# Presentation: 315345

## School Health Guidelines to Prevent Unintentional Injuries and Violence

**Notes:**
School Health Guidelines to Prevent Unintentional Injuries and Violence
I’m here today to talk about how we can help make schools safe places for students to learn, and how schools can teach students the skills they need to prevent unintentional injuries and violence at home, at play, at work, and throughout their lives. 

## Slide 2

**Notes:**
This information is captured in a recent CDC report titled “School Health Guidelines to Prevent Unintentional Injuries and Violence.” Before I describe the guideline recommendations, I have some information for you about adolescent violence, suicide, and injury; why we need to focus on schools; what schools already do to prevent injuries and violence; and how the guidelines were developed.
(image of CDC Morbidity and Mortality Weekly Report).

## Injuries Kill More Children and Adolescents Than All Diseases Combined

- Source: CDC, 2000 Vital Statistics

**Notes:**
Injuries kill more children and adolescents than all diseases combined. In 2000, nearly 14,000 deaths among children and adolescents aged 5 to 19 were caused by injuries. Two-thirds of all deaths in this age group are caused by unintentional injury (mainly motor vehicle crashes), homicide, and suicide.  
Unintentional Injury 46%

## The Injury Pyramid

**5.5 million annual visits to emergency departments (children aged 5-14).**
**20 million children and adolescents/year have injuries requiring medical attention or restricted activity; $17 billion/year in medical costs.**

**Notes:**
But deaths are just the tip of the iceberg. Each year children aged 5 to 14 make 5.5 million visits to hospital emergency departments for injuries, and 20 million children and adolescents suffer injuries requiring medical attention or restricted activity. This costs the nation 17 billion dollars each year in medical costs alone.

## Adolescent Violence

- From 1990 to 1998, the adolescent homicide rate dropped 28%.
- The U.S. child homicide rate (2.6/100,000) is 5 times that of 25 other industrialized nations combined.
- Among adolescents aged 16 to 19 in 1995:
- 1 in 10 was a victim of violent crime.
- >100,000 were arrested for violent crimes.
- 2,944 were homicide victims.

**Notes:**
Let’s look at some data about adolescent violence. From 1990 to 1998, the adolescent homicide rate dropped 28%. Even with this drop, however, U.S. children still suffer disproportionately from violence. The U.S. child homicide rate is 5 times higher than that of 25 other industrialized nations combined. In 1995, 1 in 10 16- to 19-year olds was the victim of a violent crime, more than 100,000 adolescents were arrested for violent crimes, and nearly 3,000 were  victims of homicide.

## Suicide

- More than 1,700 adolescents aged 15-19 complete suicide each year.
- In 2001:
- 19% of high school students considered suicide.
- 15% made a suicide plan.
- 9% attempted suicide.
- 3% made an attempt requiring medical attention.

**Notes:**
Turning to another adolescent violence problem, more than 1,700 adolescents aged 15 to 19 complete suicide each year. In 1999, 19% of high school students considered suicide – that’s nearly 1 in 5. 15% made a suicide plan. 8% – or nearly 1 in 10 –  attempted suicide. And 3% made a suicide attempt requiring medical attention. 

## Percentage of US High School Students Involved in Violence-Related Behaviors, 2001

- *In the 30 days before the survey.   **In the 12 months before the survey.
- Source:  CDC, National Youth Risk Behavior Survey

_**Behavior**_** ****	****	****	****	****  **_**% of Students**_** **
- Carried a weapon* 			17.4
- Carried a gun* 				  5.7
- In a physical fight** 			33.2

**Notes:**
Adolescents engage in behaviors that put them at risk for violence-related injury. For example, nearly 1 in 5 U.S. high school students reports carrying a weapon, and 5% report carrying a gun. More than one-third have been in a physical fight in the past year.

## Percentage of US High School Students Engaging in Unsafe Behaviors, 2001

_**Behavior**_**	****	****	****	****       **_**% of Students**_
- Rarely or never wore seatbelts		14.1
- Rarely or never wore bicycle			84.7
-    helmets*
- Rode with driver who had been		30.7
-    drinking alcohol**
- Drove after drinking alcohol**		13.3

- *Among students who rode bicycles in the 12 months before survey.
- **In the 30 days before the survey.
- Source:  CDC, National Youth Risk Behavior Survey

**Notes:**
Adolescent behaviors are also related to unintentional injury risks. Nearly 1 in 6 high school students rarely or never wears seatbelts. Most high school students, 85%, rarely or never wear bicycle helmets when riding bicycles. One-third rode with a driver who had been drinking alcohol at least once in the 30 days before the survey. And more than 1 in 8 drove after they themselves had been drinking.

## Injuries Occur Everywhere

**Notes:**
Injuries occur everywhere. 

## Why Focus on School?

***Schools are Places of Living and Learning***

**Notes:**
Why focus on schools? Schools are places of living and learning.  98% of kids aged 5 to 17 are students. Every day nearly 53 million young people attend more than 114,000 schools where 6 million adults work as teachers or staff. Counting students and staff, on any given weekday more than one-fifth of the U.S. population can be found in schools. 
Unfortunately, schools are not always safe places.

## Injuries and Violence in the School Environment

- 80% of elementary school students visit a school nurse for injury in a 2 year period.
- 10-25% of child and adolescent injuries occur at school:
- 4 million school injury victims per year.
- School-associated injuries resulting in hospitalization:
- Falls (43%).
- Sports activities (34%).
- Assaults (10%).

**Notes:**
There is no national reporting system for school-associated injuries or violence, and only a handful of states have voluntary or mandatory reporting systems. So these data are based on different national and local studies.  
Injury is the most common condition treated by school health personnel. Between 10% and 25% of child and adolescent injuries occur on school premises. This means that about 4 million children and adolescents are injured at school each year.
Most school injuries are unintentional, not violence-related. The most frequent causes of school-associated injuries resulting in hospitalization are falls, 43%, sports activities, 34%, and assaults, 10%. This is 9 unintentional injuries for every violence-related injury.

## Injuries and Violence in School

- Most school injuries are minor:
- 6% of EMS incidents.
- 1 in 400 injury fatalities.

**Notes:**
Most school injuries are minor; serious injuries are more likely to occur at home or in the community. Emergency Medical Service, or EMS, dispatches to schools represent only 6% of all EMS incidents for school-aged children. Fatalities are rare: about 1 in 400 injury-related fatalities among children aged 5 to 19 occurs at school. 

## High School Students Who Felt too Unsafe to Go to School, U.S., 1993-2001

- Source: Youth Risk Behavior Survey, CDC

**Notes:**
Since the early 1990s CDC has been asking high school students if they felt too unsafe to go to school on any day during the previous month.  From 1993 to early spring in 1999, the percentage reporting feeling too unsafe was stable at about 4%, or 1 student in a classroom of 25. After the shooting at Columbine High School the percentage of U.S. high school students feeling too unsafe to go to school jumped to 10%, or 3 students in every classroom. And the percentage stayed elevated – it was about 6% in 2001.

## Violent Deaths Among School-Aged Children, 1994-1999

**Notes:**
Despite the horrific school shootings in recent years at Columbine High School in Colorado, Santee High School in San Diego, and Heath High School in Paducah, Kentucky, few schools will ever experience such traumatic events. In fact, less than 1% of all violent deaths – homicides and suicides – among school-aged children are associated with schools. 

## What Are Schools Doing to Prevent Injuries and Violence?

**Notes:**
We’ve talked about schools as places where injuries and violence sometimes occur.  But what are schools doing to help prevent unintentional injuries and violence? The School Health Policies and Programs Study – or SHPPS 2000 – is the largest study of school health policies and programs ever undertaken in this country. SHPPS looked at state, district, school, and classroom policies and activities in many areas of school health, including classroom education, the environment, health services, and food services. SHPPS provided data on injury-related policies and programs.

## Percentage of Schools with Specific Safety Policies, by Level

**Type of Policy**

** **

**Elementary **

** **

**Middle/JHS **

** **

**Sr. High **

** **

- Hall monitors

- 70%

- 77%

- 82%

- Bathroom monitors

- 60%

- 57%

- 59%

- Check bags, lockers

- 18%

- 38%

- 45%

- Uniformed police

- 6%

- 19%

- 30%

- Surveillance cameras

- 12%

- 21%

- 24%

- Require uniforms

- 21%

- 28%

- 10%

- Metal detectors

- 3%

- 10%

- 10%

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
This table shows some things schools are doing to try to prevent violence. Most elementary, middle/junior, or senior high schools use staff or volunteers to monitor halls and bathrooms. Focusing on senior high schools in the right hand column, you can see that nearly half of all senior high schools routinely check student bags, desks, and lockers for contraband. Nearly one-third of senior high schools employ uniformed police to patrol their campuses. And nearly one-quarter use surveillance cameras. Only 1 in 10 senior high schools requires uniforms or uses metal detectors.

## School Policies: Unintentional Injury

- More than 94% of schools inspect and maintain:
- Fire extinguishers.
- Athletic facilities and equipment.
- Halls, stairs, and regular classrooms.
- Kitchen facilities and equipment.
- Playground facilities and equipment.
- School buses.

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
Nearly all schools report inspecting and maintaining their facilities to prevent unintentional injuries. This includes fire extinguishers; athletic facilities and equipment; halls, stairs, and regular classrooms; kitchen facilities and equipment; playground facilities and equipment; and school buses. 

## School Policies: Unintentional Injury

- 85% of schools inspect and maintain smoke detectors.
- 81% of schools inspect and maintain chemistry  labs, workshops, and art rooms.

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
Fewer schools, 85%, inspect and maintain smoke detectors, and 81% inspect and maintain chemistry labs, workshops, and art rooms.

## Percentage of Schools Requiring Unintentional Injury, Violence and Suicide Prevention Education, by School Level

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
Most schools – at all levels – require some type of prevention education about violence and unintentional injuries, but half of middle/junior high schools and few elementary schools require suicide prevention. 

## Health Education

- Median hours teaching violence prevention:
- 4-5 hours/year.
- Median hours teaching unintentional injury prevention:
- 4-5 hours/year.

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
When prevention instruction on violence or unintentional injuries is offered, it is not very extensive. Classroom teachers spend only 4 to 5 hours per year on either subject.

## Techniques to avoid interpersonal conflicts/fights: 95%.
Anger management: 92%.
Handling stress in healthy ways: 88%.
Dating violence: 62%.
Sexual assault: 61%.
Recognizing stressors/signs of depression: 42%.
What to do if someone is thinking about suicide: 38%.

- Anger management: 92%.
- Handling stress in healthy ways: 88%.
- Dating violence: 62%.
- Sexual assault: 61%.
- Recognizing stressors/signs of depression: 42%.
- What to do if someone is thinking about suicide: 38%.

**Percentage of Schools Teaching Skills Related to Violence and Suicide Prevention in at Least One Required Class or Course**

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
The SHPPS study also examined violence- and suicide-related topics and skills taught in the classroom. Almost all schools address techniques to avoid interpersonal conflicts and fights, anger management, and handling stress. Nearly two-thirds address dating violence and sexual assault. But fewer than half help students understand how to recognize stressors or signs of depression, or what to do if someone is thinking about suicide.

## Protective equipment (biking, skating, sports): 86%. 
Fire safety: 84%.
Road/transportation safety: 80%.
Water safety: 66%.
First aid/ CPR: 56%.

- Fire safety: 84%.
- Road/transportation safety: 80%.
- Water safety: 66%.
- First aid/ CPR: 56%.

**Percentage of Schools Teaching Topics Related to Unintentional Injury Prevention in at Least One Required Class or Course**

- Source:  CDC, School Health Policies and Programs Study, 2000

**Notes:**
Nearly all schools, 86%, teach about protective equipment for bicycling, skating, and sports, and about fire safety (84%). 80% teach road or transportation safety. Only two-thirds teach water safety and just over half teach first aid or CPR.  

## How Were the Guidelines Developed?

**Notes:**
Let’s move on to what schools can do to help prevent unintentional injuries and violence – on campus and beyond. I’ll start by telling you how the guidelines were developed.

## Guidelines Development Process

- Literature review.
- Expert panel:
- Is there appropriate _evidence_?
- How _effective_ is the strategy? (effect size)
- How _feasible_ is the strategy?
- What _priority_ should the strategy be assigned?
- Agency and organization review.
- Revision.
- MMWR publication.
- Dissemination and diffusion.

**Notes:**
The School Health Guidelines to Prevent Unintentional Injuries and Violence are based on an extensive literature review and input from a 16-member expert panel. The panel examined more than 200 strategies to determine if there is evidence that each is effective, how effective each is; how feasible each is for school implementation; and what priority each should be assigned. Those who reviewed and commented on guideline drafts included federal, state, and local agencies, and national organizations representing state and local policymakers, educators, parents, allied health professionals, and experts in unintentional injury, violence and suicide prevention. The revised guidelines were published in the December 2001 Morbidity and Mortality Weekly Report. We are now in the dissemination and diffusion phase.

## The Breadth of the Guidelines

- Suicide

- Violence

- Unintentional injury

- Crisis response

- Social environment

- Physical environment

- Health education

- Physical education

- Family/community

- Staff development

- Health services

- Elementary

- Middle/JHS

- High school

**Notes:**
The guidelines include recommendations for preventing unintentional injury, violence, and suicide in and outside school.  They cover elementary, middle, and senior high school issues. They are broader than the heath education curriculum or installing devices such as metal detectors. Instead, they cover the social and physical environment, health and physical education, family and community involvement, staff development, health services, and crisis response. Recommendations are based on scientific evidence where it exists, and on theory and best practices where it is missing. Not every school can implement every recommendation; the guidelines try to balance the ideal school program with what is practical. 

## Coordinated School Health Programs

**Notes:**
The guidelines are based on the coordinated school health program model, which 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; nutrition services; counseling, psychological, and social services; a healthy and safe school environment; staff health promotion and training; and family and community involvement.

## Recommendations to Prevent Unintentional Injuries, Violence, and Suicide

- 1.  Social environment
- 2.  Physical environment
- 3.  Health education
- 4.  Physical education and physical activity                                                                                              programs
- 5.  Health services
- 6.  Crisis response
- 7.  Family and community involvement
- 8.  Staff development

**Notes:**
The guidelines’ 8 recommendations parallel components of the coordinated school health program model. Each guideline has a list of implementation strategies that are grouped by guiding principles and describe essential qualities of coordinated school health programs to prevent unintentional injury, violence, and suicide. I will now present guiding principles and some of the strategies for the 8 recommendations.

## (1) Establish a Social Environment that Promotes Safety and Prevents Unintentional Injuries and Violence

- Ensure high academic standards:
- Provide administrative leadership to promote the academic success of all students.
- Establish a strong academic mission statement.
- Establish academic support mechanisms.
- Provide opportunities for students to experience success.

**Notes:**
The first guideline is to establish a school social environment that promotes safety and prevents unintentional injuries and violence. The first guiding principle states that a safe school is one that ensures high academic standards. Strategies for promoting academics include: 
Ensuring that school leaders promote the academic success of all students; 
Establishing a strong academic mission statement; 
Establishing academic support mechanisms (for example, counseling, tutoring, or mentoring); and 
Providing opportunities for all students to experience success, for example, through athletics, drama, school-to-work experiences, or community service. 

## (1) Establish a Social Environment that Promotes Safety and Prevents Unintentional Injuries and Violence

- Encourage connection to school:
- Develop prosocial norms (disapprove of bullying, promote helpful acts).
- Involve faculty, staff, students, families, and community members in all aspects of school management.

**Notes:**
Students who like and feel connected to their school are less likely to experience emotional distress and suicidal thoughts; less likely to drink alcohol, carry weapons, or engage in other delinquent behaviors; and more likely to cooperate and help each other. To encourage connection, schools can develop policies and practices that create a supportive climate and foster development of prosocial norms in the school community, for example, disapproving of bullying or promoting helpful acts. Involving faculty, staff, students, families, and community members in all aspects of school management can also promote connection.

## (1) Establish a Social Environment that Promotes Safety and Prevents Unintentional Injuries and Violence

- Develop, implement, and enforce written policies:
- Support nonviolence and protect all from harassment, violence, or discrimination.
- Emphasize positive behaviors expected of students.
- Explicitly state, communicate, and implement consequences of policy violations.

**Notes:**
Written policies provide formal rules that help schools plan, implement, and evaluate their activities. Policies that support nonviolence and protect students, staff, and faculty from harassment, violence, or discrimination are essential. Such policies can emphasize the positive behaviors expected of students and should explicitly state how they will be implemented and the consequences of policy violations. Schools can use multiple communication methods to inform students, families, staff, and community members of the policies.

## (1) Establish a Social Environment that Promotes Safety and Prevents Unintentional Injuries and Violence

- Designate a person to coordinate safety activities.
- Have a school safety committee or school health council address safety issues.
- Regularly assess programs and policies.

**Notes:**
These strategies may seem basic, but they are essential. Designate a person to coordinate safety activities. Make sure a school safety committee or school health council addresses these issues. And it’s important to assess programs and policies at regular intervals. Evaluations can improve the quality of school programs; increase family and community support; help schools reward exceptional work by faculty, staff members, and students for exceptional work; and support grant applications.  

## (1) Establish a Social Environment that Promotes Safety and Prevents Unintentional Injuries and Violence

- Integrate prevention of unintentional injuries and violence in:
- Academic classes.
- Employment certificates.
- Vocational education and school-to-work programs.

**Notes:**
Injury and violence prevention can be integrated into any school activity. Addressing these topics in health education classes is important, but they can also be infused into other curriculum components. For example, physics courses can explore how bicycle helmets absorb energy to prevent injuries. History courses can explore the causes and consequences of violence, using examples from wars and civil disturbances. Principles of nonviolence and prosocial behavior can be infused into physical education and sports.
Several states require schools to issue student employment certificates who work. Schools could use this process to foster communication among the school, employer, student, and family about occupational safety and the relationship between academic success and employment. Schools can teach safety behaviors and model safe working environments in vocational education and school-to-work programs.

## (2) Provide a Safe Physical Environment to Prevent Unintentional Injuries and Violence

- Conduct regular safety and hazard assessments.

**Notes:**
The second guideline deals with the school’s physical environment. Schools can make sure the physical environment inside and outside school buildings promotes safety and prevents unintentional injuries and violence by doing a comprehensive safety assessment at least annually. 

## (2) Provide a Safe Physical Environment to Prevent Unintentional Injuries and Violence

- Maintain structures, equipment, and grounds:
- Uncluttered paths.
- Slip-resistant floors.
- Proper storage of poisons and chemical hazards.
- Sufficient lighting.
- First aid equipment available throughout school.

**Notes:**
Maintaining structures, equipment, and grounds can help prevent unintentional injuries and violence. For example, having uncluttered paths or sufficient lighting can help reduce crime and violence prevent trips and falls.

## (2) Provide a Safe Physical Environment to Prevent Unintentional Injuries and Violence

- Actively supervise all student activities, especially in:
- Hallways.
- Bathrooms.
- Playgrounds.
- Shop and vocational education activities.

**Notes:**
Supervision is critical to maintaining an environment that promotes safety and prevents injuries and violence. Active supervision includes observation, listening to students, anticipating and responding to unsafe situations, and promoting positive behaviors. Key areas for active supervision are hallways, bathrooms, playgrounds, and shops.

## (2) Provide a Safe Physical Environment to Prevent Unintentional Injuries and Violence

- Ensure that the school is free from weapons:
- Improve physical environment.
- Implement appropriate disciplinary measures.
- Work with families and communities.
- Supervise students and monitor campus.
- Consider environmental changes (fencing, limiting number of entrances, security technologies).

**Notes:**
Schools can use various mechanisms to decrease the likelihood that students will bring weapons onto school property. Having a pleasant environment (for example, one that’s free of graffiti) raises expectations for safety. By complying with the federal Gun Free Schools Act, implementing appropriate disciplinary measures, working with families and communities, supervising students, and monitoring the campus, schools can go a long way toward reducing the likelihood of weapons in school. In some schools, environmental security devices such as fencing, limited access to the campus, and metal detectors might be helpful.

## (3) Implement Health and Safety Education Curricula and Instruction

- Choose programs and curricula grounded in theory or with evidence of effectiveness.
- Implement curricula consistent with national and state standards:
- Part of comprehensive health education.
- Adequate time.
- Sequential from preschool through high school.
- Developmentally and culturally appropriate.

**Notes:**
To help prevent injuries and violence in and away from school, schools can implement health and safety education curricula that help students develop the knowledge, attitudes, behavioral skills, and confidence needed to adopt and maintain safe lifestyles, and to advocate health and safety. To do this, schools can select programs and curricula that are grounded in theory or have scientific evidence of effectiveness. They can also discontinue programs that have no or negative effects. 
National and state health education standards also provide guidance. Curricula should be part of comprehensive health education, be given adequate time in the classroom, be sequential from preschool through high school, and be developmentally and culturally appropriate. 

## (3) Implement Health and Safety Education Curricula and Instruction

- Use active learning strategies and interactive teaching methods:
- Proactive classroom management.
- Repeated opportunities to practice skills.
- Involve families, community members, and community resources.

**Notes:**
Active learning strategies encourage student involvement in learning and help them develop concepts, attitudes, and behavioral skills they need to prevent injuries and violence. Proactive classroom management techniques are designed to create calm, orderly classrooms. Techniques include reinforcing positive behaviors, monitoring classroom activity, and promoting cooperative and interactive learning. Students should have repeated opportunities to practice using skills, for example, to resolve conflicts nonviolently. Involve families, community members, and community resources by incorporating injury and violence prevention skills in community-based programs such as service learning projects, and through programs like mentoring that bring adults into schools.

## (3) Implement Health and Safety Education Curricula and Instruction

- Provide adequate staffing and resources:
- Budget.
- Facilities.
- Staff development.
- Class time.

**Notes:**
For these curricular activities to be effective and to reach all students, adequate staffing and resources must be devoted to injury and violence prevention, including budget, facilities, staff development, and class time.

## (4) Provide Safe Physical Education and  Extracurricular Physical Activity Programs

- Promote injury prevention and non-violence through physical education and sports participation:
- Offer a range of experiences.
- Reward sportsmanship, effort, teamwork, and adherence to safety rules.
- Strictly enforce prohibitions against alcohol and drug use and violence during sporting events.
- Promote use of well-maintained, personal protective equipment.

**Notes:**
Physical education and extracurricular physical activity programs must be safe. They can be excellent places to promote injury prevention and non-violence and offer many opportunities to teach skills needed for lifelong safe participation in physical activity. This can be done by offering a range of experiences; rewarding sportsmanship, effort, teamwork, and adherence to safety rules; strictly enforcing prohibitions against alcohol and drug use and violence during sporting events; and promoting the use of well-maintained personal protective equipment. 

## (4) Provide Safe Physical Education and  Extracurricular Physical Activity Programs

- Develop, teach, implement, and enforce safety rules:
- Match participants according to size and ability.
- Adapt rules to skill levels and available protective equipment.
- Modify rules to eliminate unsafe practices.
- Establish criteria for reentering play after an injury.

**Notes:**
Safe physical activity requires proper conditioning and appropriate protective equipment. Prohibit dangerous behaviors, such as high sticking in hockey. Also match participants according to size and ability, adapt rules to skill levels and available protective equipment, modify rules to eliminate unsafe practices, and establish criteria for reentering play after an injury. 

## (4) Provide Safe Physical Education and  Extracurricular Physical Activity Programs

- Ensure that spaces and facilities meet or exceed recommended safety standards:
- Regular inspection and maintenance.

**Notes:**
Schools should ensure that spaces, facilities, and equipment meet or exceed safety standards. One way to do this is through regular inspection and maintenance. 

## (4) Provide Safe Physical Education and  Extracurricular Physical Activity Programs

- Hire PE teachers, coaches, athletic trainers, and other staff members who are trained in injury prevention, first aid, and CPR, and offer ongoing staff development.

**Notes:**
Schools can hire teachers, athletic trainers, coaches, and other staff members trained in injury prevention, first aid, and CPR, and offer ongoing staff development.

## (5) Provide Health, Counseling, Psychological, and Social Services

- Coordinate school-based counseling; psychological, social, and health services; and the educational curriculum.
- Establish strong links with community resources.

**Notes:**
Student risk for injury and violence is affected by physical, mental, emotional, and social health. Schools often provide health, counseling, psychological, and social services. To provide optimum student care, these services should be coordinated and integrated with the educational curriculum. Schools can play an important role by linking students to community-based resources and identifying providers to bring resources into the school. 

## (5) Provide Health, Counseling, Psychological, and Social Services

- Identify and help students who have been injured, have witnessed violence, or have been the victims of violence or harassment:
- Establish confidential and nonjudgmental mechanisms for students to report that they have been abused, harassed, or injured by a member of the school community.
- For students at high risk for injury or violence, provide targeted prevention programs and services or link to community services.

**Notes:**
Students who have been victims of child abuse, dating violence, sexual assault, bullying, harassment, or other forms of violence, and those who have observed violence in their homes and communities usually need intervention and help. Schools can have systems for identifying and helping these students. They can establish confidential and nonjudgmental mechanisms for students to report that they have been abused, harassed, or injured by a member of the school community. For students at high risk for injury or violence, schools can provide targeted prevention programs and services or link students to community services. 

## (5) Provide Health, Counseling, Psychological, and Social Services

- Assess the extent to which injuries occur on school property, at school-sponsored events, or on the way to or from school or school-sponsored events:
- Identify patterns and risks for each type of injury.
- Use findings to correct hazards and improve safety.

**Notes:**
To prevent injuries, schools should assess the extent to which injuries occur on their property, at school-sponsored events, or on the way to or from school or school events. Collecting data is not enough. Schools should review the data to identify patterns and risks and use the findings to correct hazards and improve safety.  

## (5) Provide Health, Counseling, Psychological, and Social Services

- Develop and implement emergency plans to assess, manage, and refer injured students and staff to appropriate care:
- Collaborate with local EMS.
- Obtain parental consent for transport in emergency.
- List staff assignments and instructions.
- Include methods for contacting parents.
- Practice plans annually, revise as needed.

**Notes:**
Plan for emergencies. Develop and implement plans to assess, manage, and refer injured students and staff to appropriate care. This might include collaborating with local EMS; obtaining parental consent for transport in emergencies, listing staff assignments and instructions, listing contact information for parents, practicing plans annually, and revising them as needed.

## (6) Establish Mechanisms for Responding to Crises, Disasters, and Injuries

- Establish a written response plan (1):
- Review district and state crisis plans.
- Create a crisis response team.
- Assign roles and responsibilities, provide training.
- Get community input.
- Consider need for school to serve as shelter in community crisis.

**Notes:**
It is essential for schools to establish mechanisms for responding to crises, disasters, and injuries –in the school and the community.  To do this, schools should formulate a written response plan. This involves reviewing district and state crisis plans and adapting them as needed; creating a crisis response team; assigning roles and responsibilities to school and community staff; providing training; getting community input, particularly from local health, emergency management, and law enforcement agencies; and considering how schools might serve as shelters in a community crisis like a flood or earthquake.

## (6) Establish Mechanisms for Responding to Crises, Disasters, and Injuries

- Establish a written response plan (2):
- Include plans for evacuating students.
- Include procedures for handling suspicious packages or envelopes.
- Communicate basic emergency procedures to families.
- Share floor plans with security agencies.
- Practice annually, revise as needed.

**Notes:**
School crisis plans should include plans for evaluating students and procedures for handling suspicious packages or envelopes. Such a plan must be communicated to families, students, and staff. The plan and facility floor plans should be shared with local law enforcement and emergency management officials. And it should be practiced at least annually and revised as needed.

## (6) Establish Mechanisms for Responding to Crises, Disasters, and Injuries

- Prepare to implement the plan in a crisis:
- Know who can do first aid and CPR.
- Have a phone tree, emergency contact list, and “go box” with tools and information for the crisis-response post.
- Have transportation ready to evacuate students and establish reunion areas and procedures.
- Be prepared for contact with media.

**Notes:**
Schools can do several things to prepare to implement the plan in a crisis.
Know who can do first aid and CPR. 
Have a phone tree, emergency contact list, and “go box” with tools and information for the crisis response post. 
Have transportation ready to evacuate students. 
Establish reunion areas and procedures. 
Prepare for contact with media; designate and train one media point person.

## (6) Establish Mechanisms for Responding to Crises, Disasters, and Injuries

- Have short-term responses and services:
- Consider reopening ASAP after the crisis.
- Make grief counselors available, seek community resources.
- Be proactive in helping students express their feelings.
- In the event of a death, allow grieving; beware of public tributes for suicides.

**Notes:**
Crises are not over when the excitement subsides or the last fire truck leaves. Schools need short-term responses and services in place after a crisis. They should:
Consider reopening as soon as possible after the crisis because schools and teachers give students support and stability.
Make grief counselors available, seeking community resources as appropriate.
Be proactive in helping students express their feelings.
In the event of a death, allow grieving but beware of public tributes for suicides because there is evidence they may glorify the suicide and lead to copycat events.

## (6) Establish Mechanisms for Responding to Crises, Disasters, and Injuries

- Have long-term responses and services:
- Help students who need counseling and psychological services.
- Teach coping and grieving strategies.
- Anticipate anniversary dates.
- Have the school crisis-response team analyze the school’s experience and consider changes.

**Notes:**
Crises and disasters have long-term consequences that schools must be prepared to deal with so student learning is not endangered. Long-term responses include counseling and psychological services, teaching students coping and grieving strategies, and anticipating anniversary dates. The school crisis-response team should learn from crises by analyzing the school’s experience and considering plan modifications.

## (7) Integrate School, Family, and Community Efforts to Prevent Unintentional Injuries and Violence

- Involve family members in all aspects of school life.
- Educate family members and help them secure assistance.
- Coordinate school and community services:
- Make school facilities available.
- Increase supervised after-school programs.
- Encourage support for community initiatives.
- Promote service learning.

**Notes:**
Schools alone cannot prevent unintentional injuries, violence, and suicide in communities and families they serve, but they can work to integrate efforts. This might mean involving family members in all aspects of school life, including planning and implementing programs and policies to prevent injury, violence, and suicide. Schools can also educate, support, and involve family members in child and adolescent injury and violence prevention. Schools can do several things to help coordinate school and community services. For example, schools can make facilities available to community groups, increase the availability of supervised after-school programs, encourage support for community initiatives to prevent violence and promote safety, and promote service learning activities in the community. 

## (8) Provide Staff Development Opportunities that Promote Safety

- Ensure that all school personnel know about unintentional injuries and violence and have prevention skills:
- First aid, CPR, injury prevention.
- Classroom management, cooperative and interactive learning, social skills training.

**Notes:**
The eighth guideline states that schools can provide all personnel with regular staff development activities that impart the knowledge, skills, and confidence to promote safety and prevent injuries, violence, and suicide. Schools can offer all staff opportunities to learn about unintentional injury and violence prevention topics like first aid and CPR. Topics for teachers include classroom management, cooperative and interactive learning, social skills, and injury prevention. 

## (8) Provide Staff Development Opportunities that Promote Safety

- Teach all personnel to be positive role models for a healthy and safe lifestyle:
- Treat students respectfully.
- Intervene to stop harassment.
- Model safety behaviors.
- Provide links to community services.

**Notes:**
Schools can teach personnel to be positive role models for a healthy and safe lifestyle. Bus drivers, teachers, coaches, and custodians can learn to treat students and each other respectfully, intervene to stop harassment, and model safe behaviors. Shop teachers, for example, can use protective equipment and coaches can support nonviolent play. Staff can learn about community services to which they can refer students and families.

## Target Audiences 
Policymakers.
State and local health and education agencies.
National health and education organizations.
Post-secondary institutions.
School personnel, community leaders, health service providers.

- Policymakers.
- State and local health and education agencies.
- National health and education organizations.
- Post-secondary institutions.
- School personnel, community leaders, health service providers.

**Notes:**
The guidelines target policymakers at all levels, state and local health and education agencies, national health and education organizations, post-secondary institutions that can build these recommendations into their training programs, school personnel, community leaders, and health service providers.

## More Resources Will Follow

*School Health Index*
*Curriculum Analysis Tool*
- Policy guide
- School resource database
- Case studies

**Notes:**
The guidelines publication is a first step in giving schools tools they can use to become safer places for students to learn. We’re working on some exciting tools right now, including the School Health Index that helps schools assess their efforts in relation to the guidelines and plan improvements, and the Curriculum Analysis Tool for looking at injury and violence prevention curricula.

## Questions?

_**www.cdc.gov/HealthyYouth**_

**Notes:**
Unintentional injuries and violence are complex problems that require complex solutions. But complex does not necessarily mean difficult. By involving the whole school and each member of the school community, these guidelines lay out a comprehensive plan to  help schools prevent unintentional injuries and violence, promote safety, and be safe places for students to learn.

Thank you.