**Schools and Terrorism**

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**A Supplement to the**

**National Advisory Committee on Children and Terrorism**

**Recommendations to the Secretary**

**August 12, 2003**

**Schools and Terrorism**

**A Supplement to the Report of the**

**National Advisory Committee on Children and Terrorism**

**Introduction**

Schools may or may not be the targets of terrorism, but they are certain
to be affected by terrorism, whether directly or indirectly. The
likelihood that one or more schools will be in the vicinity of terrorist
targets is demonstrated by the events of September 11, 2001. When the
first airplane hit the north tower of the World Trade Center, four
elementary schools and three high schools were beginning classes within
6 blocks of the site of the attack (Bartlett and Patrarca, 2002).
Thousands of children were exposed to the dust cloud from the collapsing
buildings. Even those children not in the immediate vicinity experienced
a great deal of anxiety. Children in at least three states (New York,
New Jersey, and Connecticut) had parents working in or around the World
Trade Center that day. Their schools were forced to consider whether to
allow students to watch the events unfold, whether family members would
be able to return from lower Manhattan to retrieve their children at all
that day, and whether some students might have lost family members in
the attack. In the Washington, DC area schools faced similar questions
after the Pentagon was attacked. Gridlocked streets and parents
desperate to get to their children compounded problems. In fact, all
across the country, schools were inundated by parents rushing in to pick
up their children.

The U.S. Department of Education strongly encourages every school,
public and private, to have an emergency management plan (U.S.
Department of Education, Office of Safe and Drug-Free Schools, 2003). In
addition, many states require districts and public schools to develop
such plans. Schools do not need new plans to address terrorism-related
issues. The basic components of most plans (i.e., crisis response team,
communications, emergency organizational chart, operations plans,
evacuation, shelter-in-place, transportation, emergency care, short- and
long-term mental health care) apply whether an emergency is caused by
terrorism, tornado, or school shooting. However, few plans address how
the school fits in with the larger public health (including mental
health) and emergency management response to a community-wide event,
such as a terrorist attack. Fewer still address foodborne or other
infectious disease outbreaks or contaminated food recalls. Some parts of
existing plans might need to be expanded or revised to address
terrorism-specific issues (e.g., terrorism may arouse different fears
and anxieties than natural disasters). Schools also might be required to
engage in some unique tasks to respond to a terrorism event (e.g.,
administering potassium iodide in the event of radiation exposure or
atropine for nerve gas). School health services vary by state and
community. Some schools have full-service school-based health centers
providing primary care and mental health services, some have full-time
school nursing staff, and some have only part-time nursing and
fragmented mental health and other services. Food service, physical
education staff, and health education staff are also school health
personnel and should be included in preparedness, response, recovery,
and mitigation activities.

In order to adequately address the special needs of children, public and
mental health agencies, and other emergency responders, must involve
education agencies and schools in their planning processes. Local level
coordination is essential, but a good deal of planning occurs at the
state and national levels. Collaboration at these levels is also
necessary. The best way to address the needs of schools is through
collaboration between public health, mental health, medical care,
education, emergency management, law enforcement, fire, homeland
security, and transportation.

The recent TOPOFF 2 exercises provide a good example. Chicago used a
vacant school as a medical center for plague victims. Seattle conducted
drills, such as sheltering-in-place, after schools hours. Although
school officials were involved in the planning and enactment of the
drills, there were many questions that were not considered during the
planning and evaluation phases of the exercises, including: Can classes
continue to be held? Are school and community plans well-integrated, or
in conflict with one another? How would parents, students, and staff
respond to the idea that their building was being used to triage or
treat infected people? How could authorities and emergency responders
let parents, students, and staff know whether or not the disease or
condition was not one that spreads person-to-person? How would the
medical needs of children with chronic or disabling conditions be met?
How would alternative education be provided until students are able to
return to school? How would parents, students, and staff be given
assurance that they could safely return to the school building? How
would students be returned to their normal routine as quickly as
possible?

Preparation is the responsibility of every school, community, and state.
No one can afford to subscribe to an "It won't happen here" mentality.
As the fall 2002 sniper attacks in the Washington, DC, Maryland, and
Virginia area showed, no region of the country is safe from the impact
of terror.

***Why Schools?***

Schools are integral parts of their communities, but they also have
special needs that must be given consideration when integrating schools
into community plans, including the lack of dedicated fiscal and
staffing resources to support activities and services beyond the normal
role of schools. Schools are different from most other community
settings in a number of important ways.

**Schools are places where large numbers of children are gathered on a
daily basis**. Every day 53 million young people attend more than
119,000 public and private schools where 6 million adults work as
teachers or staff (U.S. Department of Education, 2002). Counting
students and staff, on any given weekday more than one-fifth of the U.S.
population can be found in schools. Nearly all -- 98% \-- of young
people aged 5 to 17 are students. The needs of schools to protect these
young people in their care in a terrorist event are critical to address.
In addition, if a disaster occurs during school hours, parents will go
to schools, which will serve as a point of reunification of children
with their families -- yet another reason for schools to be involved in
community planning.

**Schools are *in loco parentis****.* School officials have a special
responsibility for the children in their care. They are responsible for
their safety, and their safe return to their families. If an event
occurs in or near even a single school, the health care system will need
to collaborate with these school officials in order to triage and treat
many children at once. Because of their responsibilities towards
children with special needs, schools often have permission to dispense
medications, and access to health records of students documenting
medical history and requirements (e.g., medications available at school,
allergies, etc.). Schools are also responsible for children at times and
in ways that are not traditionally considered. These include, for
example: traveling to or from school via school or public
transportation; before or after school programs at school sites;
sporting events; field trips; Head Start programs; infants of teen
mothers attending high schools; and even students who are dropped off
before school hours for unofficial child care. Schools are places with a
cadre of individuals trained in the care, education, and supervision of
children. This is a key resource for children requiring supervision and
temporary guardianship.

**Schools are resources for response for their communities.** In times
of crisis, schools are often called upon to act as shelters, food
distribution centers, community meeting places, and even command
centers. Communities place extra, unfunded burdens on schools in this
situation. On September 11^th^, for example, Stuyvesant High School's
evacuation was prompted by an FBI agent who wanted the building for a
command center close to the site of the attack (Bartlett and Patrarca,
2002).

**Schools are places of learning**. Communities can work with schools to
build upon their inherent educational mission to teach children the
skills they need to be alert and respond to potential dangers in their
schools and communities, prepare for possible disasters that might
strike while they are at home, in the community, or at school, and even
emergency first aid skills they can use in response to a disaster.
Schools can also be a source of education for families and community
members.

**Schools are places of health care delivery**. In some communities,
schools may be the only health care provider for disadvantaged children.
In addition, schools maintain medical records for children. This is
especially important for children with special health care needs. In
many cases, the only other location besides home where a child with
special health care needs may have their medications, medical supplies,
and individuals who know about their medical history, medications, and
needs is at school.

**Schools are food service settings**. In addition to breakfasts,
snacks, potlucks, and food served at after-school events, 28 million
school lunches are served to students every day (U.S. Department of
Agriculture, Food and Nutrition Service, 2003). Schools have a
responsibility to ensure that foods provided to students and staff are
safe and free from intentional contamination.

**Schools are also places where recovery services can be delivered**.
Schools provide access to people in the neighborhoods in which they
live. No place else in the community has access to such a high
percentage of children and adolescents, and, through them, adult family
members. After past community crises, mental health, and other recovery
services, have often been offered through or at schools. As microcosms
of their communities, anxieties, tensions, and intolerance will be
played out in schools. A basic capacity, or partnerships with community
agencies, to deliver health and mental health services is a necessity
for schools.

***Integration is key.***

Recovery services and schools are a natural fit. Nonetheless, all phases
of emergency management can and should be addressed in conjunction with
local education agencies (also known as "districts") and schools. Many
different federal, state, and local agencies are developing plans and
resources to address potential terrorist events. In order to adequately
address the special needs of children, public health agencies (including
mental health), and other emergency responders, must involve education
agencies, schools, and parents in their planning processes. Working
together at the federal level will model collaborative approaches for
states and locals. For example, the Federal Response Plan is a system
for bringing together multiple federal agencies. However, the US
Department of Education (ED) is included in only one component of the
multifaceted plan. The same is true for the involvement of state
education agencies in state plans. For schools and education agencies to
be effective partners, they should be included in all components of the
planning process. What happens in schools in a disaster situation does
not happen in a vacuum.

Similarly, large amounts of funds have been made available to the
states. For example, the Centers for Disease Control and Prevention
(CDC) Public Health Preparedness and Response for Bioterrorism funding
provided \$940 million to the states to upgrade state and local public
health jurisdictions' preparedness for and response to bioterrorism and
other public health threats and emergencies. States were not directed to
work with state or local education agencies to address the special needs
of children. In addition, the CDC has funded several Centers for Public
Health Preparedness, but working with local education agencies and
schools is not an integral part of their activities.

In other cases, funding is directed locally and state-wide coordination
or collaboration is limited. Multiple resources might be directed to
only one or two large cities while other parts of a state are not
provided resources. State agencies can play an important role in
conducting broad-based efforts, including the allocation of resources
and training to local agencies to ensure a coordinated and seamless
state-wide effort.

Schools and local education agencies need to be an integral part of
community-wide plans. Comprehensive, multi-hazard emergency management
plans must be developed and implemented by local public health, law
enforcement, emergency response, and education agencies together. Joint
trainings are one way to build partnerships across multi-disciplinary
trainings. For example, in October 2002, the City of Memphis (TN)
provided multi-hazard emergency planning training to 500 planning team
members representing all of the Memphis public schools and at least one
private school. The purpose of this training was to assist schools to
implement a comprehensive emergency planning process in coordination
with their local fire, police, EMS, and emergency management personnel.

A partnership between public health and education has many potential
benefits for all involved. Public health can provide, for example,
expert health guidance on appropriate school responses to specific
hazards, and plans for triaging injured students. Schools can provide
health and mental health services onsite and ensure the safety of
students in their care. Together public health and education can provide
for the safety and health of children.

**Preparedness**

Preparedness involves planning how to respond when an emergency or
disaster occurs and working to marshal the resources needed to respond
effectively. Just as schools and education agencies cannot prevent
natural disasters, they may not be able to prevent a terrorist event.
But, they can plan how to respond when an emergency does take place,
either in school or the community. Federal and state education agencies
urge every school to have an emergency management plan, but do not
require school plans to be integrated with statewide planning efforts.
Most preparedness efforts originating from the education arena are
targeted at, or take place at the local level. Most public health
preparedness efforts do not fully engage local education agencies and
schools.

***What is currently being done?***

In March 2003, ED revealed a new website**,
[www.ed.gov/emergencyplan](http://www.ed.gov/emergencyplan)**, to
provide school leaders with more information about emergency
preparedness. The website includes crisis planning resources and links
to other federal, state, local, and nongovernmental resources.

In addition to the website, ED is making **\$38 million** available in
FY 2003 to help school districts improve and strengthen emergency
response and crisis management plans. Funds can be used to train school
personnel, parents and students in crisis response; coordinate with
local emergency responders including fire and police; purchase
equipment; and coordinate with groups and organizations responsible for
recovery issues, such as health and mental-health agencies. An
additional \$30 million is included in the proposed FY 2004 budget.

ED recently released **Practical Information on Crisis Planning: a Guide
for Schools and Communities** (May 2003). The Guide is intended to guide
schools and school districts through crisis planning. The plan describes
key components and action steps to address mitigation, preparedness,
response, and recovery.

In April of 2002, ED and the Harvard School of Public Health sponsored a
teleconference, entitled **The Three R's to Dealing with Trauma in
Schools: Readiness, Response, and Recovery**. The purpose of this
teleconference was to provide educators and community workers with the
most current information on effective steps for dealing with crises such
as school shootings or attacks like those of September 11^th^.

The National Clearinghouse for Educational Facilities website,
www.edfacilities.org, includes an extensive resource list on **Disaster
Preparedness for Schools**. The list includes links, books, and journal
articles on building or retrofitting schools to withstand natural
disasters and terrorism, developing emergency preparedness plans, and
using school buildings to shelter community members during emergencies.

CDC funds education and health agencies in 18 states to strengthen their
capacity to plan and implement **Coordinated School Health Programs**.
The coordinated school health program model holds that all components of
the school health program must interact, support, and reinforce each
other to ensure student health. A coordinated school health program goes
beyond the health education curriculum to include physical education;
health services (including mental health and counseling); food services;
a healthy and safe school environment; staff health promotion and
training; and family and community involvement. The CDC funded states
build partnerships between education and health agencies to address
school health, but have not yet focused on terrorism or disaster
preparedness through coordinated school health programs.

In May 2002, CDC, ED, Federal Emergency Management Agency (FEMA), and
the FBI hosted a teleconference, entitled **CDC and US Department of
Education Collaborate to Help Schools Prepare for Possible Terrorism,**
to provide state and local education, health, emergency management, law
enforcement and homeland security agencies with updated information on
biological, chemical, and radiological threats; answer questions about
school preparedness and response; and describe roles of partnering
agencies in the case of a terrorist threat. This teleconference is
available as an archived webcast or on videotape. The website,
<http://www.phppo.cdc.gov/PHTN/schools/default.asp>, also includes
frequently asked questions and a state team discussion guide.

CDC's **School Health Guidelines to Prevent Unintentional Injuries and
Violence**, published in December 2001, include recommendations for
establishing mechanisms for short- and long-term responses to crises,
disasters, and injuries that affect the school community as part of a
coordinated school health program. Recommendations address written
response plans, preparations for response, and short- and long-term
responses and services after a crisis.

In addition, the CDC funds **Centers for Public Health Preparedness**
throughout the country with the goal of linking schools of public
health, state and local health agencies, and other academic and
community health partners to prepare the nation's public health and
healthcare workforce to respond to terrorist incidents and other
emerging health threats. Working with schools is not an integral part of
their activities

The Agency for Healthcare Research and Quality (AHRQ) has provided the
American Academy of Pediatrics with one year of funding for the
development of a **Pediatric Terrorism Preparedness Resource**. This
resource will include information such as equipment lists, medication
dosages, protocols, and training packages that could improve the ability
of all health care professionals to undertake preparation and planning
activities for schools. The resource also will include educational and
training material that could be used by pediatricians and other health
care professionals to guide school disaster preparedness efforts.

In February 2003, AHRQ and Emergency Medical Services for Children
(EMS-C) co-sponsored a **National Consensus Conference** which developed
guidelines for Pediatric Disaster and Terrorism Preparedness. In
addition to the multitude of recommendations that apply to children,
there is a specific section providing recommendations and guidelines for
children in schools.

The Health Resources and Services Administration (HRSA) and EMS-C
jointly published the **Basic Emergency Lifesaving Skills** (BELS)
framework for teaching emergency lifesaving skills to children and
adolescents. The framework includes information on the sequence of basic
emergency lifesaving skills performance and K-12 developmental
principles and teaching strategies for learning basic emergency
lifesaving skills. The **BELSS Initiative** is designed to increase the
number of school-aged youth who are competent in safety, first aid,
cardiopulmonary resuscitation, and automatic external defibrillator
skills by training their teachers as instructors and providing curricula
to promote the development of these skills. Trainings currently are
planned for Wisconsin, Minnesota, North Dakota and South Dakota.

FEMA has numerous resources for school disaster preparedness. The
**Multi-Hazard Emergency Planning for Schools Train-the-Trainer Course**
trains state and local multi-disciplinary teams representing education,
police, fire, emergency management, EMS, and public health. These teams
return to their communities and conduct additional training for
education personnel. The **Multi-Hazard Emergency Planning for Schools
Independent Study Course** provides the basic information and tools
needed to develop effective all-hazard emergency operation plans for the
wide array of potential emergencies that schools may face. Course
components include understanding emergency management, team recruitment,
hazard assessment, and plan development and testing.

**FEMA for Kids**, www.fema.gov/kids, was created to help children cope
with disasters and to educate them about mitigation strategies.
Highlights include \"The Disaster Area,\" which teaches children
disaster-specific information about what to do in each disaster,
including a national security emergency and \"Get Ready, Get Set\" that
teaches children preparedness and mitigation measures to protect their
homes and families before disaster strikes. The FEMA website,
[www.fema.gov](http://www.fema.gov/) includes resources on community and
family preparedness.

***What are the gaps?***

Clearly, there are many preparedness activities underway. However, there
is no coordination between these activities. Few activities, notably the
CDC and ED teleconference and the FEMA multi-hazards training course,
are designed to foster collaboration between education, public health,
and other emergency responders at the state or local level, or across
levels.

Although schools are urged to plan, and the recent ED emergency planning
grants will help the process, school plans are often treated as a
separate plan rather than as part of the community plan. When
collaboration with other community agencies is discussed, it is usually
with law enforcement, fire, and homeland security, not with public
health and mental health preparedness efforts. School plans tend not be
practiced as part of larger community preparedness exercises. By working
together, education and health agencies could:

-   Address preparedness as part of a coordinated school health program;

-   Provide for baseline school health services, including mental
    health;

-   Integrate existing school-based health services into plans to
    coordinate health care service delivery in schools;

-   Give schools the information they need to prepare for the
    possibility of chemical, biological, and radiological threats as
    well as the terror generated by these threats;

-   Plan for students with special health needs;

-   Plan for the needs of schools and students outside mainstream
    educational settings, e.g., schools for the deaf, juvenile justice
    facilities;

-   Understand issues around bioterrorism and mass trauma events of
    particular importance to children and schools (e.g., developmentally
    appropriate responses);

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-   Establish mechanisms for reviewing outside offers for help after an
    event;

-   Train first responders about the special needs of schools and
    children;

-   Train teachers, other school personnel, and parents to triage
    injured and sick children, manage trauma reactions in children, and
    take care of their own needs;

-   Involve schools, parents, and students in the planning process;

-   Measure the level of preparedness at state, district, and school
    levels;

-   Conduct practice exercises for biological, chemical, radiological,
    and mass casualty events where public health will have the lead in
    response (in ways that do not increase fears among children, or
    where such fears can be addressed); and

-   Address mental health issues that arise around doing practices.

***Recommendations***

1.  Ensure that every major DHHS-funded terrorism initiative, and other
    federal terrorism initiatives, appropriately addresses the role and
    needs of schools by providing regulatory requirements, oversight and
    funding to result in effective linkages between state and local
    education agencies, schools, public health agencies and other
    emergency preparedness entities.

    a.  Establish an ongoing schools workgroup within homeland security
        efforts (e.g., Operation Liberty Shield) in order to ensure that
        all relevant federal agencies plan together for the safety of
        schools and students and the integration of schools into
        community plans.

2.  Expand CDC's School Health Program by supporting a high-level staff
    position in every state education agency and health department to
    coordinate policies and programs focused on the physical and mental
    health needs of students. As a central part of their mission, these
    staff should collaborate to ensure that schools are prepared to
    protect the lives and health of students and staff in emergencies.
    State school health leads, in education and health agencies, should
    work closely with state mental health, law enforcement, emergency
    management, and homeland security agencies and should receive at
    least a one-week course on the essentials of terrorism preparedness
    and risk communication.

3.  Develop a plan and mechanism for flow of models of cooperation
    between the federal, state, and local levels. Some local communities
    and states have been very successful at developing collaborative
    planning relationships between public health, education, law
    enforcement, and homeland security. Reviewing these models could
    help improve other state and local, as well as federal, efforts at
    collaboration. Federal collaborations can also be models for states
    and locals.

4.  Develop and disseminate information and measurement instruments to
    assess and improve the capacity of schools to prepare for and
    respond to chemical, biological, radiological, and mass trauma
    (physical and psychological) terrorism including:

    a.  materials on the handling, identification, response, and
        decontamination for acts of chemical, biological, and
        radiological terrorism and related to specific hazards;

    b.  psychosocial preparedness interventions for students and school
        personnel to increase resilience;

    c.  mechanisms for addressing the needs and concerns of students and
        family members in preparedness and planning activities;

    d.  instruments schools and education agencies can use to establish
        baseline mental "wellness" as well as the impact of school
        violence and other crises; and

    e.  protocol templates for working with outside individuals or
        groups to provide mental health services after an event.

5.  Build the capacity of education and public health agencies to work
    together on preparedness by:

    a.  developing additional collaborative efforts built upon the May
        2002 teleconference developed by the Department of Education
        (ED), Centers for Disease Control and Prevention (CDC), Federal
        Emergency Management Agency (FEMA) and Federal Bureau of
        Investigation (FBI) to provide state and local education, public
        health, mental health, emergency management, law enforcement,
        and homeland security agencies with updated information on the
        agents of terrorism, provide technical assistance on school and
        community preparedness and response, and serve as a model for
        state-based collaborations.

    b.  developing and disseminating resources on how schools work and
        on working with schools to the public health community;

    c.  providing technical assistance to schools to assist them in
        joining community planning activities;

    d.  developing and disseminating guidance for schools on how to
        establish agreements with local medical facilities and health
        departments and what such agreements should contain;

    e.  developing expertise on the school-based management of emergency
        response for children with special healthcare needs, including
        medically fragile children;

    f.  funding mechanisms to provide the minimum necessary number of
        health professional staff in schools to provide planning
        leadership and technical expertise if an event occurs; and

    g.  ensuring that existing school health and school-based health
        services have necessary equipment and support the acquisition
        and upkeep of such equipment, and staff development on its
        operation.

6.  Conduct and support research addressing preparedness of schools and
    their ability to respond to terrorism by:

    a.  identifying \"best practices\" related to preparedness and
        recovery mental health services;

    b.  determining the impact of preparedness activities on student
        mental health and wellness;

    c.  studying whether schools are getting adequate information on
        chemical, biological, radiological, and mass trauma threats;
        whether they are satisfied with the information they are
        receiving; what types of information they would like to receive;
        and how they would like to receive it;

    d.  describing the ability of school staff to balance the needs of
        their own children and families with those of the children in
        their care; and

    e.  expanding the CDC School Health Policies and Programs Study to
        gauge state, district, and school preparedness, particularly in
        the areas of mental health services and availability and
        preparation of school health personnel to triage and respond to
        chemical, biological, radiological, or mass trauma events.

**Response**

Schools have a key role to play in the response phase. The response
phase involves providing emergency assistance and trying to reduce the
likelihood of further damage during and immediately following a
disaster. If any type of disaster happens in the community during a
school day, schools will be either safe havens for students or will be
responsible for safely reuniting them with their families. If an event
directly impacts a school, school personnel will be the first responders
on the scene, with responsibility for safeguarding students' physical
and mental health. However, few schools have nurses or other health
professionals on-site or available in sufficient numbers to recognize an
outbreak in progress or to handle a disaster situation without
assistance from other school staff or community responders. For example,
a recent California State PTA survey found that 25.8% of California
public schools (which educate over 6.2 million students) never have a
school nurse on campus (California State PTA, 2003). School personnel
will also have concerns about the well-being of their own children and
families. During community-wide events, schools are also often emergency
assistance sites or staging areas for community response.

***What is currently being done?***

The **Federal Response Plan** (FRP) "establishes a process and structure
for the systematic, coordinated, and effective delivery of Federal
assistance to address the consequences of any major disaster or
emergency." (FRP, p. 1) The Basic FRP, its 21 Annexes, and 4 Appendices
contain only three mentions of the term "school" -- once each in the
Information and Planning Annex, Mass Care Annex, and Food Annex. ED is a
party only to the Information and Planning Annex as a support agency. In
this capacity, ED should identify a staff liaison or a point of contact
at both the regional and headquarters levels to provide technical
expertise, data, advice, and staff support for disaster operations and
situation assessment activities that relate to schools (ESF #5, p.94).
The Mass Care Annex description of a likely disaster condition states
that "Thousands of family members may be separated immediately following
a sudden-impact disaster, such as children in school and parents at
work" (ESF #6, p.102). The Food Annex points out that "on the fringes of
the geographic areas affected will be schools and small institutions
having large inventories estimated to be sufficient to feed up to 10,000
people for 3 days and supply their fluid needs for 1 day" (ESF #11,
p.173).

CDC's **Public Health Preparedness and Response for Bioterrorism**
funding has provided \$940 million to the states to upgrade state and
local public health jurisdictions' preparedness for and response to
bioterrorism, other outbreaks of infectious disease, and other public
health threats and emergencies. The funding addresses preparedness
planning and readiness assessment, surveillance and epidemiology
capacity, laboratory capacity, communications and information
technology, health information dissemination, and education and
training. Schools are mentioned twice in the Budget Year Four
Continuation Guidance: recipients might establish the capacity to
conduct public outreach campaigns which could include presentations to
schools; and recipients are to develop communications materials
regarding smallpox for local stakeholders such as school
representatives.

The **Bioterrorism Hospital Preparedness Program** (BHPP) program is
administered by HRSA in collaboration with the Assistant Secretary for
Public Health and Emergency Preparedness and coordinated with other
entities that assist state and local health agencies with bioterrorism
preparedness. The mission of the BHPP is to ready hospitals and
supporting health care systems to deliver coordinated and effective care
to victims of terrorism and other public health emergencies. The program
will also allow state and regional planning among local hospitals,
emergency medical services systems, community health centers, poison
control centers, and other health care facilities to improve their
preparedness to combat a terrorist attack. BHPP recipients are directed
to establish a Healthcare System Terrorism Preparedness Planning
Committee that meets at least quarterly to provide guidance, direction
and oversight to the state health department in planning for the state's
terrorism response. Recent guidance directs recipients to create a joint
advisory committee for both the CDC and HRSA cooperative agreements.
Recipients have not been directed to include state and local education
agencies or schools on these committees.

The **Metropolitan Medical Response System** (MMRS) operates at the
local level to respond to a mass casualty event. The primary focus of
the MMRS program is to develop or enhance existing emergency
preparedness systems to effectively respond to a public health crisis,
until state or federal resources are mobilized. Through preparation and
coordination, local law enforcement, fire, hazmat, EMS, hospital, public
health, and other first responders plan to more effectively respond in
the first 48 hours of a public health crisis. Currently, over 120
metropolitan areas have developed, or begun to develop MMRS. Although
communities are directed to create a steering committee, state or local
education agencies are not suggested as members. In addition, MMRS does
not address special medical responses that might be needed if a
terrorist event were to occur in the vicinity of a school, potentially
impacting hundreds or thousands of children simultaneously. On March 1,
2003, MMRS moved from HHS to the Department of Homeland Security.

ED, in partnership with the American Red Cross, has created a **program
to certify teachers and other school staff in first aid**. The first
pilot training program occurred in May 2003 in Montgomery County,
Maryland. ED will be conducting pilot training programs around the
country in upcoming months to train school staff and provide students
basic first aid and emergency preparedness information that they can
take home to their families.

***What are the gaps?***

As was clear in the Preparedness phase, lack of coordination and
communication between public health, education, and other first
responders, remains a concern in the Response phase. State and local
education agencies are not included on terrorism response planning
committees mandated by various funding mechanisms. State and local
agencies are not given meaningful information on how to involve
education agencies and schools in the planning process.

Although school nurses, where available, and other school personnel will
likely be heavily involved in triaging and treating injured students in
the event of a terrorist attack at or near a school, school personnel
have not typically been included in emergency response plans or trained
in handling medical emergencies. Neither are mental health concerns
typically addressed in the response phase.

Little attention has been given to the possibility that students might
need to be quarantined at school, which could include being separated
from parents. Communication with parents should be effective and
efficient. Schools and other first responders must be able to
immediately address parent concerns about their children's health and
safety. Students with special health care needs need particular
consideration if sheltering-in-place or quarantine becomes necessary.
Schools need an adequate supply of medications and special medical
equipment to care for these students for up to 72 hours, as well as
staff who are trained in their care.

In the aftermath of a terrorist event, schools will be called upon to
provide services typically not within their realm of expertise. By
working together, health and education agencies can ensure that schools:

-   Coordinate their response with that of public health, emergency
    management, law enforcement, and homeland security agencies;

-   Communicate effectively with these agencies;

-   Are prepared to look after student physical health, triage injured
    and exposed students, provide emergency medical assistance, and
    engage in quarantine;

-   Are prepared to immediately address student mental health concerns;

-   Have an adequate supply of medications, medical equipment, and
    trained staff to care for students with special health care needs
    for an extended period of time;

-   Provide staff with the training necessary to identify foodborne and
    other disease outbreaks and methods for preventing their spread;

-   Address the needs of school personnel to ensure that their own
    children and families are safe in order to effectively care for
    their students;

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-   Can work with public health officials to administer to all students
    potassium iodide within 2 hours of exposure to radioactive iodine
    from a nuclear plant catastrophe or "dirty bomb" explosion;

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-   Have recommendations on hand related to specific biological,
    chemical, and radiological hazards;

-   Know when it is appropriate to shelter-in-place or evacuate the
    school, and have the means to do both;

-   Know what activities are appropriate when sheltering-in-place (e.g.,
    whether classes should continue, whether other activities are
    appropriate, how to feed and shelter students);

-   Plan for the possibility of quarantining classrooms or schools;

-   Address the needs of students who are in transit to or from school
    when an event takes place; and

-   Are prepared for the possibility of serving as either a staging area
    for community response or as a community shelter.

***Recommendations***

1.  Ensure that each major content area in DHHS-funded terrorism
    initiatives, and in other federal initiatives, addresses the role
    and needs of schools by providing dedicated fiscal resources and
    regulatory oversight to ensure that state and local health
    departments, and other agencies involved in this work, truly build
    partnerships with state and local education agencies and schools.

    a.  Revise the **Federal Response Plan**, indicating the need for
        schools to be an integral part of preparedness, response,
        recovery, and mitigation efforts.

        -   The Department of Health and Human Services is responsible
            for the Health and Medical Services Annex to the FRP (ESF
            #8). The Secretary should request that the Department of
            Education sign on as a Support Agency. Support
            responsibilities might include: (a) assist in providing
            emergency health services, including quarantine, to children
            in schools at the time of a disaster; (b) assist in
            identifying and addressing special needs of children in
            regards to reuniting with families, communication, and
            transportation; (c) assist in providing mental health
            services for children affected by the disaster; and (d)
            communicate to constituents that providing healthcare and
            mental health services are key roles of schools.

        -   The American Red Cross has the lead for the Mass Care Annex
            of the FRP. The Secretary should suggest that the Department
            of Education sign on as a Support Agency to assist in
            addressing the special needs of schools and students. This
            could include management and coordination of sheltering,
            feeding, evacuating, and providing emergency first aid
            services to children in school at the time of a disaster, or
            otherwise separated from their families; providing
            logistical guidance and support for reuniting students with
            their families; identifying schools that can serve as
            community shelter locations; and planning for the use of
            schools as alternative health care sites for triage and/or
            treatment by identifying specific schools and ensuring that
            they are equipped with pediatric equipment and supplies.

        -   The Department of Agriculture, Food and Nutrition Service
            (FNS) has the lead for the Food Annex of the FRP. Suggest to
            FNS that schools be considered not only as potential sources
            of food and fluids on the fringes of the affected area, but
            that the special needs of schools within a disaster area
            also be addressed. Suggest that the Department of Education
            sign on as a Support Agency to assist in this regard.

    b.  In renewed and future Requests for Applications/Cooperative
        Agreement Awards for **Public Health Preparedness and Response
        for Bioterrorism**, and in associated guidance documents, add
        the following language:

        -   In the Introduction, add School Health Programs to the list
            of CDC programs with which recipients should "augment,
            complement, and closely coordinate."

        -   In Attachment X, Cross-Cutting Benchmark #2, add state and
            local education agencies to the list of required members of
            the Advisory Committee.

        -   In Focus Area A, Critical Benchmark #2, require the
            recipients to work with the advisory committee to develop or
            enhance their response plans.

        -   In Focus Area A, Critical Capacity #3, Item 5, add education
            agencies to the list of agencies recipients should work with
            to identify vulnerabilities in terms of human health
            outcomes.

        -   In Focus Area B, Critical Capacity #5, Item 5, add school
            health professionals to the list of healthcare professionals
            for whom ongoing disease surveillance and epidemiology
            training should be provided.

        -   In Focus Area B, Enhanced Capacity #6, Item 6, add state and
            local education agencies to the list of organizations with
            whom recipients should establish designated points of
            contact and cross-training.

        -   In Focus Area E, Critical Capacity #11, add state and local
            education agencies to the list of entities with whom
            recipients should ensure effective communications
            connectivity.

        -   In Focus Area G, Critical Capacity #16, add school health
            personnel to the list of public health professionals to be
            educated and trained in preparedness for and response to
            bioterrorism.

    c.  CDC conducts site visits to states to provide technical
        assistance in implementing Cooperative Agreement Awards for
        **Public Health Preparedness and Response for Bioterrorism**.
        The Secretary should direct CDC to specifically review efforts
        to include educational agencies in the planning process and to
        meet the needs of schools. Funding should also be provided to
        bring educational agencies into the planning process.

2.  Add language to the *Model Public Health Act* indicating the need
    for schools to be an integral part of bioterrorism planning.

3.  Conduct and support research addressing issues affecting the ability
    of schools to respond to terrorism including:

    a.  what constitutes an adequate supply of potassium iodide,
        antitoxins, and other medical supplies and equipment necessary
        to treat students in schools. Make these supplies available to
        schools and train school personnel to use them; and

    b.  availability and preparation of school health and mental health
        personnel to triage and respond to chemical, biological,
        radiological, nuclear or mass trauma events, as well as the
        terror generated before, during and after an event.

**Recovery**

Schools are uniquely positioned to provide normalization and security to
children and should be a part of recovery efforts. The recovery phase
includes engaging in short-term efforts to restore people to physical
and mental health and vital systems to minimum operating conditions; and
long-term efforts to restore entire disaster areas to previous
conditions or better. Schools should remain open whenever possible.
Keeping students engaged in their regular routine, including attending
school, is a key to maintaining their resiliency. However, school
buildings may be damaged or contaminated and in need of repair before
classes can resume and services can be offered. Alternate locations may
be needed if school buildings need extensive repairs or rebuilding.
Transportation systems to and from school also may be damaged. The
mental health of students is an essential ingredient for meeting
schools' academic mission: Students suffering from anxiety, PTSD, or
grieving the loss of friends or loved ones will have difficulty
learning. Mental health services can be delivered through schools,
particularly in underserved areas, in order to efficiently reach a large
number of children. Schools provide an optimal location for discussion,
peer, and adult support. In order for schools to support children who
are having difficulty coping with a traumatic event, staff must be
supported and be aware of their own responses to the traumatic event.

***What is currently being done?***

Immediately following the events of September 11^th^, ED made \$8.9
million of **Project School Emergency Response to Violence** **(Project
SERV)** funds available to the New York City Board of Education, and
state educational agencies in New York, New Jersey, Connecticut,
Virginia, Maryland, and Washington D.C. Funds awarded to the state
educational agencies were distributed to school districts that were
impacted by September 11^th^. Funds awarded to the New York City Board
of Education were distributed to various school districts within the
city. Funds from Project SERV were used by school districts to help
restore the learning environment and for a variety of mental health
services. Project SERV funds also supported a study conducted by
Columbia University to assess the mental health effects of September
11^th^ on children in over 8,000 school children in NYC public schools.
CDC provided technical assistance to this study.

The Substance Abuse and Mental Health Administration (SAMHSA), in
collaboration with Project SERV, has developed a **Guide for
Intermediate and Long-Term Mental Health Services after School-Related
Violent Events**. This document provides guidelines for school staff and
community mental health personnel to establish and maintain immediate,
intermediate, and longer-term mental health recovery services necessary
to restore the social and emotional equilibrium and well-being of
students and staff after violent events. SAMHSA also developed a guide
on **Coping with Traumatic Events, Tips for Teachers** which provides
tools to assist teachers to develop students' emotional and
psychological coping and resilience skills during times of crisis.

SAMHSA funds the **National Child Traumatic Stress Network (NCTSN)** to
raise the standard of care and improve access to services for
traumatized children, their families, and communities throughout the
United States. The NCTSN will work with established systems of care,
including the educational system, to ensure that there is a
comprehensive continuum of care available and accessible to all
traumatized children and their families.

For over 25 years, the FEMA/SAMHSA Interagency Agreement to Provide
Crisis Counseling Assistance and Training **Crisis Counseling Program**
has supported short-term interventions with individuals and groups
experiencing psychological sequelae as a result of large-scale
disasters. These interventions assist disaster survivors in
understanding their current situation and reactions, assist survivors in
reviewing their options, promote the use of coping strategies, provide
emotional support, and encourage linkages with other people and
services. Upon receiving a Presidential disaster declaration, if a state
determines that state and local resources are insufficient to meet
mental health service needs, the state mental health authority can
request supplemental funds from FEMA.

The Trauma Psychiatry Program at UCLA, as part of the NCTSN, has
produced a **Trauma Information Pamphlet for Teachers**. This pamphlet
includes information on types of posttraumatic stress reactions,
consequences of these reactions for adolescents, things that make these
reactions worse, and information on how teachers can help.

***What are the gaps?***

> Only a small percentage of children in the United States receive the
> mental health treatment they need. For those children who do receive
> needed mental health services, schools are the primary providers (U.S.
> Department of Health and Human Services, 1999). However, short- and
> long-term mental health services in schools or tied to schools remain
> scarce. In addition, there is a lack of information on baseline mental
> health of children in the absence of a terrorist event.

Children who are displaced from their schools due to a terrorist event,
disrupting their daily routines for an extended period of time, are
likely to be at increased risk for post-event difficulties. In addition,
anxious or ill children do not learn well, jeopardizing the school's
academic mission. Most schools are not well-equipped to address the
mental health needs of students, and staff, after a terrorist event.
Funding to support school mental health services is scarce.
Relationships between mental health providers and schools need to be
established in advance of a crisis. School staff can be trained to
identify and refer students who appear to be in need of mental health
services. Mental health providers should develop working partnerships
with schools in order to address the mental health impact of terrorism
on children. Project SERV and FEMA/SAMHSA activities should be
coordinated to prevent gaps in service provision. Schools may be
inundated with outside proposals to provide services and conduct
research. Schools must review these to determine their appropriateness
for the setting and to balance the needs for supportive intervention and
normalization.

> School officials are responsible for ensuring the physical safety of
> school buildings and grounds. Little information is available to help
> school officials understand what remediation actions are needed to
> ensure the safety of school property after a terrorist event,
> especially an event involving biological, chemical, or radiological
> agents. Nor is there guidance for schools about when it is safe to
> reopen damaged school buildings, or those impacted by biological,
> chemical, or radiological agents.

***Recommendations***

1.  Collaborate with the Secretary of Education to formalize
    partnerships at the federal, state and local levels, and coordinate
    activities to ensure that schools are fully integrated into
    preparedness, response, recovery, and mitigation efforts. Specific
    activities on which HHS and ED can work together are:

-   Add funds to the School Emergency Response to Violence Project
    (SERV) contingency fund, increasing the government's capacity to
    respond in a fast and flexible manner to meet the critical needs of
    schools and students after a crisis in the school or community.

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-   Increase collaboration and linkages between Project SERV and SAMHSA
    crisis counseling services.

-   Fund demonstration projects that evaluate the effectiveness of
    school-based responses to past emergencies (e.g. Columbine high
    school shootings, September 11^th^) and expand and evaluate existing
    emergency planning and response models (e.g., New York City, Los
    Angeles) for involving education agencies and schools in a
    coordinated system of response and recovery.

-   Train students, staff, and family members to be first responders.

-   Ensure that schools are part of community-based planning and
    training as both community resources and as places where large
    numbers of children and adolescents are congregated.

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-   Ensure that schools place a high priority on returning students to
    school and their normal routines as quickly as possible after an
    event as one important method for supporting their resiliency.

-   Establish a school terrorism and disaster psychosocial preparedness
    and recovery technical assistance center.

2.  Develop and disseminate materials and fund staff development for
    teachers and other school personnel about:

    a.  symptoms of psychological disturbances among children and how to
        refer students to appropriate care;

    b.  the importance of fostering resiliency among children and
        methods for doing so; and

    c.  methods for managing the stress of on-going terrorism threats.

3.  Develop and disseminate guidance for school officials regarding:

    a.  remediation actions that might be necessary after different
        potential types of terrorist events;

    b.  the importance of mental health screening and mechanisms for
        determining what should be permitted in an emergency setting;
        and

    c.  when it might be safe to reopen damaged school buildings, or
        those contaminated by biological, chemical, or radiological
        agents.

**Mitigation**

Public health and education agencies can work together to reduce the
chance that terrorism will lead to a disaster in schools. Mitigation
includes activities that eliminate or reduce the chance of occurrence or
the effects of a disaster. Mitigation can include modification to
policies and practices (e.g., visitor policies, baggage checks, food
biosecurity practices); to facilities (e.g., physical barriers, air
filtration systems, building design); and even to people (e.g., students
and staff can be taught to be alert to potential terrorist threats).

Schools cannot mitigate the chance of a terrorist event in isolation
from public health and other state and local agencies. Partnerships
between education and public health can benefit both schools and their
communities. Schools could collect, compile, and report health data that
might indicate a biological, chemical, or radiological terrorist event
to appropriate health authorities. Likewise, schools could collect,
compile, and report health data that might rule out terror events (i.e.,
false positives). For example, data collection by schools was used to
rule out last year's skin rash epidemic as terror-related. In addition
to meals and snacks eaten throughout the school environment, 28 million
school meals are served daily in cafeterias. Public health and
agriculture officials could work with schools to ensure that this food
supply remains safe.

***What is currently being done?***

The US Department of Agriculture (USDA) Food and Nutrition Service is
developing **School Food Biosecurity Guidelines**. The USDA guidelines
include suggestions on how to form a school foodservice biosecurity
management team, how to identify and respond to intentional foodborne
disease outbreaks, use a checklist to prioritize suggestions for
strengthening biosecurity inside and outside the primary foodservice
area, and create a school foodservice biosecurity management plan. CDC
plans on working with USDA to integrate the school food biosecurity
guidelines into a forthcoming **Food-Safe Schools Action Guide**.

FEMA is developing a **Primer for Security Component for Safe Schools**
to provide comprehensive school security information with a focus on
physical attack prevention, mitigation design, and renovation. Primary
physical attack methods will include explosive, ballistic, sabotage,
biological, chemical, and radiological. The primer will include threat,
vulnerability, and criticality assessment; the relationships between
design for building security and design for natural hazards; measures
related to building sites and site planning, attack impacts on buildings
and their contents; methods of resisting attack; development of risk
management programs; and the relationship to emergency operations and
disaster recovery plans. This document is targeted towards design
professionals -- architects and engineers -- and school officials
involved in the technical and financial decisions of school
construction, repairs, and renovations.

On February 13-14, 2002, ED, in partnership with the US Department of
State and the Organization for Economic Cooperation and Development
(OECD), held an **International Forum on Response to Terrorism** to
discuss how schools could be protected from violence and terrorism. Key
educators and law enforcement personnel from ten countries (including
Israel, Turkey, Northern Ireland and Spain which have experienced
terrorist threats and attacks) attended the conference. A key finding
from this conference was that while terrorists generally have not had a
significant direct impact on education, they have had an indirect or
collateral effect on education in many countries; students have been
killed, injured, and experienced mental health problems even though they
were not the primary targets. In Turkey, however, terrorists did attack
schools directly. Over a period of 13 years (1984-1997), approximately
146 teachers were killed and 370 schools destroyed in terrorist
incidents. There was also a consensus among all participants that
security needs to be balanced with the need to maintain an environment
that is conducive to learning; none of the participants wanted to see
their schools become "bunkers."

ED is working with officials from the OECD to sponsor a **Second
International Meeting on the Prevention of School Violence and
Terrorism** with key education and law enforcement officials to share
information on the extent and nature of school violence and terrorist
threats and the best strategies for addressing them.

ED and the U.S. Secret Service released a guide, **Threat Assessment in
Schools: a Guide to Managing Threatening Situations and to Creating a
Safe School Climate***,* in May 2002. The guide is designed to help
educators and others charged with responsibility for ensuring school
safety identify youth who pose a threat to the school environment. ED
and the U.S. Secret Service trained state and local educators and law
enforcement personnel on the principles of effective threat assessment.
The threat assessment guide and its companion document, *The Final
Report and Findings of the Safe School Initiative: Implications for the
Prevention of School Attacks in the United States*, can be accessed at
[www.secretservice.gov/ntac_ssi.shtml](http://www.secretservice.gov/ntac_ssi.shtml).

ED has been working closely with the Bureau of Alcohol, Tobacco, and
Firearms to develop and disseminate a **Bomb Threat Guide**, based upon
the latest science, which will help school officials, develop strategies
for preventing and responding to bomb threats.

***What are the gaps?***

The challenge of mitigation is to make schools safer without turning
them into places where children would not want to be and where learning
would be more difficult. When schools look and act like prisons,
students do not learn well. By building partnerships at the state and
local level, schools can remain open to the community and still be safe.

Schools have the greatest chance of making improvements related to
policies, practices, and people, rather than in facility design. By
linking policies and practices to other areas of school health, school
safety can be improved efficiently while also addressing ongoing health
needs of children (e.g., by revising indoor air quality policies schools
can impact asthma and tobacco use in addition to terrorism, food
biosecurity programs can be tied to school nutrition efforts, safe
transportation systems might include ensuring the presence of sidewalks
for students who walk between school and home.)

Schools do not routinely collect or analyze illness, injury, or absence
data. By linking schools or districts with public health agencies to
improve data collection and analysis, it might be possible to quickly
detect health trends that could indicate the use of biological,
chemical, or radiological agents.

Schools can infuse lessons throughout the educational curriculum that
help students understand the root causes and history of terrorism,
conflict, and violence in their communities and throughout the world.
Schools can also teach students the skills, such as conflict resolution,
prosocial behaviors, and problem-solving that might lead to a decrease
in violence in their world.

***Recommendations***

1.  Fund CDC to work with USDA and other federal agencies to integrate
    model food biosecurity programs into existing coordinated school
    health programs. As part of this effort, states should be funded to
    forge state and local partnerships among health, education, and
    agriculture agencies to develop and implement strategic plans for
    integrating and improving school food biosecurity efforts within
    Food-Safe Schools.

2.  Integrate schools with public health surveillance programs that
    allow for trends in increased disease incidence and early detection
    of possible chemical, biological, or radiological terrorism.

3.  Collaborate with the U.S. Department of Education to develop and
    disseminate guidance for schools on effective modifications to
    policies, practices, facilities, and people that might mitigate the
    impact of terrorism on schools and students.

4.  Support school-based violence prevention education and programs that
    help students understand the root causes and history of terrorism,
    conflict, and violence in their communities and throughout the world
    and teach them skills (e.g., conflict resolution, problem-solving)
    that might lead to a decrease in violence in their world.

**References**

Bartlett S, Patrarca J. Schools of Ground Zero: Early Lessons Learned in
Children's Environmental Health. Washington, DC: American Public Health
Association and Healthy Schools Network, 2002.

California State PTA. California State PTA Healthcare Survey Statistics.
Los Angeles, CA: 2003.

U.S. Department of Agriculture, Food and Nutrition Service. Child
Nutrition Tables. Washington, DC: 2003. Available at
\<http://www.fns.usda.gov/pd/cnpmain.htm. Accessed June 5, 2003.

U.S. Department of Education, National Center for Education Statistics.
Digest of Education Statistics, 2001. Washington, DC: 2002.

U.S. Department of Education, Office of Safe and Drug-Free Schools.
Practical Information on Crisis Planning: A Guide for Schools and
Communities. Washington, DC: 2003.

U.S. Department of Health and Human Services. Mental Health: a Report of
the Surgeon General. Washington, DC: US GPO, 1999.

**This paper was prepared by:**

Brenda Greene

School Health Programs Director

*National School Boards Association*

*and*

*Member, National Advisory Committee on Children and Terrorism*

Lisa C. Barrios, DrPH

Joy Elizabeth Blair

Lloyd Kolbe, PhD

*Division of Adolescent and School Health*

*Centers for Disease Control and Prevention*

The paper and recommendations were developed through a process that
involved the following representatives of federal and state agencies and
nongovernmental organizations who reviewed drafts, participated in a
conference call, and submitted comments.

+-------------------------------------+-------------------------------+---+
| Nancy Birkhimer                     | Nora Howley                   |   |
|                                     |                               |   |
| State Adolescent Health             | Council of Chief State School |   |
| Coordinators Network                | Officers                      |   |
|                                     |                               |   |
| Augusta, ME                         | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+
| Evelyn Boeckler                     | Moniquin Huggins              |   |
|                                     |                               |   |
| EMS-C National Resource Center      | Department of Health and      |   |
|                                     | Human Services                |   |
| Washington, DC                      |                               |   |
|                                     | Administration for Children   |   |
|                                     | and Families                  |   |
|                                     |                               |   |
|                                     | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+
| Jim Bogden                          | Mary Grenz Jalloh             |   |
|                                     |                               |   |
| National Association of State       | New York State Center for     |   |
| Boards of Education                 | School Safety                 |   |
|                                     |                               |   |
| Washington, DC                      | New Paltz, NY                 |   |
+-------------------------------------+-------------------------------+---+
| Lorraine Brown                      | Mitzi Johnson                 |   |
|                                     |                               |   |
| Department of Health and Human      | National Association of       |   |
| Services                            | School Nurses                 |   |
|                                     |                               |   |
| Health Resources and Services       | Denver, CO                    |   |
| Administration                      |                               |   |
|                                     |                               |   |
| Head Start                          |                               |   |
|                                     |                               |   |
| Rockville, MD                       |                               |   |
+-------------------------------------+-------------------------------+---+
| Stephanie Bryn                      | Milagros Kennett              |   |
|                                     |                               |   |
| Department of Health and Human      | Department of Homeland        |   |
| Services                            | Security                      |   |
|                                     |                               |   |
| Health Resources and Services       | Federal Emergency Management  |   |
| Administration                      | Agency                        |   |
|                                     |                               |   |
| Maternal and Child Health Bureau    | Washington, DC                |   |
|                                     |                               |   |
| Rockville, MD                       |                               |   |
+-------------------------------------+-------------------------------+---+
| Cecilia Rivera Casale               | Theresa Lewallen              |   |
|                                     |                               |   |
| Department of Health and Human      | Association for Supervision   |   |
| Services                            | and Curriculum                |   |
|                                     |                               |   |
| Substance Abuse and Mental Health   | Development                   |   |
| Services Administration             |                               |   |
|                                     | Alexandria, VA                |   |
| Rockville, MD                       |                               |   |
+-------------------------------------+-------------------------------+---+
| Cheryl Connelly                     | William Modzeleski            |   |
|                                     |                               |   |
| National Association of City and    | Department of Education       |   |
| County Health Officials             |                               |   |
|                                     | Office of Safe and Drug Free  |   |
| Washington, DC                      | Schools                       |   |
|                                     |                               |   |
|                                     | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+
| Jill Cook                           | Sharon Murray                 |   |
|                                     |                               |   |
| American School Counselors          | Society of State Directors of |   |
| Association                         | Health, Physical              |   |
|                                     |                               |   |
| Alexandria, VA                      | Education and Recreation      |   |
|                                     |                               |   |
|                                     | Reston, VA                    |   |
+-------------------------------------+-------------------------------+---+
| Linda Davis-Alldritt                | Ron Palomares                 |   |
|                                     |                               |   |
| California Department of Education  | American Psychological        |   |
|                                     | Association                   |   |
| Sacramento, CA                      |                               |   |
|                                     | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+
| Kellie Dressler                     | John Schlitt                  |   |
|                                     |                               |   |
| Department of Justice               | National Assembly for School  |   |
|                                     | Based Health Care             |   |
| Office of Juvenile Justice and      |                               |   |
| Delinquency Prevention              | Washington, DC                |   |
|                                     |                               |   |
| Washington, DC                      |                               |   |
+-------------------------------------+-------------------------------+---+
| Ted Feinberg                        | Rick Smith                    |   |
|                                     |                               |   |
| National Association of School      | Department of Health and      |   |
| Psychologists                       | Human Services                |   |
|                                     |                               |   |
| Bethesda, MD                        | Health Resources and Services |   |
|                                     | Administration                |   |
|                                     |                               |   |
|                                     | Maternal and Child Health     |   |
|                                     | Bureau                        |   |
|                                     |                               |   |
|                                     | Rockville, MD                 |   |
+-------------------------------------+-------------------------------+---+
| Sascha Fielding                     | Allen Sosebee                 |   |
|                                     |                               |   |
| Department of Health and Human      | Department of Justice         |   |
| Services                            |                               |   |
|                                     | Federal Bureau of             |   |
| Centers for Disease Control and     | Investigation                 |   |
| Prevention                          |                               |   |
|                                     | Atlanta, GA                   |   |
| National Center for Environmental   |                               |   |
| Health                              |                               |   |
|                                     |                               |   |
| Atlanta, GA                         |                               |   |
+-------------------------------------+-------------------------------+---+
| Stacey Gooding                      | Heidi Taylor                  |   |
|                                     |                               |   |
| Department of Health and Human      | American Red Cross            |   |
| Services                            |                               |   |
|                                     | Arlington, VA                 |   |
| Health Resources and Services       |                               |   |
| Administration                      |                               |   |
|                                     |                               |   |
| Maternal and Child Health Bureau    |                               |   |
|                                     |                               |   |
| Rockville, MD                       |                               |   |
+-------------------------------------+-------------------------------+---+
| Amy Greene                          | Kenneth Trump                 |   |
|                                     |                               |   |
| Association of State and            | National School Safety and    |   |
| Territorial Health Officials        | Security Services             |   |
|                                     |                               |   |
| Washington, DC                      | Cleveland, OH                 |   |
+-------------------------------------+-------------------------------+---+
| Isadora Hare                        | Farris Tuma                   |   |
|                                     |                               |   |
| Department of Health and Human      | Department of Health and      |   |
| Services                            | Human Services                |   |
|                                     |                               |   |
| Health Resources and Services       | National Institutes of Health |   |
| Administration                      |                               |   |
|                                     | National Institute of Mental  |   |
| Office of Adolescent Health         | Health                        |   |
|                                     |                               |   |
| Rockville, MD                       | Bethesda, MD                  |   |
+-------------------------------------+-------------------------------+---+
| Gabriella Hayes                     | Eleanor Wagoner               |   |
|                                     |                               |   |
| National PTA                        | Department of Health and      |   |
|                                     | Human Services                |   |
| Chicago, IL                         |                               |   |
|                                     | Administration for Children   |   |
|                                     | and Families                  |   |
|                                     |                               |   |
|                                     | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+
| Molly Hicks                         | Dawn Warehime                 |   |
|                                     |                               |   |
| American Academy of Pediatrics      | Department of Homeland        |   |
|                                     | Security                      |   |
| Chicago, IL                         |                               |   |
|                                     | Federal Emergency Management  |   |
|                                     | Agency                        |   |
|                                     |                               |   |
|                                     | Washington, DC                |   |
+-------------------------------------+-------------------------------+---+

**Appendix**

**Sample National Nongovernmental Organization Resources and
Activities**

**Preparedness**

-   The **American Academy of Pediatrics** website,
    [www.aap.org](http://www.aap.org/), includes a section on Children,
    Terrorism, and Disasters. Included in this section are links to
    other relevant resources and information for pediatric health care
    providers on chemical, biological, radiological, and other agents,
    psychological aspects of terror and disasters, disaster planning,
    and public policy.

-   The **American Red Cross** has a variety of materials and programs
    to help schools and students prepare for disasters, including
    terrorism. They have developed a list of Recommended Emergency
    Supplies for Schools. Available from the American Red Cross website,
    the list includes information on what and how much to store, and
    where to store it. The *Masters of Disaster*® curriculum provides
    students with information to help them prepare for disasters and
    stay safe during and after a disaster in their home, school, or
    community. The Together We Prepare effort includes web-based tools
    for making a plan, building an emergency supply kit, getting trained
    in emergency preparedness, donating blood, and volunteering. The
    American Red Cross Homeland Security Advisory System Recommendations
    for Schools provides recommended actions that can be taken at the
    different color-coded threat levels, available for downloading in
    English and in Spanish.

-   The **National Education Association** Crisis Communications Guide
    and Toolkit provides resources for preparing for a crisis,
    responding during a crisis, and long-term actions to move beyond a
    crisis.

-   The **National Association of School Nurses** (NASN) published
    Disaster Preparedness Guidelines for School Nurses in 2002. The
    manual contains information for the school nurse regarding the
    nurse's role in each of phase of disaster preparedness. Forms,
    checklists, and planning tools are included. NASN also developed a
    full-day workshop on Disaster Preparedness for School Nurses.
    Developed through a partnership with EMS-C, the course addresses the
    four phases of disaster preparedness as well as emerging diseases.
    Skill development in triage and disaster response is included.

**Response**

-   An important effort of the **National Association of School
    Psychologists** (NASP) is the National Emergency Assistance Team
    (NEAT). The mission of NEAT is to "develop policies and procedures,
    disseminate information, provide consultation, and facilitate the
    training of school-based crisis teams in response to significant
    emergencies impacting children and adolescents." The team is
    composed of school psychologists with expertise in prevention,
    intervention, and postvention who can provide assistance in response
    to large-scale emergencies.

-   NEAT works in partnership with the **National Organization for
    Victim Assistance** (NOVA). NOVA helps local decision-makers
    identify all the groups at risk of experiencing trauma; trains local
    caregivers to reach out to those groups after NOVA has departed; and
    leads model crisis intervention sessions.

**Recovery**

-   The **American Red Cross** has added a supplement to the *Masters of
    Disaster* curriculum, *Facing Fear*: *Helping Young People Deal with
    Terrorism and Other Tragic Events,* to address dealing with feelings
    of loss, sadness and anger after a tragic event; provides
    information about understanding media coverage; and provides
    positive ways for children and their families to respond to past
    events and plan for future uncertain times. Also available for
    downloading from the Red Cross website, is a series of brochures
    that provide age-appropriate suggestions for how adults (parents and
    educators) can help children cope with disasters and terrorist
    attacks.

-   Many national organizations provide resources for teachers to help
    students cope with terrorism. A few are listed here:

```{=html}
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```
-   In addition to resources available on their website,
    [helping.apa.org](http://www.helping.apa.org/), the **American
    Psychological Association** has developed four pamphlets containing
    tips for parents and teachers of elementary school children and
    teens, day-care providers of preschool children, and tips for teens
    themselves.

-   The **American Counseling Association**, www.counseling.org, has
    developed a counselor's guide to preparing and responding to
    terrorism, trauma, and tragedies. The guide provides information on
    strategies to help students cope with a school tragedy.

-   The **American School Counselor Association**,
    [www.schoolcounselor.org](http://www.schoolcounselor.org/), has a
    resource center on their website with links, information, suggested
    books, and sample documents on school safety and trauma. The ASCA
    also recently completed an on-line symposium entitled the Human Side
    of School Crisis in which more than 1900 people participated. The
    symposium addressed both short- and long-term effects of crisis on
    school staff and students.

-   The **Association for Supervision and Curriculum Development**,
    [www.ascd.org](http://www.ascd.org/), has many resources for schools
    including *How to Prepare for and Respond to a Crisis*, and *Quick
    Response: A Step-by-Step Guide to Crisis Management for Principals,
    Counselors, and Teachers*.

-   The UCLA School Mental Health Project **Center for Mental Health in
    Schools** offers a guide to school-based crisis intervention that
    can be used as an in-service session or self-tutorial. They also
    have materials on responding to a crisis at school.

-   The **National Center for Children Exposed to Violence**,
    [www.nccev.org](http://www.nccev.org/), has a teachers' guide for
    talking to students about war and terrorism.

-   The **National Association of School Psychologists**,
    [www.nasponline.org](http://www.nasponline.org/), includes a wide
    range of materials on coping with crisis, children's fears, and
    memorial activity suggestions.

-   The **National Mental Health Association**,
    [www.nmha.org](http://www.nmha.org/), has materials on coping with
    disaster and helping children cope with loss resulting from war or
    terrorism.

-   The **National PTA**, [www.pta.org](http://www.pta.org/), provides
    resources on coping with tragedy, addressing prejudice, and teaching
    children about empathy.

-   The **National Youth Violence Prevention Resource Center**,
    [www.safeyouth.org](http://www.safeyouth.org/), provides information
    for educators on responding to terrorism.

-   A number of national organizations (e.g., **Connect for Kids**,
    **School Social Work Association of America**, and the
    **International Society for Traumatic Stress Studies**) have
    compiled lists of resources for helping children cope with trauma,
    terrorism, and war. Some include age-specific guidance and lesson
    plans.

**Mitigation**

-   The **National Association of School Resource Officers** (NASRO),
    [www.nasro.org](http://www.nasro.org/), conducted a national survey
    of school resource officers regarding their schools' vulnerability
    to terrorism and preparedness for such an attack. NASRO is calling
    for terrorism training for school police officers and teachers, and
    standards and funding for school security assessments, emergency
    planning, and security-related information sharing with public
    safety officials.

-   The **National Food Service Management Institute** recently released
    Emergency Readiness Plan: A Guide for the School Foodservice
    Operation. This document provides recommendations for developing an
    emergency readiness plan, assessing a situation that disrupts food
    service, and special requirements for serving as a designated relief
    shelter.