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Why should I care about Health Services in schools?
 Health Services are services provided for students to appraise, protect, and promote health. Qualified professionals such as physicians, nurses, dentists, health educators, and other allied health personnel provide these services to:
- ensure access or referral to primary health care services or both,
- foster appropriate use of primary health care services,
- prevent and control communicable disease and other health problems,
- provide emergency care for illness or injury,
- promote and provide optimum sanitary conditions for a safe school facility and school environment, and
- provide educational and counseling opportunities for promoting and maintaining individual, family, and community health.
These services are critical to help deal with the many health challenges facing students:
- 25,000 children in Rhode Island have asthma.
- One-third of all high school students report being overweight.
- Almost 15% of all school children and youth take prescription medications.
- 20.8 million children and adults throughout the US have diabetes, and rates of diabetes among children are increasing.
Research shows that children learn better and experience school success more readily if their health needs are addressed. To achieve high standards, to improve test scores, to increase attendance, to have all students engaged in learning, schools must address students’ need for comprehensive, high quality health services on-site at the school or through an effective referral system to the community.
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What are Rhold Island's State requirements for Health Services in schools?
The health services that are provided in schools are guided by the Rules and Regulations for School Health Programs. The regulations apply to both public and non-public schools. These required services include screenings, records review, acute care, chronic disease management, and health risk prevention.
School Health Personnel (Sec. 6 & 7)
- Every public school has a certified school nurse teacher assigned to provide services at that school. Most middle and high schools have a full-time nurse at the school. Many elementary schools share a nurse between two or three schools in the district. (See
RIGL §16-21-8). Certification is governed by the Rhode Island Requirements for the School Nurse Teacher Certificate.
- Each district must employ a school physician to provide oversight, supervision, guidance, and consultation to the school nurses and to the district and schools in establishing appropriate health policies and protocols. (See RIGL §16-21-7).
- Each district must employ a school dentist to provide oral health screenings and/or supervision of dental screenings, as well as providing oversight, guidance and consultation to school nurses, the district and the schools in establishing appropriate oral health policies and protocols. (See RIGL §§ 16-21-7, 16-21-9, and
16-21-12).
Health Screenings (Sec. 8 to 16)
- Schools provide the following screenings (See RIGL §§ 16-21-9, 16-21-10, 16-21-12, 16-21-14, 16-21-14.1 and 23-24.6-8):
- Vision
- Hearing
- Speech and Language
- Scoliosis
- Dental
- Any student who provides documentation that this screening has been performed by his/her family doctor does not need to participate in the school screening services.
Physical Exams (Sec. 8)
- All students in both public and non-public schools must show documentation of the completion of a physical examination by the student’s primary care provider at two times during their school years:
- At school entry (usually at kindergarten, but may be at any time a student enters a Rhode Island school for the first time) and
- At 7th grade entry.
- A student may not be excluded from school due to the lack of documentation of the above mentioned physical examinations.
Lead Screening (Sec. 26)
Prior to enrollment in kindergarten, schools must receive evidence that a child has been screened for lead poisoning or certification that this test is contrary to the parents' beliefs. (See RIGL §23-24.6-8).
Immunizations (Sec. 20)
- All students in both public and non-public schools must show documentation of a standard set of immunizations that protect against vaccine-preventable diseases (e.g., measles, mumps, polio, diphtheria, rubella, hepatitis B, etc.).
- The Rhode Island Department of Health’s Rules and Regulations Pertaining to Immunization and Testing for Communicable Diseases govern childhood immunizations.
- Allowable Exemptions (Forms are available through the Department of Health):
- Medical Immunization Exemption Certificate, which documents medical reasons for not receiving a specific vaccine; or
- Religious Immunization Exemption Certificate, which documents that immunization conflicts with the family’s religious beliefs.
Emergencies (Sec. 17)
- During normal school hours, each school must have available at least one person other than the school nurse who is trained and responsible for the administration of basic first aid, cardiopulmonary resuscitation (CPR), and the administration of the epinephrine auto-injector.
- In emergency situations that need to be addressed using CPR, basic first aid, epinephrine injection, and in some other situations, non-medical personnel may provide medical services or dispense life-saving medications.
- Students engaged in potentially hazardous tasks (e.g. science laboratories, industrial arts, physical education, etc.) must be directly supervised by teachers or instructors who are trained in basic first aid.
Acute Care Services (Sec. 17)
- Certified school nurse teachers in public schools and registered nurses in non-public schools provide acute care services for students and staff. Acute care services include such things as basic first aid for injuries, medication administration for sudden on-set illness (e.g., headache, fever, digestive problems, etc.), and identification of health issues that need further attention by a student’s primary care provider.
Chronic Disease Management (Sec. 18)
- Any student with a chronic disease or a long-term health issue (e.g., asthma, diabetes, seizure disorder, attention deficit disorder, hyperactivity, etc.) are entitled to have an individual health care plan (IHCP) and an emergency health care plan (ECP) as part of the student’s permanent health record.
- The IHCP and ECP are developed collaboratively by the certified school nurse teacher, the family, the student, and the primary care provider.
- Teachers, administrators, and other school personnel that may be involved in the care of the student must be informed of the plans.
Medication Administration (Sec. 19)
- In most cases, the certified school nurse teacher is the only person in the school legally allowed to administer medications to students.
- There are exceptions to nurse administration of medications related to student self-carry and self-administration of medications and in certain emergency situations.
- Each district must have a policy that allows students to self-carry and self-administer medications. This includes the self-carry of inhalers for students diagnosed with asthma.
- The regulations include guidelines to allow students to self-carry and self-administer medications while participating in off-site school-sponsored activities.
Health Records (Sec. 14)
- Every student in public and non-public schools must have a complete, cumulative health record at the school where the student is enrolled.
- The student’s health record is confidential and subject to all state and federal laws, rules, and regulations that ensure confidentiality.
- The health record shall be maintained by the school for five years after the student turns eighteen (18) years of age or five years after the student leaves the district.
Peanut/Tree Nut Allergies
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A new law was passed in the 2007legislative session that addresses the issue of peanut allergies in schools (see H5671 Sub A as amended). The law applies to all elementary and middle schools, but is recommended to apply to all high schools, as well. If there is a student in your school(s) identified with a peanut or tree nut allergy, the district/school must do the following:
- Post a notice within the school in a conspicuous place at every point of entry and within the cafeteria providing notice that a student in the school has an allergy to peanuts/tree nuts (see sample sign);
- Prohibit the sale of peanuts/tree nuts, peanut butter and other peanut-based products in the school cafeteria;
- Designate a peanut/tree nut free table in the cafeteria;
- Designate a table in the cafeteria as “peanut/tree nut” table; and
- Designate one classroom per grade to be peanut/tree nut free.
To assist schools with implementing this law, RIDE has disseminated guidance memos, a copy of the legislation, a sample sign, and Frequently Asked Questions for parents. Also see the Peanut/Tree Nut Allergies section of the Physical Environment in Schools page for additional resources.
NEASC Requirements
- In addition to the state requirements above, all high schools in Rhode Island must be accredited by the New England Association of Schools & Colleges (NEASC), following the NEASC Standards for Accreditation. Standard 6, Indicator 9 states that a "school's health services shall provide:
- preventive health services and direct intervention services;
- appropriate referrals;
- mandated services;
- emergency response mechanisms;
- ongoing student health assessments."
In addition, Standard 6, Indicator 6 requires that student health and immunization records be kept confidential and secure.
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What are some of the best practices for schools around Health Services?
Student health needs are best addressed by:
- A full time school nurse in every school building during school hours, before and after school activities, and at school sponsored events;
- A ratio of school nurses to students that aligns with the national standard of one nurse to 750 students (in schools with a high proportion of students with special health care needs, this ratio drops to one nurse to 350 students);
- Regular communication between a student’s family and health providers in the school and community;
- School-based health centers that provide primary care services on-site for students, including such services as physical and sports exams, dental care, mental health counseling, nutrition services, immunizations, emergency care, acute illness diagnosis and treatment services, referrals to specialists, etc.
The Rhode Island School Health Manual
Specific guidelines for school health service providers and best practices for a wide variety of conditions can be found in this document, compiled by Dr. Gregory Fox from the Rhode Island Chapter of the American Academy of Pediatrics.
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What data are available about Health Services in Rhode Island schools?
Quick Facts
According to the School Health Profiles, in 2006 among middle and high schools in Rhode Island:
- 66% provide identification or school-based management of chronic health conditions, such as asthma or diabetes;
- 59% provide identification or school-based management of acute illness;
- 60% provide immunizations to students;
- 52% provide assistance with enrolling in Medicaid or RIte Care;
- 54% provide an Asthma Action Plan (or Individualized Health Plan) for all students with asthma; and
- 32% permit students to carry and self-administer a prescription quick-relief inhaler, an epinephrine auto-injector, and insulin or other injected medications.
More Data
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I'm a parent, teacher or administrator... What resources or tools for schools are available on Health Services?
Center for Health and Health Care in Schools
This site provides topical information, fact sheets, news alerts, grant alerts and resources on school health issues for parents, students, media, school administrators, school health providers, and others.
National Assembly on School Based Health Care
This site provides a variety tools and resources for quality school-based health care.
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I'm a School Nurse Teacher, school physician, or other school health professional... What resources or tools for schools are available on Health Services?
Rhode Island School Health Manual
Compiled by Dr. Gregory Fox from the Rhode Island Chapter of the American Academy of Pediatrics, this document contains general guidelines for school health service providers and best practices for a wide variety of conditions.
Center for Health and Health Care in Schools
This site provides topical information, fact sheets, news alerts, grant alerts and resources on school health issues for parents, students, media, school administrators, school health providers, and others.
National Assembly on School Based Health Care
This site provides a variety tools and resources for quality school-based health care.
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Where can I learn more?
Please see the comprehensive list of Health Services resources below:
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Whom do I contact for more information?
Rosemary Reilly-Chammat, Ed.D.
Program Manager, Initiative for Healthy Youth
Rhode Island Department of Health
401-222-5922
Rosemary.Reilly-Chammat@health.ri.gov
Jackie Ascrizzi
School Health Policy and Program Specialist
Rhode Island Department of Education
401-222-8953
Jackie.Ascrizzi@ride.ri.gov
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