School Health Guidelines to Prevent Unintentional Injuries and Violence

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School Health Guidelines to Prevent Unintentional
Injuries and Violence
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(No Transcript)
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Injuries Kill More Children and Adolescents Than
All Diseases Combined
Source CDC, 2000 Vital Statistics
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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.

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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.
• gt100,000 were arrested for violent crimes.
• 2,944 were homicide victims.

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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.

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Percentage of US High School Students Involved in
Violence-Related Behaviors, 2001
Behavior of Students Carried a weapon
17.4 Carried a gun 5.7 In a
physical fight 33.2
In the 30 days before the survey. In the 12
months before the survey. Source CDC, National
Youth Risk Behavior Survey
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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
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Injuries Occur Everywhere
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Why Focus on School?
Schools are Places of Living and Learning
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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).

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Injuries and Violence in School

• Most school injuries are minor
• 6 of EMS incidents.
• 1 in 400 injury fatalities.

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High School Students Who Felt too Unsafe to Go to
School, U.S., 1993-2001
Source Youth Risk Behavior Survey, CDC
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Violent Deaths Among School-Aged Children,
1994-1999
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What Are Schools Doing to Prevent Injuries and
Violence?
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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

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Source CDC, School Health Policies and Programs
Study, 2000
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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
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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
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Percentage of Schools Requiring Unintentional
Injury, Violence and Suicide Prevention
Education, by School Level
Source CDC, School Health Policies and Programs
Study, 2000
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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
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Percentage of Schools Teaching Skills Related to
Violence and Suicide Prevention in at Least One
Required Class or Course

• 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.

Source CDC, School Health Policies and Programs
Study, 2000
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Percentage of Schools Teaching Topics Related to
Unintentional Injury Prevention in at Least One
Required Class or Course

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

Source CDC, School Health Policies and Programs
Study, 2000
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How Were the Guidelines Developed?
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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.

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The Breadth of the Guidelines
Unintentional injury
Violence
Suicide
Social environment
Physical environment
Health education
Physical education
Family/community
Staff development
Health services
Crisis response
Elementary
Middle/JHS
High school
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Coordinated School Health Programs
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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

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(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.

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(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.

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(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.

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(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.

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(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.

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

• Conduct regular safety and hazard assessments.

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(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.

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(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.

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(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).

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(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.

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(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.

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(3) Implement Health and Safety Education
Curricula and Instruction

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

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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.

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(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
  schools experience and consider changes.

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(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.

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(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.

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(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.

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• 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.

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More Resources Will Follow

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

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Questions?

• www.cdc.gov/HealthyYouth