Feasibility of obtaining parental consent for special education record review in autism surveillance

Purpose The purpose of this study was to describe the feasibility of an alternative approach to public health surveillance for autism via parental consent when FERPA restricts access to special education records. Specific questions were: What is the process for obtaining parental consent by mail to review and abstract information from the child's special education records, what are the obstacles, what are the costs in time and money, and what is the yield of affirmative replies to requests for access to records? Methods The feasibility study was conducted over 18 months. Data were collected from telephone, email, observation and meetings, among investigators and personnel of the Philadelphia School District. Results Negotiations comprised multiple meetings with various stakeholders for 27 months before the mailing was sent. District representatives were concerned about violating the Family Education Rights Protection Act (FERPA). Discussions with attorneys were needed to confirm adequacy of privacy protection. Significant barriers related to practical issues of implementation and cost included: limited district resources, low cooperation of staff, FERPA regulations, and parent variables. One problem was the ability to generate parent support and cooperation to collect a sufficient number of affirmative responses. The population of children and parents was multiracial, spoke over 120 primary languages and was socioeconomically diverse. Nineteen hundred letters were sent to parents in English and Spanish. Within 2 weeks of delivery 214 responses were received (11%); 20% of these declined record review, and 105 letters were returned undeliverable. The study coordinator received over 70 calls from parents requesting more information. The monetary cost of the project exceeded $22,000. Conclusion The complexity of establishing collaboration among multiple stakeholders requires considerable human and other resources. More effort is needed to establish credibility and visibility of a surveillance program in the school community before requesting cooperation from parents. Initial expenses may be the first investments in a long-term cooperative relationship.

The Case Johnny plays on the high school football team; he is not a starter but can sub in at several positions on offense and defense. His best friends since kindergarten are the starting quarterback, wide receiver, and middle linebacker. The four are inseparable, and this past week was no exception. Johnny visited his older brother at college last weekend and now is mildly symptomatic and tests positive for COVID-19. He has been practicing with the team all week, and the team is playing tonight. The Problem(s) What do I do with this information as Johnny's physician and as a team physician for the local high school? Should his close friends and teammates be in quarantine? Is there a public health prerogative to disclosure to the coaches and school administration? These questions go to the heart of confidentiality and highlight the COVID-19 conundrum of public health in the sports arena. The team physician generally reports conditions rendering athletes unable to play to the coach. COVID-19 is more complicated because it has implications for all players and staff that came into close contact with Johnny. All close contacts need to quarantine for 14 d. But what constitutes "close contact"? For our medical residents working in the hospital setting, that threshold is more than 15 min in the same room as a COVID-positive case, irrespective of symptoms, but the Centers for Disease Control and Prevention recently updated the definition of exposure to "accumulating more than 15 minutes within 6 feet of an infected individual(s)." Contact tracing for Johnny may influence decisions regarding the team — several key players have had extended contact with Johnny and their exclusion from play will severely handicap the team. The Minnesota Department of Health (MDH) among others, consider COVID-19 a mandatory reporting condition. "The MDH is requiring all mandated reporters to report any cases and deaths due to SARS-CoV-2 to MDH within one working day" (1). When all is working well, positive tests are reported by the laboratory, and the report triggers contact tracing by the Department of Health. However, we are in a public health emergency, and all is not working well. Is it up to the team physician to interview Johnny and determine who needs to be tested and who needs to be quarantined before tonight's game? Also, what about contact tracing for nonplayers who came into close contact with Johnny? What about contact tracing for his family? This quickly expands well beyond the regular scope of a team physician. Physicians are required by our medical boards and the courts to uphold the standard of care. The Federal Public Readiness and Emergency Preparedness Act (PREP Act) (2) recently passed, significantly limiting physician liability when evaluating and treating COVID-19, precisely because there is little consensus on a standard of care. Moreover, working conditions are so atypical that once-a-decade judgment calls, like the contact tracing described above, are now commonplace. In short, how the team physician ought to proceed is an open question. Personally, performing some degree of contact tracing for exposures within the team seems prudent. This duty comes with at least two complications: Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA). More Problems HIPAA 1996 is "a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge" (3). FERPA is "a federal law that protects the privacy of student education records" (4). The Departments of Health and Human Services and Education have released joint guidance regarding the application of HIPAA and FERPA in situations where health records and educational records might intertwine (5). FERPA applies to student health records at federally funded schools, and HIPPA applies to external health records and health records at private schools (if clinicians affiliated with those schools engage in HIPPA-qualifying activities, such as electronic billing of health insurance plans). Over and above the legal implications of HIPAA, FERPA, and the PREP Act, the moral tenets of clinician-patient confidentiality remain. On the one hand, we have an obligation to pursue limited contact tracing and to promote public health. On the other hand, we want to keep Johnny's COVID-19 status confidential. To help balance this paradox, it is worth considering why Johnny and his family may not want to share his COVID-19 status. Several reasons may exist, including simply a desire to keep all health information private. A practical concern is the stigma surrounding a COVID-19 diagnosis, an internationally recognized phenomenon that could sway a family toward nondisclosure (6,7). Stigmatization can lead to further social isolation on top of that already imposed by self-quarantine. The effect of isolation on mental health is significant, especially among adolescents (8), and only exacerbates other psychosocial aspects of the COVID-19 pandemic (9,10). Racism and stigma toward certain minority communities, such as the Chinese-American community, during the pandemic is yet another reason for some to keep positive results private (11). "COVID shaming," an emerging phenomenon, may be another concern. It involves the assumption that a person's COVID-19 diagnosis is the result of poor mitigation practices — a personal failure of social distancing, mask-wearing, sanitization, and hygiene. A COVID-19 diagnosis is, thus, seen as a moral failing worthy of shame (12). Johnny's potential for shame, stigma, and isolation is compounded by his potential impact on "Friday Night Lights." Some Clarity So how do we respect confidentiality and limit the spread of COVID-19? First, let's address the legal requirements. Parental consent is generally needed to share medical or education records with others. FERPA provides permission to disclose private information if necessary in an emergency to protect the health and safety of the student and the public, and HIPPA provides for a similar disclosure when the disclosure could prevent or lessen the risk of serious harm (5). The federal government has declared the COVID-19 pandemic to be a public health emergency (13). In these instances, clinician judgment will determine if the threat of harm is serious enough to warrant disclosure (14). Here, the moral reasoning of the clinician becomes especially important, because they must balance public health against individual confidentiality. Ideally, parental consent and student assent could be obtained prior to any disclosure of a COVID-19 result. Many parents and students would surely agree. However, if a test result must be shared despite parental or student objection, it should contain the minimum necessary protected information needed to effectively convey the risk of infection and facilitate contact tracing (5,14). Contact tracing 101 teaches to never directly disclose the source of an infection. Statements like, "It has come to our attention that you have come into close contact with someone who tested positive for COVID-19" should replace, "Johnny tested positive for COVID-19." A final twist in this case is unfortunately not too far-fetched. What if the coach and players do not follow your quarantine recommendations? After all, Johnny's close contacts are key players, asymptomatic, and have not even been tested. This situation can be addressed as a general question about what a team physician does if the coach is playing ill or injured players. It may be more akin to hiding herpes gladiatorum in wrestling matches — unproblematic for the athlete in question but a danger to others. There should be a way to report to the coach's supervisor. That is why some sports' national governing bodies under the US Olympic Committee have the medical team report to an administrator above the performance team — so the performance aspects of decision making do not create a conflict of interest with player and team safety (15). We recommend setting up the option to report to a higher administrative level when negotiating your initial role as team physician. In the absence of such an arrangement, it is the team physician's moral conviction and clinical judgment that will determine their actions. Conclusions This hypothetical case lands at the intersection of public health ethics (COVID-19 is a mandatory reportable disease without adequate contact tracing), ethics of sport (duties of a team physician), and issues of confidentiality (HIPAA, FERPA, duty to patient). It exposes the conflicting obligations of a team physician to uphold individual confidentiality, support the team, and protect the public.

Incorporating Academic and Health-Related School Needs into Pediatric Nursing Practice

T he welfare of children is central to the mission of public schools. Teachers, counselors, and admi istrators strive to create a safe environment where each student can learn, grow, and develop to his or her full potential. Educators provide this environment by getting to know individual students and by tailoring the school's programs and services to each student's needs and interests. Some very real obstacles to this public school mission are found, however, in the laws and court decisions that presently define the privacy rights of students and their families. The Family Educational Rights and Privacy Act of 1974 (FERPA) and the Hatch Amendment to the General Education Provisions Act of 1978, as well as ambiguous and inconsistent court rulings, pose real problems for educators. FERPA was originally drafted to bring fairness and consistency to the way schools handle student records. Before its passage, access to student records was largely controlled by state statute, state educational agency rules, local school board regulations, and common law principles that varied greatly from state to state and from one school district to another (Butler, Moran, and Vanderpool 1972). Studies such as that done by the Russell Sage Foundation in 1970 showed that privacy rights at the time were, for the most part, abused, nonexistent, or not communicated to parents and students. Schools often collected and retained information about students and their families without the informed consent of the family, and, even when consent was given, information was used for purposes other than those for which it had been collected (Splain 1976). FERPA has redressed these wrongs by giving parents and students access to school records and the right to question and challenge the content of these records and to determine to whom the records shall be released. The Hatch amendment has extended family privacy rights by restricting a school's access to personal information regarding students and their families. As a result of the amendment, -there are some questions that simply cannot be asked without prior parental permission. Specifically, parental consent must be given for student participation in any program, test, or psychological or psychiatric exam or treatment with the purpose of revealing (1) political affiliation; (2) mental and psychological problems potentially embarrassing to the student or family; (3) sex behavior and attitudes; (4) illegal, antisocial, self-incriminating, and demeaning behavior; (5) critical appraisals of other individuals with whom respondents have close family relationships; (6) legally recognized privileged and analogous relationships, such as those of lawyers, physicians, and ministers; or (7) income. The courts have also had a hand in defining the privacy rights of minors and their families. There have been several significant cases in which the privacy of students has been a central legal concern or where the privacy rights of students and their parents have conflicted. Court opinions in these cases have given mixed and often ambiguous messages regarding student and family privacy rights. This article will illustrate the potential problems that family and student privacy rights pose for public schools and the inherent conflict between the perceived mission of the public school and the legal parameters within which it must function.

Pediatric health-care providers may be unaware of how best to partner with their patients’ schools to create asthma-friendly environments in which patients’ asthma health needs are communicated clearly, school heath staff are empowered and equipped to react to asthma exacerbations appropriately, and school personnel reinforce asthma health maintenance messages with families.After completing this article, readers should be able to: More than 5.5 million school-age children in the United States are diagnosed as having asthma. (1) This equates to almost 1 in 10 school-age children, making asthma the most common chronic childhood condition in the country. More than half of all children with a diagnosis of asthma have at least 1 asthma exacerbation each year. Particularly concerning, rates of pediatric asthma deaths have been increasing. In 2018, 156 children aged 5 to 17 years died of asthma. Non-Hispanic black children have a 6 times greater mortality rate from asthma complications than Hispanic white children and a 7 times greater rate than non-Hispanic white children. (1) Deaths that occur outside the clinical setting account for 13% of all asthma deaths in children.Asthma can affect a child’s academic attendance and education. Children with asthma miss more school than those without asthma and are at greater risk for missing more than 10 school days per year, a degree of absenteeism that may put them at risk for grade retention. (2)(3) Almost half of all students with asthma miss at least 1 day of school each year due to related symptoms, accounting for 13.8 million lost days. (4) Absences occur most frequently during colder months, among students with persistent rather than intermittent asthma, and among students attending a school with a part- versus full-time nurse on staff. (3)(5) Studies suggest that 1 of the peak times for ambulance-treated pediatric asthma exacerbations is around 1 pm (ie, in the middle of the school day), further underscoring the importance of school factors in contributing to students’ asthma outcomes. (6)A recent policy statement from the American Academy of Pediatrics highlights the importance of coordination of care between community-based pediatricians and other child health-care providers (hereafter referred to collectively as pediatricians) and school health staff. (7) This review article focuses on the role of pediatricians in supporting and contributing to high-quality school-based asthma management. By gaining an understanding of the challenges that schools face in promoting asthma wellness, and of how to partner with students, families, school nurses, and school staff to overcome these challenges, pediatricians can help ensure that their patients with asthma are safe, healthy, and primed to learn.The Centers for Disease Control and Prevention (CDC) Healthy Schools and the CDC’s National Asthma Control Program (NACP) have developed strategies to guide school personnel and other stakeholders in creating asthma-friendly schools. (8) Asthma-friendly schools are defined as environments that are safe for children with asthma and have policies and practices in place that support children and their caregivers in managing their asthma. The NACP recommends multiple evidence-based strategies to address asthma in schools, including supporting students in asthma self-management, educating school staff and caregivers, improving school air quality, linking students to medical providers for asthma health maintenance, allowing students to self-carry quick-relief medication (such as albuterol), and having schools stock a supply of albuterol for communal student use.In interventional studies, school-based asthma management programs have typically involved a combination of interventions designed to improve schools’ ability to identify students with asthma and assess their level of symptom control, educate high-risk students on disease management, link students to primary care providers, and/or develop protocols for managing asthma emergencies. (9)(10)(11)(12) School-based asthma interventional trials have achieved varying levels of success in terms of improving students’ quality of life and reducing their number of hospitalizations and emergency department visits. Results suggest that strong partnerships among schools, families, and health-care providers are key to programmatic success, and limitations in available resources for program implementation are a primary barrier. (12)Note that interventional trials are typically conducted in relatively highly resourced school settings with engaged stakeholders. Depending on local context, the level of medical support that can be provided to students at any given school may be very different. Although US federal laws mandate that all children have access to health services at school, individual states determine the minimum qualifications for school nurses, which may or may not include a baccalaureate degree, nursing certification, registered nursing license, and minimum amount of experience. (13) States also regulate which activities, such as administering medications, can be performed only by a registered nurse versus a licensed practical nurse. Although the American Academy of Pediatrics strongly endorses a minimum of 1 full-time registered nurse in every school, this standard is not always met. (14) Access to school nurses has been associated with improvements in chronic disease management, including reduced frequency of asthma exacerbations and absenteeism due to asthma. (14) Nonetheless, only 63% of schools have full-time nursing coverage, 19% have part-time coverage, and 18% have no nursing coverage. (15) Approximately 80% of public schools have support from a registered nurse, either full- or part-time, whereas among private schools the percentage is much lower at 35%. In addition to nurses, nearly 1 in 5 schools use volunteers, and nearly 3 of 4 schools use teachers or school staff to supplement nursing activities, including performing health promotion education.Most assessments of barriers to asthma care management at school have exclusively included schools with nurses on staff. Presumably schools without nursing staff experience even greater obstacles to the provision of quality care to students. In a survey of school nurses that sampled from a national database, 78% of respondents reported that albuterol was available at their school. (16) However, because most schools do not stock albuterol for communal student use, it is unclear how many of the respondents were simply reporting that at least 1 student at their school had access to a personal supply of albuterol brought from home. (17) In another survey of nurses from 36 predominantly urban schools in Alabama, respondents collectively reported that only 14% of students with asthma had an albuterol inhaler at school. (18) Another survey of 126 nurses from a different urban school district found that nearly three-quarters of the respondents agreed that “asthma is one of the biggest health problems I deal with among students in my school,” and “most of the kids who have to be dismissed early because of asthma symptoms could go back to class if they had an inhaler at school.” (19) These results underscore the perceived impact of asthma on student health and suggest that some asthmatic children with mild symptoms and no inhaler are being sent home, leading to higher rates of absenteeism.Beyond limited access to albuterol, school nurses have also reported that their efforts to manage students’ asthma are hampered by inadequate nurse staffing and time, limited support from school administrators, and challenges in communicating with parents and pediatricians. Other barriers cited by school nurses include a lack of knowledge about asthma management guidelines among students, parents, teachers, school personnel, pediatricians, and school nurses, as well as a lack of appreciation for school nurses’ expertise. (20)Pediatricians’ efforts to partner with schools on asthma management should begin with self-evaluation to determine whether personal clinical practice adheres to guidelines for asthma diagnosis and management. In 2007, the National Heart, Lung and Blood Institute’s National Asthma Education and Prevention Program (NAEPP) established age-based criteria for the classification of asthma based on patients’ level of risk for severe exacerbation and degree of daily impairment. (21) In 2020, the NAEPP published focused updates across 6 topic areas to the original guidelines. (22).Assessing asthma risk involves considering all of a child’s significant asthma exacerbations in the preceding year, and assessing asthma impairment involves considering all of the child’s daily symptoms in the past 2 to 4 weeks. Risk and impairment are used to classify a child’s asthma severity (intermittent, mild persistent, moderate persistent, and severe persistent) and control (well controlled, not well controlled, or very poorly controlled). The NAEPP guidelines provide standardized recommendations for therapy initiation, escalation, and de-escalation based on the child’s risk and impairment classification at the time of the assessment. For more details on asthma diagnosis and management, see the article “Asthma” in the November 2019 issue of Pediatrics in Review and the 2007 and 2020 NAEPP recommendations. (21)(22)(23)NAEPP guidelines emphasize the importance of patient and family education regarding asthma diagnosis, symptom recognition, and management. Pediatricians should provide families with asthma self-management education at the time of diagnosis and reinforce key messages routinely at follow-up visits. Messages should be tailored to a child’s level of comprehension and developmental stage to encourage engagement. Proper use of inhalers should be repeatedly reviewed using the teach-back method, with parents and older children demonstrating their ability to administer medication. Asthma education initiated in the medical home should establish concepts and language that transcend care setting.Beyond following evidence-based guidelines in caring for individual patients with asthma, pediatricians can also leverage the functionality of their electronic medical record system to optimize asthma management on a practice or population level. Specifically, pediatricians can use medical record search tools to identify their at-risk patients and patients with asthma who have had gaps in care (eg, missed appointments or lack of prescription for an indicated controller medication).Guidelines dictate that all patients with asthma have an asthma action plan that is individualized. The written asthma action plan provides individualized instructions and a roadmap for education at school to reinforce appropriate medication use by families. The treatment plan should be developed through a joint decision-making process among the pediatrician, the patient, and the patient’s family. Input from a child’s school nurse may also be helpful for proper execution of the plan at school. Coordinating educational messages via the asthma action plan and other health records shared with school health staff allows the pediatrician to be sure that families receive consistent advice across care settings.Key elements of the asthma action plan include the following (24): Many pediatricians and school systems have adopted asthma action plans with these important components. These plans often use a stoplight format designating green, yellow, and red zones to indicate the actions needed when a child is doing well, should be monitored for worsening symptoms, or requires emergency medical intervention, respectively. Helpful asthma action plan examples in English and Spanish are available for download from the American Lung Association website. (25) Of note, some schools and school districts only accept their own, approved asthma action plan as the official form authorizing school health staff to administer asthma medication to students.A 2012 survey of 1,412 health-care providers (including adult-focused health-care providers and mid-level providers) found that only 16.4% of primary care providers “almost always” gave asthma action plans to patients, and 17.6% “never” gave them to patients. (26) A 2013 CDC survey found that only half (50.8%) of parents of a child aged 0 to 17 years with asthma recalled ever having received an asthma action plan. (27)Giving an asthma action plan to a family at medical visits does not guarantee that the form reaches school health staff. Manual delivery of asthma action plans to the school nurse by families has not been found to be reliable. (28) Faxing or mailing forms to the school are other options but require accurate school information and appropriate labeling of documents because they contain protected health information that should not be shared with non–health personnel at the school. Sharing of medical forms using electronic medical record interfaces, portals, and direct secure messaging should be explored as options for communicating with schools as these tools become more widely available.Communication between pediatricians and school health staff must comply with federal privacy laws governing the exchange of protected health information. Local school districts and health organizations may have additional regulations. Misconceptions regarding the requirements of these laws and regulations pose a barrier to effective care coordination across sectors.The Health Insurance Portability and Accountability Act (HIPAA) is a US federal law that protects the privacy of patient health information held by “covered entities.” (29) Pediatricians are considered covered entities, and thus, signed parental consent for the disclosure of a child’s protected health information by the pediatrician is required; however, there are exceptions. The exchange of protected health information with other health-care providers for treatment purposes is one of those exceptions permitting pediatricians to discuss a student’s medications and plan for the provision of care with the student’s school health staff without the written authorization of the student’s parent. (30)The Family Educational Rights and Privacy Act (FERPA) is a US federal law that protects the privacy of students’ personal records held by educational agencies or institutions that receive federal funds under programs administered by the US Secretary of Education. (31) School health records are maintained as part of the students’ educational records and are, therefore, governed by FERPA, not HIPAA. Under FERPA, school health staff is not allowed to disclose information in a student’s educational record to any party outside the school without written consent from parents. As such, school health staff can request documents and forms from the pediatrician but may not share information about asthma symptoms and medication use at school, absenteeism, or school performance without parental authorization. (32) In other words, HIPAA allows the pediatrician to communicate with the school nurse regarding the child’s health without written consent. However, FERPA requires parental consent for the school nurse to share any educational record information, including student health data, with the pediatrician.Bidirectional health information exchange between pediatricians and school health staff is a key component of creating an asthma-friendly school. Obtaining parental consent for this exchange needs to be standard procedure and, ideally, should be documented in the asthma action plan. Supplementary consent documents or treatment orders can also be used. Beyond the asthma action plan, standardized forms or documents to facilitate communication between school health staff and pediatricians can be used to streamline information exchange, particularly for children with poorly controlled asthma and/or chronic absenteeism due to asthma. Such a form may include space to document details about a student’s hospital admissions, emergency department visits, urgent care visits, school health suite visits, school days missed, whether the student has an asthma action plan and medication at school, and how both health-care parties prefer to exchange documents in the future. A standardized form may also include a place to document parental consent to permit bidirectional communication between the school and the pediatrician if consent is not already captured in the asthma action plan.In 2004, the US Congress passed the Asthmatic Schoolchildren’s Treatment and Health Management Act, which gives states preference for certain sources of federal funding if they enact local laws requiring schools to permit students to access their asthma medications during the school day. (33) Complying states must require public schools to authorize students to self-carry and self-administer asthma medication if 1) a health-care provider prescribed the medication for use during school hours; 2) the student demonstrates to the health-care provider and school nurse (if available) the skill level necessary to use the medication; 3) the health-care provider has written a treatment plan guiding medication use and asthma management (ie, an asthma action plan); and 4) the student’s parent or guardian has submitted to the school the asthma action plan and any other documents required by the school related to liability. Per the Act, students must have immediate access to their asthma medication while 1) at school; 2) at school-sponsored activities, including sporting events; and 3) traveling to or from school or school-sponsored activities. The asthma action plan, any other related documents, and backup medication, if provided to the school, must all be kept in a location at school to which the student and staff have immediate access in case of emergency. The medication authorization can apply only to the school for which it was granted, and it must be renewed by the parent each school year.All states and the District of Columbia now have albuterol self-carry laws for students. Nonetheless, states differ in the amount of detail included in their local laws. Those with less-detailed legislation rely on individual schools and school systems to determine the specific policies used to implement the mandate. It has been found that schools and school systems often create policies that add restrictions beyond what is minimally required. (34) For example, school systems may require the submission of extra forms beyond the asthma action plan. They may dictate that backup medication must be new and unopened, or accompanied by the asthma action plan at the time it is received rather than working with families to collect all the necessary items piecemeal. These policies effectively limit the number of asthmatic students with access to lifesaving treatment at school. Local variation in medication access rules can also cause confusion for parents and pediatricians in terms of knowing what items need to be submitted for which school.There are multiple prerequisite steps for a student to have access to a personal supply of quick-relief medication at school: Depending on when parents initiate the process and the time it takes for all the steps to be completed, a student may not gain access to albuterol at school until the winter or spring. In such cases, it is helpful for the pediatrician to alert the family that the process will need to be repeated again in the fall for the new school year.Access to albuterol remains low despite every state passing laws allowing students access to their self-supplied asthma medications at school. (18)(19) As a result, the NACP, professional organizations such as the National Association of School Nurses, and advocacy groups such as the American Lung Association all maintain the position that schools should stock albuterol inhalers for students who experience asthma symptoms or emergencies at school and lack access to their own medication. (8)(35)(36) In addition to the inhalers, schools need spacers to ensure effective delivery of medication. School policies and procedures need to minimize any contagion risk related to the use of medications and delivery devices.Most successful legislative efforts to enact so-called stock albuterol policies for schools have been modeled on existing stock epinephrine laws. (37) Currently, all states and the District of Columbia allow or require schools to stock epinephrine. In contrast, fewer than 20 states have passed laws or provided guidelines for stock albuterol in schools, and legislative efforts at the federal level have not been successful thus far. Important considerations for creating and implementing stock albuterol policies include the following: Toolkits and recommendations are available to help guide efforts to enact stock albuterol policies and programs, including from the American Lung Association (https://www.lung.org/), the National Association of School Nurses (https://www.nasn.org/home), and state agencies that have succeeded in such efforts. (35)(38)(39)(40)Some early adopters of stock albuterol policies have found promising results. For example, the state of Missouri enacted its stock albuterol legislation in 2012. Data collected in the 2013–2014 school year revealed that 981 students received stock albuterol, with 86% of those students returning to the classroom. (41) A low-income urban district in Arizona saw a 20% reduction in 911 calls and a 40% reduction in medical transports to the emergency department after implementing a stock albuterol policy that delivered 222 albuterol doses to 55 children at 22 schools. (42)Importantly, establishing a stock albuterol program does not replace the necessary components for the appropriate clinical diagnosis and management of asthma, such as effective communication between pediatricians and school health staff, use of an asthma action plan, and ongoing asthma self-management education for patients and families. Rather, stock albuterol should be viewed as 1 important tool among many in the toolbox for creating asthma-friendly school settings.Daily use of inhaled corticosteroids, with or without concomitant long-acting beta2-agonist (LABA) therapy depending on age and asthma severity, is recommended for many children who meet the NAEPP’s definition of having persistent asthma. (21) add Ref: National Asthma Education and Prevention Program Expert Panel. 2020 Focused Updates to the Asthma Management Guidelines. National Heart Lung and Blood Institute; December 2020. Poor adherence to prescribed use of a daily inhaled corticosteroid as a controller medication among children with persistent asthma is associated with lower quality of life and increased frequency of asthma exacerbation, sleep disruption, and school absence. (21)(43) Nonetheless, mean adherence among children with their prescribed inhaled corticosteroid regimen is likely less than 50%. (44)(45)(46) The school nurse may be an underused resource for achieving asthma control for students with persistent asthma, poor adherence to an inhaled corticosteroid regimen, and high asthma morbidity. In addition to providing outreach to families to educate them about the need for improved asthma control, school nurses may administer daily inhaled corticosteroid medication to students.To implement school-based asthma controller therapy, the pediatrician prepares an asthma action plan with separate for inhaled corticosteroid use or without on school days versus to be shared with the student’s family and school nurse. school the student to the health suite on that typically be daily is administered all at by the school nurse. and on other days that school is not in students or parents administer and doses of the controller medication at to of school-based asthma controller therapy are School-based asthma controller therapy is only at schools with an nurse to administer In plans must be to the of 2 controller medication at a Although most will only 1 per without some will authorize the of a for school use for children with a of high health-care for asthma school nurses and parents must be able to maintain an of communication because the parent must supply the school nurse with a new controller medication each Pediatricians can parents that the US delivery of medications, and parents can for to go to the school. delivery to the school needs to be and with school staff. all the school-based asthma controller therapy is most for students with very poor asthma control who are at high risk for morbidity. In such cases, it can be well the necessary to for school-based asthma controller therapy because multiple trials have it to be associated with fewer and symptoms, a greater number of days without any symptoms, and albuterol use and frequency of urgent care visits.

Juvenile JusticeVolume 26, Issue 3 p. 15-19 The Family Educational Rights and Privacy Act of 1974 vs Child Abuse Reporting Laws: The Teacher's Dilemma David L. Herbert, Corresponding Author David L. HerbertAssistant Stark County Prosecuting Attorney 1124 Apple, N.E. North Canton, Ohio 44720Search for more papers by this author David L. Herbert, Corresponding Author David L. HerbertAssistant Stark County Prosecuting Attorney 1124 Apple, N.E. North Canton, Ohio 44720Search for more papers by this author First published: August 1975 https://doi.org/10.1111/j.1755-6988.1975.tb01093.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume26, Issue3August 1975Pages 15-19 RelatedInformation

Privacy law in the United States is a complicated patchwork of state and federal caselaw and statutes. Harvard Law School’s Cyberlaw Clinic, based at the Berkman Center for Internet & Society, prepared this briefing document in advance of the Privacy Initiative's April 2013 workshop, Student Privacy in the Cloud Computing Ecosystem, to provide a high-level overview of two of the major federal legal regimes that govern privacy of children’s and students’ data in the United States: the Children’s Online Privacy Protection Act (COPPA) and the Family Educational Rights and Privacy Act (FERPA). This guide aims to offer schools, parents, and students alike a sense of some of the laws that may apply as schools begin to use cloud computing tools to help educate students. Both of the relevant statutes – and particularly FERPA – are complex and are the subjects of large bodies of caselaw and extensive third-party commentary, research, and scholarship. This document is not intended to provide a comprehensive summary of these statutes, nor privacy law in general, and it is not a substitute for specific legal advice. Rather, this guide highlights key provisions in these statutes and maps the legal and regulatory landscape.

From the classroom to clinical: A Family Educational Rights and Privacy Act primer for the nurse educator

Misunderstanding of privacy laws and regulations impedes appropriate information sharing by post-secondary educational institutions under the Family Educational Rights and Privacy Act of 1974 (‘FERPA’). Post-Virginia Tech regulatory amendments allow institutions to ‘connect the dots’ regarding a student's behavior and to be proactive in problem resolution. The article encourages university officials to re-examine FERPA, to eliminate restrictive information sharing barriers not required by the law or regulations, to educate faculty and staff on the scope of student information dissemination and offers a clear and concise policy and process to help fill this crucial gap in campus crisis action planning documents.

Despite its prominence, the Family Educational Rights and Privacy Act (FERPA) is often misinterpreted and misapplied. This chapter clarifies historical developments, common misconceptions, and modern applications of the law.

Technology integration and learning analytics offer insights to improve educational experiences and outcomes. In advancing these efforts, laws and policies govern these environments placing protections, standards, and developmental opportunities for higher education, students, faculty, and even the nation‐state. Nonetheless, evidence of educational restrictions, encumbered actions, and archaic approaches pervades the legal literature and case law demonstrating that these laws and policies do not always function well in evolving and emerging technology spaces. To examine these laws and policies of student privacy, the author employs the combination of a critical policy analysis, which derives from critical social research as a means to explore discourse and policy through drawing out the policy contexts, texts, and consequences, and Flood's liberating systems theory, which directs the analysis to a problem‐solving approach by examining the policy discourse from a systems‐thinking lens. Based on a review of 184 court cases, 74 policies from a diversified representation of US states/territories, and seven developed nations or multi‐nation consortia, this examination illuminates how context and text such as the type and setting of the privacy matter (eg, various freedom of information acts, educational records under the Family Educational Rights and Privacy Act, and General Data Protection Regulation in the European Union ) presents opportunities for protections and standardization efforts; however, they also illustrate significant protection gaps, guesswork and insufficiency around the type and degree of data subject consent, and ghosting effects of data subjects' protections. While the extant literature already supports aspects of these findings, it does not account for this holistic view of these three privacy vulnerabilities—especially in light of the principles to which these laws purport to achieve. Moreover, the three identified privacy vulnerabilities suggest overlooked inclusion of two overarching privacy concepts—transparency and equity. This study recommends that key actors in the policy construction realm (ie, university leaders, policymakers, and judges) should engage in analyses, dialogue, and consideration about transparency and equity by considering contemporary privacy problems in the contexts of artificial intelligence, quantum computing, and cybersecurity as a way to improve transparent and equitable policies in these areas rather than exacerbating the privacy dilemmas already in place. Practitioner notes What is already known about this topic In the United States, the Family Educational Rights and Privacy Act of 1974 (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are well documented evidence of privacy protections for education and health records, but they fail to offer sufficient protections for students as data subjects with emerging technologies. Existing federal‐level laws in the United States do not offer a systematic or uniform approach in the manner that data users obtain consent, so data subjects are largely unaware of what is being consented. Other than matters of consent, policy strategies based on student privacy laws (ie, voluntary consensus standards, basic practices to maintain privacy, an ethics review board, data/record retention and destruction, and data sanitation of equipment) are significant and informative largely from the university‐perspective, not the students as data subjects. What this paper adds A new comprehensive examination of US laws including statutes, regulations, and cases as well as seven key nation‐state or national consortia laws—especially the EU's General Data Protection Regulation and selected state laws in the United States, which offer consistent and greater student privacy protections . Insights about the principles designed among the laws, which centre around their application, essentiality, consent, and security. Attention to areas in which student privacy laws still present privacy concerns, but specifically identifying issues of significant gaps, guesswork and insufficiency around levels and types of consent, and ghosting effects of data subjects' protections. Implications for practice and/or policy Data subject consent should be established and consistent– whether an opt‐out provision, opt‐in provision, or some extensive engagement. Student privacy policies should incorporate principles of transparency and equity for data subjects and data treatment. Policymakers should consider now how the intersections of data subject privacy matters shall be addressed in the context of artificial intelligence, quantum computing, and cybersecurity.

* Abbreviations: FERPA — : Family Educational Rights and Privacy Act HIPAA — : Health Insurance Portability and Accountability Act PHI — : protected health information STI — : sexually transmitted infection In the American Academy of Pediatrics statement “Role of the School Nurse in Providing School Health Services,” the authors acknowledge that misinformation about federal privacy laws can be problematic,1 creating misunderstandings among pediatricians and school nurses that impact student care. Confusion arises when clinicians, covered by the Health Insurance Portability and Accountability Act (HIPAA), work collaboratively with school nurses, covered by the Family Educational Rights and Privacy Act (FERPA), to conduct health programs. The majority of school nurses report working with their local health department2 but are unsure about what procedures to follow for documenting and communicating health information, and existing federal guidance does not speak adequately to the complications arising from cross-sector collaboration.3 In this article, we use an example of a school-based sexually transmitted infection (STI) screening program to highlight the 2 main federal privacy laws that impact school and health provider collaboration: FERPA and HIPAA. State privacy laws and institutional policies impose restrictions beyond federal law. These local laws and policies vary, as does their intersection with federal law. School and health department collaborators must negotiate this complex web when they plan joint projects. Passed in 1974, FERPA is designed to protect students’ educational records.4 Any educational institution receiving funding from the US Department of Education must allow parents or an eligible student (>18 years of age or has begun postsecondary education) to access the student’s … Address correspondence to Patricia A. Elliott, DrPH, Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, Room 440, Boston, MA 02118. E-mail: pelliott{at}bu.edu

The Family Education Rights and Privacy Act's Impact on Residency Applicant Behavior and Recommendations: A Pilot Study

FERPA — the Family Education Rights and Privacy Act — protects student privacy by laying out when and how education records that are maintained by the school can be used within and outside of the school district and when student records can be released. FERPA’s goal is to prevent unauthorized disclosure of students’ personally identifiable information. School employees (and school attorneys) handle student records and data according to FERPA every day. But the law was enacted in 1974, before digital recordkeeping, big data, texts, email, the internet, and easy digital transmission of information, which means that much about FERPA is now outdated.

New types of digital technologies and new ways of using them are heavily impacting young people’s learning environments and creating intense pressure points on the “pre-digital” framework of student privacy. This chapter offers a high-level mapping of the federal legal landscape in the United States created by the “big three” federal privacy statutes—the Family Educational Rights and Privacy Act (FERPA), the Children’s Online Privacy Protection Act (COPPA), and the Protection of Pupil Rights Amendment (PPRA)—in the context of student privacy and the ongoing digital transformation of formal learning environments (“schools”). Fissures are emerging around key student privacy issues such as: what are the key data privacy risk factors as digital technologies are adopted in learning environments; which decision makers are best positioned to determine whether, when, why, and with whom students’ data should be shared outside the school environment; what types of data may be unregulated by privacy law and what additional safeguards might be required; and what role privacy law and ethics serve as we seek to bolster related values, such as equity, agency, and autonomy, to support youth and their pathways. These and similar intersections at which the current federal legal framework is ambiguous or inadequate pose challenges for key stakeholders. This chapter proposes that a “blended” governance approach, which draws from technology-based, market-based, and human-centered privacy protection and empowerment mechanisms and seeks to bolster legal safeguards that need to be strengthen in parallel, offers an essential toolkit to find creative, nimble, and effective multistakeholder solutions.