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School Nurse Cooperative

Staff Development Opportunities for Nurse Cooperative Members

Nurse Cooperative members may send an unlimited number of nurses and health assistants to each workshop.

 

Nurse Cooperative

Nurse Coordinator Meetings
Back to School Nurse Workshop
New School Nurse and Health Assistant Orientation
Medication Administration and Documentation in the School Setting
School Clinic Substitute Training
Youth Mental Health First Aid
Alcohol and Drug Abuse Prevention Training
Internet Safety
Local Wellness Policy
Parenting and Paternity Awareness (p.a.p.a.)
UDCA and Diabetes Skills Training
Vision Screening Certification
Hearing Screening Certification
Vision and Hearing Recertification
Spinal Screening
American Heart Association Basic Life Support CPR/AED Certification
 
 

School Nurse FAQ

 

Vision and Hearing Screening Certifications

Registration for all vision and hearing courses is available through ESC-20’s online registration system, Connect20: Home (escworks.net)
 
If this is your first time to register for a course, you will need to create an account.
 
Search using the keyword “Vision” or “Hearing” to find a list of available courses.
All of the vision and hearing certification courses offered through ESC-20 are led by an instructor from the Texas Department of State Health Services.
The Texas Department of State Health Services requires individuals to either have a GED or High School Diploma in order to complete the training course to become a certified DSHS screener. LEAs may send individuals from their districts who meet these qualifications to become certified DSHS screeners and assist with conducting the vision and hearing screenings on campus.
 
LEAs may also accept screening results from licensed professionals, such as optometrists and ophthalmologists, who conduct screenings according to their professional standards.
 
Texas Administrative Code Rule §37.27Texas Administrative Code (state.tx.us)
The following age/grades must receive vision and hearing screening:
  • Screened within the first 120 days of admission:
    • 4-years-old by September 1st
    • Kindergartners
    • Any students entering school for first-time (4 years through 12th grade)
  • Screened within the School Year (preferable within first semester):
    • Grades: 1st, 3rd, 5th, and 7th
  • Handout: VisionHearing and Spinal Screening Requirements (texas.gov)
The following are the two approved eye charts to test for distance acuity:
  • Sloan Letter Chart
  • HOTV Matching-Symbol Test
Photoscreening devices may be used to conduct vision screening on children age 5 and younger, as well as on any individual with disabilities who does not respond well to other allowable screening methods.
 
Photoscreening does not test for visual acuity, therefore when screening children age 6 and older who do not have a disability the use of an approved eye chart to test visual acuity is required.
 
Texas Administrative Code RULE §37.23 Texas Administrative Code (state.tx.us)
 
Recertification
Vision and hearing certifications are valid for 5 years. A recertification course must be completed prior to the end of the calendar year (December 31st) of the fifth year.  If the recertification course is not completed by December 31st of the fifth year, the individual must complete the initial vision and hearing certification courses again.
 
Reporting
The Texas Department of State Health Services utilizes an online Child Health Reporting System for collecting vision and hearing screening results. The online system for reporting vision and hearing data is open from January 15th through June 30th of each school year. 
 
The deadline for submission of vision and hearing screening results to the Texas Department of State Health Services is June 30th of each school year.
Additional information can be found on the Texas Department of State Health Service’s Vision and Hearing Screening Program website: Vision and Hearing Screening | Texas Department of State Health Services

 

Spinal Screening Certification

Registration for all spinal courses is available through ESC-20’s online registration system, Connect20: Home (escworks.net)
 
If this is your first time to register for a course, you will need to create an account.
 
Search using the keyword “Spinal” to find a list of available courses.
All of the spinal certification courses offered through ESC-20 are led by an instructor from the Texas Department of State Health Services.
The Texas Department of State Health Services requires individuals to either have a GED or High School Diploma in order to complete the training course to become a certified DSHS screener. LEAs may send individuals from their districts who meet these qualifications to become certified DSHS screeners and assist with conducting the spinal screenings on campus.
 
Texas Administrative Code Rule §37.146 Texas Administrative Code (state.tx.us)
The Texas Department of State Health Services specifies that licensed professionals may conduct spinal screening assessments without prior completion of a certification course if their education included physical assessment, this includes: Physicians (MD/DO), Nurse Practitioners, Registered Nurses, Physician Assistants, Chiropractors, and Physical Therapists. These individuals may choose to attend a spinal screening certification course if desired for additional practice and guidance on spinal assessment in the school setting.
The following age/grades must receive spinal screening:
  • Girls – Required to be screened twice
    • Age 10 – or fall semester of 5th grade and
    • Age 12 – or fall semester of 7th grade
  • Boys – Required to be screened once
    • Age 13 or 14 - or fall semester of 8th grade
  • Note: Schools must identify any students who do not fall into the grade category (i.e. student held back or promoted to different grade levels) and ensure they receive screening at the appropriate age.
  • Handout: VisionHearing and Spinal Screening Requirements (texas.gov)
 
Reporting
The Texas Department of State Health Services utilizes an online Child Health Reporting System for collecting spinal screening results. The online system for reporting vision and hearing data is open from January 15th through June 30th of each school year. 
 
The deadline for submission of spinal screening results to the Texas Department of State Health Services is June 30th of each school year.
 
Recertification
Spinal screening certifications are valid for five years. Prior to the end of the calendar year (December 31st) of the fifth year, individuals must complete the initial spinal screening certification course again in order to continue providing spinal screenings.
There is not a recertification course for spinal screening certification. At the end of the five-year period, individuals need to complete the initial spinal screening certification course again.
Additional information can be found on the Texas Department of State Health Service’s Spinal Screening Program website: Spinal Screening Program | Texas Department of State Health Services

 

Unlicensed Diabetes Assistant Training (UDCA)

The Texas Health and Safety Code §168.004 requires the school principal at each school where a student with diabetes is enrolled to identify school employees who are not health care professionals to serve as UDCAs to assist with the care of students with diabetes.
If the campus has a full-time nurse assigned to the school, then at least one UDCA should be identified and trained. 
 
If there is not a full-time nurse assigned to the campus then at least three UDCAs should be trained.
 
The UDCA training must be provided by a health care professional with expertise in the care of persons with diabetes or by the school nurse.
Training of UDCAs must be provided before the beginning of the school yer or as soon as practicable following:
  1. the enrollment of a student with diabetes at a campus that previously had no students with diabetes; or
  2. a diagnosis of diabetes for a student at a campus that previously had no students with diabetes.
The Texas Diabetes Council recommends that after an individual goes through the initial UDCA training that a review of course information and hands-on skill practice is conducted at least annually.
The Texas Diabetes Council updated their electronic resource, Guidelines for Training School Employees who are not Healthcare Professionals, in February 2020. A copy of the guidelines can be found at the following web address: Guidelines for Training School Employees who are not Licensed Healthcare Professionals (texas.gov)

 

Acanthosis Nigricans: Texas Risk Assessment for Type 2 Diabetes in Children (TRAT2DC)

Acanthosis nigricans is a skin marker that is associated with high levels of insulin and insulin resistance. Presence of this marker on the skin is considered a risk factor for the development of chronic diseases including Type 2 Diabetes.  If a student has the acanthosis nigricans skin marker, additional assessments of blood pressure, body mass index (BMI), and BMI percentile are conducted. TRAT2DC: Risk Assessment Background (utrgv.edu)
The Texas Risk Assessment for Type 2 Diabetes in Children is legislatively mandated requirement in the following ESC Regions: 1, 2, 3, 4, 10, 11, 13, 15, 18, 19, and 20. The screening is conducted during vision, hearing, and spinal screenings of 1st, 3rd, 5th, and 7th.
The University of Texas Rio Grande Valley Border Health Office’s reporting system opens in September each school year and typically closes the third Friday in June, assessments conducted during the school year must be submitted during this time frame. The reporting system can be accessed at the following website: TRAT2DC RFES Login (utrgv.edu)
The University of Texas Rio Grande Valley Border Health Office provides an online training certification for Type 2 Diabetes Risk Assessment. This training and certification is required prior to conducting risk assessment on students.  Information on how to register for the training can be found on the following website: TRAT2DC: Certification (utrgv.edu)
Texas Risk Assessment for Type 2 Diabetes in Children website: TRAT2DC: Risk Assessment Background (utrgv.edu)

 

Immunizations

The current K-12 immunization requirements can be found on the Texas Department of State Health Services Texas School and Child Care Immunization webpage: Texas School & Child-Care Facility Immunization
The Texas Minimum State Vaccine Requirements for Students Grades K – 12 are updated annually. Each school year LEAs should ensure they are utilizing the immunization requirements for the current school year.
The Texas Department of State Health Services sends out information to LEAs at the start of each school year regarding the submission of the Annual Report of Immunization Status. Typically, LEAs are required to select an assessment date to report immunization data between the last Friday in October and the second Friday in December.  Generally, the deadline for submitting immunization data is the second Friday in December.
The Texas Department of State Health Services utilizes an online Child Health Reporting System for collecting immunization data. The online system for reporting immunization data is only available during the dates specified in the Annual Report of Immunization Status packet each year.
 
In Texas, students who are not up-to-date on all of the required immunizations are not allowed to enroll and attend school. The only exceptions are if the student either meets the qualifications allowing for provisional enrollment or if the student has a current conscientious exemption form on file.
 
If the student has started a vaccine series, the student may be provisionally enrolled and attend school as long as the student continues progressing forward in the series as medically feasible.
Provisional enrollment allows for students meeting certain criteria to be admitted temporarily to school, 30-day time period, without the normally required immunizations. During the 30-day provisional enrollment period the student must receive the needed vaccines (as medically feasible) and/or submit the required immunization record.
Provisional enrollment is based on 30 calendar days.
The following students may be enrolled in school provisionally:
  1. Students who are homeless or in foster care;
  2. Students who are transferring from another Texas public or private school;
  3. Students who are military dependents of an individual who is on active duty with the armed forces of the United States
  4. Students who are in-progress receiving the required immunizations series, to remain enrolled the student must receive the following doses in the vaccine series on schedule and as medically feasible.
The Texas Department of State Health Services has created a Provisional Enrollment Flowchart to assist LEAs with determining the eligibility of students to enroll in school based on immunization status. The flowchart can be downloaded at the following web address: E11-13255.doc (texas.gov)
The Texas Administrative Code Rule §97.62 allows individuals to obtain exemptions from immunization requirements for the following reasons:
  1. Medical contraindications;
  2. Reasons of conscience, including a religious belief;
  3. Active duty with the armed forces of the United States – this applies to active-duty military only, not to dependents of active-duty service members.

Texas Administrative Code (state.tx.us)

A parent or guardian may submit a request in writing via mail or in-person to the Texas Department of State Health Services or electronically through a secure online website: CO Request (texas.gov).
 
Additional information on the process for requesting the exemption affidavit can be found on the Texas Department of State Health Services website at the following web address: Obtaining Exemptions to Texas School Immunization Requirements
Yes, the original vaccination exemption form issued by the Texas Department of School Health Services must be notarized and given to the school.
No, only the original vaccination exemption affidavit that has been signed and notarized may be accepted by the school, a copy may not be accepted as valid.
The conscientious exemption for immunizations form is valid for two years from the date the document was notarized.
No, if the student is not eligible for provisional enrollment, he/she would be required to receive the required vaccination or begin the vaccination series and be progressing as medically feasible in order to enroll in school.
No, the Texas Department of State Health Services rules do not allow a student to enroll in school until immunization records are provided showing, either:
  1. the student has received the required immunizations;
  2. the student has a current conscientious exemption from on file; or
  3. the student is entitled to provisional enrollment.
Yes, LEAs may accept immunizations that were provided in Mexico. The CDC developed the Binational Immunization Tool to provide information on immunizations received in Mexico vs. the United States. This tool can be downloaded at the following web address: 2016 Binational Immunization Resource Tool for Children from Birth through 18 Years (slcc.edu)  In addition, the CDC has an immunization resource to assist with translating vaccines in other languages, which cab be accessed at the following web address: Foreign Language Terms Tables 1 and 2 Disease, Vaccine and Tradename (cdc.gov)
Additional information can be found on the Texas Department of State Health Service’s Texas School and Child Care Immunization webpage: Texas School & Child-Care Facility Immunization

 

School Nursing

No, there is not a law in Texas requiring public schools to hire school nurses.
It is important for LEAs to be familiar with the Texas Board of Nursing Scopes of Practice for RNs and LVNs. LVNs have a directed scope of practice under the supervision of a registered nurse, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. According to the Texas Board of Nursing, when LVNs are utilized in the school setting they should be under the supervision of the RN.  The RN is responsible for assigning activities to the LVN that are within the LVN's educational preparation and demonstrated competency to provide.
 
The RN needs to consider how closely they can supervise the LVN in the school setting and how the RN will direct, guide, and influence the outcome of the LVN’s performance and respond to any situations where the LVN needs onsite supervision. More information on the Role of LVNs and RNs in School Health can be found on the Texas Board of Nursing website at the following web address: Texas Board of Nursing - Practice - Nursing Practice 
The Texas Board of Nursing Scopes of Practice can be found at the following web address: Texas Board of Nursing - Practice - Position Statements
The Texas Administrative Code §153.022(a)(1)(D) defines the minimum salary schedule for certain professional staff, in these guidelines, a school nurse is an educator employed to provide full-time nursing and health care services and who meets all the requirements to practice as a registered nurse (RN) pursuant to the Nursing Practice Act and the rules and regulations relating to professional nurse education, licensure, and practice and has been issued a license to practice professional nursing in Texas.
 
The Texas Department of State Health Services has developed a comprehensive School Health Services website, which includes school nursing practice resources, DSHS-School Nurse Notes, Texas Guide to School Health Services, and a detailed guidebook on medication administration.
 
The Texas School Nurse Organization (TSNO) and the National Association of School Nurses (NASN) are professional organizations that support the practice of school nurses. The TSNO and NASN websites include resources, toolkits, and publications to support school nurses in their roles.
 
 

 

Medication

The Texas Education Code §22.052 provides civil immunity for school district employees when administering medication according to the LEA’s adopted medication administration policies. In accordance with the school district policies, the superintendent or campus principal can assign medication administration to school employees who are not healthcare professionals. 
 
Similar to on-campus medication administration, the superintendent or campus principal may assign the task of medication administration to a school employee to provide the medication to the student off-site. Procedures for handling the medication off-site, documenting medication administered, as well as training of employees should be included the LEA medication administration policies.
Yes, according to the Texas Education Code §38.015 a student with asthma or anaphylaxis is entitled to possess and self-administer prescription asthma or anaphylaxis medicine while on school property or at a school-related event or activity, if:
  • the prescription medicine has been prescribed for that student as indicated by the prescription label on the medicine;
  • the student has demonstrated to the student's physician or other licensed health care provider and the school nurse the skill level necessary to self-administer the prescription medication, including the use of any device required to administer the medication;
  • the self-administration is done in compliance with the prescription or written instructions from the student's physician; and
  • a parent provides to the school:
    • a written authorization from the parent, for the student to self-administer the prescription medicine; and
    • a written statement from the student's physician that states:
      • the student has asthma or anaphylaxis and is capable of self-administering the prescription medicine;
      • the name and purpose of the medicine;
      • the prescribed dosage for the medicine;
      • the times at which or circumstances under which the medicine may be administered; and
      • the period for which the medicine is prescribed.
      • The physician's statement must be kept on file at the school.
 
 
In addition, the Health and Safety Code §168.008 states that a student with diabetes, in accordance with the student’s individualized health plan (IHP), may attend to the management and care of his/her diabetes, which may include:
  • performing blood glucose level checks;
  • administering insulin through the insulin delivery system the student uses;
  • treating hypoglycemia and hyperglycemia;
  • possessing on the student's person at any time any supplies or equipment necessary to monitor and care for the student's diabetes; and
  • otherwise attending to the management and care of the student's diabetes in the classroom, in any area of the school or school grounds, or at any school-related activity.
 
A local school board may choose to adopt a policy to allow for the administration of OTC medications. It is recommended that any policies regarding medication administration comply with the Texas Education Code §22.052, including a written request from a parent/guardian to administer the medication and the medication being administered from the original, properly labeled container. 
 
The Texas Department of State Health Services developed a Guide to Medication Administration in the School Setting, which may be downloaded at the following web address: Guide to Medication Administration in the School Setting (texas.gov)

 

Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillators (AEDs)

The Texas Education Code §33.086 states the following individuals must be certified in CPR and First Aid: A school district employee who serves as the head director of a school marching band or as the head coach or chief sponsor for an extracurricular athletic activity, including cheerleading, sponsored or sanctioned by a school district or the University Interscholastic League must maintain and submit to the district proof of current certification in first aid and cardiopulmonary resuscitation issued by the American Red Cross, the American Heart Association, or another organization that provides equivalent training and certification.
 
 
Additional staff at the school district may be required to maintain certification in CPR and First Aid related to health care licenses/certifications (i.e. Registered Nurse, Athletic Trainer)
The Texas Education Code §28.902 states that a school district must annually make available to district employees and volunteers instruction in CPR and the use of an AED. In addition, each school nurse, assistant school nurse, athletic coach or sponsor, physical education instructor, marching band director, cheerleading coach, and any other school employee specified by the commissioner and each student who serves as an athletic trainer must participate in the instruction in the use of an AED.  These individuals must also receive and maintain certification in the use of an AED from the American Heart Association, the American Red Cross, or a similar nationally recognized association.
 

EDUCATION CODE CHAPTER 22. SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS (texas.gov)

Yes, the Texas Education Code §38.017 requires each school district to have at least one AED available at each campus in the district. In determining the location to store the campus AED, the principal of the campus shall consider the primary location on campus where students participate in athletic activities.
 
Each LEA shall ensure the presence of at least one campus/district employee at each location at which an AED is required at any time a substantial number of district students are present at the location.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Yes, the Texas Education Code §38.017 requires a campus AED be readily available during any University Interscholastic League athletic competition held on the campus.
 
To the extent practicable, each LEA, shall make reasonable efforts to ensure that an AED is available at each UIL athletic practice held at a district campus.
 
Each LEA, shall determine the extent to which an AED must be available at each UIL athletic competition held at a location other than a district campus. The determination must be based on relevant medical information and whether emergency services personnel are present at the athletic competition under a contract with the school district.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Yes, The Texas Administrative Code (Title 19, Chapter 74, Subchapter C, §74.38) specifies that school districts and open-enrollment charter schools must provide instruction in cardiopulmonary resuscitation (CPR) between the grades of 7-12.
 

TAC §74.38 Texas Administrative Code (state.tx.us)

No, the CPR instruction for students is not required to result in certification. If the instruction is intended to result in CPR certification, the course instructor must be authorized to provide the instruction by the American Heart Association, the American Red Cross, or a similar nationally recognized association. TAC §74.38(d)
Yes, the training must use nationally recognized, evidence-based guidelines for emergency cardiovascular care and incorporating psychomotor skills to support the instruction. TAC §74.38(b)(2)
The TAC §74.38(c) specifies the following individuals may instruct the CPR training for students: emergency medical technicians, paramedics, police officers, firefighters, representatives of the American Heart Association or the American Red Cross, teachers, other school employees, or other similarly qualified individuals to provide CPR instruction and training under this section. Except as specified in subsection (d) of this section, an instructor of this training is not required to be certified in CPR.
Yes, the Texas Administrative Code (Title 19, Chapter 74, Subchapter A, 74.5(j)) states: A student who completes the required instruction in cardiopulmonary resuscitation (CPR) as specified in §74.38 of this title (relating to Requirements for Instruction in Cardiopulmonary Resuscitation (CPR)) in Grade 9, 10, 11, or 12 shall have completion of the CPR instruction clearly indicated on the academic achievement record.
 

TAC §74.5: Texas Administrative Code (state.tx.us)

 

Bleeding Control Training (STOP the Bleed)

The Texas Education Code, §38.030 requires that agency-approved training on the use of a bleeding control station in the event of an injury to another person be provided to the following LEA staff:
  1. each school district peace officer or school security personnel employed who provides security services at the campus;
  2. each school resource officer who provides law enforcement at the campus; and
  3. all other district or school personnel who may be reasonably expected to use a bleeding control station

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Yes, the bleeding control training is an annual training requirement for staff specified in Texas Education Code §38.030.
Each LEA is required require to annually offer instruction on the use of a bleeding control station to students enrolled at the campus in grade seven or higher.  The instruction must be provided by a school resource officer or other appropriate district or school personnel who has received the state-approved training.
The list of bleeding control training programs approved by TEA that meet all requirements outlined in the Texas Education Code §38.030 can be found on the TEA website at the following web address: Healthy and Safe School Environment of the Coordinated School Health Model | Texas Education Agency
The Texas Education Code §38.030 specifies that bleeding control stations are to be stored in easily accessible areas of the campus that are selected by the LEA's school safety, which may be areas of the campus where automated external defibrillators are stored.

 

Seizure Recognition and Training

Yes, Texas Education Code §38.033 requires school nurses employed by a school nurse to complete an agency-approved online course for school nurses on managing students with seizure disorders, including information on seizure recognition and related first aid.
The Texas Education Code §38.033 requires school district employees whose duties include regular contact with students to complete an agency-approved online course for school personnel regarding awareness of students with seizures that includes information about seizure recognition and related first aid.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The Texas Education Code §38.033 does not state the frequency the training on seizures is required by school nurses and school personnel. The agency is charged with the adoption of rules for the implementation of TEC §38.033, which may provide requirements for training frequency.  At this time the rules have for implementation have not been adopted, thus training frequency is currently a local decision.
The Texas Education Agency provides a list of online courses that meet the requirements of Texas Education Code §38.033 for both school nurses and school personnel at the following web address: Healthy and Safe School Environment of the Coordinated School Health Model | Texas Education Agency

 

Individualized Health Plans (IHPs)

An Individualized Health Plan (IHP) is the tool school nurses utilize to document the nursing process used to plan and provide care for students with health care needs that require ongoing health-related services throughout the school day.
The licensed registered nurse (RN) should develop the IHP. In the development of the IHP, the RN can utilize information provided by the student, parents, teachers, and other members of the LEA team who support the student throughout the school day.
 
Note, in Texas, licensed vocational nurses (LVNs) cannot perform independent assessments as the LVN has a directed scope of practice under supervision; therefore, the LVN cannot develop IHPs for students with health care needs. The LVN may assist in the implementation of the IHP under supervision.
The Texas Department of State Health Services has developed a IHP decision making flow-chart to assist LEAs in determining when an IHP would be necessary for a student with health care needs. The flow-chart can be accessed on the Texas Department of State health Services’ website at the following web address: IHP_Needed_Flowchart pdf.pdf (texas.gov)
The Texas Department of State Health Services Nursing Practice Resources webpage: Nursing Practice Resources (texas.gov)
 
The Texas School Nurse Organization (TSNO) IHP Templates: IHP Templates - Texas School Nurses Organization (txsno.org)

 

Head Lice

No, there is not a state law nor public health requirement to exclude children with head lice or nits (lice eggs) from school. Each LEA may set local policies and procedures regarding head lice if desired.  The Texas Department of State Health Services encourages LEAs to ensure any polices regarding head lice do not cause children to miss class unnecessarily nor encourage the embarrassment or isolation of students with repeated cases of head lice.
 
For additional guidance and considerations on the development of school policies regarding head lice and nits, LEAs are encouraged to review the Texas Department of State Health Services website, Managing Head Lice in School Settings and at Home: Setting Policies for School Districts. Managing Head Lice (Pediculosis) in School Settings and at Home (texas.gov)
Yes, the Texas Education Code §38.031 requires the board of trustees of an independent school district to adopt a policy that requires a school nurse of a public elementary school who determines or becomes aware that a child enrolled in the school has lice to provide written or electronic notice of that fact to both:
  1. (1) The parent of the child with lice (as soon as practicable but not later than 48 hours after becoming aware of that fact); and
  2. (2)  The parent of each child assigned to the same classroom as the child with lice not later than the fifth school day after the date of becoming aware of that fact.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Yes, the notification to parents may be sent either in writing or electronically.
No, although head lice can be a nuisance, they do not carry disease and are not a threat to public health. LEAs are not required to track or report cases of head lice to the Texas Department of State Health Services or their local health authority.
Additional information on head lice can be found at the following web addresses:
  1. Texas Department of State Health Services: Managing Head Lice in School Settings and at Home Managing Head Lice (Pediculosis) in School Settings and at Home (texas.gov)
    • Includes handouts and downloadable fact sheets in English and Spanish.
  2. National Association of School Nurses: Head Lice Management in Schools: Head Lice Management in Schools - National Association of School Nurses (nasn.org)
  3. American Academy of Pediatrics – Pediatrics Journal Article: Head Lice Head Lice | American Academy of Pediatrics (aappublications.org)

 

HIPAA

The Health Information Portability Accountability Act, HIPPA, are federal laws regarding the disclosure of confidential health and medical information. Detailed information on HIPAA can be found on the U.S. Department of Health and Human Services website at the following web address: Health Information Privacy | HHS.gov
 
The Family Education Rights and Privacy Act, FERPA, are federal laws that protect the privacy of student records. Detailed information on FERPA can be found on the United States Department of Education website at the following web address: Family Educational Rights and Privacy Act (FERPA)
The HIPAA Privacy Rules apply to covered entities, which individual health care plans, clearinghouses, and providers who transmit health information electronically. It is possible for a LEA to be considered a “covered entity” if, for example, the LEA processes medical claims for third parties or electronic transactions for payment (i.e., Medicaid, SHARs).
 
LEAs are encouraged to review the resources below for more detailed guidance on HIPAA in the school setting and consult with their legal counsel to determine how the HIPAA Privacy Rules apply to their LEA.
  1. Texas Department of State Health Services: HIPAA School Health Information website School Health Information (texas.gov)
  2. Comparison of FERPA and HIPAA Privacy Rule for Accessing Student Health Data Comparison of FERPA and HIPAA Privacy Rule | State Public Health | ASTHO

 

Health Records

According to the Texas Education Code §38.009 a school administrator, nurse, or teacher is entitled to access to a student's medical records maintained by the school district for reasons determined by district policy; these individuals are required to maintain the confidentiality of the medical records.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Yes, the Texas Education Code §38.0095 states that parents/guardians are entitled to access to the student's medical records maintained by the LEA. On request of a student's parent/guardian, the LEA shall provide a copy of the student's medical records to the parent/guardian.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The Texas State Library and Archives Commission provides guidance on records retention schedules for school districts; Local Schedule SD, Part 5 is specific to school health records. This information can be found on the Texas State Library Archives Commission at the following web address: Local Government Retention Schedules | TSLAC (texas.gov)

 

Epinephrine

Yes, the Texas Administrative Code Rule §37.602 and the Texas Education Code §38.208 allows a school district, open-enrollment charter school, or private school to adopt and implement a written policy regarding the maintenance, administration, and disposal of unassigned epinephrine auto-injectors at each school campus.
 
 
No, the Texas Administrative Code Rule §37.602 is voluntary – LEAs may adopt and implement a policy on unassigned epinephrine autoinjectors.
The Texas Education Code §38.210 requires each LEA that adopts an unassigned epinephrine auto-injector policy to provide training school personnel and school volunteers in the administration of an epinephrine auto-injector. The training must include information on:
  1. recognizing the signs and symptoms of anaphylaxis;
  2. administering an epinephrine auto-injector;
  3. implementing emergency procedures, if necessary, after administering an epinephrine auto-injector; and
  4. properly disposing of used or expired epinephrine auto-injectors; and

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The training is required annually and may be conducted through either an in-person, formal training session or online education session. The LEA must maintain record of trainings provided.
Yes, the Texas Education Code §38.211 allows a physician or person who has been delegated prescriptive authority to prescribe epinephrine auto-injectors in the name of a LEA. The standing order under is not required to be patient-specific, and the epinephrine auto-injector may be administered to a person without a previously established physician-patient relationship. Additional details regarding the provisions of the standing order can be read in the Texas Education Code §38.211.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

A school is required to submit a report no later than the 10th business day after the date school personnel or a school volunteer administers an epinephrine auto-injector in accordance with the unassigned epinephrine auto-injector policy.
 
The report must be submitted to the following groups:
  1. school district, charter holder if the school is an open-enrollment charter school, or governing body of the school if the school is a private school;
  2. the prescribing physician of the epinephrine auto-injector, and;
  3. the commissioner of the Texas Department of State Health Services.
DSHS has created an online reporting form for schools to utilize to report the use of an unassigned epinephrine auto-injector. The form can be found on the DSHS website at the following link: Required Reporting of Epinephrine Auto-Injectors to DSHS (texas.gov)

 

Asthma Medication

No, the Texas Education Code 38.208(a-1) is voluntary - LEAs may adopt and implement a policy authorizing a school nurse to maintain and administer asthma medicine at each campus in the district or school
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

According to the Texas Education Code §38.208(b-1) if a policy is adopted, the policy must provide that the school nurse may administer prescription asthma medicine to a student only if the school nurse has written notification from a parent or guardian of the student that the student has been diagnosed as having asthma and stating that the school nurse may administer prescription asthma medicine to the student. In addition, a school nurse may administer the prescription asthma medicine only at a school campus.
Yes, the Texas Education Code §38.211 allows a physician or person who has been delegated prescriptive authority to prescribe asthma medication in the name of a LEA. The standing order under is not required to be patient-specific. The asthma medication may be given to an individual reasonably believed to be experiencing a symptom of asthma who has written notification from a parent or guardian that the student has been diagnosed as having asthma and stating the school nurse may administer prescription asthma medicine to the student.  Additional details regarding the provisions of the standing order can be read in the Texas Education Code §38.211.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The Texas Department of State Health Services developed a School Nurse Notes document on Asthma Care in Schools, which can be found at the following web address: DSHS-School Nurse Notes | December 2020 (texas.gov)

 

Food Allergies

Yes, the Texas Education Code §38.0151 requires the board of trustees of each school district and the governing body of each open-enrollment charter school to adopt and administer a policy for the care of students with a diagnosed food allergy at risk for anaphylaxis based on guidelines developed by the Commissioner of the Texas Department of State Health Services (DSHS) in consultation with the legislated SB-52 Ad-Hoc Committee.
A LEA is required to annually review and revise, as necessary, its policy for the care of students with a diagnosed food allergy at risk for anaphylaxis to ensure the policy is consistent with the most current version of the guidelines developed by the Commissioner and legislated Ad-Hoc committee.
The current version of the Guidelines for the Care of Students with Food Allergies can be downloaded from the DSHS School Health website at the following web address: Allergies and Anaphylaxis (texas.gov)
Yes, the Texas Education Code §25.0022 requires LEAs, upon enrollment of a child to a public school, to request a parent/guardian disclose whether the child has a food allergy or a severe food allergy that, in the judgment of the parent/guardian, should be disclosed to the district to enable the district to take any necessary precautions regarding the child's safety; and specify the food to which the child is allergic and the nature of the allergic reaction. The request can be made through a form or other method determined by the LEA.
 

EDUCATION CODE CHAPTER 25. ADMISSION, TRANSFER, AND ATTENDANCE (texas.gov)

The Texas Education Code §25.0022(d-f), specifies the following
  1. Information provided by a parent/guardian regarding a child's food allergy, shall be retained in the child's student records, but may not be placed in the health record maintained for the child by the school district.
  2. Documentation the LEA receives from a physician regarding a food allergy shall be placed in the health record maintained for the child by the LEA.
  3. A registered nurse may enter appropriate notes about a child's possible food allergy in the health record maintained for the child by the LEA, including a notation that the child's student records indicate that a parent has notified the LEA of the child's possible food allergy. EDUCATION CODE CHAPTER 25. ADMISSION, TRANSFER, AND ATTENDANCE (texas.gov)
The Food Allergy and Education Resource (FARE) organization has sample Emergency Care Plan templates in both English and Spanish that can be downloaded from their website at the following web address: Food Allergy & Anaphylaxis Emergency Care Plan | Food Allergy Research & Education

 

Concussions

The Texas Education Code §38.143 and §38.154 require each school district and open-enrollment charter school with students who participate in interscholastic athletics to create a COT. The COT is required to establish a return-to-play protocol for a student’s return to practice or competition following sustaining an impact believed to have caused a concussion.
The Texas Education Code §38.154 states that each COT must include at least one physician and to the extent practicable one or more of the following: athletic trainer, advanced practice nurse, neuropsychologist, or a physician assistant. If the LEA employs an athletic trainer, the athletic trainer must be on the COT; if the LEA employs a school nurse, the school nurse may be on the COT if requested by the school nurse.  All members of the COT must have received training in the evaluation, treatment, and oversight of concussions at the time of appointment/approval as a member to the COT.
The COT is responsible for the development of a return-to-play protocol for the LEA, based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion. Requirements for return-to-play are further outlined in the Texas Education Code §38.157. 
 
The Texas Education Code §38.158 specifies that the following individuals, who serve as members of the Concussion Oversight Team (COT), must take an approved course that is at least two-hours in duration once every two years:
  1. a coach of an interscholastic athletic activity;
  2. a school nurse who serves as a member of a concussion oversight team;
  3. a licensed health care professional (including an athletic trainer) who serves as a member of a concussion oversight team (LEA employee and volunteers)
Additional Notes on Training Requirements:
  1. A physician who serves as a member of a concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.
  2. A school nurse or licensed health care professional who is not in compliance with the training requirements under this section may not serve on a concussion oversight team in any capacity.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The University Interscholastic League (UIL) Concussions and Concussion Management Protocol Requirements and Information website contains information over state requirements, sample forms, and information on training requirements.
 

Health & Safety — University Interscholastic League (UIL) (uiltexas.org)

 

Bloodborne Pathogens

Yes, the Texas Administrative Code §96.201 provides minimum bloodborne pathogen standards that apply to a governmental unit that employs employees who:
  1. provide services in a public or private facility providing health care-related services; or
  2. otherwise have a risk of exposure to blood or other potentially infectious material containing bloodborne pathogens in connection with exposure to sharps.

A public school district clinic is considered a governmental unit and is required to meet the minimum standards. Texas Administrative Code (state.tx.us)

LEAs must comply with the minimum standards provided in the Texas Department of State Health Services Exposure Control Plan; this includes universal precautions, biohazard labeling, waste disposal, training requirement for employee, and record keeping set forth in the plan.
The Texas Department of State Health Service’s adopted Exposure Control Plan can be downloaded from the DSHS website at the following web address: Bloodborne Pathogens | Resources (state.tx.us)
Training should be provided to any employees who provide health-care related services or who otherwise have a risk of exposure to bloodborne pathogens related to exposure to sharps.
Employees should receive bloodborne pathogen training prior to being assigned to tasks where bloodborne pathogen exposure may occur. Employees should receive annual refresher training reviewing district policies and procedures related to bloodborne pathogens.
A LEA should offer the Hepatitis B vaccine to any employee who is determined to be "at risk" of being exposed to "blood or other material potentially containing bloodborne pathogens in connection with exposure to sharps,” in connection with their job duties.
The Texas Department of State Health Service’s Exposure Control Plan provides a list of required training content, which can be found on page 11 of the adopted plan. [PFP#800227789] (state.tx.us)
Bloodborne pathogen requirements for LEAs are addressed in the Health and Safety Code §81.307-81.307 and the Texas Administrative Code §96.
 
 
 
The Texas Department of State Health Services has developed a FAQ regarding Bloodborne Pathogen Control in Texas Schools, which can be found at the following web address: Bloodborne Pathogen Control in Texas Schools FAQs

 

Sexual Education

The Texas Education Code §28.004(c)(3) specifies that the local school health advisory council's duties include recommending appropriate grade levels and methods of instruction for human sexuality instruction.
 
The Texas Education Code §28.004(e) requires that any course materials and instruction relating to human sexuality, sexually transmitted diseases, or human immunodeficiency virus or acquired immune deficiency syndrome be selected by the board of trustees with the advice of the local school health advisory council.
 

EDUCATION CODE CHAPTER 28. COURSES OF STUDY; ADVANCEMENT (texas.gov)

Yes, the Texas Education Code §28.004(e)(1-5) requires that any course materials and instruction relating to human sexuality, sexually transmitted diseases, or human immunodeficiency virus or acquired immune deficiency syndrome must:
  1. present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;
  2. devote more attention to abstinence from sexual activity than to any other behavior;
  3. emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases, infection with human immunodeficiency virus or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;
  4. direct adolescents to a standard of behavior in which abstinence from sexual activity before marriage is the most effective way to prevent pregnancy, sexually transmitted diseases, and infection with human immunodeficiency virus or acquired immune deficiency syndrome.
  5. teach contraception and condom use in terms of human use reality rates instead of theoretical laboratory rates, if instruction on contraception and condoms is included in curriculum content.
No, the Texas Education Code §28.004(f) states a school district may not distribute condoms in connection with instruction relating to human sexuality.
Yes, The Texas Education Code §28.004(g) states a school district that provides human sexuality instruction may separate students according to sex for instructional purposes.
Yes, the Texas Education Code §28.004(i) requires the school district, before the start of each school year, to provide written notice to parents of the board of trustees' decision regarding whether the district will provide human sexuality instruction to district students. If instruction will be provided, the notice must include:
  1. a summary of the basic content of the district's human sexuality instruction to be provided to the student, including a statement informing the parent of the instructional requirements under state law;
  2. a statement of the parent's right to:
    • review curriculum materials; and
    • remove the student from any part of the district's human sexuality instruction without subjecting the student to any disciplinary action, academic penalty, or other sanction imposed by the district or the student's school; and
  3. information describing the opportunities for parental involvement in the development of the curriculum to be used in human sexuality instruction, including information regarding the local school health advisory council.
Yes, the Texas Education Code §28.004(i)(2)(b) allows parents the right to remove their student from any part of the district's human sexuality instruction without subjecting the student to any disciplinary action, academic penalty, or other sanction imposed by the district or the student's school.

 

Child Abuse

Yes, the Texas Family Code, Chapter 261 requires that a professional who has cause to believe that the child has been abused or neglected make a report within 48 hours. A professional may not delegate to or rely on another person to make the report. A professional is anyone licensed or certified by the state or works for an agency or facility licensed or certified by the state and has contact with children as a result of their normal duties, this includes teachers and nurses.
 

FAMILY CODE CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT (texas.gov)

Yes, the Texas Education Code §38.0041 requires LEAs to provide training to increase awareness of issues regarding sexual abuse, sex trafficking, and other maltreatment of children, including prevention techniques and knowledge of likely warning signs indicating that a child may be a victim of sexual abuse, sex trafficking, or other maltreatment.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Training must be provided, as part of a new employee orientation, to all new LEA employees. The LEA must maintain records that include the name of each school staff member who participated in the training.
Yes, the Texas Family Code, Chapter 261 includes human trafficking in the definition of child abuse. The Texas Education Code §38.0041 requires LEAs to adopt and implement a policy addressing sexual abuse, sex trafficking, and other maltreatment of children.
 
 
The Texas Education Agency website has a list of training resources on their website at the following web address: Child Abuse Prevention an Overview | Texas Education Agency
Yes, the Texas Education Code §38.0042 requires each public school and open-enrollment charter school to post a sign in English and in Spanish that contains the toll-free telephone number operated by the Department of Family and Protective Services to receive reports of child abuse or neglect. The sign must be posted in a clearly visible location in a public area of the school that is readily accessible to students.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The TEA “No Go Tell” posters may be downloaded in English and Spanish from the TEA Child Abuse Prevention webpage: Child Abuse Prevention an Overview | Texas Education Agency
The Texas Education Agency website has additional information on child abuse available at the following web address: Child Abuse Prevention an Overview | Texas Education Agency
 
The Texas Department of Family and Protective Services has additional information on reporting child abuse on their website at the following web address: Training on Reporting Suspected Abuse or Neglect of a Child (state.tx.us)
 
The Texas Education Agency website has additional information on human trafficking available at the following web address: Human Trafficking of School-aged Children | Texas Education Agency

 

Pregnancy Related Services (PRS)

PRS include the support services provided to a student receives during the prenatal and postpartum pregnancy periods to help the student adjust academically, mentally, and physically and stay in school. These services may be provided to the student during the following time periods:
  1. The student is pregnant and attending classes on a district campus,
  2. A valid medical necessity for confinement occurs during the pregnancy prenatal period, which prevents the student from attending classes on campus, or
  3. A valid medical necessity for confinement during the postpartum pregnancy period prevents the student from attending classes on campus.
No, a LEA is not required to provide Pregnancy Related Services (PRS). However, if a LEA decides to offer PRS, the LEA must offer Compensatory Education Home Instruction (CEHI) as part of their PRS program.
CEHI provides academic services to the student at home or hospital bedside during the prenatal or postpartum pregnancy periods when a valid medical necessity for confinement prevents the student from attending classes on campus. CEHI must consist of face-to-face instruction by a certified teacher of the district. CEHI is a required component of PRS and must be provided if the district offers PRS.
Information on PRS can be founded on the Texas Education Agency Website at the following web address: Pregnancy Related Services | Texas Education Agency
 
The Texas Education Agency Student Attendance Accounting Handbook provides detailed guidance on PRS and CEHI in Section 9: Student Attendance Accounting Handbook | Texas Education Agency

 

School Health Survey

The Texas Education Code §38.0141 requires each school district and public charter school to submit information regarding school health and physical activity. The Texas Education Agency (TEA) utilizes the School Healthy Survey to collect this information from LEAs.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The School Health Survey gathers data regarding the School Health Advisory Council (SHAC), Physical Education, School Health, recess, Coordinated School Health programming, menta health/suicide prevention, and district policies, thus completion of the survey will require a team approach involving individuals familiar with the work done in each of these areas.
Typically, the School Health Survey is made available in January and due at the end of May. The Information is submitted electronically through an online survey.

 

Coordinated School Health

Coordinated School Health is a comprehensive approach to promoting the health and well-being of students and staff. The original Coordinated School Health model included 8 components: nutrition services, physical education, health education, health services, counseling and support services, healthy school environment, health promotion for staff, and family/community involvement. Through the coordinated approach, each component works synergistically with the other components to maximize health/wellness benefits to the campus community.
 
The original 8-component Coordinated School Health model has been updated by the Centers for Disease Control and Prevention to the Whole School, Whole Community, Whole Child (WSCC) model.
  1. CDC WSCC Website: Whole School, Whole Community, Whole Child (WSCC) | Healthy Schools | CDC
School districts are required to provide training and implement an approved Coordinated School Health Program in each elementary, middle, and junior high school in the district.
 
The list of the currently approved Coordinated School Health Programs can be found on the TEA website at the following web address: Approved Coordinated School Health Programs | Texas Education Agency

 

School Health Advisory Committee (SHAC)

The Texas Education Code §28.004 specifies that the board of trustees of each school district is required to establish a local School Health Advisory Council (SHAC) to assist the district in ensuring that local community values are reflected in the district's health education instruction. In addition, a school district must consider the recommendations of the local school health advisory council before changing the district's health education curriculum or instruction.
 

EDUCATION CODE CHAPTER 28. COURSES OF STUDY; ADVANCEMENT (texas.gov)

The duties of the SHAC specified in the Texas Education Code §28.004 include recommending:
  1. the number of hours of instruction to be provided in: health education in kindergarten through 8th grade; and if the school district requires health education for high school graduation, health education, including physical health education and mental health education, in grades 9 - 12;
  2. policies, procedures, strategies, and curriculum appropriate for specific grade levels designed to prevent physical health concerns, including obesity, cardiovascular disease, Type 2 diabetes, and mental health concerns, including suicide, through coordination of:
    • health education, which must address physical health concerns and mental health concerns;
    • physical education and physical activity;
    • nutrition services;
    • parental involvement;
    • instruction on substance abuse prevention;
    • school health services, including mental health services;
    • a comprehensive school counseling program;
    • a safe and healthy school environment; and
    • school employee wellness;
  3. appropriate grade levels and methods of instruction for human sexuality instruction;
  4. strategies for integrating the curriculum components specified by above in a coordinated school health program for the district:
    • school health services, including physical health services and mental health services;
    • a comprehensive school counseling program;
    • a safe and healthy school environment; and
    • school employee wellness;
  5. joint use agreements or strategies for collaboration between the school district and community organizations or agencies; and
  6. strategies to increase parental awareness regarding:
    • risky behaviors and early warning signs of suicide risks and behavioral health concerns, including mental health disorders and substance use disorders; and
    • available community programs and services that address risky behaviors, suicide risks, and behavioral health concerns
  7. appropriate grade levels and curriculum for instruction regarding opioid addiction and abuse and methods of administering an opioid antagonist.
The Texas Education Code §28.004 specifies that the majority of members of the SHAC must be parents of students enrolled in the district who are not employed by the district. A parent is required to serve as chair or co-chair of the local SHAC.
 
In addition, the board of trustees shall appoint at least five members to the local SHAC. The board may appoint individuals from the following groups or representatives from other groups:
  1. classroom teachers employed by the district;
  2. school counselors employed by the district;
  3. school administrators employed by the district;
  4. district students;
  5. health care professionals licensed or certified to practice in this state, including medical or mental health professionals;
  6. the business community;
  7. law enforcement;
  8. senior citizens;
  9. the clergy;
  10. nonprofit health organizations; and
  11. local domestic violence programs.
Yes, The Texas Education Code §28.004 (l-1) requires the SHAC to establish a physical activity and fitness planning subcommittee. The purpose of the subcommittee is to consider issues related to student physical activity and fitness and make policy recommendations to increase physical activity and improve fitness among students.
 
Recommendations made by the physical activity and fitness planning subcommittee should be included in the SHAC’s annual report to the board.
The Texas Education Code §28.004(d-1) specifies that local SHACs must meet at least four times during the school year.
Aside from the specified duties in the Texas Education Code, local SHACs can provide valuable feedback to the school district on topics related to school health. The Texas School Health Advisory Committee (TSHAC) has compiled numerous resources to support local SHACs.  One document the TSHAC developed is titled “Topics for Local SHAC Meetings” – this resource includes a list of potential topics SHACs may want to consider addressing.  The resource can be found at the following web address: School Health Advisory Committee: Resources (texas.gov)
The Texas Education Code §28.004 specifies that the local SHAC must submit an annual written report to the board that includes:
  1. any SHAC recommendation concerning the school district's health education curriculum and instruction;
  2. any suggested modification to a SHAC recommendation previously submitted to the board;
  3. a detailed explanation of the SHAC's activities during the period between the date of the current report and the date of the last prior written report; and
  4. any recommendations made by the physical activity and fitness planning subcommittee of the SHAC.
The TSHAC has developed a PowerPoint presentation template to assist local SHACs with their annual report to the board. This template may be downloaded from the TSHAC website at the following web address: School Health Advisory Committee: Resources (texas.gov)
No, the Texas Education Code 28.004which discusses local SHACs does not pertain to public charter schools. It would be considered a best practice for a public charter school to have a SHAC, but it is not a requirement. EDUCATION CODE CHAPTER 28. COURSES OF STUDY; ADVANCEMENT (texas.gov)
No, a district of innovation is required to comply with the state and federal provisions that are applicable to an open-enrollment charter school operating under the Texas Education Code, Subchapter D, Chapter 12. The Texas Education Code 28.004 which discusses local SHACs does not pertain to public charter schools, thus it would not be required of a district of innovation unless the district has identified having a SHAC in their plan.  It would be considered best practice for the district of innovation to have a SHAC.
 
 
For more information on SHACs and a downloadable guidebook, visit the Texas Department of State Health Services, School Health Advisory Council Website: School Health Advisory Councils (texas.gov)

 

Wellness Policy

The United States Department of Agriculture (USDA) requires all LEAs that participate in the National School Lunch Program and/or the School Breakfast Program to have a Wellness Policy.
 

Local School Wellness Policy | USDA-FNS

The Wellness Policy is intended to be a tool for LEAs to utilize to promote student health and wellness, reduce childhood obesity, and provide assurance that school meals meet federal standards. The Wellness Policy should include specific goals for nutrition education and promotion, physical activity, and other school-based activities that promote student wellness.  Guidelines should also be included for all food and beverages sold or provided during the school day.
The Wellness Plan is a written document that provides guidance on how the board-approved Wellness Policy will be implemented within the LEA. Specific strategies and actions steps for accomplishing goals set in the Wellness Policy are detailed within the Wellness Plan.
Yes, in Texas LEAs are required to have both the Wellness Policy and the Wellness Plan in order to meet the requirements of both the Healthy, Hunger-Free Kids Act of 2010 and USDA federal rules.
The Local Wellness Policy and Plan should be developed by the Local School Health Advisory Council (SHAC) or a similar group that contains a broad group of representatives. Parents, students, school food service staff, physical education teachers, school health professionals, the school board, school administrators, and the general public should all have the opportunity to participate in the development of the Local School Wellness Policy and Plan.
Yes, the Local Wellness Policy requires approval of the School Board. The Wellness Plan provides information on how the LEA will implement the Wellness Policy and does not require approval of the School Board.
At a minimum, LEAs must evaluate their wellness policy at least once every three years. The results of the wellness policy assessment must be made available to the public.
The United States Department of Agriculture (USDA) Local School Wellness Policy Website: Local Wellness Policy (squaremeals.org)
 
The Texas Department of Agriculture (TDA) Square Meals website: Local Wellness Policy (squaremeals.org)
 
The Texas Association of School Boards (TASB) has developed Wellness Policy and Wellness Plan templates, which are available on their website at the following web address: Student Health and Wellness (tasb.org)

 

Bats

If a bat is found in a school facility, the LEA is required to:
  1. Remove the bat and bat colony (if present)
  2. Make repairs so bats are excluded in the future
  3. Disinfect the areas where bats roosted or a dead bat was found

Texas laws pertaining to bats | Bats in Schools (agrilife.org)

Any direct contact with a mammal infected with rabies can transmit the disease. Rabies can be contracted through touching an infected mammal– even if the mammal is not alive.
 
If testing cannot rule out rabies in the mammal, the individual will need post-exposure treatment.
Yes, the Texas Administrative Code Rule §169.25 requires any person having knowledge of a potential rabies exposure to a human will report the incident to the local rabies control authority as soon as possible after the incident.
 

Texas Administrative Code (state.tx.us)

A potential rabies exposure should be reported to the local Animal Care Services.
 
In San Antonio, Animal Care Services can be contacted at: 210-207-6668 or 311.
Texas A&M AgriLife Extension provides resources, sample letters, and templates for schools on responding to bat incidents on their website at the following web address: About bats | Bats in Schools (agrilife.org)

 

School Nursing Peer Review

According to the Texas Occupation Code §303.001(5) "Peer review" means the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered by a nurse, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint.
 
Peer Review includes:
  1. the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;
  2. a report made to a nursing peer review committee concerning an activity under the committee's review authority;
  3. a report made by a nursing peer review committee to another committee or to the board as permitted or required by law;
  4. implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee; and
  5. the provision of information, advice, and assistance to nurses and other persons relating to:
    • the rights and obligations of and protections for nurses who raise care concerns or report under Chapter 301 of the Texas Occupations Code or other state or federal law;
    • the rights and obligations of and protections for nurses who request nursing peer review under this chapter;
    • nursing practice and patient care concerns; and
    • the resolution of workplace and practice questions relating to nursing and patient care.

OCCUPATIONS CODE CHAPTER 303. NURSING PEER REVIEW (texas.gov)

A LEA is required to have a nursing peer review committee if the LEA regularly employs, hires or contracts for the services of eight (8) or more nurses; and for nursing peer review of an RN, at least four (4) of the 8 must be RNs.
 

Texas Administrative Code (state.tx.us)

Yes, a LEA that is required to have a nursing peer review committee may contract with another entity to provide this for the LEA.
The Texas Administrative Code Title 22 Rule §217.20 defines safe harbor as a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for nursing peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules.
 
Safe harbor must be invoked prior to engaging in the conduct or assignment for which nursing peer review is requested, and may be invoked at any time during the work period when the initial assignment changes.
 

Texas Administrative Code (state.tx.us)

The Texas Administrative Code Title 22 Rule §217.19 incident-based nursing peer review focuses on determining if a nurse's actions, be it a single event or multiple events (such as in reviewing up to five (5) minor incidents by the same nurse within a year's period of time), should be reported to the Board or if the nurse's conduct does not require reporting because the conduct constitutes a minor incident that can be remediated. The review includes whether external factors beyond the nurse's control may have contributed to any deficiency in care by the nurse and to report such findings to a patient safety committee as applicable.
 

Texas Administrative Code (state.tx.us)

No, ESC-20 does not have a nursing peer review committee, as the Texas School Nurse Organization (TSNO), Region 20 Chapter has established this for LEAs in our region. LEAs interested in participating should contact the current president of the TSNO Region 20 Chapter for additional information.
 

Regional Presidents - Texas School Nurses Organization (nasn.org)

Detailed information on the Peer Review Process as well as Frequently Asked Questions can be found on the Texas Board of Nursing website at the following web address: Texas Board of Nursing - Nursing Peer Review FAQ
 
The Texas Department of State Health Services developed a School Nurse Notes document on the Peer Review Process; this document can be downloaded from the following web address: Peer Review Process-BON DSHS SNN 2.18 pdf.pdf (texas.gov)

 

Communicable Diseases

Yes, the Texas Administrative Code Rule §97.2 (d) specifies that school authorities, including a superintendent, principal, teacher, school health official, or counselor of a public or private school should report those students attending school who are suspected of having a notifiable condition.
 

Texas Administrative Code (state.tx.us)

The current Communicable Disease Chart can be found on the Texas Department of State Health Service’s Recommendations for the Prevention and Control of Communicable Diseases in a Group-Care Setting webpage: School Health | IDPS (texas.gov)
Suspected or confirmed cases of communicable diseases should be reported to the local or regional health department, contact information by county can be found at the following web address: IDPS | Disease Reporting Contacts (texas.gov)
 
Reportable conditions in San Antonio and Bexar County are reported to San Antonio Metro Health Department: Reporting Diseases - What & Who (sanantonio.gov)

 

COVID-19

The Texas Education Agency provides Public Health Guidance related to COVID-19 for LEAs to follow. The guidance is updated as changes occur at the state and national level with regards to COVID-19.  The Public Health Guidance can be found at the following web address: COVID-19 Support: Public Health Orders | Texas Education Agency
The Centers for Disease Control and Prevention Guidance for COVID-19 Prevention in K-12 Schools website provides information and best practices related to COVID-19 prevention in a school setting. The website is updated as changes occur at the national level with regards to COVID-19. Guidance for COVID-19 Prevention in K-12 Schools | CDC
The Texas Department of State Health Services Coronavirus 2019 website contains information related to vaccines, case counts, county trends, and Executive Orders issued by the Governor related to COVID-19. Coronavirus Disease 2019 (COVID-19) (texas.gov)
San Antonio Metropolitan Health District maintains a COVID-19 website for residents. The website contains a dashboard with current case counts and vaccination rates, testing and vaccine locations, as well as resources for schools. Home - City of San Antonio
If an individual who has been in a school is test-confirmed to have COVID-19, the school must notify the local health department. In addition, if any student, teacher, staff member, or visitor at a school is test-confirmed to have COVID-19, the school must submit a report to the Texas Department of State Health Services. The report must be submitted each Monday for the prior seven days (Monday-Sunday) and is submitted via an online form at the following web address: COVID-19 Public School Case... - Home (quickbase.com)

**NOTE: Reporting information may change at the start of the 2021-2022 school year.

No, the COVID-19 vaccine is not required for students enrolled in child-care, Pre-K, or K-12 schools.
The Centers for Disease Control and Prevention provides quarantine guidelines for both individuals who are fully vaccinated and unvaccinated individuals on their website at the following web address: COVID-19: When to Quarantine | CDC
The Centers for Disease Control and Prevention provides information for fully vaccinated individuals, including an explanation of “fully vaccinated” based on vaccine type on their website at the following web address: When You’ve Been Fully Vaccinated | CDC
The Centers for Disease Control and Prevention provides guidelines for international travel for both individuals who are fully vaccinated and unvaccinated individuals on their website at the following web address: International Travel During COVID-19 | CDC
 
The Texas Department of State Health Services also maintains information for travelers on their COVID-19 website at the following web address: Information for Travelers (texas.gov)

 

Miscellaneous School Health Related Questions

Yes, the Texas Education Code 37.0831 requires each LEA to adopt and implement a dating violence policy to be included in the district improvement plan.
  1. The dating violence policy must include a definition of dating violence that includes the intentional use of physical, sexual, verbal, or emotional abuse by a person to harm, threaten, intimidate, or control another person in a dating relationship.
  2. The policy must address safety planning, enforcement of protective orders, school-based alternatives to protective orders, training for teachers and administrators, counseling for affected students, and awareness education for students and parents.

EDUCATION CODE CHAPTER 37. DISCIPLINE; LAW AND ORDER (texas.gov)

No, the Texas Education Code §38.006 requires the board of trustees of a school district to prohibit smoking or using e-cigarettes or tobacco products at a school-related or school-sanctioned activity on or off school property; prohibit students from possessing e-cigarettes or tobacco products at a school-related or school-sanctioned activity on or off school property; and ensure that school personnel enforce the policies on school property.
 

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)