization that is in a position to recommend qualifications for school practice.

For those professionals already on staff and successfully performing health- and safety-related tasks for which they are not fully qualified, require that necessary training or credentials are obtained within three to five years. Maintenance of licenses and certifications requires continuing education credits in most professions. School administrators should try to provide time and financial support to assist employed professionals in obtaining continuing education. Facilitating school health and safety professionals' attainment of required continuing education credits may be an assigned responsibility of the school or district health and safety coordinator.

Personnel who are not members of a health profession but are trained to assist these professionals (i.e., paraprofessionals) may provide many services that students need at school. Establish clearly written guidelines and policies outlining what responsibilities may be delegated to health and mental health paraprofessionals.

The delegation of some health-related services to unlicensed assistive personnel requires that assistants are trained, oriented, and supervised by the appropriate professional. Assigning such duties to untrained employees may provide a poor quality of care and expose schools to legal risk.

Trained paraprofessionals can safely perform many routine functions, which relieves professional staff to provide more complex services. Minor first aid, vision screens, hearing screens and occupational therapy are examples of services that school professionals often delegate to unlicensed assistants or paraprofessionals. Examples of health-related paraprofessionals working in schools include health aides, nursing assistants, audiology assistants, occupational therapy assistants (OTA), and physical therapy assistants (PTA). In some states, certain paraprofessionals may be certified (e.g., certified physical therapy aides).

Through consultation with professional staff, school administrators should specifically and clearly identify the duties of paraprofessionals who provide school health, mental health, and safety-related services. The fully qualified professional supervising the paraprofessional must determine whether the paraprofessional has met the required level of training to perform a given function. Paraprofessionals must have the knowledge and competency to perform the designated activities. In no case should paraprofessionals provide or be asked to provide services beyond their level of training or competency.

In schools, administrative assistants or secretaries are often responsible for providing services such as first aid. Administrative assistants who provide first aid services also require appropriate training and supervision. In no case should these staff members provide or be asked to provide services beyond their level of training.

Some states have legislation or regulations that define what services may be delegated to paraprofessionals and other non-professionals. For example, in some states the Nurse Practice Act outlines those nursing tasks that may and may not be delegated to others.

Several Internet resources listed in Appendix C are useful for researching the potential role of paraprofessionals in many health and health-related fields.

Support the participation of health- and safety-related staff members in professional development opportunities that are designed to help them remain current in their fields and maintain credentials and/or licenses.

On-going updates and reviews for staff with health- and safety-related roles are required to help assure the quality of health, mental health, nutrition, dental and safety-related services, and health education and physical education provided in school.

To implement coordinated school health programs of high quality, professionals and other staff working in health- and safety-related school programs must be properly prepared and stay current in their fields. This includes those who teach health and safety (e.g., a certified health educator, an elementary school teacher) and those who provide health- and safety-related services. Rapid advances in health sciences and in the field of teaching methodology necessitate continuing education for those who provide nursing, primary health care, counseling, other mental health services, injury and violence prevention, physical therapy, occupational therapy, speech therapy, school food services, and other services, as well as for teachers who provide health education and physical education instruction. Many, but not all, staff members with these health- and safety-related roles in school require continuing education to maintain their certification or license.

Staff development programs that address educators' needs are often too generic and inadequate to help these staff members function optimally in their health- and safety-related roles. Even within one's professional field, on-going training must be targeted to cover issues specific to the age groups and developmental levels of students encountered. (For example, a staff member working with high school populations requires up-dates pertinent to adolescent development, and is less likely to benefit from training on early childhood development.) Knowledge about growth and development must include any new information on how student transitions (between grades or schools, for example) are affected by or affect a young person's health and educational status. Relevant staff development should include skills practice with feedback in a training setting as well as on-site mentoring.

In addition to updating personnel on matters related to their area of responsibility, it is beneficial for staff to be familiar with the underlying theory and conceptual framework of the district's health and safety program. Since educational systems evolve over time, health professionals working in school systems may also need to be updated on skills required for working within an educational system and on relevant educational policies.

Staff development programs for those with health- and safety-related roles are often available through regional health and educational centers, local and state education agencies, local and state health and safety agencies, colleges and universities, professional meetings and conferences, national or regional training centers, safety agencies (e.g., American Heart Association, American Red Cross; emergency medical services), and by others in the school or district who have themselves remained up-to-date professionally. Administrators should assist and encourage staff to participate in a variety of professional development activities (e.g., study groups, action research, in-service programs, mentoring programs) and to join relevant local, state, and national professional organizations (see Appendix C for list of national, professional associations).

Before allowing new employees or volunteers to have contact with students, ensure that they have no criminal background, particularly in child abuse or in child sexual molestation or assault.

Schools are liable if a school employee, whose criminal history was available but not checked by school authorities, harms a student. Schools have a responsibility to protect students.

Have each prospective employee disclose whether he or she has ever been found by either a court of law or disciplinary board to have sexually assaulted or exploited a minor or to have physically abused a minor. A criminal record might not, by itself, indicate that an adult poses a threat to students or other staff. However, a criminal background check would expose any convictions for child molestation or violence that might pose a threat to students or other staff. Many states have regulations that define schools' responsibilities for criminal record screening.

In many school districts, staff members are selected for employment by the office of the superintendent. Subsequently, employment is based on approval by the school board. Information on criminal background for sexual assault or physical abuse of a minor needs to be made available to these persons who have a responsibility to make employment decisions.

The information on employees with records of prosecution must be protected, just as health information is protected. Criminal background disclosures and fingerprinting information is highly confidential and schools must have policies and procedures to protect against unwarranted dissemination.

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American Cancer Society. Improving School Health: A Guide to School Health Councils. A series of guidebooks for volunteers and staff. Atlanta, GA: American Cancer Society; 1999.

American Cancer Society. School Health Program Elements of Excellence: Helping Children to Grow Up Healthy and Able to Learn. Atlanta, GA: American Cancer Society; 2000.

American Red Cross, Community First Aid and Safety. Washington DC: American Red Cross; 2002.

American School Health Association. School health: Findings from evaluated programs (2nd ed.). Washington, DC: US Department of Health and Human Services Public Health Service; 1998.

Bergren MD. HIPAA hoopla: privacy and security of identifiable health information. Journal of School Nursing. 2001; 17(6):336-340.

Bernado LM, Anderson L. Preparing a Response to Emergency Problems: A Self-study Module. Scarborough, ME: National Association of School Nurses; 1998.

Bogden JF. Fit, Healthy, and Ready to Learn: A School Health Policy Guide. Alexandria, VA: National Association of State Boards of Education; 2000.

Bogden JF. Someone At School Has AIDS: A Complete Guide to Developing Education Policies Regarding HIV Infection. Alexandria, VA: National Association of State Boards of Education; 2000.

Carlyon P, Carlyon W, McCarthy AR. Family and community involvement in school health. In: Marx E, Wooley SF, eds. Health Is Academic: A Guide to Coordinated School Health Programs. New York, NY: Teachers College Press; 1998:67-95.

Centers for Disease Control and Prevention. School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide. Middle School/High School Version. Atlanta, GA: Centers for Disease Control and Prevention; 2000. Available at: http://www.cdc.gov/nccdphp/dash/SHI/.

Centers for Disease Control and Prevention. Coordinated School Health Program Infrastructure Development: Process Evaluation Manual. Atlanta, GA: US Centers for Disease Control and Prevention; 1997.

Centers for Disease Control and Prevention. School health guidelines to prevent unintentional injuries and violence. MMWR. 2001; 50(RR-22):1-73.

Comer JP, ed. Rallying the Whole Village: The Comer Process for Reforming Education. New York, NY: Teachers College Press; 1996.

Community and Family Health Multicultural Work Group. Building Cultural Competence: A Blueprint for Action. Olympia, WA: Washington State Department of Health; 1995.

Davis BJ, Voegtle KH. Culturally Competent Health Care for Adolescents: A Guide for Primary Care Providers. Chicago, IL: American Medical Association; 1994.

Drug Strategies. Making the Grade: A Guide to School Drug Prevention Programs. Washington, DC: Drug Strategies; 1999. .

Drug Strategies. Safe Schools, Safe Students: A Guide to Violence Prevention Strategies. Washington DC: Drug Strategies; 1998.

EMSC (Emergency Medical Services for Children). Cultural Competence. EMSC National Resource Center, Washington, DC, 1999. Available at: http://www.ems-c.org/Cultural/framecultural.htm.

Epstein JL, Coates L, Clark-Salinas K, Sanders MG, Simon B. Partnership 2000 Schools Manual: Improving School-Family Community Connections. An Inventory of Present Practices of School-Family-Community Connections. Baltimore, MD: Johns Hopkins University; 1997.

Epstein JL, Hollifield JH. Title I and school-family-community partnerships: using research to realize the potential. Journal of Education for Students Placed at Risk. 1996;1:263-278.

Epstein JL. School/family/community partnerships: caring for the children we share. Phi Delta Kappan. 1995;76:701-712.

Family Educational Rights and Privacy Act, 20 U.S.C. 1232g, 34 C.F.R. 99.

Fetro JV. Implementing coordinated school health programs in local schools. In: Marx E, Wooley SF, eds. Health Is Academic: A Guide to Coordinated School Health Programs. New York, NY: Teachers College Press; 1998:15-42.

Fetro JV. Step by Step to Health Promoting Schools: A Guide to Implementing Coordinated School Health Programs in Local Schools and Districts. Santa Cruz, CA: ETR Associates; 1998.

Fossey R, Gregory V. Should colleges conduct criminal background checks before hiring instructors? A Louisiana court says yes. Journal of Personnel Evaluation in Education. 2000;14(2):193-97.

Fryer GE Jr, Igoe JB. Functions of school nurses and health assistants in US school health programs. J Sch Health. 1996;66:55-58.

Ginsburg KR, Winn RJ, Rudy BJ, Crawford J, Zhao H, Schwarz DF. How to reach sexual minority youth in the health care setting: the teens offer guidance. J Adolesc Health 2002; 31(5):407-416.

Greene MT, Puetzer M. The value of mentoring: a strategic approach to retention and recruitment. J Nurs Care Qual 2002; 17(1):63-70.

Hardy L. Trust betrayed. American School Board Journal. 2002;189(6):14-18.

Haynes NM, Comer JP. Integrating schools, families, and communities through successful school reform: the School Development Program. Sch Psychol Rev. 1996;25:501-506.

Hodgkinson HL. Beyond the Schools: How Schools and Communities Must Collaborate to Solve the Problems Facing America's Youth. Arlington, VA: American Association of School Administrators; 1991.

Institute of Medicine. Schools and Health: Our Nation's Investment. Washington, DC: National Academy Press; 1997.

Iowa Department of Public Health, Division of Family and Community Health. Promoting Healthy Youth, Schools, and Communities: A Guide to Community-School Health Advisory Councils. Des Moines, IA: Iowa Department of Public Health, 2001. Available at: http://208.142.197.5/hkn/pdfs/PDF-Part 1.pdf.

Irvine Doran DM, Baker GR, Murray M, Bohnen J, Zahn C, Sidani S, Carryer J. Achieving clinical improvement: an interdisciplinary intervention. Health Care Manage Rev. 2002; 27(4):42-56.

King MA., Sims A, Osher D. How is Cultural Competence Integrated in Education? Center for Effective Collaboration and Practice. Available at: http://cecp.air.org/cultural/Q_integrated.htm.

Lewis KD, Bear BJ. Manual of School Health. 2nd ed, St. Louis MO: Saunders-Elsevier Science, 2002.

Marx E, Northrop D. Educating for Health: A Guide to Implementing a Comprehensive Approach to School Health Education. Newton, MA: Education Development Centers Inc., 1995.

Melaville A. Community Schools: Partnership for Excellence. Coalition for Community Schools, Washington, DC. Available at: http://www.communityschools.org/partnerships.html.

Messina SA. A Youth Leader's Guide to Building Cultural Competence. Washington, DC: Advocates for Youth, 1994. Available at: http://www.advocatesforyouth.org/publications/guide.pdf.

Mukherjee S, Lightfoot J, Sloper P. Communicating about pupils in mainstream school with special health needs: the NHS perspective. Child Care Health Dev. 2002; 28(1):21-7.

Nastasi BK, Varjas K, Bernsetin R. Exemplary Mental Health Programs: School Psychologists as Mental Health Service Providers. Bethesda MD: National Association of School Psychologists, 1997.

National Association for Sport and Physical Education. National Standards for Athletic Coaches. Dubuque, IA: Kendall/Hunt Publishing, 1995.

National Association of Partners in Education. Seven Stage Partnership Development Process: Creating, Managing and Sustaining School-Community Business Partnerships. 901 N. Pitt Street, Suite 320, Alexandria, Virginia. 2001.

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://208.5.177.157/briefs/hippa.htm.

National Association of School Nurses. Scope and Standards of Professional School Nursing Practice. Scarborough, ME: National Association of School Nurses, 2001.

National Association of School Psychologists. Standards for the Credentialing of School Psychologists. Bethesda, MD: National Association of School Psychologists, 2000.

National Association of School Nurses. The School Nurse's Role in Delegation of Care: Guidelines and Compendium. Scarborough, ME: National Association of School Nurses, 1996.

National Association of State School Nurse Consultants. Delegation of school health services to unlicensed assistive personnel: a position paper of the National Association of State School Nurse Consultants. J Sch Health. 1996;66:72-74.

National Education Association. Report of the NEA Task Force on Sexual Orientation. 2002. Available at: http://www.nea.org/nr/02taskforce.html.

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.

Nebraska Department of Health and Human Services. Emergency Guidelines for School Personnel. Lincoln, NE: Nebraska Department of Health and Human Services, 1997.

Newton J, Adams R, Marcontel M. The New School Health Handbook: A Ready Reference for School Nurses and Educators. 3rd ed. Paramus, NJ: Prentice Hall, 1997.

Office of National Drug Control Policy. Understanding Substance Abuse Prevention: Toward the 21st Century: A Primer on Effective Programs. Brounstein PJ, Zweig JM, eds. US Department of Health and Human Services; DHHS Publication No. (SMA) 99-3301; 2001. Available at: http://www.whitehousedrugpolicy.gov/prevent/high_Frisk/index.htm.

Ohio Chapter American Academy of Pediatrics, Emergency Guidelines for Schools, 2000. Available at: http://www.ems-c.org/downloads/pdf/emscguide.pdf.

Parents, Families and Friends of Lesbians and Gays (PFLAG). From our House to the School House: A Brochure for Educators. 2002. Available at: http://www.pflag.org/publications/schools.pdf.

Payne RK. A Framework for Understanding Poverty. Baytown, TX: RFT Publishers, 1998.

Redding CA, Rossi JS, Rossi SR, Velicer WF, Prochaska JO. Health behavior models. Int Elec J Health Educ. 2000;3:180-193.

Resnicow K, Allensworth D. Conducting a comprehensive school health program. J Sch Health. 1996;66:59-63.

School Health: Findings from Evaluation Programs. 2nd ed. Office of Disease Prevention and Health Promotion. 1998. Available from American School Health Association at: http://www.ashaweb.org/.

Schwab N. Guidelines for School Nursing Documentation: Standards, Issues, and Models. Scarborough, ME: National Association of School Nurses; 1998.

Sheridan SM. Best Practice in fostering school/community relationships. In: Thomas A, Grimes J, eds. Best Practices in School Psychology - III. Washington, DC: National Association of School Psychologists; 1995:203-212.

Smith DW, Steckler AB, McCormick LK, LeRoy KR. Lessons learned about disseminating health curricula to schools. J Health Educ. 1995;26:37-43.

Sobocinski MR. Ethical principles in the counseling of gay and lesbian adolescents: issues of autonomy, competence, and confidentiality. Prof Psychol. 1990; 21(4):240-247.

Survival of the Fittest: A Tool Kit for Creating Lasting Comprehensive School Health Programs. Washington, DC: Public Education Network; (no date). Available at: http://www.publiceducation.org/sc-tools-survival.asp.

ULadson-Billings, G: Crossing Over to Canaan: The Journey of New Teachers in Diverse Classrooms; San Francisco: Jossey-Bass, 2001.

US Department of Education, Office of Special Educational Research and Improvement, Office of Reform Assistance and Dissemination. Safe, Disciplined, and Drug-Free Schools Programs. Washington, D.C., 2001.

US Department of Education. Safe and drug-free schools program: notice of final principles of effectiveness. Federal Register. 1998;63:29901-29906.

US Department of Health and Human Services. What You Need To Know About Youth Violence Prevention. Rockville, MD: DHHS, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services; 2002.

US Department of Health and Human Services. Public Health Service. Food Code. Washington DC: Food and Drug Administration; 2001. Available at: http://www.cfsan.fda.gov/~dms/fc01-toc.html.

Valois RF, Hoyle TB. Formative evaluation results from the Mariner Project: a coordinated school health pilot program. J Sch Health. 2000;70:95-103.

Windsor R, Baranowski T, Clark N, Cutter G. Evaluation of Health Promotion, Health Education, and Disease Prevention Programs. 2nd ed. Mountain View, CA: Mayfield Publishing Company; 1994.

Zetlin A, Ramos C, Valdez A. Integrating services in a school-based center: an example of a school-community collaboration. J Community Psychol. 1996;24:97-107.

American Academy of Allergy, Asthma, and Immunology
Includes a school nurse tool kit for asthma and allergy management.

American Association for Health Education

American Cancer Society
In addition to health education curricula, the ACS has a training program for school health coordinators and resources for forming school health advisory councils.

American Dental Association
Includes information on National Dental Board Examinations.

American Diabetes Association
Includes information on non-discriminatory practices for students with diabetes.

American Heart Association

American Red Cross

American School Food Services Association

American School Health Association
Resources for practicing school health professionals (Health in Action), and policy resolutions of many school health and safety issues.

Centers for Disease Control and Prevention (CDC)

Centers for Disease Control and Prevention (CDC) - Division of Adolescent and School Health
Includes youth risk behavior surveillance and guidelines for school health programs.

Centers for Disease Control and Prevention (CDC) - Strategies for Addressing Asthma within a Coordinated School Health Program
Formerly Health Care Financing Administration (HCFA); Federal agency administers child insurance programs, HIPAA, (Health Insurance Portability and Accountability Act), CLIA (Clinical Laboratory Improvement Amendments), and other federally funded health programs and policies.

Centers for Medicare and Medicaid Services

Centers for Medicare and Medicaid Services - Health Insurance Portability and Accountability Act (HIPAA)
Addresses the security and privacy of health data and describes national standards for electronic health care transactions and patient identifiers to be used by providers, health plans, and employers.

Coalition for Community Schools
Information on school partnerships with community agencies, parents, volunteers.

Collaborative for Academic, Social, and Emotional Learning

Colorado Anti-Bullying Project
Part of the Center for the Study and Prevention of Violence. Provides information for teachers, parents, and students to prevent bullying, including resources, links, and a bullying quiz.

Consumer Product Safety Commission
Safe playground equipment and other products.

Council of Chief State School Officers

Education Development Center
A non-profit organization with model projects that enhance learning and promote health.

Emergency Medical Services for Children (EMS-C)
Resources available through their clearinghouse, including: Basic Emergency Lifesaving Skills (BELS): A Framework for Teaching Emergency Lifesaving Skills to Children and Adolescents.

Environmental Protection Agency

Family Educational Rights and Privacy Act (FERPA)
A US Department of Education web site that describes a Federal law that protects the privacy of student education records.

Gay Lesbian Straight Education Network (GLSEN)
Includes a comprehensive training program for educators to increase knowledge, skills, and tools that build sexual orientation awareness and inclusive school environments from K-12.

Healthy Newsletters
A biannual publication of information on health and family issues.

Maternal and Child Health Bureau; Health Resources and Services Administration
Includes programs, data and resources on health and safety issues for school children.

Maternal and Child Health Bureau; Health Resources and Services Administration - Child Health USA
Annual report on health status and service needs of American children.

National Assembly of School-Based Health Centers
In regard to school-based health centers, this site provides resources and support related to advocacy, public policy, technical assistance, training, evaluation and quality.

National Association for Multicultural Education

National Association of School Nurses

National Association of School Psychologists

National Association of State Boards of Education

National Asthma Education and Prevention Program

National Center for Family and Community Connections with Schools

National Education Association

National Education Association - Code of ethics

National Highway Traffic Safety Administration (US Department of Transportation)
Information on child safety restraint systems, training for child passenger safety technicians, and on laws and regulations governing transporting children. The "Child Passenger Safety" pages include information on transporting children with disabilities, and school bus safety.

National Maternal and Child Health Oral Health Resource Center
Information on current and emerging public oral health issues.

National Network of Partnership Schools

National PTA

National School Boards Association
Includes sample school policies (including health-related), resources for school attorneys, school governance, and advocacy.

Occupational Safety and Health Administration

Office of School Health, University of Colorado
Includes a School Health Evaluation Services (SHES) site that assists schools with school health quality assurance issues.

Safe Child
Teaches prevention of sexual, emotional, and physical abuse of children.

Substance Abuse and Mental Health Services Administration (SAMHSA)
Includes information on researched prevention programs for substance abuse, violence, and other mental health related problems affecting youth.

US Department of Agriculture
National school lunch program and school breakfast program regulations.

US Department of Education

US Department of Education - Individuals with Disabilities Education Act (IDEA)

US Department of Education - Office of Civil Rights
Provides information on Section 504

US Department of Education - Office of Safe and Drug-Free Schools
Includes publications on effective violence and substance abuse prevention programs.

US Department of Education - Partnership for Family Involvement in Education
US Department of Education

US Department of Health and Human Services, Office of Civil Rights

US Department of Justice, Americans with Disabilities Act
Information and technical assistance on compliance with the Americans with Disabilities Act.

US Department of Labor, Family and Medical Leave Act
Information about employee eligibility, employee/employer notification responsibilities, and employee rights and benefits.