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A la carte offerings means a set of foods from which students can choose individual items that are not usually counted as part of a reimbursable meal.
Actions are steps to take to improve areas you have identified as weaknesses. After analyzing the module scores and using them to identify your school’s strengths and weaknesses, you can use the information to brainstorm possible actions for improving the weak areas.
Active learning strategies include interactive teaching methods to encourage student involvement rather than relying solely on a lecture format. Active learning strategies include:

  • supervised practice
  • discussion
  • cooperative learning
  • simulations and learning games
  • teacher and peer modeling
  • role playing
  • goal-setting
  • rehearsal
  • visualization

Actively supervise means using practices such as observing, listening to students, anticipating and effectively responding to unsafe situations, discouraging pushing and bullying, and promoting pro-social behaviors.
All pertinent information is determined in partnership with parents or legal guardians, if possible. All communication should be in compliance with the Family Educational Rights and Privacy Act (FERPA). Communication may be in the form of written mechanisms, such as asthma action plans, allergy alerts, individual health care plans, or injury reports. Regardless of the communication mechanism, pertinent information includes:

  • signs or symptoms to watch for in the student
  • specific action to take if student exhibits signs or symptoms
  • special precautions, if needed
  • a reminder about the confidentiality of this information

Appropriate staff members are those who “need to know” and could include: classroom teachers, instructional assistants, physical education teachers, health education teachers, nutrition services staff, school nurses, health assistants, counseling/psychological/social services providers, recess supervisors, coaches, administrators, secretaries, bus drivers, school resource officers, and before- and after-school staff.
Asthma basics and emergency response might include the following topics:

  • basic information about asthma, including common asthma triggers, signs and symptoms of asthma
  • recognizing and responding to severe asthma symptoms that require immediate action
  • the policy permitting students to carry and self-administer prescribed quick relief medications for asthma
  • asthma action plans
  • eliminating or reducing exposure to asthma triggers
  • student health confidentiality
  • recognizing and referring signs of poorly controlled asthma

At least 50% of the time means at least half of the total time scheduled for a physical education class session.

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Barriers to learning include deficiencies in basic living resources and opportunities for development, psychosocial issues, physical health issues, general stressors, crises and emergencies, difficult transitions associated with stages of schooling, becoming a teen parent, moving to a new school, dealing with homelessness, and adapting to a new culture or customs. Services to address barriers to learning include mental health, special education, nursing, psychological, and social services; counseling; mentoring; tutoring; assistance in the classroom; orientation for new students; and English language acquisition.
Breakfast in the classroom – breakfast is offered/served in the classroom and eaten in the classroom.
Bullying is when one or more students tease, threaten, spread rumors about, hit, shove, or hurt another student over and over again. Bullying can occur in person or through technology. It is not bullying when two students of about the same strength or power argue or fight or tease each other in a friendly way. Anyone can be bullied but those who are perceived as different are more frequently bullied. Some ways in which people are diverse or different include sexual orientation, gender identity, race, color, national origin, sex, religion, appearance, or disability.

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Care coordination refers to nurse-guided activities to implement a care plan to benefit the patient (or student) through integration of services with the patient, family, health care providers, and other significant personnel, such as educators, participating in the patient’s (or student’s) care (McClanahan & Weismuller, 2015).
Case management is a comprehensive set of services provided by either an individual or a team of medical professionals, school staff, and/or social work staff. These services could include:

  • providing referrals to primary healthcare providers
  • ensuring an appropriate written asthma action plan is obtained
  • ensuring access to and appropriate use of asthma medications, spacers, and peak flow meters at home and at school
  • offering asthma education for the student and family
  • facilitating environmental modifications at home and at school
  • identifying and addressing psychosocial issues related to asthma
  • providing additional support services as needed

Certified or licensed means teachers who have been awarded a certificate or license by the state, permitting them to teach physical education.
Cessation services can include any of the following:

  • group tobacco-use cessation counseling
  • brief clinical counseling
  • self-help educational material
  • computer-based cessation program
  • referral to local physician
  • telephone quit line
  • pharmacological cessation aid (e.g., nicotine replacement therapy)

Chronic health conditions may include asthma, diabetes, overweight/obesity, food allergies, anemia, eating disorders, epilepsy, oral/dental conditions, sickle cell disease, or other health conditions.
Chronic health conditions basics and emergency response might include the following topics:

  • basic information about chronic health conditions, including common triggers, signs and symptoms of chronic health conditions
  • recognizing and responding to severe symptoms of chronic health conditions that require immediate action
  • the policy permitting students to carry and self-administer prescribed quick relief medications for chronic health conditions (e.g., allergies, asthma)
  • action plans for chronic health condition care
  • eliminating or reducing exposure to triggers for asthma and other chronic health conditions
  • student health confidentiality
  • recognizing and referring signs of poorly controlled chronic health conditions

Classroom management techniques might include:

  • cooperative learning methods
  • social skills training
  • promoting interactive learning
  • classroom and environmental modification
  • conflict resolution and mediation
  • behavior management

Commitment is one of the measures used for determining or ranking the priority level of an action. The level of commitment assigned to an action indicates the dedication towards that action by school administration and staff, the community, and you.
Communication methods might include newsletter articles, public access television, website, signs, flyers, phone calls, email, and text messaging.
Community physical activity options might include clubs, teams, recreational classes, special events such as community fun runs, and use of playgrounds, parks, and bike paths.
Community-based health and safety programs might include youth sports and recreation programs; youth development programs; Women, Infants and Children (WIC); food stamps; and activities sponsored by organizations such as YMCA, 4-H programs, Students Against Destructive Decision-Making, Boys and Girls Clubs of America, American Cancer Society, American Heart Association, American Lung Association, and Asthma and Allergy Foundation of America.
Comparable means approximately the same number of students per teacher as in other classes.
Competitive foods and beverages are those outside the federal meal program. They include those offered in vending machines, a la carte, school stores, snack bars, canteens, classroom parties, classroom snacks, school celebrations, fundraisers, or school meetings. These foods are often referred to as competitive foods.
Consistent means that the curriculum addresses the key learning objectives or performance indicators identified by the standards.
Consulting school health physicians support school staff members who are employed to provide physical and mental health services for students and/or staff. He/she has training and/or experience in infant, child, adolescent and/or school health. The physician’s function should be specified in a written agreement or contract and may include planning school-based programs, procedures, and protocols; developing health-related school policies; addressing specific health issues of students or staff; or interacting with health professionals in the community on behalf of the school or district.
Coordinator is the facilitator of the SHI process. A coordinator can be someone who is a part of the school or someone external—for example, a retired health educator, community-based dietitian, professor at a local university, graduate student, or a volunteer at a community-based health organization.
Corrective actions are steps that are taken to remove the causes of an existing nonconformity with policy requirements or to make quality improvements. Corrective actions address actual problems. In general, the corrective action process can be thought of as a problem solving process. Examples of a corrective action may include training or professional development.
Cost is one of the measures used for determining or ranking the priority level of an action. The cost indicates the financial resources required to implement an action.
Counseling, Psychological, and Social Services are provided to improve students’ mental, emotional, and behavioral health and include individual and group assessments, interventions, and referrals. Organizational assessment and consultation skills of counselors and psychologists contribute not only to the health of students but also to the health of the school environment. Professionals such as certified school counselors, psychologists, and social workers provide these services.
Credentialed means teachers who have been awarded a credential, by the state, permitting them to teach health education.
Crisis preparedness and response plans, also known as school emergency operations plans, address environmental disaster (e.g., fire, flood, tornado, blizzard, and earthquake), death or serious injury of a student or staff member, suicide attempt, terrorism, bioterrorism, hazardous chemical spill, explosion, radiation release, mass illness or injury, or any other situation that threatens safety in the school. They include:

  • assigned roles and responsibilities for a crisis response team
  • procedures for collaborating with local law enforcement and emergency management agencies
  • a “go box” containing emergency tools such as: list of students and staff, emergency phone numbers, walkie-talkie system, map and school floor plan, location of power and utility connections
  • identification of back-up resources from the district, other schools, and outside groups
  • plans for dismissing school early, evacuating students to a safer location, and locking down the building
  • designated reunion areas for students and families
  • strategy for informing school staff, families, and community about the school’s plans
  • a media and communications plan
  • a plan for screening voluntary offers of assistance
  • procedures for handling suspicious packages or envelopes, including actions to minimize exposure to biological and chemical agents
  • contact list for grief counselors and other counseling and psychological services
  • plans for resuming classes
  • evaluating recovery efforts

Cross-cutting questions are questions that apply to all health topic areas and are included in a module regardless of the topics that you select.
Culturally- and linguistically-appropriate means that the materials are appropriate for the intended audience, do not promote biased or stereotypical perceptions of individuals or groups, and are in a language that families can read and understand.
Culturally-appropriate activities and examples include:

  • highlighting the contributions and skills of diverse groups of people (e.g., diversity in race, ethnicity, sex, gender identity, sexual orientation, religion, physical or mental ability, appearance, other personal characteristics)
  • acknowledging, respecting, and appreciating student diversity
  • validating and building students’ self-esteem and sense of culture and national background
  • strengthening students’ skills to engage in intercultural interactions
  • not stigmatizing or stereotyping individuals or groups
  • building on the cultural resources of families
  • featuring diverse groups of people in materials and presentations

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Delivery could be addressed through topics such as the following:

  • discussion of the curriculum’s underlying theory and conceptual framework
  • demonstration of program activities by a skilled trainer
  • opportunities to practice curricular activities during training
  • assessing students’ knowledge and skills

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Emotional, behavioral, and mental health needs can impact student learning and behavior if not treated or managed. They include diagnosed mental health disorders (for example, Attention Deficit/Hyperactivity Disorder, Anxiety, Bipolar Disorder and Depression) and challenges such as:

  • stress, anxiety and depression
  • worries about being bullied
  • problems with family or friends
  • loneliness or rejection
  • disabilities
  • thoughts of suicide or hurting others
  • concerns about sexuality
  • academic difficulties or dropping out
  • alcohol, tobacco or other drug use
  • inadequate basic life needs (e.g., housing, food, clothing, healthcare)
  • pregnancy or parenting
  • death of a friend or family member
  • addiction
  • fear of violence, terrorism or war

Enrichment experiences include athletics, drama, art, music, vocational education, technology training, tutoring services, student clubs, field trips, student advocacy, and community service. These can take place before, during, or after school hours.
Environment is the physical and aesthetic surroundings and the psychosocial climate and culture of the school. Factors that influence the physical environment include the school building and the area surrounding it, any biological or chemical agents that are detrimental to health, and physical conditions such as temperature, noise, and lighting. The psychological environment includes the physical, emotional, and social conditions that affect the well-being of students and staff.
Environmental health is the condition of the school’s physical environment as it relates to pollutants, toxins, ventilation, and comfortable lighting and temperature conditions. Promoting environmental health involves limiting the amount of exposure students and staff have to allergens, pollutants, chemicals, mold and moisture in the school building. Managing conditions, such as lighting, acoustics, ventilation, and temperature, also is important to school environmental health.

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Facilitate means to identify and refer students to case management services.
Family and community involvement is an integrated school, family, and community approach for enhancing the health and well-being of students. School health advisory councils, coalitions, and broadly-based constituencies for school health can build support for school health program efforts. Schools actively solicit family involvement and engage community resources and services to respond more effectively to the health-related needs of students.
Feasibility is one of the measures used for determining or ranking the priority level of an action. The feasibility ranking assigned to an action indicates how likely it is that the school will be able to implement the action.
FERPA, the Family Educational Rights and Privacy Act, is a Federal law that protects the privacy of students’ “education records.”
Full-time is defined as being present in the school for at least 30 hours per week.
Fully accessible means that the school (1) offers free and reduced-price meals for students who meet income requirement, in a way that ensures these students are not identified by other students as recipients of these programs and (2) coordinates class and bus transportation schedules so that all students can eat breakfast and lunch at school.

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Gender expression is how a person publicly expresses their gender to others through appearance and mannerisms (e.g., the way one dresses, talks, acts, moves). A person’s gender expression does not necessarily indicate their sexual orientation.
Gender identity is defined as an individual’s self-conception as being male or female (or in some cases, both or neither), as distinguished from actual biological sex. For most people, gender identity and biological characteristics are the same. However, some people experience little or no connection between biological sex and gender identity.
Gender roles are the set of activities, expectations and behaviors assigned to females and males based on what a society currently defines as appropriately masculine or feminine.
Grab and Go to the classroom – breakfast is offered/served from one or more central locations at the start of the day, and students have the option to eat it in their classroom after the bell has rung.

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Harassment is defined under federal civil rights law as conduct based on race, color, national origin, sex, or disability that is so severe, pervasive, or persistent that it creates a hostile environment that interferes or limits a student’s ability to participate in or benefit from the services, activities, or opportunities offered by a school. Some state and school district bullying policies go beyond prohibiting bullying on the basis of traits expressly protected by the federal civil rights laws to include sexual orientation, gender identity, and religion. Unlike bullying, harassment does not have to include intent to harm, be directed at a specific person, or involve repeated incidents.
Health assessments might include:

  • height and weight
  • blood pressure
  • cholesterol level
  • blood sugar level
  • physical activity participation
  • dietary habits
  • tobacco use
  • alcohol and substance use
  • safety (e.g., seat belts, helmets, smoke alarms, drinking and driving, coercive or abusive relationships)
  • mental health
  • confidential HIV counseling, testing, or referral for treatment and care
  • sexual health, including testing and treatment for other STD

Health-related fitness means cardiovascular endurance, flexibility, muscular strength, muscular endurance, and body composition.
Health education is a planned, sequential, K-12 curriculum that addresses the physical, mental, emotional, and social dimensions of health. The curriculum is designed to motivate and assist students to maintain and improve their health, prevent disease, and reduce health-related risk behaviors. It allows students to develop and demonstrate increasingly sophisticated health-related knowledge, attitudes, skills, and practices. The comprehensive health education curriculum includes a variety of topics such as personal health, family health, community health, consumer health, environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition, prevention and control of disease, and substance use and abuse. Health education is provided by qualified, trained teachers.
Health promotion for staff refers to activities that enable school staff to improve their health status, such as health assessments, health education, and health-related fitness activities. These opportunities encourage school staff to pursue a healthy lifestyle that contributes to their improved health status, improved morale, and a greater personal commitment to the school’s overall coordinated health efforts. This personal commitment often transfers into greater commitment to the health of students and creates positive role modeling.
Health services are designed to ensure access or referral to primary health care services or both, foster appropriate use of primary health care services, prevent and control communicable disease and other health problems, provide emergency care for illness or injury, promote and provide optimum sanitary conditions for a safe school facility and school environment, and provide educational and counseling opportunities for promoting and maintaining individual, family, and community health.
Health services providers are qualified professionals such as physicians, nurses, dentists, health educators, and other allied health personnel.
Health topics determine the questions that will be included in your SHI and therefore customize your SHI. The following topics are currently available: safety, physical activity, nutrition, tobacco use, asthma, and sexual health.
HIPAA, the Health Insurance Portability and Accountability Act of 1996 Privacy Rule, requires covered entities to protect individuals’ health records and other identifiable health information by requiring appropriate safeguards to protect privacy, and setting limits and conditions on the uses and disclosures that may be made of such information without patient authorization.
HIV, other STD, and pregnancy professional development topics might include:

  • describing how widespread teen pregnancy, HIV and other STD infections are and the possible outcomes of these conditions
  • understanding the modes of transmission for HIV and other STD and effective prevention strategies for HIV, other STD, and pregnancy
  • identifying populations of youth who are disproportionately affected by early pregnancy, HIV, and other STD and the social and behavioral factors that create these disparities
  • implementing health education strategies that are likely to be effective in providing youth with the skills to prevent HIV, other STD, and pregnancy
  • available evidence-based HIV, other STD, and teen pregnancy prevention programs

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Identifying and tracking involves reviewing existing documentation typically collected in schools, such as health history intake forms, emergency contact forms, health room visit logs, incident reports, attendance and early dismissal records, requests for medication administration, calls from school to 911 (or other local emergency numbers), and records of non-participation in physical education and other physical activity. For most chronic health conditions, it does not include screening events or symptom surveys.
Individualized physical activity and fitness plan means a written plan that contains:

  • assessment of fitness level (before beginning a new physical activity and fitness plan, individuals should assess their current level of fitness to help avoid injury)
  • long-term and short-term personal goals for participating regularly in physical activity and maintaining or improving health-related fitness
  • specific actions to achieve those goals
  • timeline for taking specific actions, assessing progress, and achieving goals
  • methods that will be used to record actions taken and assess progress
  • rewards for achieving goals

Information that can be collected on unintentional injuries and violence include:

  • date, time, and place of injury
  • names of person(s) injured and of any witnesses
  • type of injury (e.g., cut, bruise)
  • severity of injury (e.g., additional medical care required)
  • location of injury (e.g., face, arm)
  • activity during which injury occurred (e.g., sporting event, classroom lesson)
  • agents of injury (e.g., ball, bat, firearm, knife)
  • contributing factors (e.g., alcohol or drug use, lack of supervision, lack of protective gear)
  • status of injured person(s) (e.g., student, faculty, staff, visitor)
  • relationship of injured party to others (e.g., relative, member of gang)
  • intent (e.g., unintentional, assault, self-inflicted)
  • description of action taken (e.g., first aid administered, emergency medical services called, parent notified)

Integrate instruction means provide opportunities for students to develop and practice skills in areas such as:

  • behavioral skills related to health-related fitness (e.g., self-assessment, goal-setting, decision-making, self-monitoring)
  • assessment of health-related fitness (fitness test)
  • interpretation and use of fitness test results

Interactions with family members and community organizations include:

  • doing homework assignments with parents, guardians, or other family members
  • conducting surveys of family members
  • sharing information with family members
  • exhibiting student projects at school for family viewing
  • participating in fun family activities related to safe physical activity and healthy eating
  • encouraging family discussion of health topics covered in the classroom
  • preparing and practicing safety plans (e.g., home fire escape plan, natural disaster evacuation plan) with the family
  • gathering information about existing community-based services
  • having students volunteer to help deliver services through community-based organizations, service learning, and community development projects
  • participating in community-based special events and attending community-based organizations after school
  • participating in community actions such as supporting tobacco-free environments or community gardens
  • participating in community advocacy groups (Students Against Destructive Decision-Making, 4-H, and Family, Career, and Community Leaders of America)

Interscholastic sports refer to sports that a school sponsors and are competitive in nature. Examples include:

  • baseball
  • basketball
  • cheerleading or competitive spirits
  • cross-country
  • fast pitch or slow pitch softball
  • field hockey
  • football
  • golf
  • gymnastics
  • ice hockey
  • lacrosse
  • soccer
  • swimming or diving
  • tennis
  • track and field
  • volleyball

Intramural programs or physical activity clubs are voluntary in nature (i.e., students have a choice of activities or participation), provide every student an equal opportunity to participate regardless of physical ability, and provide students the opportunity to be involved in planning, organizing, and administering the programs. Examples of intramural activities or physical activity clubs are: open gym days, hiking or walking clubs, dance activities, and tennis clubs.

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Learning at home can be encouraged by giving homework assignments that involve family participation; encouraging students to teach their parents about health and safety behaviors; suggesting ways parents can promote healthy behaviors (e.g., picking fruit or hiking); and asking parents to engage their children in health-related learning experiences, such as cooking dinner and packing lunch together, shopping for healthy foods, and reading labels on over-the-counter medicines.
Less nutritious foods and beverages include baked goods and salty snacks that are not low in fat, candy, soda pop, fruit drinks that are not 100% juice, and sports drinks.
Low-fat means either ½% or 1% fat milk.

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Meeting the diverse cognitive, emotional, and social needs of children and adolescents might involve:

  • organizing and structuring a classroom to promote a positive environment
  • using developmentally appropriate discipline strategies that emphasize positive behaviors and values
  • effective instruction for diverse learners
  • strategies to effectively involve families in children’s school life
  • strategies to engage students in school and classroom decision making
  • strategies to engage English language learners

Methods to promote student participation include:

  • class discussions
  • bulletin boards
  • public address announcements
  • guest speakers who promote community programs
  • take-home flyers
  • homework assignments
  • newsletter articles
  • academic credit for participating in community physical activities and programs

Methods to promote and encourage staff member participation include:

  • information at orientation for new staff members
  • information included with paycheck
  • flyers posted on school bulletin boards
  • letters mailed directly to staff
  • announcements at staff meetings
  • articles in staff newsletters
  • incentive/reward programs
  • public recognition
  • life/health insurance discounts
  • gym or health club discounts, such as YMCA
  • posting to a website or listserv
  • e-mail messages
  • positive role modeling by administrators or other leaders

Moderately to vigorously active means engaging in physical activity that is equal in intensity to or more strenuous than fast walking.

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Nutrition services involve access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. School nutrition programs reflect the U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. The school nutrition services offer students a learning laboratory for classroom nutrition and health education and serve as a resource for linkages with nutrition-related community services. Qualified child nutrition professionals provide these services.

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Offer staff members means that the school or district has arranged for staff members to receive these services either on-site or through a community program off-site. This could be part of the employee benefits package, wellness program, employee assistance program, or through partnership with a community provider.
Offer asthma management education means providing asthma management education, partnering with organizations providing asthma education (e.g., American Lung Association, Asthma and Allergy Foundation of America), providing programming space in school, allowing time for students to participate in school- or community-sponsored programs, or disseminating asthma education materials as a supplement to a formal asthma education program on the following topics:

  • basic facts about asthma
  • adhering to asthma action plans
  • identifying and avoiding triggers
  • signs and symptoms of an asthma episode
  • medication information
  • self-management skills (e.g., monitoring asthma, use of peak flow meter, proper use of inhalers)
  • when and how to take emergency actions
  • maintaining physical activity

Offer disease-specific education means providing chronic disease management education, partnering with organizations providing chronic health conditions education (e.g., American Lung Association, Asthma and Allergy Foundation of America), providing programming space in school, allowing time for students to participate in school- or community-sponsored programs, or disseminating chronic disease education materials as a supplement to a formal chronic disease education program on the following topics:

  • basic facts about chronic health conditions
  • adhering to chronic health condition management action plans
  • identifying and avoiding triggers
  • signs and symptoms of a chronic health condition episode (e.g., asthma attack)
  • medication information
  • self-management skills (e.g., monitoring asthma, use of peak flow meter, proper use of inhalers)
  • when and how to take emergency actions
  • maintaining physical activity

Outside school hours means before and after school and during evenings, weekends, and school vacations.

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Pests may include cockroaches, mosquitoes, rats, mice, hornets, ants, spiders, and flies.
Physical activity/fitness programs include classes, workshops, and special events.
Physical education means structured physical education classes or lessons, not physical activity breaks or recess and not substitution of participation in a sport team, ROTC, marching band, etc., for physical education course credit. Physical education is a planned, sequential, K-12 curriculum that provides cognitive content and learning experiences in a variety of activity areas, such as basic movement skills; physical fitness; rhythm and dance; games; team, dual, and individual sports; tumbling and gymnastics; and aquatics. Through a variety of planned physical activities, quality physical education should promote each student’s optimum physical, mental, emotional, and social development, including sports that all students enjoy and can pursue throughout their lives. Physical education is provided by qualified trained teachers.
Policies are legal codes, rules, standards, administrative orders, guidelines, mandates, resolutions, or protocols. Policies are usually developed at the school district or state level and implemented at the school level.
Poorly controlled asthma signs include frequent absences from school, frequent visits to the school health office for asthma symptoms, frequent asthma symptoms at school, and/or frequent non-participation in physical education class or physical activity outside of PE class (e.g., recess, after-school physical activity) due to asthma symptoms.
Positive psychosocial school climate is characterized by caring and supportive interpersonal relationships, opportunities to participate in school activities and decision-making, and shared positive norms, goals, and values.
Practices that result in student inactivity include:

  • taking attendance while students stand or sit in line
  • using games that eliminate students such as dodge ball or elimination tag
  • having many students stand in line or on the sidelines watching others and waiting for a turn
  • organizing activities in which fewer than half of the students have a piece of equipment and/or a physically active role
  • allowing highly skilled students to dominate activities and games

Professional development is the systematic process used to strengthen the professional knowledge, skills, and attitudes of those who serve youth to improve the health, education and well-being of youth. It is consciously designed to actively engage learners and includes the planning, design, marketing, delivery, evaluation, and follow-up of professional development offerings (events, information sessions, and technical assistance).
Prohibit exemptions and waivers means that the school does not allow courses or activities such as interscholastic athletics, ROTC, marching band, cheerleading, or community athletics to be substituted for physical education courses and/or credits.
Punishment should not involve physical activity. Neither punishment nor reward should involve food. For example, schools should prohibit making students run laps or do push-ups as a consequence of inappropriate behavior or not giving one student a snack or meal that is offered to all other students because of inappropriate behavior. Use of food as a reward would include, for example, providing candy or fast-food coupons to students because they have behaved well or met an academic or fundraising goal. Similarly, schools should prohibit withholding of physical education class as a consequence of inappropriate behavior in another class or failure to complete an assignment in another class. (Physical education teachers can discipline students during physical education class by having them sit out for a period of time.)

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Recess is an opportunity for unstructured physical activity.
Reference number is a unique number automatically assigned to your team when you register for the online SHI. You will use this number to log in to the system and should save it for future reference.
Representative means that it includes school administrators, health education teachers, physical education teachers, mental health or social services staff members, nutrition services staff members, health services staff members, maintenance and transportation staff members, students, parents, community members, local health departments or organizations, faith-based organizations, businesses, and local government representatives.
Responsible means services are directly provided by the school nurse, or the nurse supervises services provided by licensed practical nurses (LPNs) or unlicensed assistive personnel (UAPs).

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School decision-making processes can involve students, families, and community members in many ways, including serving on school health committees or teams, youth advisory boards, or curriculum selection committees; assisting with program planning activities; assisting in the development and enforcement of school policies; participating on parent organizations such as the PTA; and designing or conducting a needs assessment or program evaluation.
School level is the grade level in your school—elementary, middle, or high school. You must choose a school level when creating your SHI.
School meals are school-sponsored or district-sponsored programs that are designed to meet the current U.S. Department of Agriculture (USDA) School Meal Nutrition Standards. As mandated in the Healthy Hunger-Free Kids Act of 2010, the USDA established new meal patterns and nutrition standards for all school meals served in the National School Lunch Program and School Breakfast Program. Key changes include:

  • ensuring students are offered both fruits and vegetables every day of the week
  • requiring that whole grain-rich foods be offered each week
  • offering only fat-free or low-fat milk varieties
  • establishing age-appropriate calorie limits for meals
  • limiting the amounts of saturated fat, trans fats and sodium

Scorecard is where you mark your scores on the paper version of the SHI. When using the online SHI, your responses to SHI items will be automatically tallied and appear on a scorecard. Module scorecards display your score for the module. The overall scorecard displays your score for all the modules.
Second Chance Breakfast (Grab and Go) – breakfast is offered/served from one or more central locations, and students have the option of picking it up between 1st and 2nd period to eat it in their classroom after the bell has rung.
Second Chance Breakfast (Cafeteria) – breakfast is offered/served and eaten in the cafeteria between 1st and 2nd period and students have at least 15 minutes to eat.
Sequential means a curriculum that builds on concepts taught in preceding years and provides opportunities to reinforce skills across topics and grade levels.
SHI name is the name you assigned to your SHI when you created it, for example, LeHigh Health Plan. A SHI name cannot be more than 20 characters long.
Sites outside the cafeteria include:

  • vending machines
  • school stores and canteens
  • concession stands
  • parties and special events
  • meetings
  • extended day programs (i.e., school-sponsored after-school programs)

Skills needed to maintain and improve health include:

  • developing critical thinking and problem solving skills
  • decision-making and assessing consequences of decisions
  • developing communication skills
  • developing refusal skills
  • expressing feelings in a healthy way
  • articulating goals to be healthy
  • accessing valid and reliable health information
  • identifying and countering health-compromising marketing strategies (e.g., tobacco or alcohol advertising) or media messages (e.g., unprotected sex has no consequences)
  • coping with difficult personal situations such as negative peer pressure and family changes
  • managing anger
  • building positive relationships
  • reading food labels
  • planning healthy snacks
  • developing a safe, individualized physical activity plan
  • wearing and correctly using protective equipment (e.g., bicycle helmet, seat belt, eye protection)

Social and emotional learning is the development of skills, including the ability to recognize and manage emotions, set and achieve positive goals, establish and maintain positive relationships, make responsible decisions, and handle interpersonal relationships (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Elias, Zins, Weissberg, Frey, Greenberg, Haynes, et al., 1997). Traditionally, social and emotional learning programs focus on five core competencies, including self-awareness, self-management, social awareness, relationship skills and responsible decision making (Collaborative for Academic, Social, and Emotional Learning, 2005; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011).
Special health care needs include learning disabilities, developmental disabilities, behavioral disorders, physical disabilities, temporary physical limitations, and chronic medical conditions such as diabetes, asthma, and scoliosis.
Staff members include administrators and clerical workers, classroom teachers, instructional assistants, physical education teachers, health education teachers, aides, nutrition services staff, school nurses, health assistants, counseling/psychological/social services providers, recess supervisors, athletic coaches, facility and maintenance staff, bus drivers, security personnel, volunteers, and before- and after-school staff.
Standard precautions are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care, or clean up and disposal of contaminated materials or fluids. Under standard precautions, blood and certain other body fluids of all individuals are considered potentially infectious for HIV, HBV and other bloodborne pathogens.
Strengths are the areas in which you scored high (e.g., 3’s and 2’s) on your scorecard.
Systematically link means to establish and implement a standardized process for referring students to community-based health service providers. A systematic process includes formal and informal mechanisms for matching students to appropriate providers, making referrals, sharing information with appropriate confidentiality, tracking and following up with students to ensure receipt of appropriate services, and addressing barriers to accessing services. Mechanisms such as memoranda of understanding can formalize the relationship between a school and community-based health service providers.

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Tailored means that the school or district has conducted a needs assessment to determine which health education topics and health-promoting activities staff members are interested in and what their needs are regarding participation in such activities.
Team is the group of people who will be working on the SHI. The team consists of individuals who are part of the school, such as the principal, students, nurse, parents and teachers; and individuals outside the school, such as local health department staff members.
Team name is the name you assigned to your team, such as LeHigh Tigers. The team name should not exceed 20 characters.
Training means taking courses taught within a college/university professional preparation program or courses provided by the school district, community youth sports programs, or national coaching education programs.

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Universal Free Breakfast – breakfast is offered to all students free of charge, regardless of their free, reduced or paid lunch status.
Use of tobacco means all forms both combustible and non-combustible: cigarettes, cigars, cigarillos, chewing tobacco and snuff, bidis, clove cigarettes, etc.

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Volunteers might help in the classroom, in the cafeteria, or with special event; lead lunchtime walks, after-school exercise programs, and other health programs; or mentor and tutor students.

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Weaknesses are the areas in which you scored low (e.g., 1’s and 0’s) on your scorecard.
Whole grain rich products are not easily identified because whole grain content is not required on product labels. In practice, the simplest way to determine if a product is whole grain rich is to look at where whole grains appear on the ingredient list. For non-mixed dishes (e.g., breads, cereals), a whole grain must be the primary ingredient by weight (that is, it is the first ingredient in the list.) For mixed dishes (e.g., pizza, corn dogs) a whole grain must be the first grain ingredient in the list.) Detailed instructions for determining if a product is whole grain rich appear in the HealthierUS School Challenge Whole Grains Resource, available online.

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Youth-friendly services are those with policies and attributes that attract young people to them, create a com¬fortable and appropriate setting, and meet young people’s needs. These services:

  • have expertise in providing sexual and reproductive healthcare services to adolescents
  • have staff who respect young people, honor their privacy and con¬fidentiality, are non-judgmental, and allow for adequate time to interact with youth
  • have conve¬nient hours (including welcoming drop-ins), short wait times, an accessible location, adequate space and privacy, and affordable fees
  • provide comfortable surroundings that are welcoming to both males and females and to youth of all sexual orientations
  • offer youth-focused group discussions, peer counselors, information, and educational materials
  • provide integrated sexual and reproductive health services that allow adolescents to meet their needs for HIV, other STD, and pregnancy prevention in one place
  • provide adolescents with information about and access to the full range of their sexual and reproductive health options, including contraception; STD prevention, testing, and treatment; and emerging biomedical strategies for HIV prevention
  • encourage youth to return and follow-up with medical referrals
  • solicit youth feedback on their needs and ways to improve services

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504 plans are written descriptions of educational, health, and other related services or modifications needed to assist students with special needs who are in a regular educational setting.


Collaborative for Academic, Social, and Emotional Learning. (2005). Safe and Sound: An Educational Leader’s Guide to Evidence-Based Social and Emotional Learning (SEL) Programs, Illinois Edition. Chicago, IL: Author.

Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D. & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82, 405–432.

Elias, M.J., Zins, J.E., Weissberg, R.P., Frey, K.S., Greenberg, M.T., Haynes, N.M., Kessler, R., Schwab-Stone, M.E., & Shriver, T.P. ( 1997). Promoting social and emotional learning: Guidelines for educators. Alexandria, VA: Association for Supervision and Curriculum Development.

McClanahan, R., & Weismuller, P. C. (2015). School nurses and care coordination for children with complex needs: An integrative review. Journal of School Nursing, 31, 34–43.