STEP 1: Assess Existing Resources and Infrastructure

Identify a lead office within a state agency that can work with other agencies and assess existing state initiatives and any existing laws, policies, or regulations that address healthy school environments.

Existing state healthy schools initiatives can serve as a foundation for establishing or improving a state environmental health program for schools. By identifying a lead office to coordinate and, where feasible, expand on existing initiatives, states can begin to build the infrastructure necessary to maintain a successful program. The overall infrastructure for the program will vary based on the agencies involved, available resources, and existing policies.

Leadership and Coordination

Several state agencies are likely to be central to a state environmental health program for schools, including the departments of education, public health, environment, and agriculture. Ideally, an office in one of these agencies will take the lead role in managing the overall program (e.g., Washington's lead agency is the state Department of Health and Connecticut's lead agency is the state Department of Public Health). The lead office should be responsible for coordinating across state agencies with authorities, programs, policies, guidelines, and standards affecting school environmental health. The lead office might already be doing work in an area that can easily be expanded to include school environmental health, or might be an office that has resources (e.g., time, personnel, funds, or subject matter expertise) available to commit to the program. In some cases, non-governmental organizations (NGOs) have acted as conveners of school environmental health activities. One example is the Maryland Association of Environmental and Outdoor EducationExit.

When initiating the program, the lead office should consider reaching out to other states with existing programs to share ideas on potential approaches and strategies for establishing a school environmental health program. At a minimum, the lead office should meet with relevant agencies and departments within the state to better understand, identify, and maintain points of contact for existing environmental health initiatives and resources.

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Steering Committee and Program Partners

Many state and local agencies that provide public health, education, and environmental services (e.g., energy, commerce, and local county health departments) will likely have staff with complementary knowledge, expertise, and skills that can be helpful in developing or enhancing various aspects of a school environmental health program. To ensure better coordination on cross-cutting issues and initiatives, the lead office should work with these agencies to establish an interagency team or steering committee. The steering committee will work to set the direction, scope, and priorities of the program.

The following list provides examples of the many types of participants who could serve on or work with the steering committee to establish an effective state environmental health program for schools:

• State legislators and local administrative officials (e.g., county executives, council members, and mayors);
• Local education authorities (e.g., superintendents, chief academic officers, school board members, and school business officials);
• School administrators and staff (e.g., school administration, nurses, educators, and facility managers);
• Community members (e.g., parents, students, concerned citizens, local college/university outreach partners, and commercial businesses contracted by school districts);
• School organizations and associations (e.g., school health councils, education associations, nurse associations, parent-teacher organizations, and labor/teachers unions); and
• Non-profit/non-governmental organizations (e.g., buildings and grounds associations and asthma coalitions).

The roles of the steering committee members and participants should be well established prior to developing or enhancing a state environmental health program for schools. For instance, one agency might take responsibility for consulting with school districts and providing technical assistance, while another agency might take responsibility for responding to emergency incidents or forming a response team. A program might be strengthened by memoranda of understanding between the lead agency and other participating agencies to help outline the roles and responsibilities of each agency in every aspect of the program.

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Subject Matter Experts

School environmental health can be a complex topic to address. States might need to reach out to various subject matter experts for technical information and additional guidance throughout the development of the program. For example, when determining the proper protocol for addressing specific environmental emergencies, it might be beneficial to consult with experts such as an industrial hygienist for information about environmental testing for mold, or to contact a hazardous material (HAZMAT) specialist to learn more about chemical contamination and clean-up.

Others outside of state agencies, such as Cooperative Extension System Offices, might also be able to provide expertise on promoting healthy school environments. The Cooperative Extension System is a nationwide educational network funded by the U.S. Department of Agriculture to provide research-based information. Cooperative Extension System offices can provide locally relevant information on environmental issues including, but not limited to, radon, mold, and integrated pest management.

Another resource available to state environmental health programs for schools is Pediatric Environmental Health Specialty Units (PEHSUs)Exit, which provide consultation and recommendations on children's environmental health issues. PEHSUs are academically based, typically at university medical centers, and are located across the United States, Canada, and Mexico. PEHSUs form a respected network of experts in children's environmental health that is capable of responding to requests for information throughout North America and can offer advice on prevention, diagnosis, management, and treatment of environmentally related health effects in children. In addition, the PEHSU network can be helpful in interpreting reports or testing results from on-site school environmental health investigations and in providing risk communication to school stakeholders. PEHSUs work with schools and health care professionals, parents, community groups, and others to provide information on protecting children from environmental hazards.

States can leverage PEHSUs as a resource for medical information on health symptoms and advice on environmental conditions that affect children's health at schools. The PEHSU network can work in an advisory capacity to assist school districts with specific problems that they might encounter where local resources are not available. Although PEHSUs can be contacted on an as-needed basis for advice on interpretation and messaging regarding specific exposure concerns, they can also be valuable in providing education and directing the lead office and steering committee members toward helpful resources in the planning stages of new programs.

States and steering committees can also consult staff in EPA's Regional offices regarding information and technical assistance in such areas as children's health, indoor air quality, integrated pest management, chemical management, asbestos, lead, and radon. EPA Regional Office contacts are available on EPA's website.

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Existing Initiatives

When establishing or enhancing a state environmental health program for schools, it is important to identify and assess existing state healthy schools initiatives such as indoor air quality, integrated pest management, green cleaning, anti-idling, or chemical management efforts. The strengths and opportunities presented by existing school environmental health initiatives can serve as the starting point for an overall state program and can help determine where to focus initial efforts. In addition to assessing existing initiatives, the state emergency management plan should also be reviewed to ensure proper procedures are in place in the event of an environmental emergency (e.g., a chemical spill, mold and mildew damage, or an accidental exposure to contaminants).

As states move toward developing a plan for a new or enhanced state environmental health program for schools, this assessment can serve as a baseline and help identify potential gaps that need to be addressed.

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State Laws and Policies

The foundation of many effective state environmental health programs for schools is state laws and policies that ensure all school districts, including those serving children with disabilities and low-income and minority communities, take steps toward improving environmental conditions in schools by establishing a benchmark or standard to which all schools must comply. The lead office should identify any existing laws, regulations, or policies that can help support a state environmental health program for schools. The lead office is encouraged to conduct a review of the environmental health-related laws, regulations, and policies that are currently in place.

The review should assess how the laws, regulations, and policies are being implemented or enforced within the state to help identify gaps and outdated policies that no longer serve the state's environmental health goals and objectives. This will also help determine ways that existing authorities can be utilized to improve implementation of the state program. The Environmental Law InstituteExit maintains a database, including an assessment of impact or effectiveness, of state laws and policies covering a variety of school environmental health issues. The lead office should work with the steering committee to consider how existing regulations, policies, and legislation can be used to support, influence, or affect school facility decisions.

The process of reviewing state laws, policies, and regulations should be an on-going effort. The steering committee can help ensure that the state program remains relevant, effective, and sustainable by building on existing laws and addressing any gaps identified in the review process. The work of the steering committee can be facilitated by reviewing regulations and policies to promote healthy school environments that have been put in place by other states. For example, Connecticut has established several school health laws and policies, including anti-idling and diesel emission reduction laws; a green cleaning mandate for schools; a pesticides-in-schools law; and a law requiring new schools to be constructed to high-performancef standards (i.e., energy-efficient, well-ventilated, and good indoor air quality). Existing laws like these and Connecticut's Indoor Air Quality lawExit, as well as state education and labor laws, can serve as examples and might help other states identify opportunities to strengthen their own state environmental health program for schools. Laws, policies, and regulations that support a state environmental health program for schools might:

• Promote the establishment of local school environmental management systems that consider student and staff health and safety in all practices related to design, construction, renovation, operations, and maintenance of school buildings and grounds.
• Establish specific criteria to ensure that school facility, health, and safety inspections help prevent common environmental health issues found in school facilities (i.e., mold and moisture, exposure to chemicals and contaminants, poor indoor air quality, pests, and pesticide exposure).
• Recommend that new and renovated school facilities be designed and built to ensure a sustainable, healthy environment that also conserves energy and saves money.
• Ensure that environmental factors are considered in school siting decisions as recommended in EPA's School Siting Guidelines.
• Provide additional support to schools that are identified as most in need of critical infrastructure repair or maintenance.
• Promote healthy energy-efficient products and practices.
• Encourage environmentally safe purchasing policies for school districts.

STEP 2: Determine Capacity

Determine the capacity of each state agency to contribute to an effective state environmental health program for schools.

Once existing or potential support has been identified through an assessment of state initiatives, laws, and policies, the next step is to determine the capacity of each state agency to contribute to an environmental health program for schools.

The capacity of state agencies to contribute to an environmental health program for schools depends on having both the authorization and the resources (e.g., time, personnel, funds, or subject matter expertise) needed to support the program. No two states are alike in how they prioritize, prevent, and address environmental health issues in schools. Thus, it is important for states to determine which agencies are authorized or funded to cover environmental health- and education-related concerns. The lead office, working with the steering committee, should determine how each state agency might be able to contribute to a coordinated environmental health program for schools based on the state's priorities or most immediate needs. The areas that will likely benefit from interagency support include:

• Communicating regulations, policies, standards, and recommendations to prevent environmental health threats in schools;
• Developing tools for monitoring local school district practices to track the progress and challenges of providing healthy and safe indoor environments. For example, RIDE encourages schools to use the Northeast Collaborative for High Performance Schools Verified for Performance ScorecardExit to evaluate the success of their school health programs.
• Engaging with state school-based organizations (e.g., parent-teacher organizations and teachers' unions) to disseminate information and encourage them to communicate with their constituents;
• Coordinating existing resources and tools that can support the state program. For example:
  • Technical assistance for school districts;
  • Potential funding for school districts to implement the program; and
  • Training, certification, and continuing education programs for teachers, administrators, nurses, facility managers, custodians, other school staff, and community leaders.
• Developing an emergency management plan that outlines protocols, procedures, and points of contact that can be used in the event of an environmental health emergency (e.g., a chemical spill, mold and mildew damage, or an accidental exposure to contaminants).

Establishing an effective infrastructure to provide ongoing support is an essential step in ensuring that a state environmental health program for schools will be successful. States should ensure that effective lines of communication, management support, adequate resources, and a coordination group or points of contact for existing initiatives are in place to manage the basic elements of the state program. States can strengthen partnerships with school districts, parents, and communities by establishing accountability procedures for the program and being transparent about the limitations of available resources.

STEP 3: Develop a Plan

Develop an initial plan to establish a new, or enhance an existing, state environmental health program for schools based on available resources.

Once a lead office has been established, the existing resources and infrastructure have been identified, and the capacity of each state agency to contribute to an environmental health program for schools has been assessed, the state should use this information to develop a plan for establishing a new, or enhancing an existing, state environmental health program for schools.

The goals and objectives of the state program plan should address how the environmental health program for schools will work to protect the health of children and staff. When setting program priorities, states should first ensure that schools and school districts understand and adhere to local, state, and federal environmental health laws and regulations. States can then focus on ways to help school districts address school facilities with the greatest needs, or those with immediate health issues and concerns (e.g., extensive water damage or mismanaged chemicals). State program plans should give special consideration to ways that assistance can be provided to schools that serve students with disabilities and to school districts in underserved or low-income areas.

Schools serving these communities often face the most challenging school environmental health issues.35 School districts with funding limitations might need additional resources and information to address environmental health concerns. These school districts also could need additional assistance with identifying issues and solutions that are inexpensive to implement and can have an immediate positive impact on the school environment. States should reach out to potential partners such as colleges and universities, state associations and organizations, and other stakeholders that can provide technical assistance and resources to schools and school districts in these areas.

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Establish Goals and Priorities of the State Program Plan

It is critical for states to develop goals in the early planning stages of an environmental health program for schools to provide focus and a basis for measuring progress. Using the information gathered from the initial program assessment and capacity determination, states can set goals that are clear and measureable, and can be reasonably accomplished within a specified timeframe. Goal-setting provides a tangible roadmap for the state program as it progresses. Thus, states are encouraged to set short-term, intermediate, and long-term goals. It is imperative that all individuals involved in the state program understand the program goals. Examples of general goals include:

• Develop an environmental management system that school districts across the state can adopt to improve the health of children and school staff.
• Promote the importance of environmental health in schools and help school districts identify those schools that could benefit most from an enhanced focus on environmental health (e.g., schools with critical maintenance and repair needs, high absentee rates or above average rates of asthmatic children, children from low-income or underserved communities, and children with disabilities).
• Ensure that resources (e.g., tools, training, and information) are accessible to help school districts implement local school environmental health programs.
• Ensure that procedures, protocols, resources, and points of contact are established to manage environmental health emergencies.
• Establish policies, guidance, and best practices at the state level that address key environmental health issues, including:
  • Green cleaning,
  • Chemical management,
  • Indoor air quality,
  • Integrated pest management,
  • Construction and renovation, and
  • Classroom comfort (e.g., ventilation, acoustics, lighting, and temperature control).
• Identify options for smart materials selection (i.e., products that have less effect on human health and the environment than equivalent, competing products) when building new or renovating existing school facilities, and the use of healthier, less toxic products in all school facilities.
• Provide tools, such as those included in the Model K-12 School Environmental Health Program, that can be adopted by schools and school districts to facilitate implementation of their own environmental health programs.
• Develop state learning standards for incorporating environmental health instruction into the student curricula.

To support program goals, a state program plan should include metrics. The metrics should be specific to the goals, resources, and needs of each state. The States of Connecticut and Rhode Island provide two examples of metrics that have been developed for existing school environmental health initiatives that also can be used as metrics for other state programs.

• The State of Connecticut collects data from school districts on health statistics that can be influenced by school environments (e.g., asthma-related data and reductions in absenteeism).
• The State of Rhode Island tracks the number of school districts that are participating in a component of the state program (e.g., EPA's IAQ Tools for Schools) or that have implemented the overall state program.

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Emergency Management

Schools and school districts need to know the appropriate procedures and points of contact when faced with an environmental emergency. States can assist in these emergency situations by ensuring that schools and school districts are included in, and are aware of, the state emergency management plan. Emergency management planning can help ensure that states, schools, school districts, parents, and local communities are equipped to respond properly to environmental emergencies in schools. If one does not already exist, states are urged to develop an emergency management plan prior to implementing the environmental health program for schools. Basic emergency management and preparedness at the state level involves:

• Maintaining a consistent and up-to-date emergency preparedness guide and occupant emergency action plan;
• District-wide emergency preparedness training on topics such as safety drills, emergency evacuation, chemical spills and contamination, shelter-in-place, bomb threats, poison control, natural disasters, and fire;
• Addressing the unique needs of children with disabilities;
• Identifying reliable consultation service(s) with industrial hygienists, physicians, HAZMAT teams, and PEHSUs;
• Ensuring points of contact for reporting potential environmental health concerns are identified and available to stakeholders and local communities;
• Establishing a reporting and investigation process for addressing incident reports;
• Conducting periodic assessments of new and emerging hazards relevant to schools; and
• Providing frequent guidance and recommendations to schools and school districts throughout the emergency situation.

States are encouraged to provide an emergency preparedness guide as a general safety directive to which schools and school districts can refer for various emergencies as part of the emergency management plan. States also should consider including an occupant emergency action plan outlining protocols and procedures that can be used or adapted by schools and school districts to reflect specific information (e.g., individual school building structures, fire department regulations, school chemical inventories, and procedures for assisting children with disabilities). At a minimum, states should set up a process that schools, school districts, parents, and local communities can follow to report environmental emergencies and incidents.

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Program Implementation

Developing a strategy for implementing a state environmental health program for schools is a key component of the program plan. Methods for implementation will vary across states and will be driven by each state's needs and available resources. The lead office can work with the program participants or the steering committee to develop an implementation strategy that:

• Outlines the goals of the program;
• Identifies the activities to be completed for each goal;
• Defines a timeline for taking action toward each program goal;
• Lists the resources and funding needed to implement the program;
• Incorporates a communication plan outlining how information and resources will be disseminated to school districts and program participants;
• Identifies training needed to implement the program;
• Defines milestones and measurement criteria to guide and assess program progress;
• Establishes a process for tracking the milestones and measurement criteria that will be used to guide and assess program progress;
• Ensures compliance with all federal, state, and local environmental laws and regulations; and
• Enforces existing policies, sets school standards, modifies school inspection criteria, or adds school environmental health responsibilities to position descriptions to institutionalize and sustain the program.

As part of the implementation strategy, states can consider customizing the Model K-12 School Environmental Health Program to reflect their priorities. Customized information can include specific policies and standards for environmental health issues; emergency management protocols, procedures, and points of contact; and local resources that can assist schools and school districts in developing and sustaining their own environmental health programs and activities. The customized model program can be disseminated to schools and school districts by states as part of an outreach campaign to generate interest and participation in the state program.

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Public Communication and Outreach

Regular, effective, and transparent communication is vital to the state program's success. In addition to school districts and program participants, parents and local communities need to understand school environmental health issues and how the state program will help protect children and school staff. Prior to implementing an environmental health program for schools, states are encouraged to develop a communication strategy that outlines how program information will be shared with schools, school districts, parents, and local communities. States should consider using practical and creative outreach methods to increase program support including websites, social media, newsletters, articles, and listservs. To keep the public engaged in the program, states can center communication efforts on key topics such as:

• The priorities, goals, and benefits of the program;
• How the program will address underserved communities or populations, or those that might be disproportionately impacted by environmental risks (e.g., low-income and minority populations and children with disabilities);
• Which schools and school districts are taking action toward implementing environmental health programs;
• Assessments of school conditions;
• Interventions concerning school environmental health issues; and
• Points of contact for additional information and to report concerns.

States should identify key messages and opportunities to keep the public engaged and informed of actions that are being taken within the state to create healthy school environments for children and school staff.

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Staff Training and Education

Providing training and education opportunities to state program participants as part of the program implementation is crucial for future success. Training can be provided by the state, members of the steering committee, a trainer with expertise in school environmental health, a partnership between governmental organizations and NGOs, or successful peer trainers. Trainers should be able to speak from experience and communicate effectively with the audience. In addition to having the expertise to address environmental health issues in schools, the PEHSU networkExit can serve as a resource in identifying existing evidence-based curricula or presentations to assist with the training process. Training topics could include:

• Children's environmental health and safety in schools,
• The basic elements of the state program,
• Plans for implementing the state program,
• Best practices and lessons learned from existing state environmental health programs for schools, and
• The policies or standards currently in place that support the state program.

Educational material and information might include:

• An overview of children's environmental health issues;
• Actions that schools and school districts can take to ensure that school environments are healthy;
• See Creating Healthy Indoor Air Quality in Schools for resources to help schools and school districts learn more about the strategies, challenges, and commitments of others to protect children and school staff on a peer-to-peer basis;
• Protocols, procedures, and points of contact for environmental health emergencies;
• Existing training, certification, continuing education, and other learning opportunities for program participants;
• Outreach tools and approaches (e.g., public television, events, word-of-mouth campaigns, peer-to-peer collaboration, and social networking) to increase awareness of the state program; and
• Feedback, success stories, and lessons learned.

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Measures to Assess Progress

Having measures to assess progress can help sustain state environmental health programs for schools. When planning and coordinating the program, it is important for states to recognize early program success. Communicating milestones such as identifying the top priorities for the program and developing an emergency management plan can keep interest and enthusiasm high. Once the program has been implemented, immediate successes like increased participation, new partnerships, and incremental steps that schools or school districts take to adopt the program can be used to help measure progress. Data obtained by conducting site visits, regular reporting, and other methods can help benchmark efforts and outcomes across school districts within a state. Some baseline data might already exist (e.g., absenteeism rates and energy use). The steering committee can help establish a mechanism and timeline for tracking progress, and can determine whether the measurement plans need to be vetted by a human subjects research review process (e.g., a state institutional review board). States can use this information to make key decisions and to identify strengths, weaknesses, and gaps in the overall program.

After considering and applying these initial steps, states might wish to consider piloting the program among selected schools or school districts before implementing the program more broadly.

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