School Health. Policy and Practice. 7th EDITION. Policy of the American Academy of Pediatrics

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1 Policy of the American Academy of Pediatrics School Health Policy and Practice 7th EDITION

2 School Health Policy and Practice 7 TH EDITION Author: American Academy of Pediatrics Council on School Health Editors: Rani S. Gereige, MD, MPH, FAAP Elisa A. Zenni, MD, FAAP American Academy of Pediatrics 141 Northwest Point Blvd Elk Grove Village, IL

3 Library of Congress Control Number: ISBN: ebook: The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. The American Academy of Pediatrics is not responsible for the content of the resources mentioned in this publication. Web site addresses are as current as possible but may change at any time. This book has been developed by the American Academy of Pediatrics. The authors, editors, and contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in the development of the content of this publication. The publishers have made every effort to trace the copyright holders for borrowed materials. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. Copyright 2016 American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior permission from the publisher (locate title at click on Get Permissions). Printed in the United States of America. MA /

4 American Academy of Pediatrics Council on School Health Executive Committee Members Breena Welch Holmes, MD, FAAP, Chairperson Mandy A. Allison, MD, MSPH, MEd, FAAP, Chairperson-Elect Richard C. Ancona, MD, FAAP Elliott S. Attisha, DO, FAAP Nathaniel S. Beers, MD, MPA, FAAP Cheryl Duncan De Pinto, MD, MPH, FAAP Peter A. Gorski, MD, MPA, FAAP Chris L. Kjolhede, MD, MPH, FAAP Marc A. Lerner, MD, FAAP Adrienne Weiss-Harrison, MD, FAAP Thomas L. Young, MD, FAAP Liaisons Nina R. Fekaris, MS, BSN, RN, NCSN Linda M. Grant, MD, MPH, FAAP Veda Charmaine Johnson, MD, FAAP Sheryl Kataoka, MD, MSHS Sandra Leonard, DNP, RN, FNP Former Executive Committee Members/Reviewers ( ) Cynthia DiLaura Devore, MD, MS, FAAP, Past Chairperson Robert Gunther, MD, MPH, FAAP Jeffrey Lamont, MD, FAAP Mark Minier, MD, FAAP Jeffrey K. Okamoto, MD, FAAP, Immediate Past Chairperson Lani S. M. Wheeler, MD, FAAP, FASHA Staff Madra Guinn-Jones, MPH Florence Rivera, MPH

5 American Academy of Pediatrics Reviewers Board of Directors Reviewer Kyle Yasuda, MD, FAAP Committees, Councils, and Sections Committee on Infectious Diseases Committee on Medical Liability and Risk Management Committee on Nutrition Committee on Pediatric Emergency Medicine Committee on State Government Affairs Committee on Substance Abuse Council on Children With Disabilities Council on Early Childhood Section on Allergy and Immunology Section on Endocrinology Section on Orthopaedics Section on Ophthalmology Section on Early Career Physicians

6 v Editors and Contributors Editors Rani S. Gereige, MD, MPH, FAAP Director of Medical Education Designated Institutional Official Nicklaus Children s Hospital Miami Children s Health System Clinical Professor, Department of Pediatrics Florida International University Herbert Wertheim College of Medicine Miami, FL Elisa A. Zenni, MD, FAAP Associate Dean for Educational Affairs Professor, Department of Pediatrics University of Florida College of Medicine Jacksonville Jacksonville, FL Contributors Oxiris Barbot, MD First Deputy Commissioner New York City Department of Health and Mental Hygiene Queens, NY Seraphine Pitt Barnes, PhD, MPH, CHES Health Scientist, Division of Population Health, School Health Branch National Center for Chronic Disease Prevention and Health Promotion US Centers for Disease Control and Prevention Atlanta, GA Nathaniel S. Beers, MD, MPA, FAAP Chief Operating Officer District of Columbia Public Schools General and Developmental Pediatrician Children s National Health System Washington, DC

7 SCHOOL Editors and HEALTH: Contributors POLICY and PRACTICE vi CAPT Stephanie Bryn, MPH US Public Health Service (Ret.) Director, Injury and Violence Prevention US Department of Health and Human Services Health Resources and Services Administration Rockville, MD SHARON DABROW, MD, FAAP Professor of Pediatrics Program Director, Residency Program University of South Florida Tampa, FL William Potts-Datema, MS, FASHA, FAAHE Chief, Program Development and Services Branch Division of Adolescent and School Health US Centers for Disease Control and Prevention Atlanta, GA Cynthia DiLaura DEVORE, MD, MS, FAAP Pediatrician, school physician Williamsburg, VA Joyce L. Epstein, PhD Director, Center on School, Family, and Community Partnerships Johns Hopkins University Baltimore, MD Robert J. Geller, MD, FAAP, FACMT Professor of Pediatrics Emory University School of Medicine Atlanta, GA Linda M. Grant, MD, MPH, FAAP Associate Professor of Pediatrics Boston University School of Medicine Director, Medical Services From School Health Policy & Practice, 7th Boston Edition: Public, Schools Boston, MA

8 Editors and Contributors vii Manuel E. Jimenez, MD, MS, FAAP Assistant Professor and Chancellor s Scholar Departments of Pediatrics & Family Medicine and Community Health Director of Developmental and Behavioral Pediatrics Education Rutgers Robert Wood Johnson Medical School Attending Developmental and Behavioral Pediatrician Children s Specialized Hospital New Brunswick, NJ Veda C. Johnson, MD, FAAP Associate Professor, Department of Pediatrics Emory University School of Medicine Executive Director, Partners for Equity in Child and Adolescent Health Atlanta, GA LLOYD J. Kolbe, PhD Emeritus Professor of Applied Health Science Indiana University School of Public Health Bloomington, IN Claire MA LeBlanc, MD, FAAP, FRCPC Associate Professor of Pediatrics McGill University Health Centre Division Head, Rheumatology Montreal Children s Hospital Montreal, Quebec, Canada Susan P. Limber, PhD, MLS Dan Olweus Professor Department of Youth, Family, and Community Studies Clemson University Clemson, SC David K. Lohrmann, PhD, MA, MCHES Professor and Chair, Department of Applied Health Science Indiana University School of Public Health Bloomington Bloomington, IN

9 SCHOOL Editors and HEALTH: Contributors POLICY and PRACTICE viii Erin D. MAUGHAN, PhD, MS, RN, APHN-BC Director of Research National Association of School Nurses Robert Wood Johnson Foundation Executive Nurse Fellow Silver Spring, MD Robert D. MURRAY, MD, FAAP Professor of Human Nutrition Department of Human Services The Ohio State University Columbus, OH Blaise A. Nemeth, MD, MS, FAAP Associate Professor, Department of Orthopedics and Rehabilitation University of Wisconsin School of Medicine and Public Health Pediatric Orthopedics and Pediatric Fitness American Family Children s Hospital Madison, WI Jeffrey K. Okamoto, MD, FAAP Medical Director, Developmental Disabilities Division Hawaii State Department of Health Assistant Professor of Pediatrics, John A. Burns School of Medicine University of Hawaii at Manoa Honolulu, HI Janeth CEBALLOS OSORIO, MD, FAAP Assistant Professor of Pediatrics University of Kentucky Lexington, KY Joy A. OstERHOUt, MS, MCHES Principal, Health & Education Consultants Augusta, ME

10 Editors and Contributors ix Olga Acosta Price, PhD Associate Professor, Department of Prevention and Public Health Director, Center for Health and Health Care in Schools Milken Institute School of Public Health The George Washington University Washington, DC Catherine N. RASBERRY, PhD, MCHES Health Scientist, Division of Adolescent and School Health National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention US Centers for Disease Control and Prevention Atlanta, GA SHIRLEY SCHANTZ, EDD, ARNP Director of Nursing Education National Association of School Nurses Silver Spring, MD David J. SCHONFELD, MD, FAAP Director, National Center for School Crisis and Bereavement University of South California School of Social Work USC Department of Pediatrics Children s Hospital Los Angeles Los Angeles, CA Kenneth Tellerman, MD, FAAP Clinical Assistant Professor of Pediatrics University of Maryland School of Medicine Chairman, Emotional Health Committee Maryland Chapter American Academy of Pediatrics Baltimore, MD Weijun Wang, PhD Post-doctoral Fellow of Education and Psychology Faculty of Education, University of Ottawa Ottawa, Ontario, Canada

11 SCHOOL Editors and HEALTH: Contributors POLICY and PRACTICE x Howell Wechsler, EdD, MPH Chief Executive Officer Alliance for a Healthier Generation New York, NY Lani S. M. Wheeler, MD, FAAP, FASHA School Health Consultant Naples, FL Yuri Okuizumi-Wu, MD Assistant Professor Emory University School of Medicine Atlanta, GA thomas L. Young, MD, FAAP Jim and Suzanne Elliot and Family Professor of Pediatrics University of Kentucky Department of Pediatrics Lexington, KY

12 xi Table of Contents Preface... xiii Chapter 1 An Overview of School Health in the United States Chapter 2 School Health and Medical Education...23 Chapter 3 Health Services Section 1: Guidance for School-Based Screenings Section 2: School-Based Health Centers Section 3: Populations With Unique Needs...59 Section 4: Role of the School Physician Section 5: The School Nurse Chapter 4 Comprehensive Health Education Chapter 5 Physical Education, Physical Activity, and School Sports Chapter 6 Mental Health and Social Services Section 1: Special Education Section 2: Mental Health Chapter 7 Nutrition and Schools Chapter 8 Healthy and Safe Environment Section 1: Emergency and Disaster Preparedness in Schools Section 2: The School Environment Section 3: School Climate Chapter 9 Family and Community Involvement Chapter 10 Staff Wellness Chapter 11 Global School Health Chapter 12 Program Assessment and Evaluation

13 xiii Preface More than 50 million children and adolescents from kindergarten through 12th grade spend every school day in 130,000 public and private schools, usually for 13 of the most developmentally sensitive years of their lives. Throughout successive generations, these schools indelibly weave the fabric and the future of our nation substantively shaping the health and education of our children and, consequently, the adults they will become. During the past several decades, efforts to respectively reform our education system and our health system sometimes have neglected the great potential for carefully designed school health programs to improve both the health and education of all young people; especially young people most likely to suffer health and education problems. The American Academy of Pediatrics (AAP) was established in 1930; today it is an organization of 64,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Since its inception, the AAP purposefully has been working to help our nation s schools protect and improve the health and education of children and youth. Since its scientific journal, Pediatrics, first was published in 1948, the AAP has regularly provided expert information about practical means schools could use to ensure the health of students. The AAP Council on School Health (formerly the Committee on School Health) has provided a wide array of continuously evolving resources that can be used to inform and implement effective school health policies, programs, and practices. These resources can be reviewed or acquired at Paramount among them is School Health: Policy and Practice, the 7th edition of which follows this Preface. Since 60% of public schools have pre-k children (< 5 years of age), the reader may refer to Caring for Our Children: National Health and Safety Performance Standards for policies and best practices related to the pre-k age group. School Health: Policy and Practice purposefully has been written not solely for school physicians. Rather, it has been written for a broader complement of health, education, and social service professionals as well as others who care about school children and youth; who might work together as a team with physicians as crucial partners to improve the lives of young people.

14 SCHOOL HEALTH: POLICY and PRACTICE xiv Certainly, School Health: Policy and Practice has been written for school physicians and for all pediatricians, as well as family practitioners, to help them understand specific means by which schools more than any other institution profoundly influence the short- and long-term health of children and youth. Indeed, in our current era of expanding private, independent, and charter schools and of increasingly more parents who are providing home-schooling for their children health care providers must be ever more informed and vigilant about recommended health interventions that may not be provided for those children who do not attend public schools. School Health: Policy and Practice, thus, can serve as a priceless in-service training tool for pediatricians who are committed to staying up-to-date about ever-changing health hazards among young people as well as ever-changing means that could be used by schools to mitigate those hazards. Equally important, School Health: Policy and Practice also can serve as a text and curriculum for preservice pediatrician training and residency programs. Such preservice training could do much to expand the informed participation and leadership of pediatricians across our nation in improving school health programs, and, thus, might help precipitate a more robust national public health strategy to protect and improve the health of school-aged populations. However, School Health: Policy and Practice was also written for school teachers, who bear close witness to often insidious health threats; for school nurses, to whom everyone first turns when health threats emerge; and for school administrators principals as well as district, city, and state superintendents who ultimately are responsible for protecting and fostering the health of children in schools and who (perhaps uniquely) can help establish healthy psychosocial climates in schools. It was written for school counselors, psychologists, and social service workers, who often help students with difficult life circumstances and emotional health problems and who sometimes can help when others cannot. It was written for school food service personnel, physical educators, and coaches, who shape early if not longer-lived habits of eating and physical activity that we now know affect short- and long-term health and education outcomes. It was written for school health educators, who help young people develop the skills they will need to cultivate their own health, the health of families for which they will become responsible, and the health of the communities and the world in which they will live. It was written for school custodial staff, who protect students from school environmental hazards, and for school safety officers, who protect students from school-wide emergencies. It was From School written Health for Policy teachers & Practice, unions 7th and Edition: other, organizations that strive to secure the

15 Preface xv health of all school employees. It was written for parent teacher associations and for governmental and nongovernmental agencies that serve youth. It was written for local and state education agencies, boards of education, health departments, and boards of health. It was written for local, state, and federal legislators, whose support sometimes is required to help schools implement good health policies and practices. It was written for school health coordinators appointed by schools, districts, and states to garner efficiency and synergy by integrating otherwise independent and scattered efforts of the many individuals listed previously. And it was written as a unifying text to help otherwise disconnected faculties across colleges of medicine, education, public health, and social work to provide more integrated training for various professionals so they consequently might work together with schools to improve the health and education of young people. School Health: Policy and Practice aims to help these individuals and agencies answer the fundamental question: How might schools most effectively improve the health and education of students in a rapidly changing world? More specifically, how might schools most effectively manage administration of many different medications required by students? What mental health services might schools provide? On which priorities might school health education programs focus? How might schools be made safe for students acutely sensitive to peanuts and other allergens? What might schools do to reduce student exposures to toxic molds, pesticides, and cleaning solutions? How might schools protect students from bullying, cyber-bullying, and other violence? What might schools do to help the increasing number of students who have asthma, diabetes, attentiondeficit/hyperactivity disorder, autism spectrum disorders, and other special health care needs? How might schools employ school nurses, school-based clinics, and other community health services to meet the needs of their students? What kind of food and physical activity might schools provide? What might schools do to preserve the health of school employees? How might school health policies and programs increase educational achievement, especially among students who live in poverty? Why and how might schools establish means to coordinate their plans and procedures to efficiently address each of these discrete questions? Indeed, these questions are merely a few of many fundamental health policy and practice questions that each school must address questions carefully answered by School Health: Policy and Practice. How each of our nation s 130,000 schools answers these questions will greatly affect the lives of students in each school. How schools across the nation collectively answer these questions will shape the health and education of successive generations of Americans.

16 SCHOOL HEALTH: POLICY and PRACTICE xvi The AAP, its Council on School Health, and those who collaboratively produced this text have codified into one source the disparate technical information that could enable our nation s schools to markedly improve the health and education of our young people. What remains is for this information to be used that is, for the wide and varied institutions and professions named above to come together and collaboratively exert the political will needed to implement those school health policies, programs, and practices so well explained in the pages that follow. Lloyd J. Kolbe, PhD Emeritus Professor of Applied Health Science Indiana University School of Public Health Bloomington Founding Director ( ), Division of Adolescent and School Health US Centers for Disease Control and Prevention