13 Healthy and Safe School Environment State Questionnaire

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Healthy and Safe School Environment
State Questionnaire

6 January 2011

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-74, Atlanta, GA 30333; Attention PRA (0920-0445).

Healthy and Safe School Environment
State Questionnaire

Questions

State Assistance to Districts and Schools 1–3

Professional Development 4–5

Faculty and Staff Health Promotion 6–8

Violence Prevention 9

Crisis Preparedness, Response, and Recovery 10–15

School Health Coordination 16–38

THIS QUESTIONNAIRE WILL BE ADMINISTERED USING WEB-BASED INTERVIEW TECHNOLOGY. AS THE RESPONDENT TYPES RESPONSES TO THE QUESTIONS INTO THE COMPUTER, THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE.

The first questions ask about state assistance to districts and schools.

1. During the past two years, did your state develop, revise, or assist in developing model policies, policy guidance, or other materials to inform district or school policy on each of the following topics?

Yes No

1. Classroom management 1 2

2. Electronic aggression or cyber-bullying prevention 1 2

3. Other bullying prevention 1 2

4. Dating violence prevention 1 2

5. Other violence prevention 1 2

6. Injury prevention and safety 1 2

7. Sun safety 1 2

8. Tobacco use prevention 1 2

9. Alcohol use prevention 1 2

10. Illegal drug use prevention 1 2

11. Crisis preparedness, response, and recovery 1 2

12. Indoor air quality 1 2

13. Access to free drinking water throughout the day 1 2

14. Drinking water quality 1 2

15. Integrated pest management 1 2

16. Green building design 1 2

17. Radon testing and mitigation 1 2

18. Choosing sites for new school buildings 1 2

19. Faculty and staff health promotion 1 2

2. During the past 2 years, did your state distribute to district or school staff model policies, policy guidance, or other materials to inform district or school policy on each of the following topics?

Yes No

1. Classroom management 1 2

2. Electronic aggression or cyber-bullying prevention 1 2

3. Other bullying prevention 1 2

4. Dating violence prevention 1 2

5. Other violence prevention 1 2

6. Injury prevention and safety 1 2

7. Sun safety 1 2

8. Tobacco use prevention 1 2

9. Alcohol use prevention 1 2

10. Illegal drug use prevention 1 2

11. Crisis preparedness, response, and recovery 1 2

12. Indoor air quality 1 2

13. Access to free drinking water throughout the day 1 2

14. Drinking water quality 1 2

15. Integrated pest management 1 2

16. Green building design 1 2

17. Radon testing and mitigation 1 2

18. Choosing sites for new school buildings 1 2

19. Faculty and staff health promotion 1 2

The next questions ask about technical assistance your state may have provided to district or school staff. Technical assistance refers to tailored guidance to meet the specific needs of the district or school that may be provided through phone, e-mail, Internet, or in-person meetings.

3. During the past 12 months, has your state provided technical assistance to district or school staff on…

Yes No

1. Classroom management? 1 2

2. Electronic aggression or cyber-bullying prevention? 1 2

3. Other bullying prevention? 1 2

4. Dating violence prevention? 1 2

5. Other violence prevention? 1 2

6. Injury prevention and safety? 1 2

7. Sun safety? 1 2

8. Tobacco use prevention? 1 2

9. Alcohol use prevention? 1 2

10. Illegal drug use prevention? 1 2

11. Crisis preparedness, response, and recovery? 1 2

12. Indoor air quality? 1 2

13. Access to free drinking water throughout the day? 1 2

14. Drinking water quality? 1 2

15. Integrated pest management? 1 2

16. Green building design? 1 2

17. Radon testing and mitigation? 1 2

18. Choosing sites for new school buildings? 1 2

19. Faculty and staff health promotion? 1 2

20. Developing joint use agreements? 1 2

21. Developing health and safety plans? 1 2

22. Using the School Health Index or other self-assessment tool
    to assess school health and safety policies and activities? 1 2

23. Using data to plan or evaluate school health policies
    and practices? 1 2

24. Establishing district or school health councils, committees,
    or teams? 1 2

25. Establishing district or school health coordinator positions? 1 2

The next questions are about professional development, which might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

4. During the past two years, has your state provided funding for or offered professional development to districts or schools on how to implement school-wide policies and programs related to…

Yes No

1. Classroom management? 1 2

2. Electronic aggression or cyber-bullying prevention? 1 2

3. Other bullying prevention? 1 2

4. Dating violence prevention? 1 2

5. Other violence prevention? 1 2

6. Injury prevention and safety? 1 2

7. Sun safety? 1 2

8. Tobacco use prevention? 1 2

9. Alcohol use prevention? 1 2

10. Illegal drug use prevention? 1 2

11. Crisis preparedness, response, and recovery? 1 2

12. Indoor air quality? 1 2

13. Access to free drinking water throughout the day? 1 2

14. Drinking water quality? 1 2

15. Integrated pest management? 1 2

16. Green building design? 1 2

17. Radon testing and mitigation? 1 2

18. Faculty and staff health promotion? 1 2

5. During the past two years, has your state provided funding for or offered professional development on…

Yes No

1. Developing joint use agreements? 1 2

2. Developing health and safety plans? 1 2

3. Using the School Health Index or other self-assessment
   tool to assess school health and safety policies
   and activities? 1 2

4. Using data to plan or evaluate school health
   policies and practices? 1 2

5. Establishing district or school health councils, committees,
   or teams? 1 2

6. Establishing district or school health coordinator positions? 1 2

7. Choosing sites for new school buildings? 1 2

The next questions ask about health promotion for faculty and staff who work in schools. For the purposes of these questions, consider services offered to faculty and staff because they work in schools.

The first questions in this section ask about health insurance for faculty and staff that may be offered by your state. For the purposes of this question, “offer” means that the state pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at a discounted group rate.

6. Does your state offer health insurance to faculty and staff?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q8

7. Does this health insurance cover the following for faculty and staff?

Yes No

1. Preventive health care, such as physicals 1 2

2. Prescription drugs 1 2

3. Vision care 1 2

4. Dental care 1 2

5. Immunizations 1 2

6. Mental health care 1 2

7. Tobacco use cessation 1 2

8. Alcohol or other drug use treatment 1 2

8. Does someone at the state level oversee or coordinate health promotion activities or services for faculty and staff throughout the state?

Yes 1

No 2

The next question asks about information districts or schools might report related to violence.

9. Do districts or schools in your state routinely report the following information to the state education agency?

Yes No

1. The number of times students are caught
   physically fighting 1 2

2. The number of times students are caught using
   or possessing a handgun or other firearm 1 2

3. The number of times students are caught using
   or possessing any other weapon 1 2

4. The number of school-associated violent deaths 1 2

5. The number of times students are caught violating
   any rule on gang activity 1 2

The next questions ask about crisis preparedness, response, and recovery in the event of a natural disaster or other emergency situation.

10. Has your state used any materials from the U.S. Department of Education, such as Practical Information on Crisis Planning: A Guide for Schools and Communities, to develop policies related to crisis preparedness, response, and recovery?

Yes 1

No 2

11. Is your state education agency a member of the state emergency planning committee?

Yes 1

No 2

12. Do districts or schools in your state report all unplanned school dismissals or school closures to the state education agency?

Yes 1

No 2

13. How often do districts or schools in your state submit information on student attendance or absenteeism rates to the state education agency?

Daily 1

Weekly 2

Monthly 3

Quarterly 4

Annually 5

Only on designated days
during the school year 6

Other time frame 7

Districts and schools are

not required to submit
information on student

attendance or absenteeism 8

14. Do districts or schools in your state report student absenteeism rates by the cause or reason for the absence?

Yes 1

No 2

15. Does your state recommend that districts or schools use a specified electronic system for reporting student absenteeism rates?

Yes 1

No 2

The next questions ask about state-level coordination of school health-related activities.

16. Is there one or more than one group—for example, a committee, council, or team—of people who are formally charged with coordinating state-level school health-related activities?

Yes 1 SKIP TO Q21

No 2

17. Do any of these groups include representatives from the following state-level agencies or organizations?

State does
not have this
agency or
Yes No organization

1. The state education agency 1 2 3

2. The state health department 1 2 3

3. A state mental health or social services
   agency 1 2 3

4. The state juvenile justice department 1 2 3

5. The state transportation agency 1 2 3

6. A state-level school nurses’ association
   or organization 1 2 3

7. A state-level physicians’ organization,
   such as the American Academy of Pediatrics 1 2 3

8. A state-level health organization, such as
   the American Heart Association or the
   American Cancer Society 1 2 3

9. A state-level parents’ organization, such as
   the Parent Teacher Association (PTA) 1 2 3

10. A state-level student government
    organization, such as the Student Council
    Association, Associated Student Body,
    or Student Activity Council 1 2 3

11. A state-level youth organization, such as
    the Boys and Girls Clubs 1 2 3

18. Do any of these groups…

Yes No

1. Identify student health needs based on a review
   of relevant data, such as Youth Risk Behavior Survey Data? 1 2

2. Develop or review a state health and safety plan? 1 2

3. Recommend new or revised health and safety policies,
   programs, or activities to the State Superintendent
   of Schools or the State Board of Education? 1 2

4. Seek funding or leverage resources to support school
   health and safety priorities for students and staff? 1 2

5. Recommend or review health-related curricula
   or instructional materials? 1 2

19. Do any of these groups address…

Yes No

1. Tobacco use prevention? 1 2

2. Alcohol or other drug use prevention? 1 2

3. Food service or nutrition? 1 2

4. Physical education or physical activity? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Violence prevention, for example bullying, fighting,
   or dating violence prevention? 1 2

9. Injury prevention and safety? 1 2

10. Health education? 1 2

11. Health services? 1 2

12. Mental health or social services? 1 2

13. The psychological and social environment
    or school climate? 1 2

14. Faculty and staff health promotion? 1 2

(Q19 continued)

Yes No

15. Family and community involvement in school
    health programs? 1 2

16. Physical school environment? 1 2

17. Crisis preparedness, response, and recovery 1 2

18. Management of chronic health conditions,
    such as asthma or diabetes? 1 2

19. Management of infectious diseases such as flu
    or foodborne illnesses? 1 2

20. Management of food allergies? 1 2

21. Local wellness policies? …………………………………………1 2

For the next question, please think about the school health council, committee, or team that met the most during the past 12 months.

20. During the past 12 months, how many times did this committee, council, or team meet?

0 times 1

1 or 2 times 2

3 or 4 times 3

5 or 6 times 4

More than 6 times 5

21. Does your state education agency have an internal school health council, committee, or team that meets regularly to plan and coordinate school health activities?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q24

22. Does this council, committee, or team include any of the following state education agency staff?

State Education
Agency
does not have
Yes No this position

1. Health education director, coordinator,
   or consultant 1 2 3

2. Physical education director, coordinator,
   or consultant 1 2 3

3. Health services director, coordinator,
   or consultant 1 2 3

4. Nutrition or food service director,
   coordinator, or consultant 1 2 3

5. Mental health and social services director,
   coordinator, or consultant 1 2 3

6. Coordinated school health director,
   coordinator, or consultant 1 2 3

7. Physical activity, nutrition, and
   tobacco (PANT) director, coordinator,
   or consultant 1 2 3

8. Parent/family involvement coordinator
   or consultant 1 2 3

9. Community involvement coordinator
   or consultant 1 2 3

10. School improvement involvement
    coordinator or consultant 1 2 3

11. Curriculum director 1 2 3

12. Assessment director 1 2 3

23. During the past 12 months, how many times did this group meet?

0 times 1

1 or 2 times 2

3 or 4 times 3

5 or 6 times 4

More than 6 times 5

The next questions ask about a plan your state might have developed to improve district and school health-related polices and activities.

24. Does your state have a state-wide plan to improve district and school health and safety-related policies and activities for students and staff?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q28

25. Did your state analyze the following types of data when developing the plan?

Yes No

1. Health behavior data, such as Youth Risk Behavior
   Survey data 1 2

2. Educational achievement data, such as standardized
   test scores 1 2

3. Educational data, such as absences, dropouts,
   or grade retention 1 2

4. Health services data, such as the number of

visits to the school nurse 1 2

5. Other types of data, such as school meal participation 1 2

26. Does the state-wide plan address any of the following school health-related areas?

Yes No

1. Health education 1 2

2. Physical education and physical activity 1 2

3. Nutrition services and foods and beverages
   available at school 1 2

4. Health services 1 2

5. Mental health and social services 1 2

6. Healthy and safe school environment 1 2

7. Faculty and staff health promotion 1 2

8. Family and community involvement 1 2

27. How often is the state-wide plan reviewed?

Every year 1

Every 2 to 3 years 2

Every 4 to 5 years 3

More than every 5 years 4

As needed 5

Other time frame 6

Never 7

The next questions ask about the person responsible for overseeing or coordinating all of the state’s school health and safety policies and activities.

28. Currently, does someone in your state oversee or coordinate the state’s school health and safety policies and activities, for example a state school health coordinator?

Yes 1

No 2 SKIP TO END

29. Are you this person?

Yes 1

No 2 SKIP TO END

30. Have you ever received any training in your role as the director or coordinator of your state’s school health and safety policies and activities, such as school health coordinator training sponsored by your state health agency, colleges, universities, or health organizations such as the American Cancer Society?

Yes 1

No 2

31. Are the following activities included in your responsibilities as director or coordinator of your state’s school health and safety policies and activities?

Yes No NA

1. Developing or assisting in the development
   of school health and safety policy language,
   policy guidance, or other policy materials 1 2

2. Securing funding or other resources
   to support school health and safety
   policies and activities 1 2

3. Communicating school health and safety
   priorities to state decision-makers such as
   the State Superintendent of Schools,
   State Board of Education, or State Health
   Agency Director 1 2

4. Facilitating collaboration among state-level
   staff responsible for the health and safety
   of students and staff 1 2

5. Serving as a liaison between state agencies
   and those who oversee or implement school
   health and safety policies and activities at

the district level 1 2

6. Conducting meetings of a state-level
   school health coordinating committee,
   council, or team 1 2 3

7. Directing implementation and
   evaluation of the state health and safety
   plan for schools 1 2 3

8. Facilitating the provision of school

health-related professional development 1 2 3

32. Counting this year as a full year, how many years have you been responsible for directing or coordinating school health and safety policies and activities at the state level?

Years

The last few questions ask about your educational background.

33. Do you have an undergraduate degree?

Yes 1

No 2 SKIP TO END

34. What did you major in?

Health education 1

Physical education 2

Other education 3

Kinesiology, exercise physiology,
or exercise science 4

Nursing 5

Nutrition 6

Public health 7

Biology or other science 8

Home economics or family
and consumer science 9

Other 10

35. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q37

36. What did you minor in?
    MARK ALL THAT APPLY

Health education 1

Physical education 2

Other education 3

Kinesiology, exercise physiology,
or exercise science 4

Nursing 5

Nutrition 6

Public health 7

Biology or other science 8

Home economics or family
and consumer science 9

Other 10

37. Do you have a graduate degree?

Yes 1

No 2 SKIP TO END

38. In what area or areas?

Health education 1

Physical education 2

Education administration 3

Other education 4

Kinesiology, exercise physiology,
or exercise science 5

Nursing 6

Nutrition 7

Public health 8

Biology or other science 9

Home economics or family
and consumer science 10

Other 11

Thank you very much for taking the time to participate in this study.

If you would like more information or would like clarification of any questions in this questionnaire, please call 800-287-1815.