School health terminology, definitions and acronyms, relevant to Domain 2 & 4: nutrition, physical education and physical activity, and the management and care of chronic health conditions


Nutrition

Chronic Disease Prevention and Health Promotion Domain 2 (Domain 2): Environmental approaches that promote health and support and reinforce healthful behaviors facilitate improvements in social and physical environments to make healthy behaviors easier and more convenient for Americans. The investment in this activity supports statewide programmatic efforts and targeted efforts in schools, early care and education (ECE), worksites, and communities.

Competitive foods and beverages: are those that are sold or served at school outside of and in competition with the federally reimbursable meal programs. Examples of competitive foods and beverages include those sold during the school day including à la carte (foods and beverages sold in the cafeteria that are not reimbursable), vending machines, school stores, and school fundraisers, as well as items that are available to students during classroom celebrations, and rewards for academic performance and good behavior. Competitive foods and beverages sold during the school day must meet the USDA's Smart Snacks in School nutrition standards. These standards set limits on calories, sodium, sugar and fat in foods and beverages and promote snack foods that have whole grains, low fat dairy, fruits, vegetables or protein foods as their main ingredients. These standards are the minimum requirement for schools. States and school districts may have additional rules about competitive foods and beverages.

Fundraising exemptions: The Smart Snacks standards allow state governments to develop a policy on the number of exemptions (or events) for food fundraisers that do not meet the nutrition standards. States determine the number of events/exemptions a state will allow.

Healthy school nutrition environment: Includes multiple elements: access to healthy and appealing foods and beverages available to students in school meals, vending machines, school stores, à la carte lines in the cafeteria, fundraisers, and classroom parties; consistent messages about food and healthy eating, and the opportunities students have to learn about healthy eating.

Local education agency (LEA): Another word for school district.

Local school wellness policy (LWP): A written document that guides a local education agency or school district's efforts to create supportive school nutrition and physical activity environments.

It is required of all districts that participate in the National School Lunch Program or other USDA child nutrition program (e.g., School Breakfast Program). At a minimum, a local school wellness policy must:

  1. Include goals for nutrition promotion and education, physical activity, and other school-based activities that promote student wellness
  2. Include nutrition guidelines to promote student health and reduce childhood obesity for all foods available in each school district
  3. Permit parents, students, representatives of the school food authority, teachers of physical education, school health professionals, the school board, school administrators, and the general public to participate in the development, implementation, and review and update of the local wellness policy
  4. Inform and update the public (including parents, students, and others in the community) about the content and implementation of local wellness policies
  5. Be measured periodically on the extent to which schools are in compliance with the local wellness policy, the extent to which the LEA's local wellness policy compares to model local school wellness policies, and the progress made in attaining the goals of the local wellness policy, and make this assessment available to the public

Nutrition standards for school meals: Outline the requirements that foods and beverages must meet in order to be sold or available and are aligned with the Dietary Guidelines for Americans. Nutrition standards can address nutrient requirements, types of foods and beverages to make available, portion sizes, time of day and locations where items may be offered or sold, served or consumed. New regulations went into effect on July 1, 2012. The changes require more fruits and vegetables, whole grains, sodium limits, calorie limits, limits on unhealthy fat, low-fat and fat-free milk, and free water.

National School Lunch Program (NSLP): A federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day.

Professional development (PD): refers to a set of skill-building processes and activities designed to assist targeted groups of participants in mastering specific learning objectives. Such events are delivered in an adequate time span (at least 3 hours) and may include curriculum and other training, workshops, and on-line or distance learning courses. Professional development should be focused on highly effective trainings and workshops. Professional development may be delivered by the State Department of Health and/or its partners.

Schools: Include all elementary, middle, and high schools within the targeted LEAs.

School Campus: Areas that are owned or leased by the school and used at any time for school-related activities such as the school building or on the school campus, including on the outside of the school building, school buses or other vehicles used to transport students, athletic fields, and stadiums (e.g. on scoreboards, coolers, cups, and water bottles), or parking lots.

School Day: Midnight the night before to 30 minutes after the end of the instructional day. An "Extended School Day" is the time during before and after school activities that includes clubs, intramural sports, band and choir practice, drama rehearsals, etc.

Smart Snacks in School nutrition standards: A USDA rule effective July 1, 2014 that outlines the requirements including specific nutrient standards that all foods and beverages sold to students during the school day in vending machines, school stores, snack cars and a la carte lines, as well as through fundraising must meet in order to be sold or available.

Technical assistance (TA): refers to tailored guidance to meet the specific needs of a site or sites through collaborative communication between a specialist and the site(s). Assistance takes into account site-specific circumstances and culture and can be provided through phone, mail, e-mail, Internet, or in-person meetings. Technical assistance may be delivered by the State Department of Health and/or its partners.

Triennial: Recurring every three years.


Physical Education and Physical Activity

Chronic Disease Prevention and Health Promotion Domain 2 (Domain 2): Environmental approaches that promote health and support and reinforce healthful behaviors facilitate improvements in social and physical environments to make healthy behaviors easier and more convenient for Americans. The investment in this activity supports statewide programmatic efforts and targeted efforts in schools, early care and education (ECE), worksites, and communities.

Comprehensive School Physical Activity Program(CSPAP): A multi-component program that includes the following: quality physical education as the foundation, physical activity before, during, and after school, staff involvement, and family and community engagement. In addition to quality physical education, examples of activities that are implemented within a CSPAP are recess, classroom physical activity breaks, intramurals and physical activity clubs, interscholastic sports, walk and bicycle to school initiatives, and joint-use agreements.

Development and implementation of a CSPAP requires strong coordination and synergy across all of the components. Quality or "enhanced" physical education:

  • meets the needs of all students
  • is an enjoyable experience for all students
  • keeps students active for most of physical education class time
  • teaches self-management
  • teaches skills to maximize movement proficiency
  • emphasizes knowledge and skills for a lifetime of physical activity

With respect to physical activity access, reach is defined as potential reach, indicating that the proximity to the place improves access. Proximity does not indicate the place has been used by the residents; only that it is in close proximity for use. Therefore it is potential reach.

Daily physical education: Defined as the daily delivery of the curricular subject, physical education, to all students within the school.

Exercise: Any physical activity that is planned, structured and repetitive for the purpose of improving or maintaining one or more components of fitness.

Joint Use Agreement (JUA): A formal agreement between two separate government entities - often a school and a city or county - setting forth the terms and conditions for shared use of public property or facilities. Just as there is no one model JUA, there is no single method to develop an agreement. Successful JUAs require a lot of thought, effort, and cooperation to reach agreement on a range of issues.

Local education agency (LEA): another word for school district

Local school wellness policy (LWP): A written document that guides a local education agency or school district's efforts to create supportive school nutrition and physical activity environments.

It is required of all districts that participate in the National School Lunch Program or other USDA child nutrition program (e.g., School Breakfast Program). At a minimum, a local school wellness policy must:

  1. Include goals for nutrition promotion and education, physical activity, and other school-based activities that promote student wellness
  2. Include nutrition guidelines to promote student health and reduce childhood obesity for all foods available in each school district
  3. Permit parents, students, representatives of the school food authority, teachers of physical education, school health professionals, the school board, school administrators, and the general public to participate in the development, implementation, and review and update of the local wellness policy
  4. Inform and update the public (including parents, students, and others in the community) about the content and implementation of local wellness policies
  5. Be measured periodically on the extent to which schools are in compliance with the local wellness policy, the extent to which the LEA's local wellness policy compares to model local school wellness policies, and the progress made in attaining the goals of the local wellness policy, and make this assessment available to the public

Multi-component physical education policy: A single policy or multiple policies that indicate, at a minimum, a state has requirements for: teacher qualifications; substitutions, waivers, exemptions; providing physical education at all school levels; professional development/continuing education requirements for all who teach physical education.

A multi-component state-level physical education policy should address the following requirements:

  • All elementary, middle, and high schools must teach physical education.
  • Do not grant exemptions, waivers, or substitutions for physical education.
  • State has its own (i.e., state-developed) standards for physical education.
  • All who teach physical education (elementary, middle, and high school) are required to be a state-licensed or state-certified who is endorsed physical education.
  • physical education teachers must participate in PD to maintain or renew one's teacher certification or licensure and state endorsement to teach physical education.

Physical Activity (PA): Any bodily movement that results in energy expenditure.

Professional development (PD): refers to a set of skill-building processes and activities designed to assist targeted groups of participants in mastering specific learning objectives. Such events are delivered in an adequate time span (at least 3 hours) and may include curriculum and other training, workshops, and on-line or distance learning courses. Professional development should be focused on highly effective trainings and workshops. Professional development may be delivered by the State Department of Health and/or its partners.

Quality physical education: consists of four main areas: 1) curriculum, 2) policy and environment, 3) appropriate instruction that keeps students physically active for at least 50% of class time, and 4) student assessment. Ideally, PE should be required daily for students in grades K-12 with 150 minutes per week required for Elementary school students and 225 minutes per week required for Secondary school students (i.e., Middle and High School).

Recess: A time period that may consist of unstructured free-play or structured games and activities. Recess should complement, not replace physical education. Ideally, all elementary schools should offer at least one daily, 20-minute period of recess to all students in all grades. State policies to support recess should, at a minimum, require a daily, 20-minute recess period for all students.

Schools: Include all elementary, middle, and high schools within the targeted LEAs.

School Campus: Areas that are owned or leased by the school and used at any time for school-related activities such as the school building or on the school campus, including on the outside of the school building, school buses or other vehicles used to transport students, athletic fields, and stadiums (e.g. on scoreboards, coolers, cups, and water bottles), or parking lots.

School Day: Midnight the night before to 30 minutes after the end of the instructional day. An "Extended School Day" is the time during before and after school activities that includes clubs, intramural sports, band and choir practice, drama rehearsals, etc.

State-level recess policy: For purposes of the 1305 performance measure, a state-level recess policy has a clearly specified requirement of at least 20 minutes of daily recess for all students in elementary schools.

Substitution: A substitution policy or practice indicates that a state, district, or school will allow students to substitute a different subject or activity for physical education class.

Technical assistance (TA): refers to tailored guidance to meet the specific needs of a site or sites through collaborative communication between a specialist and the site(s). Assistance takes into account site-specific circumstances and culture and can be provided through phone, mail, e-mail, Internet, or in-person meetings. Technical assistance may be delivered by the State Department of Health and/or its partners.

Triennial: Recurring every three years.

Waivers/exemptions: A policy or practice that allows or enables students to not participate in physical education class for a specified reason (e.g., participation in school or community sports team). In many states, school districts or schools may apply for a waiver from state-mandated physical education policy, requirement or law. When a waiver is granted, the school district or school no longer is required to provide students with state-mandated physical education class time or credit.


Chronic Conditions

Chronic Conditions: A health condition that requires more than routine health services and may include, or increase the risk for, ongoing physical, developmental, behavioral, and/or emotional conditions. While states have the freedom to address any chronic conditions affecting children in their jurisdiction, the CDC encourages awardees to focus on at least one of the following conditions (in no particular order): asthma, diabetes, epilepsy or seizure disorder, food allergies, hypertension/high blood pressure, or obesity.

  • Activity, Diet, and Weight-related chronic conditions may be, but are not limited to, overweight and obesity, type 2 diabetes, high blood pressure, and disordered eating (e.g., anorexia, bulimia).
  • Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing.
  • Diabetes is a disease characterized by high blood glucose levels. It is a disorder in how the body uses digested food for growth and metabolism. Diabetes is a result of defects in insulin production, insulin action, or both and is classified as either type 1 (insulin-dependent diabetes) or type 2 (usually non-insulin-dependent diabetes).
  • Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. It's also called a seizure disorder. When a person has 2 or more unprovoked seizures, they are considered to have epilepsy.
  • Food Allergy is a condition when the body mistakenly targets a harmless food protein as a threat and attacks it. It is an immune system reaction that occurs soon after eating a certain food. In some people, a food allergy can cause severe symptoms or even a life-threatening reaction known as anaphylaxis. Anaphylaxis is the condition when a food allergy threatens breathing and blood circulation.
  • Hypertension is the term to describe high blood pressure. Blood pressure is the measurement of force against the walls of your arteries as a person's heart pumps blood through their body. High blood pressure creates a higher force of blood flow and makes the heart pump harder.
  • Obesity is the condition of excess body fat; overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. For persons aged 2-20 years, overweight is classified as BMI > 85th to < 95 percentile for age and sex; obesity is classified as BMI > 95th percentile for age and sex.

Case Management: Also referred to as 'care coordination' or 'care management', case management is the process of helping an individual or family explore options and services based on a review of a person's or family's needs, then helping the family or individual plan and implement care. A case manager plans, implements, coordinates, monitors and/or evaluates the provision of all the selected services.

Chronic Disease Prevention and Health Promotion Domain 4 (Domain 4): Strategies to improve community-clinical linkages ensures that communities support and clinics refer patients to programs that improve management of chronic conditions. The investment in this activity addresses those with or at high risk for chronic diseases and facilitates access, referral and payment for quality community resources, to best manage their condition or disease. These supports include interventions such as clinician referral, community and school delivery and third-party payment for effective programs that increase the likelihood that people with high blood pressure, diabetes, or prediabetes or other chronic conditions in school-age children such as asthma and food allergies will better manage their condition.

Community Medical Care Provider: School-based and/or school-linked health centers, outside health-care providers (e.g., private physicians and dentists, hospitals, psychologists, and other mental health workers, pediatric weight management clinics, community health clinics, and managed care organizations), pharmacies, local health departments, community-based nutrition and physical activity providers and services (e.g., dieticians, recreational programs, and cooking classes).

Daily Management of Chronic Conditions in School Settings: Refers to a set of activities, actions, and protocols that collectively provide a safe and supportive environment in which the risk for an exacerbation of the chronic condition is reduced and/or eliminated. For example, establishing protocols for ensuring that daily, preventive, and/or quick-relief medications are available at school, when appropriate, and are taken as prescribed by a physician; educating students with a chronic condition about their condition and how to recognize and monitor symptoms; and providing appropriate modifications to the environment to reduce or eliminate exposure to substances that may initiate an exacerbation.

Delegation: The process by which a registered nurse trains and allows non-licensed personnel to provide standardized routine health services when the registered nurse is not immediately available during an emergency.

Electronic Health (Medical) Record (EHR or EMR): a computerized medical file that contains the history of a patient's medical care, commonly abbreviated as "EHR," in contrast to "PHR," which stands for personal health record. An EHR or EMR enables patients to transport their health care information with them at all times.

Emergency Response to Chronic Conditions in School Settings: Refers to a set of activities, actions, and protocols that collectively provide a safe and supportive environment in which all parties are aware of the signs and symptoms of a worsening episode/exacerbation of a chronic condition that requires taking immediate action. For example, developing a system to immediately notify the appropriately training individuals in the school who will respond to emergencies that may require medical support (e.g. school nurse, or nursing assistant); providing training to school staff on recognizing the signs and symptoms of a worsening episode (increased wheezing during an asthma exacerbation or observing an external change in behavior due to an abnormal decrease in blood glucose levels); and establishing protocols within the school/school district regarding the process for when and how to engage community-based emergency response support (e.g. emergency medical technicians/ambulance).

Epinephrine: A hormone secreted as a response to physical or mental stress. Sometimes administered as a medication to stimulate heart action and increase blood pressure, often used to treat severe allergic reactions (anaphylactic shock). Also called adrenaline.

Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule: FERPA is a federal law that applies to educational agencies and institutions that receive funds from the U.S. Department of Education (i.e., virtually all public elementary and secondary schools, virtually no private or religious schools) and protects the privacy of student education records, or personally identifiable information from education records, from disclosure without a parent or eligible student's (usually over 18 years old) written consent. Health records kept at a school would be considered an education record.

The HIPAA Privacy Rule protects the privacy and security of individually identifiable health information kept by covered entities (e.g., a health care provider). The HIPAA Privacy Rule specifically excludes from its coverage those records that are protected under FERPA.

Guidance clarifies that:

  • Generally, elementary and secondary schools are not covered by the HIPAA Privacy Rule (there are some exceptions but these usually relate to standards for transactions (e.g., billing Medicaid), not the records themselves).
  • Student health information maintained by the school is an education record (subject to FERPA)
  • If a person or entity acting on behalf of a school provides health services (e.g., under contract or under the direct control of the school), the records are education records regardless of whether the care is provide off-site.
  • The HIPAA Privacy Rule allows covered health care providers to disclose protected health information about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student's parent. For example, a student's primary care physician may discuss the student's medication and other health care needs with a school nurse who will administer the student's medication and provide care to the student while the student is at school.
  • An eligible student's treatment records may be shared with health care professionals who are providing treatment to the student, including health care professionals who are not part of or not acting on behalf of the educational institution (i.e., third-party health care provider), as long as the information is being disclosed only for the purpose of providing treatment to the student.
  • An eligible student's education records and treatment records (which are considered education records if used or made available for any purpose other than the eligible student's treatment) may be disclosed, without consent, to appropriate parties (e.g., law enforcement or parents of a student) in connection with an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals.

Individualized Health Plan (IHP) or Individualized Health Care Plan (IHCP): Refers to a plan developed by school (or district) health services staff (e.g. registered nurse) that ensures the health and educational needs of students who may require health management in the school setting are being met. This includes students with chronic conditions.(e.g., diabetes, asthma). Ideally, this health plan is aligned with and complements the management plan developed by the student's clinical provider and regularly updated through close communication among the student, family, school, and clinical provider. The IHP/IHCP serves as documentation for schools regarding a student's condition and describes the provisions the school will make to address the student's needs. The plan typically includes information regarding condition specific daily and emergency management activities that may be required; ensures appropriate and necessary authorizations are obtained in order to facilitate communication among schools, families, and providers, as well as granting the school permission to administer medications when appropriate; and provides overall clarification of the roles of the school, families, students and their clinical providers in ensuring the needs of the student are being adequately addressed. School health services staff maintain responsibility for management of and communication about the plan to all appropriate school personnel. An IHP/IHCP is used to develop a separate emergency care plan (ECP) for use by other school personnel. An IHP/IHCP may be used in place of or in conjunction with other condition specific plans, such as a Diabetes Medical Management Plan, Asthma Action Plan, and a Food Allergy Management Plan.

Local education agency (LEA): is another word for school district and will be referred to as LEA throughout this document.

Medical Home: A medical care system for infants, children, adolescents and their families that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. Well-trained physicians who provide primary care deliver care directly or indirectly by and help to manage and facilitate essentially all aspects of pediatric care.

Medically Fragile: A condition when a student's medical condition is unstable and as a result requires ongoing or frequent observation by persons skilled to recognize sudden changes in condition and/or who are skilled to respond to that change. A student whose airway is prone to sudden blockage, or who requires oxygen would usually be considered medically fragile.

Metered Dose Inhaler: One of many inhalation devices used to inhale medication - often for asthma. Metered dose inhalers are compact, portable devices that deliver consistent doses. Alternate popular and portable ways to deliver inhaled medications are through Dry Powdered Inhalers (devices that break a capsule releasing a dry powder that is then inhaled).

Nebulizer: Electrically-powered machines that convert a liquid medication to a fine spray; Used to deliver inhaled asthma medications.

Oral Health: Oral health is associated with the ability to eat, speak, smile, and show emotions. Conditions related to oral health, including dental caries (tooth decay) and other problems affecting the oral cavity, may cause mouth and facial pain and disability. Dental caries is one of the most common, preventable chronic conditions. When not managed well or untreated, these conditions conditions can negatively affect children’s oral health-related abilities and sleeping, physical health, self-esteem and psychosocial wellbeing, all of which may impair school attendance and performance. Oral health conditions are associated with other chronic conditions, such as diabetes, and risk behaviors including the consumption of less healthy foods and beverages high in sugar. A number of medications that are an integral part of treatment for children with chronic health conditions can cause oral side effects and contribute to tooth dec/ay.

Peak flow Meter: A simple device to measure airway restriction. It can be used at home or school to help predict asthma episode, often before symptoms appear. Peak flow values of 50-80% of an individual's personal best indicate a moderate asthma attack, while values below 50% indicate a severe attack.

Professional development (PD): refers to a set of skill-building processes and activities designed to assist targeted groups of participants in mastering specific learning objectives. Such events are delivered in an adequate time span (at least 3 hours) and may include curriculum and other training, workshops, and on-line or distance learning courses. Professional development may be delivered by the State Department of Health and/or its partners. Professional development should be focused on highly effective trainings and workshops. Below is a list of professional development options, noting length and degree of effectiveness:

  • Trainings, 3+ hours long, Highly Effective*
  • Workshops, 3+ hours long, Highly Effective*
  • Presentations, 0.5 - 3 hours long, Knowledge Transfer Only
  • Information Session, 0.5 - 1 hour long, Minimum Knowledge Transfer

*Professional development should be focused on highly effective trainings and workshops.

Schools: Include all elementary, middle, and high schools within the targeted LEAs.

School Day: Midnight the night before to 30 minutes after the end of the instructional day. An "Extended School Day" is the time during before and after school activities that includes clubs, intramural sports, band and choir practice, drama rehearsals, etc.

School health services: Services schools or school-based health centers provide to identify and resolve health care needs of students, provide case management for health and mental health issues and link students and families to community health resources.

Section 504 Plan: Refers to a plan developed to ensure that a child who has a disability identified under the law and is attending an elementary or secondary educational institution receives accommodations that will ensure their academic success and access to the learning environment. Section 504 is a part of the Rehabilitation Act of 1973 that prohibits discrimination based upon disability. Section 504 is an anti-discrimination, civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of non-disabled students. It a legal requirement for students identified with a physical and/or mental impairment, but whose needs may not be otherwise addressed under special education services. It is developed by school (or district) health services staff, in conjunction with the student’s family, parents and/or caregivers to ensure the health and educational needs of identified students are being met.

Technical assistance (TA): refers to tailored guidance to meet the specific needs of a site or sites through collaborative communication between a specialist and the site(s). Assistance takes into account site-specific circumstances and culture and can be provided through phone, mail, e-mail, Internet, or in-person meetings. Technical assistance may be delivered by the State Department of Health and/or its partners. Note that the length and degree of effectiveness of technical assistance varies.

Triennial: Recurring every three years.