School Health Issues

Posted December 31, 2004.

States—

2002 Legislative Session

The majority of enacted adolescent and school health bills involved health services, such as school-based health centers, dental services, school nurses, asthma, diabetes and epinephrine. Bills also addressed student possession and self-administration of asthma and diabetes medications while in school or on school grounds. The following is a sample of enacted legislation:

Georgia Senate Bill 472 (Act Number 925), Kentucky House Bill 353 (Act Number 50), Massachusetts House Bill 4411 (Chapter Number 258) all provided that the possession and self-administration of asthma medication by students is permitted.
Louisiana House Concurrent Resolution 14 urged and requested the Board of Elementary and Secondary Education to develop and implement an age and grade appropriate curriculum for diabetes awareness education and a policy for school diabetes screenings in all city, parish and other local public school systems.
Maine House Bill 1536 (Resolve Number 87) required the Department of Public Safety, Maine Emergency Medical Services, Medical Direction and Practices Board to review and update the protocols and training of basic emergency medical technicians to carry and administer epinephrine and treat the issues of developing protocols for the administration of epinephrine to school-age children as a priority in the process.
Tennessee Senate Bill 2525 (Chapter 808) allowed a public school nurse other properly trained school personnel to administer glucagons in emergency situations to a student based on that student’s individual health plan (IHP).

2003 Legislative Session

Enacted legislation primarily addressed the possession and self-administration of asthma medication by students. The following is a sample of legislation that passed:

Arkansas House Bill 56, Mississippi House Bill 1072, and Oklahoma Senate Bill 34 all provided for self-administration of asthma medications by students with written authorization by the student’s parent and physician.
California Assembly Concurrent Resolution 62 proclaimed May 7, 2003 as School Nurse Day.
Kentucky House Bill 328 (Chapter 127) authorized licensed primary care centers to contract with boards of education to provide school-based health care programs.

2004 Legislative Session

Legislation included administration of asthma and diabetes medications, school to nurse ratio and including students body mass index in health reports. The following is a sample of legislation that passed this session:

Arkansas House Bill 1011 (Act Number 29) required schools to include an annual body mass index percentile by age for each student and an explanation of the possible health effects of body mass index, nutrition and physical activity in student health reports to parents.
Arkansas House Bill 1141 (Act Number 67) required all school districts to have no less than the full-time equivalent of one school nurse per 750 students. With districts having a high concentration of disabled children, the ratio of school nurses to students should be one to 400 and in a district that provides a center for profoundly disabled students the ratio should be one school nurse per 125 students at that center.
California Assembly Concurrent Resolution 207 proclaimed May 12, 2004 as School Nurse Day.

Iowa Senate File 2177, Utah Senate Bill 32 (Chapter 4), and West Virginia House Bill 4271 (Act Number 98) all permitted students to possess and/or self-administer asthma medications.
Maine House Bill 1290 (Public Law Number 531) specified that the state Department of Education require public or private schools to adopt written local policy to allow students to possess and self administer asthma inhalers and epinephrine pens.
Tennessee Senate Bill 2122 allowed local public and private school boards to train school personnel to assist students with diabetes care and requires the departments of health and education to develop guidelines for student diabetes care.

School-Based Health Centers (SBHCs)

There are many obstacles to youth receiving health care services. Teenagers often lack money, insurance and information about how and where to get help. School-Based Health Centers (SBHCs) bring a wide range of health care services to students who may not otherwise receive medical care. These centers, located in schools or on school grounds and run by licensed health professionals, provide preventative health care, treat common and chronic illnesses and provide mental health and dental services. School-Based Health Centers have been known to increase overall school attendance and benefit the community through the promotion of healthy kids who become productive and healthy adults both mentally and physically.

State legislators can play several roles in SBHC policy by setting standards of care for the centers; by ensuring that centers are included in Medicaid managed care networks; or through funding by allocating state funds to the centers, expanding Medicaid to include the centers, or financing health services directly through the centers.

The number of School-Based Health Centers has grown substantially over the past decade, from a mere 200 in 1990 to 1,498 in 2002. This is an increase of 650 percent in 12 years. Currently, SBHCs can be found in 45 states plus the District of Columbia. The seven states with no SBHCs are: Arkansas, Hawaii, Idaho, Montana, North Dakota, South Dakota and Wyoming.

At least 16 states—Colorado, Connecticut, Delaware, Illinois, Kansas, Louisiana, Maine, Maryland, Michigan, New Jersey, New Mexico, New York, Oregon, Rhode Island, Texas, and West Virginia— provide grant support to school-based health centers. Other state funding for SBHCs includes funds from tobacco taxes, tobacco settlement dollars, and Maternal and Child Health block grants. Nineteen states have contracts with Medicaid for patient care and 18 of those have contracts with State Children's Health Insurance Program (SCHIP).

National Assembly on School Based Health Care http://www.nasbhc.org/

The Center for Health and Health Care in Schools http://www.healthinschools.org/home.asp

School Nurses

School nurses are perhaps the first and only consistent source of health services for millions of uninsured and underinsured children. They dispense medication, including injections; monitor blood glucose levels; monitor for diseases and abuse; conduct health screenings, assessments and referrals; and care for students with complex medical needs.

Due to mainstreaming students with severe physical or chronic conditions into public schools, school nurse duties and responsibilities have grown exponentially during the past two decades. This has affected the ability of the school nurse to care for and monitor students. Recent surveys indicate that nurses have trouble keeping up with the demands, especially in schools or school districts where the ratio of school nurse to students is exponentially large--one nurse for 1,500 or more students.

Approximately 12 states have statutory guidelines that require at least one school nurse available per school or school district. Although these positions are required by law, funding to accommodate nursing services may be limited.

Recommended guidelines proposed by the National Association of School Nurses for school nurse to student ratio:

One nurse for no more than 750 students in the general school population;
One nurse for no more than 225 students in the mainstreamed population; and
One nurse for no more than 125 students in the severely chronically ill or developmentally disabled population.

National Association of School Nurses http://www.nasn.org/

Other Resources:

Click here for NCSL's Asthma web page

Click here for NCSL's Oral Health web page

Centers for Disease Control and Prevention-Division of Adolescent and School Health http://www.cdc.gov/nccdphp/dash/index.htm

Click here for Components of School Health

NCSL provides the links above for informational purposes only, and they do not necessarily reflect NCSL positions.

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