CDC Reviews School Laws, Policies on Child/Adolescent Health In a comprehensive report by the Division of Adolescent and School Health (DASH), the Centers for Disease Control and Prevention (CDC) outlined in February the laws and policies schools need to follow as they implement a coordinated school health program (CSHP). Divided into the components defined by the CDC as making up a comprehensive school health program, the report discusses possible legal implications for schools in areas including physical education; health services, nutrition services, mental health and social services, creating healthy and safe school environments, and promoting staff wellness. Health Education This report notes a 2006 assessment found that more than 85 percent of states have policies stating that elementary, middle, and high schools will teach at least one of 14 health topics chosen to reflect the leading causes of mortality and morbidity among both youth and adults. Of the many potential subjects, the topic of human sexuality is unique in its degree of regulation. Federal restrictions on sex education prohibit recipients of federal funding from encouraging sexual activity, distributing obscene materials to students on school grounds, providing sex education or HIV prevention education unless the instruction is age-appropriate and includes the benefits of abstinence, or providing contraceptives. Courts have held that parents do not have a federal constitutional right to exempt their children from required physical education classes but state or local laws may give parents more rights. Physical Education and Activity Most states and districts have policies requiring elementary, middle, and high schools to teach physical education, including such possible activities as calisthenics and gymnastics. The report covers related topics in this area, including what is legally required of schools, the role of national physical education standards, teacher qualifications and preparation, and the provision of protective gear. Most states and districts require schools to provide adapted physical education to children with permanent physical or cognitive disabilities. Health Services The report defines school heath services as including health screening and assessment; care plan development and implementation; health education; health counseling; acute, chronic, episodic, or emergency care; nursing interventions and case management; medication and administration; assistance with access to an ongoing source of health care in the community; medical case management and referral; outreach to students and families, and provision of professional development for school staff and families. Federal law does not require such services, and regulation of health services is left largely to state and local governments and individual school districts, except for students with disabilities who must receive services under the federal Individuals with Disabilities Education Act (IDEA). Federal and state laws generally require parental consent before health services are provided to students. Use of identifiable health information about students is covered under the federal Family Educational Rights and Privacy Act (FERPA). Schools are required in some instances to report to families if a child is ill or if disabilities are uncovered in school screenings or by observation. Schools are most often not required to report student illnesses to state health authorities. Nutrition Services The report mentions the two main federal meals programs available to public schools, the National School Lunch Program and the School Breakfast Program, which provide subsidies and donated commodities to schools for meals that meet federal nutritional requirements. The report also notes that "competitive foods" are sold in competition with the federally subsidized programs in many schools, with federal law currently limiting their sale only in certain locations at certain times and prohibiting sale of "foods of minimal nutritional value" such as chewing gum. State and school districts may impose further limitations on school sale of competitive foods, and industries such as the soft drink industry have recently taken measures to limit sale of their products in schools. Commercial activities such as pouring contracts and corporate-sponsored contests and incentives aimed at students have been noted in recent reports by the Government Accountability Office (GPO) and the Institute of Medicine. Mental Health and Social Services This report notes federal laws require schools to provide psychological and social services to students whose health conditions adversely affect their educational performance (under the IDEA) and to students whose health conditions substantially limit their ability to learn (under section 504 of the Rehabilitation Act.) State laws differ on whether such services are available to all students, but schools may be authorized by their school districts to conduct screening or to develop policies for mental health conditions such as depression, suicide, substance abuse, eating disorders, ADHD, and mental or physical abuse. A federal law requires prior parental consent before a student may participate in any questionnaire that asks about mental or psychological problems, and several states have laws that limit the ability of school officials to subject a student to psychological evaluation without prior parental consent. State laws broadly authorize schools to provide counseling services, most commonly in high schools, and treatment services or referrals are "widely available," according to the report. Counseling, psychological, and social services may be provided by counselors, psychologists, social workers, nurses, and other professionals in the school setting. State laws often authorize schools to employ such professionals but do not require every school to have them. School records containing sensitive personal psychological information are subject to the same privacy protection under FERPA as other student records. Healthy and Safe School Environment According to the report, factors that influence school environment are addressed in state and federal laws and regulatory mandates. In addition to state requirements concerning the location, lighting, heating, and sanitation of school facilities, schools are subject in many states to regulations about asbestos-containing materials, indoor radon, use of pesticides, and lead in drinking water. In addition to concerns about the physical conditions of school buildings, many states and districts have developed policies to prevent unintentional injuries, and federal law sets safety standards for school buses. States and localities have laws or regulations calling for speed reduction in school zones or requiring schools to conduct fire drills. Federal law makes it a felony to possess or knowingly discharge a firearm in a school zone, and nearly all states have similar laws. Personal and property searches of students in an effort to prevent violence are subject to Fourth Amendment protections against unreasonable search and seizure, with the Supreme Court setting parameters in recent cases for what constitutes a reasonable search. Use of metal detectors and school dress codes to prevent violence are also subject to state laws and constitutional challenges. In the area of substance abuse, a federal law prohibits smoking within any indoor facility that provides routine or regular K-12 education or library services to children if that facility receives any federal funding. Nearly all states, school districts, and schools have policies prohibiting use of alcohol and illegal drugs by students. The Supreme Court has found random testing of students for drugs to be constitutional as "a reasonably effective means" of preventing and deterring student drug use. In addition to policies addressing drug use in general, some states have enacted laws to limit use of anabolic steroids by students. Staff Wellness State laws often set prerequisites for hiring school employees, requiring prospective employees to undergo physical examinations or screening for tuberculosis or illegal drug use. Many states also require school staff to submit to ongoing health-related screening at periodic intervals. Many states have enacted employee wellness initiatives that promote fitness and health in schools and other workplaces, with employers commonly encouraged but not required to have such programs. Factors that influence school wellness may include the availability of health insurance and availability of routine screening for health conditions, as well as state occupational safety laws and regulations. The report from which this article is excerpted, "A CDC Review of School Laws and Policies Concerning Child and Adolescent Health," is published in the February issue of the Journal of School Health.
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