Report Title:

School health system



Establishes a comprehensive school health system that promotes the healthy development of all students and a comprehensive school health program. Convenes a joint planning committee to coordinate a phased implementation of the program.


S.B. NO.









relating to school health.



SECTION 1. Children and most adolescents are usually dependent on parents and caregivers for access to health care to maintain good health. When they become sick or are injured, most children and adolescents have access to a health care professional or service. However, too many children and adolescents in the United States, particularly those from poor families or in rural or isolated communities, are at risk for multiple health problems because they lack health insurance or access to a primary care provider. Indigent children may experience two to three times the usual incidence of certain medical conditions, many of which are preventable. Even those adolescents who have health insurance and a primary care provider do not readily seek medical care and their parents or caregivers find it difficult to maintain regular visits to the pediatrician or family doctor for their teenagers.

The most common health problems affecting children and adolescents today include injuries, chronic illnesses such as asthma, and mental health problems. In addition, adolescents and pre-adolescents are now engaging more frequently in risky behaviors that may lead to health problems, including smoking, drinking alcohol, illegal drugs, and unsafe sex.

Since all children and adolescents are required to attend school, health services that are readily available at little or no cost would encourage students, especially adolescents, to access care or information at the earliest point of need. School-based health services will also provide access to mental health services in a non-threatening, non-labeling, and non-stigmatizing environment, since services would be provided as part of an array of services. School-based health services can play a strategic role in the delivery of school-based mental health assessments, day treatment, and mental health services as required by the Felix-Cayetano consent decree.

The legislature finds that the concept of school-based or school-linked services, which are enhanced by community agencies providing services at a school site, will facilitate school and community reforms to adopt a comprehensive, multi-faceted, and integrated approach necessary to prevent health problems. However, the legislature understands that developing a comprehensive and integrated approach requires more than outreach to link community resources, more than coordination of school-owned services, more than family resource centers and full service schools. Meeting the needs of all students also requires community input and investment to identify and plan a continuum of school and community programs and services that is appropriate to the values of the community. Collaboration, communication, and cooperation among schools, parents, students, and community agencies and organizations are essential to establishing a successful school-based health system and over time, to ensure a seamless system of prevention, early intervention, and when necessary, care of every student in need.

The purpose of this Act is to provide children and adolescents access to quality, affordable health care in an encouraging and non-threatening environment through a comprehensive school health program.

SECTION 2. (a) The department of health, with the cooperation of the department of education, shall establish a comprehensive school health program in conjunction with the department of education comprehensive schools support system. The program shall:

(1) Coordinate and integrate a range of community health and social services with components designed to:

(A) Facilitate development and learning; and

(B) Overcome barriers to regular school attendance;

(2) Integrate in-school resources;

(3) Enhance projects by integrating school and community resources, including increasing access to community programs and services by coordinating as many programs as feasible with the school to fill gaps in projects and services; and

(4) Use funds from but not limited to the following sources:

(A) Special education;

(B) Health insurance reimbursements for billable services;

(C) General funds;

(D) Federal funds; and

(E) Community resources, including community health centers, agencies, grants, donations, and volunteers.

(b) For purposes of this section, "enabling projects and services" means clusters of programmatic activity that address barriers to learning and enhance healthy development by:

(1) Enhancing classroom-based efforts to enable learning;

(2) Providing prescribed student and family assistance;

(3) Providing physical and mental health assessments and services;

(4) Responding to and preventing crises;

(5) Overcoming barriers to school attendance related to physical and mental health and family problems;

(6) Increasing home involvement in schooling;

(7) Supporting comprehensive school support services; and

(8) Supporting outreach for greater community involvement and support, including recruitment of volunteers.

(c) School-based health services shall be established through collaborative partnerships if general fund appropriations are not available.

SECTION 3. (a) The director of health, with the assistance of the superintendent of education, shall establish and operate as a program, not fewer than one comprehensive school health project in each of seven school districts; provided that at least three projects are in the Honolulu district and two are in the Hawaii district.

(b) Prior to the establishment and operation of a comprehensive school health project, the principal of the school and the school and community-based management council, in consultation with at least one health care professional, shall establish policy decisions related to the operation of the project, including but not limited to:

(1) How consent of a parent or parents will be provided;

(2) Ability to pay;

(3) Confidentiality of records;

(4) Financial responsibility;

(5) Limitation of actions; and

(6) Personnel.

(c) With the exception of the promotion of abortions, abortion-related services, condoms, or other contraceptives, the comprehensive school health projects shall be student-centered and include the following components:

(1) Health education;

(2) Physical education;

(3) Health services;

(4) Nutrition services;

(5) Counseling, psychological, and social services;

(6) Healthy school environment;

(7) Health promotion for staff;

(8) Parent and community involvement; and

(9) Mental health assessments and services.

(d) The comprehensive school health projects shall be designed using the comprehensive school health program established in section 2 of this Act.

SECTION 4. There is established a joint department of health and department of education planning committee to plan and coordinate implementation of a comprehensive school health services and comprehensive school health program in conjunction with the comprehensive school support system.

The director of health and superintendent of education shall designate members of their respective departments to sit on the joint planning committee to carry out the purposes of this Act. The planning committee shall also include representation from mental health, medical, and dental providers, community health centers, the American Pediatric Society, Hawaii Chapter, and the Hawaii State Parent-Teacher Association.

SECTION 5. The director of health shall report to the legislature on the experience of each comprehensive school health project at least twenty days prior to the convening of the regular sessions of 2005 and 2006. The report shall include:

(1) The policies of each comprehensive school health project;

(2) The number of students served and the types of health services provided;

(3) The operating cost, including income collected through fees, monetary donations, private grants, and in-kind services;

(4) Quantifiable changes in high-risk behaviors among students receiving services;

(5) Benchmarks for physical and mental health and increases in positive outcomes for children and adolescents;

(5) Recommended changes to improve the program; and

(6) Any other information that the departments of health and education may determine to be necessary to assist the legislature in evaluating the efficacy, cost-effectiveness, and intangible merits of the program.

SECTION 6. The department of health shall work in collaboration with the Primary Care Association of Hawaii to apply for federal funds and grants to implement the provisions of this Act.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $1 or so much thereof as may be necessary for fiscal year 2003-2004 for comprehensive school health projects. The money shall be allocated as follows: $175,000 for existing and/or startup school-based health clinics for at least one school in each of the seven departmental school districts.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 8. This Act shall take effect upon its approval; provided that:

(1) Section 7 shall take effect on July 1, 2003; and

(2) This Act shall be repealed on June 30, 2010.