Some health services are required for all students by California Education Code or Health and Safety Code, and others are required for certain students as outlined in the Individuals with Disabilities Education Act (IDEA). These services are typically provided by school personnel, such as school nurses, but they may be provided by other staff depending on the level of service and related legal or credentialing requirements.

The primary mandated school health services are:

• Special education related services
• School-based prescription medication administration, vision, hearing, and Scoliosis screening

See this summary of selected California Education Code and California Health and Safety Code.

List of Mandated Health Services

Special Education-Related Services

These include health assessments and treatments required for students with disabilities, as indicated by a student’s Individualized Education Program (IEP) and as outlined in IDEA. School nurses, school psychologists, speech therapists and other health professionals may be involved in both initial and triennial special education health assessments, as well as indicated treatments, such as gastric tube feedings or catheterizations.

School-Based Prescription Medication Administration

This is sometimes required for students whose education may be impeded by a health condition that requires administration of a prescription medication during school hours. Any student who is required to take medication prescribed for him by a physician may be assisted by the school nurse or other designated school personnel if the school district receives (1) a written statement from such physician detailing the method, amount, and time schedules by which such medication is to be taken and (2) a written statement from the parent or guardian of the student indicating the desire that the school district assist the student in the matters set forth in the physician’s statement. See the California Department of Education’s Program Advisory on Medication Administration.

Vision, Hearing and Scoliosis Screenings

These are required at specific intervals and grade levels in California. Schools must conduct vision screening on all students upon school entry and every third year thereafter through grade eight. For example, vision testing may be done in kindergarten or first grade and in grades two, five, and eight, as well as on enrollment and referral at any grade level. Learn more about vision screening. Hearing screening is mandated in kindergarten/first grade and in second, fifth, eighth, tenth/eleventh grade and upon first school entry (California Code of Regulations, Title 17, Section 2952 (c)(1)) . Hearing screening in California public schools must be conducted by a credentialed school audiometrist. Note that Local Education Authorities may apply for a waiver for the high school hearing testing requirement.

The state scoliosis screening mandate was suspended and it is uncertain whether it will be reinstated. Some school districts continue to conduct scoliosis screenings for girls in seventh grade and boys in eighth grade. Learn more about scoliosis screening.

Other Health Requirements

While we do not focus on this here, there are also health requirements for students to be able to enroll in school, including a physical exam, oral health screening, and certain immunizations.

School-Based Health Centers

School-based health centers (SBHCs), also referred to as school health centers, provide comprehensive medical and/or mental health care. Services may include physical exams, screenings, immunizations, management of chronic conditions, age-appropriate reproductive health care for adolescents, primary medical care for injuries and illness, laboratory tests, tuberculosis tests, over-the-counter medications and prescription writing, and referrals and coordination of outside services. Clinicians delivering medical care include nurse practitioners, physician assistants, physicians, residents, medical assistants and nurses. To learn more, review our Guidelines for California School Health Centers. Note that the federal definition of a school health center requires that the center provide both medical and mental health services, and many school health centers in California do provide both of these primary care services.

School Nursing Programs

School nursing programs focus on the prevention of illness and disability and the early detection and correction of health problems. As registered nurses, school nurses can assess for health problems (e.g., conduct vision and hearing screenings), deliver some health services (e.g., administer immunizations and insulin), and provide health education to students, families and staff; they often also coordinate school or district-wide health programs. Read more about the role of school nurses or visit the California School Nurses Organization website.

Student Counseling and Mental Health Programs

Student counseling and mental health programs provide assessments and interventions to support students’ mental and emotional wellbeing. These interventions may include crisis response, individual, group, or family counseling, drug or alcohol treatment, staff consultation on student behavior, classroom-based social and personal skill development, and family supports and linkages. School social workers, counselors, psychologists and other registered or licensed mental health clinicians provide these services. These programs are sometimes organized as a school wellness center. Learn more about San Francisco’s Wellness Centers. For more information about school mental health programs, visit UCLA’s Center for Mental Health in Schools and the California Association of School Psychologists.

School-Linked Health Services

School-linked health services or telehealth services are most appropriate when it is not feasible, or not the best use of resources, to bring clinical providers into the school. School-linked services exist when a local community health program, such as a community clinic, has a formalized, well-coordinated linkage to one or more schools. Students and families may easily access services at the community health site, and school staff know how to facilitate needed services through a close working relationship with the community health program. Read a case study of a school-linked health center in Ontario, CA.

Telehealth Services

School telehealth services connect schools to health care providers, using existing distance learning equipment and data lines (and sometimes also specialized remote medical equipment). Telehealth services allow medical providers to remotely assess an acute care problem, improve management of chronic diseases like diabetes, and increase access to mental health care, especially to psychiatrists who can prescribe and follow-up on needed medications, such as for ADHD. Read The Children’s Partnership Executive Summary of School-Based Telehealth: An Innovative Approach to Meet the Health Care Needs of California’s Children.

Mobile Clinics

Mobile clinics bring health care to one or more schools using an RV-style van that’s fully equipped with exam rooms and needed medical equipment. Mobile clinics may provide comprehensive medical care, oral health care, or specialty care for conditions like asthma. Mobile health clinics increase access to needed services in rural and urban areas alike, and are usually more economical than building several school-based clinical facilities. Read a case study of a medical mobile van in Fresno County.

Oral Health Programs

Oral health programs provide oral health assessments and, sometimes, treatments to prevent or remediate dental disease. These services range from oral health education, to assessments or dental sealant programs, to actual treatment of cavities. Lead personnel may include school nurses, dental hygienists and assistants, and dentists. When required, specialized dental equipment may be brought into a school health center or onto a school campus in a mobile van; alternatively, specialized equipment may be located off-site, in which case the school facilitates transportation to treatment services as indicated. Learn more about school oral health policies at the Center for Oral Health website.

Health Promotion Programs

Health promotion programs may cover a range of topics, including healthy eating and active living (obesity prevention), drug, alcohol and tobacco use prevention, communicable disease prevention, comprehensive sexual health education,  violence prevention, and the development of positive school climate. Various staff may develop and deliver these programs, from classroom teachers to nurses to certified health education specialists. Health promotion programs can be delivered in the classroom, in a school health center, after school, or through school wide campaigns. See California’s Health Education Content Standards for more information on school health promotion programs.