Each local school system shall provide a coordinated program of pupil services for all students which shall include but not be limited to: School counseling; Pupil personnel; School psychology; and Health services. The Pupil Services Program shall focus on the health, personal, interpersonal, academic, and career development of students. Each local school system shall develop and implement a plan to determine the Pupil Services Program needs of students. Each local school system shall define, develop, implement, and evaluate its Pupil Services Program. The Pupil Services Program may: Use preventive and remedial approaches to meet student needs; and Include alternative and supplemental programs for students at risk. Each local school system shall provide a Pupil Services Program Manual and a School Counseling Program Manual for the elementary and secondary schools under its jurisdiction. The following apply: The Pupil Services Program Manual shall include: The objectives of the Pupil Services Program set forth in §§A—E; A pupil services philosophy; Local goals and subgoals related to each of the goals established as part of the Pupil Services Program; Procedures; Program activities; and A procedure for an annual evaluation of the Pupil Services Program; The School Counseling Program Manual shall include: Measurable student performance objectives that relate to each of the goals and subgoals established as part of the School Counseling Program in Regulation .02B of this chapter; and A procedure for an annual evaluation of the extent to which student performance objectives are being attained. The following procedures shall apply to the certification and program services: Certification. By September 1, 1988, each local superintendent of schools shall certify to the State Superintendent of Schools that the Pupil Services Program meets, at a minimum, the requirements set forth in this regulation. Program Reviews. The State Department of Education shall implement a procedure for conducting periodic reviews of local school system Pupil Services Programs by September 1, 1988. The purpose of the reviews is to identify, on a regular basis, the program and professional development needs that exist in pupil services. Individuals providing services to students in the coordinated program of Pupil Services shall meet the State Certification requirements set forth in COMAR 13A.12.03, except nurses who shall meet the requirements set forth in Health Occupations Article, Title 8, Subtitle 3, Annotated Code of Maryland. The School Counseling Program is a coordinated data driven program of counseling, consulting, and informational services for students in grades K—12 that: Promotes student academic success and well-being; Enhances awareness of mental health and promotes positive, healthy behaviors; Provides school-based prevention and universal and targeted interventions for students with mental health and behavioral health concerns; Is comprehensive in scope, preventative in design, and developmental in nature; Is aligned with school system goals and objectives; Is an integral component of the school’s program and mission; Promotes systemic change through the use of leadership skills, advocacy, and collaboration; Promotes student achievement; Provides equitable access to a rigorous education for all students; Provides students with individual and group planning addressing academic, career, and social/emotional needs; Identifies the knowledge and skills all students will acquire to promote college and career readiness; Is delivered to all students in a systemic fashion; Addresses the needs of the whole child so that each student has the opportunity to be healthy, safe, engaged, supported, and challenged for long-term success; Is monitored and reviewed through accountability systems; and Is provided by a State-credentialed school counselor as defined in COMAR 13A.12.03.02. The school counseling program shall be formed around the following components: Foundation components, including: Program focus; Student competencies; and Professional competencies; Management components, including, but not limited to: School counselor competency and school counseling program assessments; Annual agreements or annual plan; Advisory councils; Use of data to measure program implementation and outcomes to promote systemic change such as use of time assessments, calendars, and student academic measures; and Curriculum, small group, and closing the gap action plans; Delivery components, including direct and indirect services to students that focus on students’ academic, career, and social/emotional needs, as follows: Direct services, recommended to be 80 percent of school counselor services, are services between school counselors and students that are in person or virtual interactions that include, but are not limited to: School counseling core curriculum; Individual student planning; and Responsive services; and Indirect services, recommended to be 20 percent of school counselor services, are services for students that result from the school counselor’s interactions with others that include, but are not limited to: Referrals for assistance; Consultation and collaboration with families, teachers and other educators, community organizations, and other stakeholders; Participation as members of the educational team; and Other activities that fall in line with the appropriate duties of a school counselor as detailed in this regulation; and Accountability components, including the use of school counseling program data to demonstrate the impact of the school counseling program on students and the school in measureable terms that include, but are not limited to: Student attendance data; Student achievement data; and Student behavior data. School counseling services shall be aligned with the following domains: Academic development intended to help students: Acquire the attitudes, knowledge, and skills that contribute to effective learning in school and across their life span; Complete school with the academic preparation essential to choose from a wide range of substantial post-secondary options, including college; and Understand the relationship of academics to the world of work and to life at home and in the community; Career development intended to help students: Acquire the skills to investigate the world of work in relation to their knowledge of self in order to make informed career decisions; Employ strategies to achieve future career goals with success and satisfaction; and Understand the relationship between personal qualities, education, training, and the world of work; and Social/emotional development intended to help students: Acquire the knowledge, attitudes, and interpersonal skills to help them understand and respect self and others; Make decisions, set goals, and take the necessary action to achieve goals; and Understand safety and survival skills. The Pupil Personnel Program is a systematic approach to programs and services that use the resources of the home, school, and community to enhance the social adjustment of students. These programs are designed to address a student's academic, personal, and physical needs by providing comprehensive casework management. Pupil Personnel Program interventions to meet a student's needs may include: Consultation with school staff and parents; Assumption of a liaison role between home, school, and community; Home visits; Evaluation of social and educational adjustment; and Assistance with the implementation of laws and regulations pertaining to rights and responsibilities of students. The Pupil Personnel Program shall encompass the following goals and subgoals: Assist in optimal health development so that the student will: Identify health problems that are interfering with academic achievement, Be aware of appropriate community agencies and organizations that provide health care and services, Be provided assistance in obtaining basic physical and personal health care needs, Understand the effect of appropriate nutritional habits and instruction in the home, school, and community, Participate as needed in programs designed to prevent or remediate potential health problems (that is, parenting education, drug and alcohol abuse), Understand the importance of good safety habits in the home, school, and community, Understand rights and appropriate responsibilities as related to health, and Have a greater awareness and understanding of physical development; Assist in optimal personal development so that the student will: Develop the ability to recognize and solve problems in the home, school, and community, Articulate personal feelings and attitudes on the values and beliefs that are characteristic of a democratic society, Understand an individual's rights and responsibilities in the home, school, and community, Identify unique talents, interests, academic skills, and personality traits that lead to more positive contributions in the home, school, and community, and Be aware of appropriate community agencies and organizations that assist in developing coping skills and improving self-esteem; Assist in optimal interpersonal development so that the student will: Assume responsibility and accountability for behavior in relation to others in the home, school, and community, Be aware of school and community resources and services that help remediate behavioral adjustment problems, Demonstrate effective communication skills in the home, school, and community, Understand the student's rights and responsibilities in relation to the home, school, and community, Demonstrate effective group participation and leadership skills, and Participate as needed in educational programs that improve behavior and reduce truancy and substance abuse; Assist in optimal academic development so that the student will: Develop a greater understanding and awareness of academic strengths and weaknesses, Attend school and all classes regularly, Understand the right to a free and appropriate education as well as responsibilities as prescribed in school policy and procedure, Be provided appropriate services and resources in the school and community to ensure a more positive educational adjustment, Demonstrate effective study skills, Demonstrate appropriate behavior in the school, and Demonstrate academic decision-making skills that enhance current and future contributions of the student to the home, school, and community; Assist in optimal career development so that the student will: Understand aptitudes, interests, and talents as they apply to future career decision making, Have access as needed to appropriate educational and vocational training programs, Be aware of appropriate public and private agencies and organizations that provide resources, services, or training for career development and employment skills, and Be aware of the consequences of, and alternatives to, leaving the educational system before graduation. The School Psychology Program is a comprehensive and integrated continuum of services and activities regarding the delivery of school psychological services. The goal of the program is to provide direct educational, behavioral, and mental health services for children and youth, as well as work with families, school administrators, educators, and other professionals to create supportive learning and social environments for all students. To meet a student’s needs, the School Psychology Program shall provide services and interventions across the following domains of practice: Data-based decision making and accountability that use varied models and methods of assessment and data collection to: Identify strengths and needs; Develop effective services and programs; and Measure progress and outcomes; Consultation and collaboration that use varied models and strategies of consultation and communication applicable to individuals, families, groups, and systems, and methods to promote effective implementation of services; To develop cognitive and academic strengths, interventions and instructional support that apply knowledge of biological, cultural, and social influences to: Academic skills; Human learning; Cognitive and developmental processes; and Evidence-based curricula and instructional strategies; To develop social and life skills, interventions and mental health services that use: Knowledge of biological, cultural, developmental, and social influences on behavior and mental health; Behavioral and emotional impacts on learning and life skills; and Evidence-based strategies to promote social/emotional functioning and mental health; Schoolwide practices to promote learning and mental health that use: School and school system structure, organization, and theory; General and special education; Technology resources; and Evidence-based school practices that promote learning and mental health; Preventive and responsive services that use: Principles and research related to resilience and risk factors in learning and mental health; Services in schools and communities to support multi-tiered prevention; and Evidence-based strategies for effective crisis response; Family-school collaboration services that use: Principles and research related to family systems, strengths, needs, and culture; Evidence-based strategies to support family influences on children’s learning and mental health; and Strategies to develop collaboration between families and schools; Development and learning to enhance services and address potential influences related to diversity by using: Individual differences, abilities, disabilities, and other diverse student characteristics; Principles and research related to diversity factors for children, families, and schools, including factors related to culture, context, and individual and role differences; and Evidence-based strategies; Research and program evaluation that use research design, statistics, measurement, and varied data collection and analysis techniques and program evaluation sufficient for understanding research and interpreting data in applied settings; and Legal, ethical, and professional practice that use: History and foundations of school psychology; Multiple service models and methods; Ethical, legal, and professional standards; and Other factors related to professional identity and effective practice of school psychology. The School Psychology Program shall encompass the following goals to meet a student’s needs: Improve academic engagement and achievement by working with educators and families to: Identify and mitigate barriers to learning, such as disabilities, mental or physical health problems, or social, cultural, language, or family issues; Implement appropriate academic interventions by monitoring the effectiveness of academic interventions, developing student organizational skills, and promoting the use of learning strategies; and Implement appropriate social/emotional and behavioral strategies such as those that are designed to improve attention, strengthen motivation, and promote student problem solving; Facilitate effective instruction that meets the individual needs of diverse learners by consulting with educators to: Individualize instructions; Manage classroom behavior; Monitor student progress; and Evaluate classroom data; Support positive behavior and socially successful students by providing services that promote a student’s: Communication skills; Social skills; Problem-solving skills; Anger management skills; Conflict resolution skills; Self-regulation; Self-determination; Resilience; and Optimism; Support positive behavior and socially successful students by consulting with teachers and administrators on: Classroom strategies; Programs promoting positive peer relationships and social problem solving; Schoolwide positive behavior interventions and supports; Use of effective discipline policies and practices; and Programs to promote student wellness and reduce risk-taking; Support diverse learners by working with teachers and other school staff to: Assess learning and behavior needs and distinguish between issues related to family, culture, or language and a learning style or disability; Plan appropriate individualized education programs for students with disabilities; Modify and adapt curricula and instruction; Adjust classroom facilities and routines to promote greater student engagement; Promote positive relationships among all students; Monitor and effectively communicate with parents about student progress; and Coordinate links to community services; Create safe, positive school climates by providing expertise to school leadership in: Data collection and analysis; Social/emotional learning; Child development and behavior; Violence prevention; Crisis and trauma prevention and response; and School-family-community collaboration; Strengthen school-family-community partnerships by: Working with teachers and other school staff to enhance their understanding and acceptance of diverse cultures and backgrounds and to promote culturally responsive schools; and Providing specific support to help families: Understand and support their child’s learning and mental health needs; Navigate the special education process; Connect with community service providers when necessary; Engage effectively with teachers and other school staff; and Reinforce the school-family-community partnership; and Improve assessment and accountability by helping school leaders and teachers to: Generate and interpret student outcome data; and Make decisions regarding programs and interventions in the district, building, classroom, and individual student levels. In accordance with Education Article, §7-401, Annotated Code of Maryland, the Department of Education and the Maryland Department of Health have developed jointly public standards and guidelines for school health programs. The law further provides that the Department of Education and the Maryland Department of Health shall offer assistance to the local boards of education and local health departments in the implementation of these standards. In Regulations .05—.15, the following terms have the meanings indicated. Terms Defined. “Communicable disease control” means the prevention, investigation, limitation, and eradication of diseases caused by infectious agents and usually spread from person to person. “Designated school health services professional” means a physician, certified nurse practitioner, or registered nurse, or all of these, with experience or special training, or both, in working with children and families in community or school health programs and practices in accordance with the current medical and nursing standards of care. “Follow-up” means the process of ascertaining if the recommended services have been obtained and evaluating the outcomes to determine if additional referrals are necessary. “Health appraisal” means the process by which a designated school health services professional identifies health problems that may interfere with learning. “Health counseling” means a service which provides opportunities for students and parents/guardians to explore options, make decisions, and receive support for understanding and adjusting to or coping with their health problems. “Nursing care plan” means the course of action to be used by the nurse to meet the health needs of a student. “Physical education” means the component of the school program that seeks, basically through the medium of physical activities, to improve each individual's physical fitness, motor skills, knowledge and appreciation of physical activities, and social competencies. “Referral” means the process of helping a student or family obtain additional or comprehensive services, or both, and information. “School health services aide” means an unlicensed person who functions under the supervision of a designated school health services professional. The designated school health professional shall determine the required degree of supervision on an individual basis. A school health services aide, at a minimum, shall be certified in cardiopulmonary resuscitation annually and a basic first aid course every 3 years. “Screening” means a procedure to identify students who are at risk of having a health problem. “Special health needs” means temporary or long-term health problems arising from physical, emotional, or social factors or any combination of these. The student with special health needs may or may not be enrolled in a special education program. “Staff development” means the process of both formal and informal acquisition by staff of further knowledge, skills, and attitudes needed to perform assigned functions. “Supervision” means the process of critically watching, directing, and evaluating another's performance. Physical Examination. A physical examination is required of each child entering the Maryland public school system for the first time. The examination shall be completed within the period of 9 months before entrance or 6 months after entrance. The physical examination form designated by the Department of Education and the Maryland Department of Health shall be used to meet this requirement. The physical examination shall be completed by a physician or certified nurse practitioner. For each school year each public school shall report to the local board of education or local health department the number of children entering the public school system for the first time who have not had a physical examination because of the lack of access to health care, insufficient financial resources, or any other reason, including a religious reason, as the public school deems appropriate. An effort should be made to facilitate students and their families in obtaining a physical examination. However, if a student is unable to obtain a physical examination, the student may not be excluded from school. For each school year the local board of education or local health department shall report the number of children who have not had a physical examination and the reason or reasons for not obtaining the physical examination to the Maryland Department of Health. Review of Students' Health Records. The initial review of students' health records may be conducted by the designated school health professional or a school health services aide. The review of records shall include a review of the student's health history, health screening reports, physical examination form as designated by the Department of Education and the Maryland Department of Health, dental examination records, and other health reports. During the record review, the designated school health services professional or school health services aide shall document whether the student has a primary care provider. Students with health problems or concerns identified during the initial review of records by the school health services aide shall be referred to the designated school health services professional for a health appraisal. Health Appraisal. A health appraisal for students identified through the review of records as having health problems or concerns shall be conducted by the designated school health services professional. The health appraisal may include health observations, interviews, and conferences with parents/guardians, students, educators, and other health professionals. Health appraisals shall be conducted as follows: The health appraisal shall take place not later than 6 months after the date of entry to a school system and after that as indicated in §C(2), of this regulation. The health appraisal of students with identified health problems shall be repeated as frequently as deemed necessary by the designated school health services professional. Screening of students shall be carried out according to mandated or recommended screening programs established by the Department of Education and the Maryland Department of Health. These shall include: Hearing and Vision Screening Tests. The local board of education or local health department shall provide and fund hearing and vision screenings for all students in the public schools. The local health department shall provide and fund hearing and vision screenings for all students in any private school that has received a certificate of approval under Education Article, §2-206, Annotated Code of Maryland, and students in any nonpublic educational facility in this State approved as a special education facility by the Department. Unless evidence is presented that a student has been tested within the past year, these hearing and vision screenings shall be given in the years that a student enters a school system, enters the first grade, and enters the eighth, or ninth grade. Additional screenings may be required under the policies adopted by the local board of education or local health department. The results of the hearing and vision screenings shall be made a part of the permanent record file of each student and given to the parents of any student who fails the screenings and reported to the local board of education or the local health department. If a student fails the screenings, the parent/guardian shall report on the recommended services received by the student to the local board of education or local health department on an approved form. The local board of education or local health department shall report to the Maryland Department of Health the results of the hearing and vision screenings and, to the extent practicable, the number of students receiving the recommended services. Students may be exempt from these hearing and vision screenings if the parent/guardian objects in writing on the ground that it conflicts with the tenets and practice of a recognized church or religious denomination of which the parent/guardian is a member. When a health problem has been identified through the health appraisal process, the designated school health services professional or designee shall notify and assist students, or parents/guardians, or both, in selecting recommended services. For students without a usual source of care, the designated school health services professional or designee shall assist the student/family to identify a primary care provider. The designated school health services professional shall be responsible for follow-up. The designated school health services professional or the school health services aide shall inform appropriate school personnel of students who have health problems which may impede learning or require special care, or both. Health Counseling. The designated school health services professional shall offer health counseling after the identification of a health need. If any additional counseling services are required, the designated school health services professional shall assist students and families in selecting the additional counseling services. Communicable Diseases. A school shall comply with the Maryland Department of Health's immunization requirements in accordance with COMAR 10.06.04. The principal or the principal's designee shall notify the local health department of all suspected or diagnosed cases of reportable communicable diseases in compliance with Health-General Article, Title 18, Annotated Code of Maryland. The local health department shall assist the local board of education in implementing a plan for preventing the spread of the reported disease. The local health department and the local board of education, following State guidelines, shall jointly develop written policies and procedures for dealing locally with outbreaks of nonreportable communicable diseases such as scabies, pediculosis, and athlete's foot. Physical Education Program. The designated school health services professional shall be available for consultation in planning, implementing, and evaluating those aspects of the physical education program which specifically relate to the health and safety of the participants. Before participating in interscholastic sports, students shall have a physical examination in compliance with COMAR 13A.06.03.02I. A copy of the results of the physical examination shall be kept in the school health record. In compliance with COMAR 13A.06.03.04B(3), all coaches shall be required to enroll and complete a one-credit course in the prevention and care of athletic injuries. A local board of education, in conjunction with the local health department, shall formulate written policies ensuring the provision of school health services to students with special health needs. A student with special health needs that may require particular attention during the school day shall have a statement of those health needs and a nursing care plan for emergency and routine care prepared by the designated school health services professional. The designated school health services professional shall make appropriate school personnel aware of the students in the school who have special health needs that may require intervention during the school day. The principal, in consultation with the designated school health services professional, shall identify school personnel who shall receive in-service training in providing the recommended services for students with special health needs. A designated school health services professional may serve on all levels of the pupil services team and the admissions, review, and dismissal committees and participate, when appropriate, in the health services component of the Individualized Education Plan (IEP), the Individualized Family Service Plan (IFSP), or the Transitional Plan or any combination of these (COMAR 13A.05.01). A local board of education, in conjunction with the local health department, shall formulate written policies regarding storage and administration of medication during school hours and during school-sponsored activities. Personnel Qualifications. At least one adult in each school, other than the designated school health services professional and the school health services aide, shall be currently certified both in the First Aid Program of the American National Red Cross or its equivalent, and in adult or pediatric cardiopulmonary resuscitation (CPR), or both. One certified person shall be available on site during the regular school day and at all school-sponsored athletic events. Emergency Care Procedures. A guide for emergency care management shall be developed and distributed by the local health department and the local board of education to each school, and copies shall be placed in multiple locations. An emergency information card shall be maintained for each student, and shall be updated at least annually. Emergency evacuation plans shall be developed in consultation with the fire department, and shall include provisions for physically handicapped students and students with other special health needs. Health Suite. School buildings constructed or renovated and occupied after January 1, 1993 shall provide a handicapped-accessible space that, at a minimum, includes space for waiting, examination and treatment, storage, and resting. There shall be a separate room for private consultation and for use as a designated school health services professional's office. Toilets, a lavatory, and a telephone shall be in the health suite. Locked file cabinets shall be available for storing health records and for medications. Schools occupied before January 1, 1993 shall provide space for use as the designated school health professional's office and shall meet the standards in §A(1), above, to the maximum extent possible. At a minimum, a lavatory and a telephone shall be easily accessible. Locked file cabinets shall be available for storing health records and for medications. A designated school health services professional shall be involved at the local level in the planning of health areas in new schools and in the modernization of old schools. A designated school health services professional at the State level shall be available as necessary for consultation. Screening Facilities. A room shall be provided for hearing screening tests. This room shall meet the following criteria: The screening room shall be as quiet as possible; Areas near fans or air conditioners, hall traffic, playground or street traffic, group activities, bathrooms, lunchrooms, office equipment, refrigerators, or snack machines shall be avoided; Excess noise, such as talking, paper shuffling, and moving furniture, shall be avoided; The room shall be uncluttered and free of visual distractions. Space and lighting requirements for the specific vision test used shall be made available. The local board of education and local health department shall jointly develop and annually implement an in-service training plan that includes: Orientation to the school health services program for all school personnel; Training in the care and prevention of athletic injuries for all coaches; Training in first aid and cardiopulmonary resuscitation (CPR) for school personnel; and Specific health programs required by federal, State, and local law for designated school health professionals. At the beginning of each school year, all parents/guardians and students shall be informed of the school health services program. The information shall include but not be limited to staffing, emergency care, medications, and communicable diseases, and be specific to that school's health services program. The information shall be updated as necessary. The local school superintendent and the local health officer shall jointly require the development of a local school health council with assistance by the Maryland State School Health Council. The local school superintendent and the local health officer shall be jointly responsible for the implementation of Regulations .05—.15 of this chapter. When medical direction is necessary, the designated school health services professional shall work in collaboration with the local health officer or the health officer's designee. The designated school health services professional, other than the physician, and the school health services aide shall receive nursing direction from a registered nurse employed by either the local health department or the local board of education. Health services provided in school shall be coordinated with other health services within the community. By September 1, 1992, the local school superintendent and local health officer shall submit to the State Superintendent of Schools a status report of the implementation of Regulations .05—.15 of this chapter. By September 1, 1995, the local school superintendent and local health officer shall certify that Regulations .05—.15 of this chapter are being implemented. Annually after that, the local school superintendent and local health officer shall certify to the Department of Education and the Maryland Department of Health that the school health services program which meets Regulations .05—.15 of this chapter is being implemented. The Department of Education and the Maryland Department of Health shall jointly develop, in collaboration with local boards of education and local health departments, a monitoring and evaluation component for school health programs that may include on-site reviews. Issues of parental consent and confidentiality shall be administered in accordance with Health-General Article, §20-102, Annotated Code of Maryland, and COMAR 13A.08.02. Education Article, §§2-205(b) and (c), 7-401—7-404, 7-409, and 7-426, Annotated Code of Maryland Effective date: July 1, 1985 (12:13 Md. R. 1281) Regulations .01 and .02 amended effective February 23, 1987 (14:4 Md. R. 419) Regulations .03—.05 adopted effective February 23, 1987 (14:4 Md. R. 419) Chapter revised effective January 15, 1989 (15:27 Md. R. 3134) Regulation .01 amended effective December 1, 2008 (35:24 Md. R. 2079) Regulation .02A, B amended effective December 1, 2008 (35:24 Md. R. 2079) Regulation .02 repealed and new Regulation .02 adopted effective July 29, 2019 (46:15 Md. R. 655) Regulation .04 repealed and new Regulation .04 adopted effective July 29, 2019 (46:15 Md. R. 655) Regulation .05 repealed and new Regulation .05 adopted effective May 13, 1991 (18:9 Md. R. 1010) Regulations .06—.15 adopted effective May 13, 1991 (18:9 Md. R. 1010) Regulation .06B amended effective June 28, 2010 (37:13 Md. R. 853) Regulation .07C amended effective June 28, 2010 (37:13 Md. R. 853)