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4-01 - Student assistance teams at each site

Provide a multidisciplinary student assistance team individualized to assist each student experiencing problems (educational, behavioral, developmental, or any health- or safety-related problem). At a minimum, include a school nurse, mental health professional, the student's teachers, and school administrator on the team.

4-02 - Supervision of clinical activities

Require that fully qualified, credentialed, and licensed health professionals supervise clinical health professionals and health care services. The leading clinical supervisor of the district should be part of the district's central administrative team and have formal training in management and administration.

4-03 - Student access to a certified school nurse

In order to meet students' physical and emotional needs, provide daily access to an on-site school nurse. School nurses should be registered nurses who have specialization in school nursing.

4-04 - The school physician

Hire, or contract with, a school physician who has training and/or experience in child, adolescent and/or school health, to work with school nurses and others on the health and safety team. The physician's function should be specified in a written agreement and may include support of school staff with health and safety roles, interaction with community health professionals, guidance of district policy, and/or specific clinical responsibilities.

4-05 - Delegation of routine clinical services

Nurses, other school health professionals (e.g., occupational, physical, speech and language therapists), paraprofessionals, and unlicensed assistive personnel should provide only those assessments and procedures (including medical observations, dental services, and administration of medications) that are appropriate to their level of training, competency and licensure.

4-06 - Mental health problems: capacity to identify, refer, manage

Have the capacity to identify students with, or at risk for, mental health problems, to refer them for assessment and interventions appropriate to their needs, and to monitor and manage their behavioral, mental health, and emotional needs at school.

4-07 - Staff trained for emergencies

Ensure that at least one adult with current training in basic first aid and lifesaving techniques is available to students and staff on site and at all off-site school-sponsored activities. Skills include cervical spine protection, Heimlich maneuver, cardiopulmonary resuscitation (CPR), use of an automated external defibrillator (AED), and specialized emergency procedures for those who need them.

4-08 - Child abuse reporting system

Establish and maintain a system to recognize and report suspected child abuse and neglect. Define schools' response to allegations of school employees' abuse or harassment of students.

4-09 - Health-related case management

Provide case management for families of students who have complex health or safety needs, who have difficulty accessing required services, or whose needs preclude optimal participation or achievement at school.

4-10 - Health records management system

Utilize a comprehensive records management system, either electronic or paper-based, for student health and safety information.

4-11 - Crisis response team and plans

Establish a crisis response protocol to manage a crisis and its aftermath, including recovery.

4-12 - Oral health services

Base the range of school-based oral health care services on the student population's needs. Services may include oral health screening, fluoride rinse programs, fluoride varnishes, dental sealants, access to dentists and/or dental hygienists, and emergency dental care.

4-13 - Maintaining current student health information

Collect and assess student health information that pertains to students' functioning and safety in school prior to school entry, every 1 to 2 years thereafter, and whenever a significant change in health status has occurred. Share information with staff members whose access to the health information is necessary for maintaining student health and safety. Obtain parents' informed, written consent to share information.

4-14 - Assessment of immunization status

Assess and document immunization status when a student enters school, transfers to another school, or advances to a next level of schooling (e.g., elementary to middle or middle to high school).

4-15 - Identification of health/safety needs prior to school entry

Develop a system to identify, prior to school entry, those students who require assistance with a special health or safety need (e.g., new students, those returning from an extended absence, those experiencing a recent health or mental health problem, and those with one or more chronic illnesses). Re-assess these students' needs at least annually and modify individualized health and safety care plans accordingly.

4-16 - Students with frequent or extended absences

Require a comprehensive health evaluation for students with frequent or extended absences from school.

4-17 - Behaviors with underlying health causes

Assess students who are frequent users of health services, who are suspended or expelled, or who demonstrate other concerning behaviors. Use a school-based multidisciplinary assessment team to assess for potential learning, emotional, and physical health problems that often underlie such behaviors.

4-18 - School health screening programs

Require health screenings on the basis of state and local mandates, public health principles, and the needs of the student population.

4-19 - Administering medications in school

Adopt medication administering policies that address prescription and non-prescription medications and outline responsibilities of student, family, prescribing clinician and school staff.

4-20 - Individualized health services plans

Provide written, individualized health services plans for students with special health care needs. Plans must be developed with a multidisciplinary core team and comply with federal laws.

4-21 - Protocols for special medical procedures

Adopt and maintain a set of up-to-date protocols for specialized medical procedures to include as part of students' individualized health services plans. Allow modifications on a student-by-student basis when there is school nurse endorsement and written consent of the parent and of the prescribing health care provider.

4-22 - Exclusion from school for illness or injury

Assess students and staff with communicable diseases, sudden illnesses, and serious injuries to determine the need to exclude them from school. Exclusion from school should apply to students and staff whose presence poses a significant risk to themselves or others.

4-23 - Students with symptoms of poor health

Assess and refer students for a comprehensive evaluation who appear to have physical or mental health-related disorders such as sudden weight loss, eating disorders, obesity, fatigue, poor attention span, behavior change, frequent urination, toothache, and any recurring symptom (e.g., cough, abdominal pain, headaches).

4-24 - Reports to the public health department

Manage and report communicable disease exposure as well as exposure to chemical, biological, or radiation hazards by complying with public health, environmental, and law enforcement codes and guidelines in local and state jurisdictions.

4-25 - Confidential health records

Keep health records of students and staff confidential and in a secured environment.

4-26 - Quality of health services, quality assurance

Write, review, monitor, and regularly update school health services and safety policies, procedures, and protocols so that they include current evidence-based information that optimizes care and safety.

4-27 - School-based health center: needs assessment

Base the selection of physical, oral, and mental health services in a school-based health center on needs of the student population and the community.

4-28 - School-based health center: community health services

Coordinate and integrate services delivered at a school-based health center with those delivered by the community's health care providers.

4-29 - School-based health center: transitioning to community-based care

Encourage school-based health centers to teach students to be good consumers of community-based health care, recognizing that school sites will not always be available for health care.

4-30 - School-based health center: other school programs

Coordinate services and education provided in all regular school health programs (e.g., school health office, classroom education) with services and education provided in school-based health centers.

4-31 - School-based health center: confidentiality

Develop policies and procedures that protect confidential student health information, yet allow for exchange of information between the school-based health center and school staff, as well as between the school based health center and community health professionals, whenever information exchange is determined to be in a student's best interest.

4-32 - School-based health center: quality assurance

Develop a quality assurance program in school-based health centers that is in accordance with standards of national certifying bodies and appropriate state regulations.

4-33 - School-based health center: financial stability

Require that school-based health centers establish financial plans that allow them to be sustainable beyond the period covered by start-up funding. Assist school-based health centers to establish these plans.

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