Health & Wellness — Missouri K-12 Education Reference

Table of Contents

1. Student Mental Health
2. Social-Emotional Learning (SEL)
3. Suicide Prevention
4. Substance Abuse Prevention
5. School-Based Health Services
6. Chronic Health Conditions
7. Immunizations
8. Crisis Response
9. Staff Wellness & Secondary Trauma
10. Health Education Curriculum
11. School Meal & Nutrition Programs
12. Physical Education Requirements

1. Student Mental Health

Prevalence

National data indicates approximately 1 in 5 children has a diagnosable mental health condition. Schools are increasingly the de facto point of access for mental health services, particularly for underserved populations.

School-Based Mental Health Services

Providers in Schools

• School counselors: academic, career, and social-emotional development (not long-term therapy)
• School psychologists: assessment, consultation, crisis intervention, short-term counseling
• School social workers: family engagement, community resources, attendance, behavioral support
• Licensed professional counselors (LPCs) / Licensed clinical social workers (LCSWs): may provide therapy in schools through district employment or community partnerships
• Community mental health partnerships: agencies providing therapists in school buildings (co-located services)

Funding for School Mental Health

• Title IV-A (Safe and Healthy Students pillar)
• Title I (part of comprehensive support)
• IDEA (related services for students with emotional/behavioral disabilities)
• State mental health grants (when available)
• Medicaid billing for eligible services to Medicaid-enrolled students
• Project AWARE (federal SAMHSA/DOE grant, when awarded)
• Community mental health partnerships (agency-funded staff placed in schools)

2. Social-Emotional Learning (SEL)

CASEL Framework

The Collaborative for Academic, Social, and Emotional Learning (CASEL) identifies five core competencies:

1. Self-awareness — recognizing emotions, strengths, limitations
2. Self-management — regulating emotions, setting goals, managing stress
3. Social awareness — empathy, perspective-taking, appreciating diversity
4. Relationship skills — communication, cooperation, conflict resolution
5. Responsible decision-making — ethical choices, evaluating consequences

Evidence-Based SEL Programs Common in Missouri

Missouri SEL Standards

Missouri adopted Social-Emotional Learning Standards (DESE) providing a framework for integrating SEL across grades K-12. Standards are not assessed via state testing but guide curriculum and instruction.

SEL and Equity

• SEL programs must be culturally responsive (avoid imposing dominant-culture behavioral norms)
• SEL should not be used as a behavior management tool to discipline students
• Disaggregate SEL survey data by race, gender, disability, and income to identify disparities

3. Suicide Prevention

Missouri Law (RSMo 170.048)

• School employees must receive training in youth suicide awareness and prevention
• Training must include: warning signs, risk factors, response procedures, referral processes
• DESE provides guidance and resources

Youth Suicide Risk Factors

• Previous suicide attempt (strongest predictor)
• Mental health conditions (depression, anxiety, PTSD, substance abuse, conduct disorder)
• Family history of suicide
• Exposure to peer suicide (contagion risk)
• Bullying (victimization or perpetration)
• LGBTQ+ identity (higher risk due to minority stress, rejection, discrimination — not identity itself)
• Access to lethal means
• Chronic pain or illness
• Trauma history (ACEs)
• Social isolation
• Acute crises (breakup, discipline, humiliation, family conflict)

Warning Signs

• Talking about wanting to die or feeling hopeless
• Giving away possessions
• Withdrawal from friends and activities
• Dramatic mood changes
• Increased substance use
• Searching online for methods
• Writing or social media about death
• Self-harm behaviors

Response Protocol (Standard Framework)

1. Take it seriously — never dismiss or promise secrecy
2. Stay with the student — do not leave them alone
3. Notify — administrator, school counselor, school psychologist (per building protocol)
4. Assess — trained professional conducts suicide risk screening (e.g., Columbia Suicide Severity Rating Scale — C-SSRS)
5. Contact parent/guardian — unless doing so would increase risk (rare; consult with crisis team)
6. Safety plan — develop immediate safety plan; may include removing access to means, supervision, follow-up appointments
7. Referral — connect to community mental health crisis services if indicated
8. Document — record actions taken; follow up
9. Re-entry plan — when student returns to school after an absence related to suicidality, develop a re-entry support plan with the family and treatment provider

Resources

• 988 Suicide & Crisis Lifeline: call or text 988 (24/7, free, confidential)
• Crisis Text Line: text HOME to 741741
• Missouri Department of Mental Health crisis line: varies by region
• Trevor Project (LGBTQ+ youth): 1-866-488-7386

4. Substance Abuse Prevention

Common Substances of Concern in Missouri Schools

• Alcohol, marijuana/THC (including vaping/edibles), nicotine/vaping (e-cigarettes), prescription drug misuse (opioids, stimulants, benzodiazepines), fentanyl, methamphetamine, inhalants

Prevention Programs

Policy

• District drug/alcohol policies (RSMo 160.261 requires reporting distribution of drugs on school property to law enforcement)
• Drug testing: some districts implement random drug testing for students in extracurriculars (must comply with constitutional requirements per Board of Education v. Earls, 2002)
• Naloxone/Narcan availability: increasingly available in Missouri schools; DESE and DHSS provide guidance on training and access

Intervention & Referral

• Student Assistance Programs (SAPs): school-based teams that identify at-risk students and connect them to services
• Referral to community treatment providers
• School-based support groups (after treatment/recovery)
• Re-entry planning for students returning from treatment programs

5. School-Based Health Services

School Nurse Services

See references/school-staff.md for detailed school nurse requirements. Key health services:

• Vision and hearing screening (mandated grades vary by state; typically K, 1, 3, 5, 7, 9)
• Height/weight/BMI screening (CDC guidelines)
• Scoliosis screening (typically grade 6-8)
• Medication administration
• Emergency care and first aid
• Chronic disease management (diabetes, asthma, seizures, allergies)
• Communicable disease surveillance and exclusion protocols

School-Based Health Centers (SBHCs)

Some Missouri schools partner with community health centers to operate SBHCs within school buildings:

• Provide primary care, mental health services, dental care, and health education
• Staffed by nurse practitioners, physicians, counselors, dental hygienists
• Serve enrolled students (and sometimes families and staff)
• Reduce barriers to health care access
• Funded through Medicaid, CHIP, grants, and health center budgets

Medicaid Billing in Schools

Districts can bill Missouri Medicaid (MO HealthNet) for health-related services provided to Medicaid-enrolled students with IEPs:

• Speech-language therapy, OT, PT, psychological services, nursing services, audiology, personal care
• Requires proper documentation and qualified providers
• Revenue generated offsets costs of related services
• Medicaid Administrative Claiming (MAC): districts can also claim reimbursement for certain administrative activities related to connecting students to health services

6. Chronic Health Conditions

Common Conditions Requiring School Management

Individualized Healthcare Plans (IHPs)

• Developed by the school nurse in collaboration with the family and healthcare provider
• Outline the student's condition, daily management needs, emergency protocols, and medication
• Not a substitute for an IEP or 504 plan, but may be referenced in either
• Should be accessible to all staff who work with the student (with FERPA considerations)

7. Immunizations

Missouri Requirements (RSMo 167.181)

Required immunizations for school entry (schedule updated periodically by DHSS):

• DTaP (Diphtheria, Tetanus, Pertussis)
• IPV (Polio)
• MMR (Measles, Mumps, Rubella)
• Hepatitis B
• Varicella (Chickenpox)
• Tdap booster (for 8th grade entry or age-appropriate)

Exemptions

Note: Missouri does not have a personal/philosophical exemption — only medical and religious exemptions are recognized.

Enforcement

• Students without documented immunizations or valid exemptions must be excluded from attendance
• Schools must maintain immunization records and report compliance data
• Schools must notify parents of exclusion and provide timeline for compliance

8. Crisis Response

Crisis Response Team

Every school should have a crisis response team (often called a Building Crisis Team):

• Membership: principal, counselor, psychologist, social worker, nurse, security/SRO, teacher representative
• Roles defined in advance: team leader, communications, student support, staff support, liaison with emergency services, parent contact

Types of Crises

Postvention (After a Suicide)

• Follow the American Foundation for Suicide Prevention (AFSP) and American Association of Suicidology (AAS) postvention guidelines
• Identify and support students at higher risk (close friends, students with known mental health conditions)
• Provide factual, age-appropriate information (avoid details of method)
• Make counseling available but not mandatory
• Monitor social media for contagion indicators
• Memorial guidelines: avoid permanent memorials or activities that could glamorize suicide
• Long-term follow-up: anniversary dates, check-ins with affected students

9. Staff Wellness & Secondary Trauma

Educator Burnout and Stress

Teaching ranks among the highest-stress professions. Contributing factors: workload, student behavior challenges, lack of resources, accountability pressures, secondary trauma exposure, low compensation.

Secondary Traumatic Stress (STS)

Staff who work closely with traumatized students may experience secondary traumatic stress:

• Symptoms mirror PTSD: intrusive thoughts, hypervigilance, emotional exhaustion, avoidance, irritability
• Highest risk: counselors, social workers, special education teachers, nurses, administrators handling crisis

Prevention and Support Strategies

• Proactive training on secondary trauma awareness
• Peer support programs
• Employee Assistance Programs (EAP)
• Administrative practices that protect staff time and boundaries
• Reasonable caseloads and workload distribution
• Wellness initiatives (mindfulness, physical activity, social connection)
• Substitute coverage for mental health days
• Supervision and consultation for counseling staff

10. Health Education Curriculum

Missouri Requirements

• Health education is part of the Missouri Learning Standards (Health & Physical Education)
• RSMo 170.015 requires districts offering sex education to provide abstinence-focused instruction; parents may opt their child out in writing
• Topics covered: nutrition, substance abuse prevention, disease prevention, mental health, personal safety, first aid, human growth and development

Controversial Topics

• Sex education opt-out: parents have the right to opt their child out of sex education and human sexuality instruction (RSMo 170.015)
• Instruction on sexual orientation/gender identity: no statewide mandate or prohibition (district policy governs)
• Districts should follow board-adopted curriculum and communicate transparently with families

11. School Meal & Nutrition Programs

See references/funding-programs.md for detailed NSLP/SBP/CEP information.

Key Points

• USDA meal patterns must be followed
• Free/reduced eligibility based on income (or CEP for high-poverty schools)
• Students must not be publicly identified by meal status (avoid stigma)
• Meal debt policies should avoid punitive measures that embarrass students (many Missouri districts have adopted "no lunch shaming" policies)
• Food allergy accommodations required with physician documentation
• Farm-to-school programs encouraged (connecting local agriculture to school meals)

12. Physical Education Requirements

Missouri Standards

• Physical education is a graduation requirement (1.0 credit minimum)
• Missouri Learning Standards for Health and Physical Education guide instruction
• PE should include: fitness education, motor skills, team and individual activities, lifetime physical activity
• Adapted PE must be provided for students with disabilities (per IEP)
• PE waivers/substitutions: some districts allow substitution of PE credit for JROTC, marching band, or varsity athletics (board policy)