This practical guide for schools includes the chapters given below, with summaries. The manual may be accessed at

Chapter 1: Challenges and Opportunities in School Health gives a national and historical context for the role of school health as it relates to the education of children and adolescents. From an initial focus on communicable disease management, school health programs have had to address the changing societal issues affecting the health of young people, including the increase in social morbidities. The chapter describes the rationale for comprehensive school health and education programs from pre-kindergarten to twelfth grade. It also suggests models for understanding and developing comprehensive programs, the need for sound policy development, and new directions for school health.

Chapter 2: Developing an Effective School Health Program gives administrative guidance to schools in developing their comprehensive school health programs with a particular focus on the school health service program and how it relates to health education and other human service programs in the educational setting. Emphasis is on a student health needs assessment, a school health advisory committee, the need for well-qualified personnel with clear role definitions, interdisciplinary collaboration, a foundation of sound policies, and program evaluation. This chapter contains a large number of sample forms, position descriptions, and policies to assist the schools in developing their own programs.

Chapter 3: School Health Curriculum identifies sound principles for health education pre-kindergarten to twelfth grade. It describes the content of a comprehensive school health curriculum and provides guidance for selecting and implementing the curriculum. An underlying principle is that the health education program and health services must be interrelated: the content the student learns in a classroom should be reinforced in the service setting and in the rest of the school environment.

Chapter 4: Safe and Healthful Environment recognizes that the school's physical, social and emotional environment can affect both the health and education of the students and staff. Because the social and emotional aspects are addressed in other chapters, this chapter emphasized the physical environment, bringing together information on such issues as space, air quality, and cleanliness with related standards and regulations. The numerous government agencies with responsibilities for the various aspects of school environment are identified.

Chapter 5: Health Assessment provides information on the health status of children and adolescents in the school setting. The school health service program utilizes population-based screenings to provide a safety net for ensuring that students are screened for vision, hearing and other health conditions. Individual student health encounters also provide opportunities for the nurse to assess a student's health status and risks in the school setting. This becomes especially important if children lack primary care providers and/or are uninsured or underinsured. The chapter identifies assessments, physical examinations, and screenings required by statute or regulations and offers specific guidelines for implementation. In addition, it includes guidelines for nursing assessment of common illnesses presented by students in the school setting.

Chapter 6: Nursing Practice in the School Setting summarizes standards of school nursing practice as developed by national professional organizations. Because school nurses typically practice in settings that are fairly isolated from colleagues in the health care field, it offers suggestions for staying maintaining current knowledge and skills, as well as networking with other professionals concerned with the health of children and adolescents. The chapter also describes some of the relevant Massachusetts Board of Registration in Nursing standards and regulations as they relate to nursing practice in the school setting. Specific attention is given to delegation to unlicensed personnel and administration of medications in the school setting.

Chapter 7: Children with Special Health Care Needs emphasizes that advances in medical technology, legislation ensuring access to education in the least restrictive environment, and the efforts of child advocacy groups have resulted in increased numbers of children with a range of health care needs in the school settings. These children require ready access to a variety of health care services. This chapter describes the importance of planning for the care of children with special health care needs, including guidelines for developing and implementing individual health care plans to ensure that the child receives safe, appropriate care during the school day. The participation of parents, health care providers, school nurses, and other school staff is essential to this process.

Chapter 8: Infectious Disease Control is a comprehensive description of the communicable diseases that school health service programs encounter, both those that are fairly common and those that are less common but have a profound health impact. The nurse's responsibilities include ensuring that students are appropriately immunized and, should an infectious disease occur, preventing its spread. The chapter is designed to assist school personnel in managing infectious diseases while providing guidelines for school attendance and parent notification.

Chapter 9: Nutritional Health presents information on the nutritional needs of school-aged children and adolescents, including their nutritional requirements, dietary guidelines, and common nutrition-related questions. It discusses current nutritional issues as well as factors influencing eating behaviors. The special nutritional needs of children with special health care needs, adolescent athletes, and pregnant adolescents are addressed, School food service, including the school breakfast program, the school lunch program, and foods served at school events, is also discussed. The chapter several exhibits including a sample nutritional assessment and key nutrients in food.

Chapter 10: Physical Fitness recognizes the importance of physical activity in maintaining the good health of all students. It outlines the state laws governing physical education and the physical activity of students in Massachusetts. The chapter discusses the current trends in physical education which include emphasis on teaching noncompetitive team skills and an understanding of fitness concepts. Fitness is described in terms of the various components which make up a program, age-appropriate activities, and the amount of physical activity necessary for fitness. Also discussed are sports in schools.

Chapter 11: Mental Health identifies the important elements of a healthy emotional and social environment. It describes in detail the developmental stages of children's and adolescent's emotional and psychological development and the prevention techniques necessary for intervention. Common psychological problems are discussed and include depression, suicidal tendencies, divorce, grief, disruptive behavioral disorders, attention deficit disorders, eating disorder, and psychosomatic illnesses. The chapter gives a description of each problem that includes symptoms and action that schools can take.

Chapter 12: Sexuality and Reproductive Health discusses the importance of sexuality and reproductive health education in the school setting. It gives an overview of sexuality education and guidance for developing a program which suits the needs of the community, the parents, families and students. The chapter examines sexual development and gives recommendations for physical examinations. Prevention of adolescent pregnancy and STDs are discussed, as well as the issues surrounding adolescent pregnancy. Other sexuality issues, including cultural diversity sexual orientation and sexual abuse and sexual assault are identified.

Chapter 13: Injury and Violence Prevention focuses on teaching safety and violence prevention as well as discussing the different types of interpersonal violence and unintentional injuries that exist. Because injuries are "no accident", the chapter emphasizes the importance of education, safety of the environment, and enforcement of safety laws and guidelines. Guidelines are given for a school-based violence prevention program. A large number of fact sheets on interpersonal violence and unintentional injuries are provided at the end of the chapter. In addition, select state laws on safety, health education and transportation are included.

Chapter 14: Alcohol, Tobacco and Other Drugs gives a detailed description of the problems of substance abuse and tobacco use in our society and the need for an effective and comprehensive prevention program in our schools. The chapter outlines and describes the components of such a program and discusses why prevention works. It discusses the prevalence of alcohol, tobacco, and other drug use, its detrimental health effects, and those who may be at risk of developing a problem. Smoking and tobacco cessation programs and the benefits of quitting smoking are emphasized.

Chapter 15: Oral Health describes the important role that schools have in promoting oral health. The chapter starts off with a discussion of the scope of the problem of oral disease. A discussion of health promotion, prevention, and education includes information on fluorides, flossing and brushing, dental sealants, dental examinations, and restricting use of sugar and refined carbohydrates. Another important aspect of oral health in the school setting is first aid for dental problems and emergencies.

Chapter 16: Refugee and Immigrant Health concentrates on the issues that may affect children and adolescents' access to health care information and services in the state. It is important for school personnel to be sensitive to the customs, health beliefs and practices, and family roles of newcomers. A discussion of different strategies for cultural assessment may help school personnel with transcultural interactions. Because access to services may be affected by many different factors, increased knowledge about the issues will help schools to better understand and communicate with newcomers.

This information is provided by the School Health Services within the Department of Public Health.

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