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This occasional paper is the ninth in a series on the National Quality Framework (NQF). The Education and Care Services National Law and National Regulations govern the minimum standards and requirements that all providers of NQF regulated services must meet, including health and safety requirements. Quality Area 2 of the National Quality Standard (NQS) upholds children's right to be protected and kept safe. The approved provider, nominated supervisors, coordinators and educators have responsibility for supporting the health, safety and wellbeing of all children. In exercising their responsibilities, they must take reasonable care to protect children from foreseeable risk of harm, injury and infection. This paper uses data from the National Quality Agenda Information Technology System (NQA ITS) to provide analysis of trends in serious incidents resulting in injury, trauma or illness in Australian children's education and care services between 1 April 2020 and 31 March 2022.

The National Quality Framework (NQF) was established in 2012 to create a more efficient and cohesive approach to regulating early childhood education and care, and outside school hours care in Australia. The NQF provides a shared vision for governments and the children's education and care sector, and an agreed tool for measuring and monitoring service quality. It sets standards for safety and quality so that all children who attend services regulated under the NQF are supported to have the best start in life. This occasional paper discusses how and why the NQF came about, what has changed in the last 10 years, and future directions.

This report, from researchers at ChildObesity180, an initiative of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, explores the impact of the Boston Foundation's investment in four nonprofits that provide structured physical activity to students. The report finds that investments in "Build Our Kids Success (BOKS)"; "Community Rowing, Inc."; "Playworks"; and "Sportsmen's Tennis and Enrichment Center" had a notable impact on the amount of physical activity students received in school. Once the pandemic forced a remote learning environment, the programs pivoted and innovated to take their work to the online space, with some success. However, the overall amount of physical activity students received in remote learning was, not surprisingly, significantly reduced.

A wide range of conditions in the places where children live, grow, play, and learn can get "under the skin" and affect their developing brains and other biological systems. Rapidly advancing science around early childhood development provides increasingly clear evidence that, beginning before birth, these environmental conditions shape how children develop, which shapes their lifelong physical and mental health, in turn. Building upon the science presented in "Working Paper 15: Early Childhood Development and Lifelong Health Are Deeply Intertwined," this Working Paper examines how the built and natural environments--and the systemic factors that shape those environments--interact with each other and with a child's social environment in deeply interconnected ways. It explains in clear language how these environmental influences shape development and lifelong health, while also highlighting the role that current and historic public policies have played, along with systemic racism, in creating a landscape where levels of exposure to risk and access to opportunity are not distributed equally. The paper encourages us to think beyond the traditional early childhood sector in policy and practice. It explores how the latest science, combined with the lived expertise of communities and fresh thinking across an array of policy domains, offers promising opportunities for re-shaping environmental influences so that all children can grow up in homes and neighborhoods free of hazards and rich with opportunity.

Personal experience, common sense, and science all confirm that temperatures are rising across the United States and around the world. Record-setting heat waves are occurring with greater frequency and lasting longer than ever before. This working paper is the first in a series focusing on the ways that environmental conditions shape young children's development. Heat is just one component of a set of interrelated conditions that affect how children's bodies and brains develop. This working paper offers a summary of current knowledge about how heat impacts developing biological systems.

In 2019, 135 million people in 55 countries were in food crises or worse, and 2 billion people did not have regular access to safe, nutritious and sufficient food. COVID-19 has exacerbated these hardships and may result in an additional 121 million people facing acute food insecurity by the end of 2020. Further, since the beginning of the pandemic, an estimated 1.6 billion learners in 199 countries worldwide were affected by school closures, with nearly 370 million children not receiving a school meal in 150 countries. The paper presents the evidence on the potential negative short-term and long-term effects of school meal scheme disruption during COVID-19 globally. It shows how vulnerable the children participating in these schemes are, how coping and mitigation measures are often only short-term solutions, and how prioritizing school re-opening is critical. For instance, it highlights how girls are at greater risk of not being in school or of being taken out of school early, which may lead to poor nutrition and health for themselves and their children. However, well-designed school feeding programmes have been shown to enable catch-up from early growth failure and other negative shocks. As such, once schools re-open, school meal schemes can help address the deprivation that children have experienced during the closures and provide an incentive for parents to send and keep their children, especially girls, in school.

This occasional paper is the seventh in a series on the National Quality Framework (NQF). It explores the quality of children's education and care services based on the socio-economic status of the area in which they are situated. The Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) is used by the Australian Bureau of Statistics (ABS) to classify services by the level of relative socio-economic advantage and disadvantage of their local area. This paper uses SEIFA as a proxy measure to identify services that are more or less likely to educate and care for children from disadvantaged backgrounds. This paper begins by highlighting contemporary research about the association between socio-economic status and developmental outcomes, and the impact of high quality education and care on children from more disadvantaged backgrounds. It then outlines the quality and availability of education and care in low socio-economic status areas, analysing service quality ratings and reassessment results. The paper also examines differences across service and provider management types, and remoteness classifications. The detailed analysis suggests that there are differences in the overall quality ratings of education and care services located in high and low socio-economic status areas. Services in relatively disadvantaged areas are slightly more likely to be rated Working Towards NQS and notably less likely to be rated Exceeding NQS than those in relatively advantaged areas.

The food stamp program (SNAP) is one of the most important elements of the social safety net and is the second largest anti-poverty program for children in the U.S. (only the EITC raises more children above poverty). The program varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefit levels are fixed across 48 states; but local food prices vary widely, leading to substantial variation in the real value of SNAP benefits. In this study, we leverage time variation in the real value of the SNAP benefit across markets to examine the effects of SNAP on child health. We link panel data on regional food prices and the cost of the Thrifty Food Plan [TFP], as measured by the USDA's Quarterly Food at Home Price Database, to restricted-access geo-located National Health Interview Survey data on samples of SNAP-recipient and SNAP-eligible children. We estimate the relationship between the real value of SNAP benefits (i.e., the ratio of the SNAP maximum benefit to the TFP price faced by a household) and children's health and health care utilization, in a fixed effects framework that controls for a number of individual-level and region characteristics, including non-food prices. Our findings indicate that children in market regions with a lower real value of SNAP benefits utilize significantly less health care, and may utilize emergency room care at increased rates. Lower real SNAP benefits also lead to an increase in school absences but we find no effect on reported health status.

Asthma is the leading chronic health condition among children in the United States and a major cause of childhood disability. It also disproportionately affects low-income and racial and ethnic minorities. Although a wide range of interventions have been implemented to improve asthma-related outcomes among socioeconomically disadvantaged and minority children, disparities persist. This paper, which was commissioned by the JPB Foundation and conducted by MDRC in partnership with the National Academy for State Health Policy, standardizes and compares effects from rigorous evaluations across three main types of interventions: those that focus on improving education and self-management, those that focus on addressing remediation of the conditions that trigger asthma in the home environment, and those that focus on improving health care provider practice. While prior reviews have summarized findings for each intervention type, this review systematically compares findings across a range of outcomes and a spectrum of different approaches to addressing childhood asthma, drawing from about 30 independent studies and earlier published reviews. In addition, the paper includes case studies of various local programs and state-level policy initiatives to illuminate current efforts to address childhood asthma in low-income communities and barriers faced in sustaining asthma programs. Key findings include: (1) Providing education on how to manage asthma is fundamental to improving outcomes, but it may not be enough to alleviate disparities in asthma management; (2) Some local programs are clearly bridging informational gaps among low-income families and are helping them maintain a safe home environment for their children with asthma; (3) The health care benefits of interventions that go beyond education are unclear; (4) Barriers to medication management are complex and medication adherence is difficult to influence; and (5) The role of the state, and the Medicaid program in particular, is relevant for the financing and sustainability of asthma programs for low-income children. Although the long-run sustainability of some of the programs highlighted in this report is uncertain, what is clear is that combating the disparities in the prevalence of asthma among different populations will require more than an agreement on standard asthma management practices within the medical community. The following are appended: (1) Methodology for Literature Review; (2) Summaries of Asthma Studies; (3) Detailed Case Studies of Local Asthma Programs; and (4) Detailed State-Based Case Studies. [This working paper was written with Felicia Heider, Carrie Hanlon, and Taylor Kniffin.]

ACECQA has published the second in its series of occasional papers, analysing one of the most challenging quality areas -- Children's Health and Safety. Quality Area 2 addresses one of the primary objectives of the National Quality Framework -- to ensure the health, safety and wellbeing of children attending education and care services. The paper examines performance across service types, socio economic and remoteness classifications, jurisdictions and management types. It also breaks down Quality Area 2 and highlights that standard 2.3 (each child is protected) and element 2.3.3 (incident and emergency planning) are the most challenging aspects of the Quality Area. One of the findings from the analysis is that services in remote and very remote areas may benefit from more support to understand and comply with the requirements of Quality Area 2. The paper also summarises recent state, territory and Commonwealth initiatives around child safe organisations, as well as some examples of the types of compliance and enforcement action that state and territory regulatory authorities have taken relating to children's health and safety.

Health and education are reciprocally related, and research indicates that unhealthy students are poorly positioned to learn. Providing services that prevent health problems or help students cope with existing health concerns is one way that schools intervene in the relationship between student background and educational outcomes. Providing health services on campus is theorized to promote educational goals by increasing access to services, improving health, and enhancing opportunities to learn. However, existing empirical tests of this relationship are rare and have important limitations. This paper uses data from Add Health, which identifies numerous services provided by schools across the U.S. Multilevel models test how availability of preventive or physical health services relates to adolescents' academic performance as well as implications for racial and socioeconomic educational inequality. Analyses consistently demonstrate that school provision of preventive/physical health services is positively related to youths' educational outcomes--including a higher GPA, lower odds of failing courses, and higher odds of graduating from high school--but also little evidence of differing associations across student subgroups. Additional results mitigate concerns that these relationships are biased by selection and offer evidence that increased opportunities to learn are one mechanism for the positive role of health services.

Objective: To determine whether the disparities in access to care observed within pediatric populations along the lines of race/ethnicity, socio-economic status, and geography are mirrored in student access to school nursing services. Method: Using school district employment records we linked 1,346 nurses to 1,141,495 students working in 296 districts within Washington state in the 2019-2020 school year. We constructed a measure of access (the student-to-nurse ratio) as the log transform of the total number of nursing full time equivalents divided by the total student enrollment within the district, and regressed these against a district's racial/ethnic composition, a measure of socio-economic status (percent eligible for Free-or-Reduced-Price-Lunch), and geography i.e. how urban vs rural. Results: A 1% percent increase in the student population that is Black is associated with a 3.7% reduction in the student-to-nurse ratio, while a 1% increase in the percent of students eligible for Free-or-Reduced-Price-Lunch is associated with a 1.1% increase in the student-to-nurse ratio. Relative to urban districts, rural districts have higher student-to-nurse ratios, but due to the sorting of students to districts by race/ethnicity, when controlling for race/ethnicity results are insignificant. Conclusions: Disparities in access to school nursing services mirror access gaps for pediatric care along socio-economic status and geography. The increased number of nurses working in school districts with more racial/ethnic minority students may play a protective role and partially ameliorate access gaps for these students observed in pediatric primary care. Policy Implications: We provide a framework for how states, absent of centralized data collection on the school nursing workforce, can use existing employment and licensing data to understand where school nurses work, and who has access to them. States should develop their school nurse workforce data in order to aid in resource allocation decisions. To address disparities in access for poorer districts, a reconsideration of state funding formulas that overly rely on local education dollars for school health services may be warranted.

We study the private market response to the National School Lunch Program, documenting economically meaningful spillovers to non-recipients. We focus on the Community Eligibility Provision (CEP), an expansion of the lunch program under the 2010 Healthy, Hunger-Free Kids Act. Under the CEP, participating schools offer free lunch to all students. We leverage both the staggered roll-out and eligibility criterion for the CEP, which is limited to schools where at least 40% of students participate in other means-tested welfare programs. We find that local adoption of the CEP causes households with children to reduce their grocery purchases, leading to a 10% decline in grocery sales at large retail chains. Retailers respond with chain-level price adjustments: chains with the most exposure lower prices by 2.5% across all outlets in the years following adoption, so that the program's welfare benefits propagate spatially. Using a stylized model of grocery demand, we estimate that, by 2016, the indirect benefit had reduced grocery costs for the median household by approximately 4.5%.

Lead poisoning has well-known impacts for the developing brain of young children, with a large literature documenting the negative effects of elevated blood lead levels on academic and behavioral outcomes. In April of 2014, the municipal water source in Flint, Michigan was changed, causing lead from aging pipes to leach into the city's drinking water. In this study, we use Michigan's universe of longitudinal, student-level education records, combined with home water service line inspection data containing the location of lead pipes, to empirically examine the effect of the Flint Water Crisis on educational outcomes of Flint public school children. We leverage parallel causal identification strategies, a between-district synthetic control analysis and a within-Flint difference-in-differences analysis, to separate out the direct health effects of lead exposure from the broad effects of living in a community experiencing a crisis. Our results highlight a less well-appreciated consequence of the Flint Water Crisis -- namely, the psychosocial effects of the crisis on the educational outcomes of school-age children. These findings suggest that cost estimates which rely only on the negative impact of direct lead exposure substantially underestimate the overall societal cost of the crisis.

The Every Student Succeeds Act (ESSA; 2015) requires states to broaden school accountability beyond achievement on standardized tests and high school graduation rates. In this Hamilton Project strategy paper, we articulate a framework for states as they oversee implementation of statewide accountability plans under ESSA and describe how states differ in their approaches. We review the literature and present novel analyses of the factors at the school and student levels that relate to chronic absenteeism. Our analysis shows that health problems and socioeconomic status predict poor attendance, and that chronic absenteeism among students and schools is strongly persistent over time. We describe evidence-based strategies for schools as they work to reduce rates of chronic absence among students.

We study whether childhood health capital affects school attendance, long-run occupational outcomes, and intergenerational mobility. We address this question in the context of London, England during the late nineteenth century using the inpatient admission records of three large hospitals linked to population census records, from which we identify household characteristics and the patients' siblings. Sibling fixed effects estimates indicate that boys with health deficiencies were 14.9 percent less likely to work in white collar occupations as adults and 13.9 percent more likely to experience downward occupational mobility relative to their fathers, in comparison to their brothers. This negative effect offsets 16.2 percent of the benefit of having a father in a high status occupation. We also explore medium-run mechanisms for both boys and girls, and find that poor childhood health reduced the likelihood of attending school by 2.5 and 4.1 percent, respectively. [Funding was provided by the Hitotsubashi Institute for Advanced Study, Hitotsubashi University, and the Economic History Association.]

Obesity is an important global health problem. Although obesity is not directly related to access to health care or constrained by resource deprivation, overweight status is predominantly found in poor, less-educated populations. This paper seeks to identify the causal role of schooling in affecting obesity among children and adolescents, using new estimation methods that exploit unique panel data on young twins in China. The estimates indicate that higher levels of schooling negatively affect being overweight and positively affect healthy behavior, with a large component of the causal effects due to increased information on the benefits of maintaining a healthy weight. There is also evidence that the higher-income associated with increased schooling increases incentives to invest in health.

It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood and that childhood vaccinations are an effective way of preventing serious childhood illnesses (U.S. Department of Health and Human Services [USDHHS], 2017). NASN supports elimination of all exemptions except those necessary for valid medical contraindications. School nurses are leaders who use evidence-based immunization strategies, such as School Located Vaccine (SLV) clinics, parent/guardian reminders about vaccine schedules, state immunization information systems (IIS), i.e., state registries, strong support of vaccination recommendations, and vaccine education for students, staff, and families. This document provides the background and rationale for NASN's position. [This position statement was initially adopted in June 1978 and was revised in June 1982, June 1996, November 2001, June 2006, September 2010, January 2015 (see ED558444), and January 2020.]

It is the position of the National Association of School Nurses (NASN) that to optimize student health, safety, and learning, a professional registered school nurse (hereinafter referred to as school nurse) be present all day, every day. The American Academy of Pediatrics' Council on School Health (2016) highlights the important role school nurses play across a child's continuum of care and recommends that every school should have at least one nurse. The Every Student Succeeds Act (2015) identifies school nurses as leaders of student chronic disease management in schools. Utilizing the nursing process, the school nurse manages chronic health conditions in the school setting by providing direct care, providing case management, and advocating for students and families to help them access needed resources and support to achieve academic success (CDC, 2017b). This position statement presents the role of the school nurse for students with chronic health conditions. [This position statement replaces the position statement titled Chronic Health Conditions Managed by School Nurses.]

It is the position of the National Association of School Nurses (NASN) that daily access to a registered professional school nurse (hereinafter referred to as a school nurse) can significantly improve students' health, safety, and abilities to learn. To meet the health and safety needs of students, families, and school communities, school nurse workloads should be determined at least annually, using student and community specific health data. [This document replaces the position statement "Caseload Assignments" (Adopted June 1982, revised June 1995, July 2004, June 2006, 2010).]

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the healthcare system through three primary goals: expanding access, improving quality and reducing cost (U. S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save healthcare dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other healthcare providers to improve overall health outcomes, including insurance reimbursement for services provided to students. [This document replaces the Position Statement "Health Care Reform" (Adopted June 2006, Revised June 2010).]

It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood. Promotion of immunizations by the registered professional school nurse (hereinafter referred to as school nurse) is central to the public health focus of school nursing practice (American Nurses Association [ANA] & NASN, 2011). NASN supports the Advisory Committee on Immunization Practices (ACIP) vaccine recommendations that are adopted by the Centers for Disease Control and Prevention (CDC) (CDC, 2014a, 2014b). The school nurse is well-poised to create awareness and influence action to increase the uptake of mandated and recommended immunizations. The school nurse should use evidence-based immunization strategies, such as school-located vaccination clinics, reminders about vaccine schedules, state immunization information systems (IIS), strong vaccination recommendations, and vaccine education for students, staff, and families. Using these strategies will help reduce health-related barriers to learning (Guide to Community Preventive Services, 2008, 2009, 2010; Ylitalo, Lee, & Mehta, 2013; Bobo, Carlson, & Swaroop, 2013).