HLTH 5433 Module 4 Legal and Ethical Analysis Example

Help Without Harm: The Laws and Ethics Governing a School Health Pilot on Chronic Absenteeism, From Student Records to Truancy Referrals

Student Name

American College of Education

HLTH5433: Leadership in Contemporary Health Education

Module 4 Assignment

Instructor Name

October 26, 2026

Introduction

A health educator who leads a school initiative works inside a web of laws and ethical obligations. The pilot developed in earlier modules, in which a district health and wellness coordinator supports an elementary school where a third of the children miss a tenth of the year or more, connects families with asthma and dental care and changes how the school responds to absence, touches several of them. It uses student records, shares information with a health center, operates alongside state attendance laws and serves children who may be homeless or have chronic health conditions. This paper identifies the laws that apply, explains what each requires and examines the ethical principles that should guide decisions where the law leaves room for judgment. It ends with safeguards the coordinator will build into the pilot.

Student Records and Privacy

Attendance records, nurse visit logs and health information kept by the school are education records under federal student privacy law, which gives parents the right to inspect their children's records and generally requires written consent before the school discloses personally identifiable information to outside parties, subject to limited exceptions such as sharing with district staff who need the information to do their jobs and sharing during a health or safety emergency (Family Educational Rights and Privacy Act, 1974). Because records maintained by school nurses are education records, they are generally governed by this law rather than by the federal health privacy rule, a point federal guidance addresses directly (U.S. Department of Health and Human Services & U.S. Department of Education, 2019).

The health center, by contrast, is a health care provider whose records are governed by the health privacy rule. Information flows in both directions in the pilot: the school wants to refer students and share attendance patterns, and the nurse wants to know whether a child was seen and what the asthma plan says. Each direction has its own legal requirement. The school needs written parent consent before sending identifiable information to the health center, and the health center needs a parent's authorization before sharing a child's health information back to the school, except as the privacy rule otherwise permits. The practical answer is a single, plain-language consent form in English and Spanish that covers both directions, explains what will be shared and why and can be revoked.

Attendance and Truancy Law

State compulsory attendance laws require children of school age to attend school and require districts to take action when absences accumulate, often including notices to parents, meetings and, in some cases, referral to court. These laws are the source of the truancy letters the district has sent for years. The pilot does not change the law, but it changes how the district meets it. Many states allow or encourage supportive interventions before court referral, and the American Academy of Pediatrics has urged pediatricians and schools to address the health causes of absence and reduce disparities rather than relying only on enforcement (Allison et al., 2019). The coordinator will review the state statute and district policy with the district's attorney to confirm which steps are required, then design the pilot so that documented supports are offered and recorded before any legal step is taken.

Students Without Stable Housing

Some chronically absent students at the pilot school live in shelters, motels or doubled up with other families. The McKinney-Vento Homeless Assistance Act gives these students specific rights, including immediate enrollment, the right to remain in their school of origin when feasible and transportation to that school, and it requires each district to have a liaison who identifies eligible students and helps them access services (McKinney-Vento Homeless Assistance Act, 1987). For the pilot, this means that absence caused by a family's move to a distant motel may be a transportation problem the district is required to solve, not a family failure. The coordinator will involve the district's liaison on the school team so that eligible students are identified and their rights are honored before any attendance consequence is considered.

Students With Chronic Health Conditions

Students whose asthma or other chronic conditions substantially limit a major life activity may be protected by Section 504 of the Rehabilitation Act, which prohibits discrimination on the basis of disability in programs receiving federal funds and requires schools to provide appropriate accommodations (Section 504 of the Rehabilitation Act, 1973). A 504 plan for a student with severe asthma might include access to an inhaler, modified physical activity during flare-ups, and support to make up work after health-related absences. Treating such absences as ordinary truancy could raise legal concerns, and it would certainly be unfair. The pilot will ensure that students with chronic conditions whose absences are health-related are referred for a 504 evaluation when appropriate.

Ethical Principles Beyond the Law

The law sets a floor, and many decisions sit above it. Four principles guide the coordinator. Respect for autonomy means families decide whether to share information and accept services; the pilot offers help but does not make it a condition of avoiding consequences. Beneficence means acting in children's interest, which supports reaching out to families rather than waiting for them to ask. Nonmaleficence asks the team to do no damage, whether through stigma, of frightening families away from school with threats and of exposing sensitive information carelessly. Justice means directing resources to students with the greatest need and ensuring that families who speak Spanish, lack transportation or distrust institutions receive the same quality of help as others.

These principles sometimes conflict. When a child with uncontrolled asthma is repeatedly absent and the family declines contact with the health center, respecting autonomy and acting in the child's interest pull in different directions. The coordinator's approach is to keep offering help, listen for the family's reasons, involve a trusted person such as the family liaison and document the effort, while recognizing that a serious risk to the child's safety could create a duty to act under child protection law.

A Professional Stance

The coordinator's professional stance draws together law and ethics. It includes knowing the laws that apply and seeking legal advice when unsure, rather than guessing; being honest with families about what information will be shared and with whom; keeping promises about confidentiality; and advocating within the district for policies that align attendance enforcement with support. It also means acknowledging the limits of the coordinator's role. She is not a lawyer, a clinician or a social worker, and part of acting ethically is knowing when to refer a question to someone who is.

Safeguards for the Pilot

The analysis leads to six safeguards. First, a bilingual, two-way consent form for sharing information with the health center, reviewed by district counsel. Second, a written team process ensuring that supports are offered and documented before any truancy step. Third, participation of the district's homeless education liaison in team meetings. Fourth, screening of chronically absent students with chronic conditions for possible 504 evaluation. Fifth, de-identified reporting of pilot data to district leaders and partners. Sixth, annual training for team members on privacy, attendance law and respectful communication. These safeguards allow the pilot to help children without creating new harms.

References

Allison, M. A., Attisha, E., & Council on School Health. (2019). The link between school attendance and good health. Pediatrics, 143(2), e20183648. https://doi.org/10.1542/peds.2018-3648

Family Educational Rights and Privacy Act of 1974, 20 U.S.C. § 1232g (1974).

McKinney-Vento Homeless Assistance Act, 42 U.S.C. § 11431 et seq. (1987).

Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 (1973).

U.S. Department of Health and Human Services & U.S. Department of Education. (2019). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records. https://studentprivacy.ed.gov/resources/joint-guidance-application-ferpa-and-hipaa-student-health-records