Guidance

High-impact areas for school nursing (ages 5 to 19)

Published 6 February 2026

Applies to England

© Crown copyright 2026

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1. Physical, mental and emotional health and wellbeing

Overview of high-impact area 1: ages 5 to 19

Promoting healthy lifestyles for school-aged children (aged 5 to 19, or up to the age of 25 for care leavers and those with special educational needs and disabilities (SEND)) means supporting them to lead active, emotionally resilient lives through accessible, evidence-based health support in schools and community settings. School nurses play a vital role in health promotion by encouraging habits that support physical, mental and emotional wellbeing, and helping to prevent ill-health. 

Schools are significant environments for early intervention, offering opportunities for school nurses and their teams to promote:

  • healthy eating
  • physical activity
  • sleep
  • personal hygiene
  • oral health
  • emotional wellbeing

They can also provide information and support for children and young people on how to avoid harmful behaviours such as:

  • smoking
  • vaping
  • substance use
  • early or unprotected sexual activity

This high-impact area aligns with national strategies including the 10 Year Health Plan for England: fit for the future and Giving every child the best start in life, which prioritise prevention, early intervention and integrated support to reduce inequalities.

It reflects the principles of proportionate universalism, recognising that, while all children benefit from support, those with greater needs require more tailored and intensive interventions. It also emphasises culturally sensitive, trauma-informed practice to ensure support is inclusive, accessible and relevant across diverse communities. 

Why physical, mental and emotional health is important

Healthy growth and development are essential for children and young people to thrive physically, mentally, emotionally and educationally. When children are healthy, they are better able to concentrate, engage and succeed in school. Promoting healthy lifestyles from an early age helps build strong foundations for lifelong wellbeing. 

Schools are major partners in reducing health inequalities. Children from disadvantaged backgrounds face higher risks of poor health, including obesity, dental decay and mental health issues. For example, according to Office for National Statistics Healthy life expectancy by national area deprivation, England and Wales: between 2013 to 2015 and 2020 to 2022 data, children in the most deprived areas of England spend around 20 fewer years in good health compared with those in the least deprived areas.

Health promotion in schools supports:

  • physical activity - this builds strength, confidence and healthy habits, and reduces risk of obesity and chronic disease
  • healthy eating - this reduces the risk of cardiovascular disease, type 2 diabetes and some cancers, guided by the Eatwell Guide and NHS tools
  • oral health - this prevents pain, infection and school absence. Children in deprived areas are twice as likely to experience dental decay
  • mental wellbeing - physical activity, nutrition, good sleep hygiene and positive environments where children feel safe support emotional resilience and reduce anxiety
  • risk reduction - health promotion and access to timely educational messages helps prevent smoking, vaping, substance use and unplanned teenage pregnancy

Since the Relationships Education, Relationships and Sex Education and Health Education (England) Regulations 2019 came into force in 2020, statutory health education ensures all pupils learn about nutrition, physical fitness, mental health and personal hygiene.

School nurses play a vital role in delivering this support, helping children and young people develop healthy habits and a positive self-image that lasts a lifetime. 

The role of the school nurse in physical, mental and emotional health

Led by the qualified specialist community public health school nurse (SCPHN), the service is delivered through a wider school nursing team comprising:

  • registered nurses
  • support staff
  • practitioners working under delegated responsibilities

The qualified SCPHN provides strategic and clinical oversight, ensuring universal services are safe, equitable and responsive to local needs.

A well structured skill mix model enhances the capacity, flexibility and responsiveness of school nursing teams. When appropriately delegated and supported, skill mix practitioners - including registered nurses, registered nursing associates, and unregulated support staff - make an essential contribution to the delivery of the healthy child programme. 

School nurses play a vital role in health promotion, prevention and early intervention for children and young people, helping to reduce inequalities and support lifelong healthy habits. Their work is central to achieving the ambitions of the government’s 10 Year Health Plan, which aims to raise the healthiest generation of children ever by:

  • improving nutrition
  • increasing physical activity
  • reshaping the wider health environment

By working in partnership with health visitors, schools, families and wider services, school nurses help children and young people adopt behaviours that support their physical, emotional and mental wellbeing. They:

  • provide early, targeted support - particularly for those with additional needs or vulnerabilities
  • co-ordinate further intervention to prevent problems escalating

Their approach promotes self-efficacy, resilience and readiness for adulthood.

The 4 levels of service offered to support physical, mental and emotional health

Community-level offer 

School nurses lead community-based health promotion, working across schools, families and local services to support resilience, independence and informed health choices among children and young people. Their visibility in community settings - including neighbourhood teams, Best Start Family Hubs, youth services and local events - helps ensure families understand their role and know how to access support. 

As trusted public health professionals, school nurses provide accessible, culturally sensitive information on physical and mental wellbeing, and maintain up-to-date knowledge of local and national services to enable effective signposting. Their leadership helps shape joined-up approaches to health improvement, recognising that whole-school and whole-community strategies are crucial to improving outcomes. 

Crucial responsibilities of school nursing teams at the community level include the following: 

  • empowering families with proactive advice that supports developmental transitions and growing independence
  • using data-driven approaches to identify population health needs, stratify risk and inform targeted prevention strategies
  • assessing whole-school health needs and leading initiatives that promote health and wellbeing across schools and communities
  • driving system change by contributing to education partnerships, early help networks and integrated care systems, influencing local practice, policy and service design

This level of the service offer lays the foundation for proportionate universalism, ensuring that all children and young people benefit from health promotion, while those with greater needs receive more tailored support.

Universal-level offer 

School nurses and their teams play a vital role in promoting healthy lifestyles across the school-aged population. Their universal offer is built on visibility, trusted relationships and early intervention, helping children and young people build lifelong habits that support physical, emotional and mental wellbeing. 

School nursing teams often include a diverse skill mix, such as qualified SCPHNs, staff nurses, nursery nurses, healthcare support workers and youth workers. This enables flexible, proportionate support to be tailored to the needs of children and young people across different settings.

Core elements of the universal offer include the following: 

  • planned health needs assessments at major transition points - typically at school entry, year 6, year 8, and year 11 - delivered through digital platforms, paper questionnaires or in-person contacts. These assessments help identify emerging needs and offer timely opportunities to promote healthy behaviours
  • visible presence in schools and communities, so children and young people know who they can turn to for support, advice or a listening ear. Drop-ins, corridor conversations and informal check-ins help build trust and reduce stigma around seeking help
  • relational practice at the heart of delivery, recognising that trusted relationships are essential for promoting healthy choices, especially in the context of rising mental health concerns. School nurses offer safe, confidential spaces for children and young people to talk, reflect and feel heard
  • use of youth-friendly digital platforms like ChatHealth to increase accessibility and confidentiality, particularly for those who may not feel comfortable seeking face-to-face support
  • collaboration with school staff, parents and in-school mental health support teams, ensuring joined-up care and consistent messaging around healthy lifestyles, emotional wellbeing and resilience
  • support for statutory health and relationships education, including inclusive, accurate information on nutrition, physical activity, relationships and emotional wellbeing
  • promotion of national and local programmes, such as: 
  • use of local data and National Child Measurement Programme (NCMP) insights to understand population-level trends and tailor universal health promotion. In some areas, NCMP delivery is commissioned separately, but school nurses still play a major role in interpreting data and supporting schools to respond
  • integrated data approaches - linking NCMP, primary care and other data sets to build a fuller picture of children’s circumstances and identify wider social determinants affecting health outcomes

This universal offer reflects the 10 Year Health Plan vision of early intervention, integrated care and neighbourhood-based support. It ensures that all children and young people receive consistent, accessible guidance to thrive, while laying the foundation for more tailored support where needed.

School nurses lead this work, but delivery is supported by the wider school nursing team, whose diverse skill mix enables flexible, proportionate responses across different settings. By combining clinical expertise with relational practice and data-informed insight, school nursing teams help reduce inequalities, promote healthier lifestyles and ensure every child can flourish.

Targeted-level offer 

School nursing teams play a critical and multifaceted role in delivering time-limited, focused interventions to children and young people with emerging or situational health needs. These may be identified through:

  • health needs assessments
  • NCMP data
  • school staff
  • the concerns of children and young people and/or their families

The targeted offer aims to build resilience, promote healthy choices, and prevent escalation through brief tailored interventions and support. 

At the targeted level, school nursing teams’ - working alongside others such as mental health support teams - can offer more targeted mental health support. This enables flexible, proportionate delivery matched to the child’s level of need and context.

Core elements of the targeted offer include the following: 

  • tailored health promotion for children and young people with additional needs, including support around nutrition, physical activity, emotional wellbeing and risk-taking behaviours. This is especially important at major developmental transitions such as school entry, year 6, year 8 and year 11
  • tailored support and appropriate referrals for children exhibiting signs of body dysmorphia, gender dysphoria or eating disorders, including referrals to:
    • child and adolescent mental health services (CAMHS)
    • gender dysphoria clinics
    • locally commissioned services
  • support for children and young people living with disabilities or long-term conditions (such as asthma, diabetes, epilepsy or allergies), including those with SEND and care-experienced or looked-after children. School nurses offer:
    • health promotion
    • care co-ordination
    • support with access and signposting
  • preservation of emotional wellbeing through early intervention, relational support and visible presence, particularly for children experiencing weight management challenges, bereavement, family breakdown or other significant life changes. This includes referrals or links to:
    • mental health services
    • youth counselling
    • wellbeing programmes
  • facilitating access to evidence-based programmes and community support, such as:
    • Kooth and Young Minds for digital mental health support and self-help resources
    • local CAMHS pathways for children needing specialist mental healthcare
    • healthy weight pathways and local nutrition services for children living with overweight or obesity
    • youth clubs, peer support groups and Best Start Family Hubs for wider wellbeing and social connection
  • safeguarding and support for complex families, with school nurses often acting as a valuable health contact in multi-agency meetings. They identify and respond to concerns around:
    • neglect
    • domestic abuse
    • substance misuse
    • other factors that impact a child’s ability to live a healthy life
  • targeted outreach to children not in mainstream education, including those excluded, persistently absent, home educated or attending alternative provision. School nurses work with Best Start Family Hubs, behavioural schools and partner organisations to ensure these children receive appropriate health support and do not miss out on universal messaging
  • support for schools with identified population-level needs, such as high rates of children living with obesity, low emotional wellbeing or poor engagement with health services. School nurses may deliver targeted interventions, staff training or whole-school campaigns to address these issues
  • collaboration with school staff, parents and in-school mental health teams, ensuring joined-up care and consistent messaging around healthy lifestyles. This includes supporting schools to embed inclusive, strengths-based approaches to wellbeing and health education

While school nurses lead assessment and planning, delivery may be delegated to the most appropriate member of the school nursing team, for example:

  • a staff nurse supporting care co-ordination
  • a nursery nurse delivering health promotion activities
  • a youth worker or mental health support team member facilitating peer-led wellbeing sessions

This ensures support is timely, compassionate and proportionate. 

This targeted offer builds on universal insight and ensures that children and young people with greater needs receive timely, compassionate and proportionate support. It reflects the principles of proportionate universalism and contributes to reducing health inequalities across the school-aged population. 

Specialist-level offer 

School nurses are highly trained public health professionals who deliver ongoing, specialist care to children and young people with complex health needs and vulnerabilities. Their role includes care co-ordination, advocacy, safeguarding and strategic contribution, ensuring inclusive, equitable support across education, health and social care systems. 

At this specialist level, school nursing teams: 

  • support pupils living with chronic illnesses (such as asthma, diabetes, epilepsy or allergies), mental health conditions, and those with education, health and care plans (EHCPs). School nurses provide personalised health information, proactive support and co-ordination to help children maximise their health and wellbeing
  • provide tailored support for children and young people with SEND, including those with sensory impairments, learning difficulties, communication challenges or where English is not their first language. Health promotion activities are adapted using accessible formats, visual tools and culturally sensitive approaches
  • collaborate with community nurses and specialist teams to ensure schools are aware of and equipped to support individual care plans. School nurses act as a bridge between home, school and healthcare, helping to embed care planning into everyday school life and ensuring continuity of care
  • establish and navigate clear referral pathways to appropriate services, including CAMHS, paediatrics, youth services and voluntary sector programmes. They play a major role in supporting families to engage confidently with these systems
  • facilitate access to evidence-based programmes and community support, such as:
    • Kooth and Young Minds for digital mental health support and self-help resources
    • local CAMHS pathways for children needing specialist mental healthcare
    • healthy weight pathways and nutrition services for children living with overweight or obesity
    • Best Start Family Hubs and youth services for wider wellbeing and social connection
  • provide specialist input into safeguarding processes, particularly for children experiencing complex vulnerabilities such as exploitation, domestic abuse, substance misuse or parental mental health issues. School nurses:
    • contribute clinical insight
    • advocate for health needs
    • ensure the most appropriate professionals are involved in multi-agency discussions
  • support children not in mainstream education, including those in alternative provision, behavioural schools or home-educated settings. School nurses work with Best Start Family Hubs and partner organisations to ensure these children receive equitable access to specialist health support
  • champion inclusive sexual health education and access, particularly for young people with SEND or those facing digital exclusion. This includes tailored resources, one-to-one support and collaboration with sexual health services to ensure safe and informed decision-making
  • use data and professional judgement to identify children at risk of poor health outcomes and intervene early. This includes interpreting NCMP data, health questionnaires and safeguarding alerts to inform personalised care and wider system improvement
  • contribute to strategic planning and commissioning conversations, ensuring that the lived experiences and health needs of vulnerable children are reflected in:
    • service design
    • workforce planning
    • resource allocation

School nurses maintain a visible and relational presence in schools and communities. This is essential for building trust and enabling children to seek help - particularly those facing stigma, isolation or complex challenges.

This specialist offer aligns with the government’s 10 Year Health Plan, which prioritises improving children’s mental health, reducing health inequalities, and integrating services across education, health and social care. School nurses are recognised as valuable professionals in delivering this vision, particularly through their:

  • public health and safeguarding expertise
  • relational practice
  • advocacy for children with complex needs

2. Supporting children and young people with additional needs 

Overview of high-impact area 2: ages 5 to 19

Supporting children and young people who have additional needs is a core responsibility of school nursing teams. These children may face barriers to health, learning and participation due to long-term physical or mental health conditions, disabilities or complex vulnerabilities.

School nurses and their teams are uniquely positioned to provide inclusive, proportionate support that promotes wellbeing and enables access to education. 

Children and young people who are disabled or have additional needs include those who: 

  • live with chronic health conditions such as asthma, diabetes, epilepsy or allergies
  • experience neurodevelopmental challenges, sensory impairments or learning difficulties
  • have continence needs, communication challenges or mental health conditions
  • are disabled, care experienced or looked after, or require special educational provision under SEND

School nursing teams deliver a range of interventions across health promotion, care co-ordination, safeguarding and advocacy. While they may not hold overall clinical responsibility for children with complex medical needs, they work collaboratively with paediatricians, community children’s nursing teams and other professionals to ensure joined-up care and inclusive access to education, healthcare and community life. 

Why supporting children and young people with additional needs is important 

Children and young people with additional needs - including those with disabilities, long-term health conditions, neurodevelopmental challenges or continence issues - face increased barriers to accessing education, maintaining wellbeing and achieving their potential. These barriers may include:

  • difficulties with social interaction
  • a higher risk of exclusion and bullying
  • reduced independence

Such children often require co-ordinated multi-agency support to ensure they can thrive.

Some children require special educational provision and are identified as having SEND. The Children’s Commissioner for England’s ‘We all have a voice’: disabled children’s vision for change states that, in the academic year 2021 to 2022, 16.6% of pupils in England - equating to 1,485,409 children and young people - had either an EHCP or were receiving special educational needs support in school.

According to the Royal College of Paediatrics and Child Health’s Child health inequalities driven by child poverty in the UK - position statement, children with SEND or disabilities may also be at increased risk of abuse and neglect due to their vulnerability and the pressures face by families caring for them. Furthermore, children living in poverty are 72% more likely than their peers to be diagnosed with a long-term illness (see reference 12 in the Annex: references), highlighting the intersection between health inequalities and socioeconomic disadvantage.

Children with a learning disability and autistic children are particularly vulnerable to poor health outcomes. Findings from Learning from lives and deaths – people with a learning disability and autistic people consistently show that this population experiences premature mortality, often from preventable causes, and faces significant barriers to accessing timely, appropriate healthcare. These insights reinforce the need for:

  • inclusive, proactive health support from school nursing teams, particularly for children with complex needs
  • where necessary, access to social care support if a child has needs resulting from their disability

All organisations providing care or education are expected to comply with relevant statutory guidance including the SEND code of practice: 0 to 25 years.

Healthcare providers, including school nursing teams, have a duty to work collaboratively with local authorities and education settings to ensure children with medical conditions can be safely supported to access learning. 

School nurses are uniquely placed to identify unmet health needs, co-ordinate care and advocate for children with additional needs. Their visible presence, relational practice and multi-agency working are essential in preventing escalation and promoting inclusion. Early identification and personalised intervention, tailored to each child’s needs, can significantly improve outcomes. 

The government’s Break down barriers to opportunity mission, outlined in the ‘Giving every child the best start in life’ strategy, supports this agenda by:

  • promoting inclusivity
  • strengthening health services
  • setting high aspirations for every child, regardless of background or ability 

The role of the school nurse in supporting children and young people with additional needs

Led by the qualified and registered school SCPHN, the service is delivered through a wider school nursing team comprising registered nurses, support staff and practitioners working under delegated responsibilities. The qualified SCPHN provides strategic and clinical oversight, ensuring universal services are safe, equitable and responsive to local needs.

School nurses and their teams play a central role in supporting children and young people who have additional needs - those who face barriers to health, learning or participation due to long-term physical or mental health conditions, disabilities or complex vulnerabilities. Their public health practice spans 4 levels of service, enabling proportionate responses based on need. 

This includes using a range of data to assess population health needs within a locality, county or borough, particularly in relation to children with SEND or complex vulnerabilities. Relevant data sets published annually by the Department for Education include the following: 

School nurses work as part of a wider school nursing team to deliver inclusive, evidence-based care that promotes health, safeguards wellbeing and enables access to education for children with additional needs. 

Collaboration is crucial. School nursing teams work alongside:

  • education
  • social care
  • youth offending services
  • paediatrics
  • community children’s nursing teams
  • voluntary organisations
  • community groups

Using evidence-based assessment tools and outcome-focused evaluation, school nurses and their teams develop programmes or packages of care tailored to individual or group needs. Their role bridges strategic needs assessment and direct clinical engagement. For example, they may adapt universal health promotion interventions, such as puberty education or mental health awareness, to meet the specific needs of children with SEND, ensuring accessibility and relevance. 

Supporting children with additional needs requires sensitivity, clinical skill and trauma-informed practice. This is especially important when working with children who:

  • have experienced adverse childhood experiences (ACEs)
  • live in homes affected by domestic abuse
  • come from families who may be mistrustful of professionals

Care should be tailored to the child’s specific area of need, whether related to cognition and learning, speech and language, or emotional and behavioural development. 

Adolescence presents a unique opportunity to build resilience, particularly for young people with additional needs. The developing adolescent brain undergoes significant changes in areas related to emotion regulation, decision-making and social connection. This means adolescence is a critical window for engaging young people in:

  • creative pursuits
  • positive relationships
  • health-promoting behaviours

These neurological shifts also make adolescents more sensitive to their environments, both protective and adverse, which can shape long-term outcomes (see reference 13 in the Annex). School nurses, working closely with schools, are ideally placed to:

  • raise awareness
  • influence school culture
  • identify young people with emerging needs as early as possible

Through regular interactions, school nursing teams gain insight into the lived experiences of children and young people, including their strengths and struggles in a rapidly evolving digital world. They can work with schools and young people to explore the impact of social media, digital devices and online platforms. Drawing on clinical expertise and evidence-based practice, school nurses can assess the influence of digital tools and apps (such as TikTok) on children with additional needs, helping to mitigate risks and promote safe, supportive environments. 

By combining relational practice with public health expertise, school nursing teams are uniquely positioned to support children with additional needs, ensuring they are seen, heard and empowered to thrive. 

The 4 levels of service offered to support children and young people with additional needs

Community-level offer 

At the community level, school nursing teams contribute to improving outcomes for children and young people with additional needs by shaping services that reflect local needs and reduce inequalities.

This includes: 

  • using population-level data, such as the local joint strategic needs assessment (JSNA), to understand the specific health needs, risks and inequalities affecting children with SEND or complex vulnerabilities. This intelligence helps school nursing teams design and plan services that are responsive, inclusive and outcome focused. For example:
    • in an area where the incidence of autism spectrum disorder is higher than average, a multi-agency pathway, supported by targeted training for professionals, could be developed to improve early identification and access to support
    • where there are high numbers of children missing from education or being home-schooled, school nursing teams can contribute to local campaigns that engage families and schools to increase the visibility of children who may have additional health needs, SEND or safeguarding concerns. These children are often less connected to universal services, and proactive outreach can help identify unmet needs and ensure appropriate support is offered
  • delivering evidence-based interventions and health promotion messaging that support whole-school approaches to physical and mental health. School nursing teams ensure that messaging is inclusive and accessible to children with additional needs, adapting content and delivery methods to reflect diverse:
    • communication styles
    • cognitive abilities
    • sensory profiles
  • promoting awareness of the SEND Local Offer, the local authority’s published directory of SEND services and support. School nurses can encourage schools and families to explore the Local Offer and use it to access relevant health, education and social care pathways
  • creating inclusive community environments that support young people with additional needs to prepare for adulthood. This includes working with schools, local authorities and voluntary sector partners to promote:
    • accessible services
    • inclusive messaging
    • opportunities for young people to build confidence, independence and life skills

School nursing teams play a vital role in connecting public health practice with local systems, ensuring that children and young people with additional needs are visible, valued and supported across their communities. 

Universal-level offer 

The universal offer ensures that every child in school is provided with opportunities for their health needs to be assessed and supported.

For children who have or develop SEND and/or complex needs, regular health needs assessments are vital because needs may evolve over time and may not be immediately apparent. Early identification of SEND is both efficient and effective, leading to improved learning, development, academic achievement and self-esteem for children and young people. It also supports a young person’s ability to:

  • prepare for adulthood
  • manage their physical and mental health independently
  • achieve positive life outcomes

These benefits contribute to reduced costs for local health and social care systems and, over time, for society.

School nurses and their skill mix teams deliver the universal offer through inclusive, evidence-based practice. Their collective expertise enables proportionate responses and ensures that all children, including those with additional needs, are seen, heard and supported. 

The universal offer includes the following: 

  • health needs assessments and screening at major developmental stages, which may lead to identification of targeted or specialist support and/or referral. These assessments should be adapted to reflect the individual needs of each child and are as follows:
    • school entry health needs assessment at reception (ages 4 to 5)
    • growth monitoring through the NCMP at school entry (ages 4 to 5) and year 6 (ages 10 to 11)
    • health needs assessment at year 6 (ages 10 to 11)
    • health needs assessment at year 8 (ages 12 to 13)
    • health needs assessment at year 10 (ages 14 to 15)
  • ‘ad hoc’ contacts, such as drop-in clinics, telephone, text or online support and the presence of a school nurse at local community venues (such as Best Start Family Hubs or neighbourhood health clinics), which provide accessible points of contact for children and families
  • health promotion activities, including school assemblies, classroom sessions and informal engagement, which promote physical and mental wellbeing. School nursing teams ensure that these activities are inclusive and adapted to meet the needs of children with additional health needs, including those with communication, sensory or cognitive differences

Universal interventions also play a role in laying the foundations for adulthood. By embedding health literacy, self-care strategies and decision-making skills into everyday school life, school nursing teams help all children - including those with additional needs - develop the confidence and capability to manage their health and wellbeing as they grow. This proactive approach supports smoother transitions into adolescence and adulthood, and helps reduce long-term health inequalities. 

Targeted-level offer 

The targeted offer provides time-limited, proportionate interventions for children and young people where a health need is emerging or has been identified. These needs may be:

  • flagged through the universal school nursing offer
  • raised by parents, children or school staff seeking support

For children with existing additional needs, school nurses and their teams play a vital role in collaborating with multi-agency partners to ensure appropriate plans are in place. These may address conditions such as eczema, anxiety, poor sleep, obesity, bereavement or other health concerns. The aim is to enable the child or young person to:

  • continue accessing education
  • participate fully in school life
  • develop to their potential

Plans should also support the child or young person to understand and manage their health conditions, thus building confidence and independence in preparation for adulthood. This is particularly important for children with life-limiting conditions who require co-ordinated, compassionate care. One study estimates that over 86,000 children and young people in England are living with life-limiting or life-threatening conditions, underscoring the need for tailored, multi-agency support (see reference 14 in the Annex). 

At the targeted level, school nursing teams:

  • prioritise prevention and early help for children and young people with SEND, short or long-term health conditions, and those from vulnerable groups (such as care-experienced or looked-after children, young carers or those affected by domestic abuse or exploitation). This involves making reasonable adjustments and adapting support to reflect each child’s strengths and needs
  • promote health, development and preventing harm, ensuring children with additional needs grow up with safe, effective care - ideally within their family - and preventing issues from escalating to crisis point
  • use tools like the early help assessment or Signs of Safety framework to support decision-making
  • advocate for children and young people with additional health needs, working with multi-agency teams to ensure they receive appropriate support in school and beyond
  • identify opportunities for reasonable adjustments in school to meet individual needs, ensuring inclusion and access to learning
  • champion children who may be less visible to services, such as those not in school, home-schooled or from marginalised communities, to ensure their health needs are recognised and addressed
  • personalise targeted interventions, according to local population needs, and ensure cultural, linguistic and neurodiverse needs are respected
  • use trauma informed, strengths-based practice and skilled communication (including motivational interviewing) to support children, young people and their families to make behaviour changes that improve their health, wellbeing and outcomes

Specialist-level offer 

At the specialist level, school nurses and their teams work collaboratively to:

  • reduce barriers to learning
  • improve access to education
  • ensure that children and young people with significant additional needs receive appropriate care and expertise

Their role is to support a better understanding of individual health needs and facilitate continuity of care across settings. 

As part of the specialist offer, school nursing teams: 

  • contribute to multi-agency assessments of children and young people’s physical and mental health, and social care needs. Care planning should be a collaborative process involving the child or young person, their family and relevant professionals. Where a child is supported by a children’s community nurse, joint working and shared assessment may be appropriate
  • refer to and liaise with specialist services - such as substance misuse services, social care, paediatrics and CAMHS - to ensure timely and co-ordinated support
  • facilitate personalised health support for children and young people with additional health needs and SEND, including contributing to or writing individual healthcare plans where appropriate. These plans are typically developed for children with specific medical needs that require support in school and should be co-ordinated with other health professionals as needed, in line with the government’s Supporting pupils at school with medical conditions statutory guidance
  • contribute to EHCPs by providing relevant health information and advice, ensuring that health needs are integrated into wider support. This may involve liaising with local authority SEND teams and other health professionals, depending on local arrangements and scope of practice
  • liaise with and advocate for the child or young person and their family, ensuring continuity of care across health, education and social care settings. This includes recognising when additional expertise is needed and facilitating referrals
  • understand the child’s individual SEND profile to inform appropriate health-related decision-making. This includes recognising how specific conditions or neurodiverse traits may influence communication, sensory processing or emotional regulation
  • use trauma-informed, strengths-based practice and skilled communication (including motivational interviewing) to support children, young people and families in making behaviour changes that promote optimal health
  • recognise and articulate the strengths of children with additional health needs, fostering resilience, self-efficacy and confidence. This empowers children to embrace their capabilities and develop to their full potential
  • deliver (or refer) specialist support to children and young people with additional needs who also face complex vulnerabilities - for example, those:
    • affected by parental conflict, domestic violence, substance misuse or asylum-seeking status
    • at risk of child sexual or criminal exploitation
    • questioning their gender and identity
  • participate in multi-agency support for children and young people on child protection plans, where the school nurse or a member of the school nursing team is the health professional actively involved in the child’s care. This includes:
    • contributing to safeguarding assessments
    • attending strategy meetings
    • ensuring health needs are considered within protection planning

3. Keeping children and young people safe and well

Overview of high-impact area 3: ages 5 to 19

Keeping young people safe and well involves a multifaceted approach, encompassing physical safety, mental wellbeing and a supportive environment. This includes protecting them from:

  • physical, emotional and sexual abuse
  • financial harm and neglect
  • exploitation (including criminal, sexual and modern slavery)
  • online harm
  • bullying

Working together to safeguard children provides statutory guidance on inter-agency working to safeguard and promote the welfare of children. Safeguarding responsibilities arise from:

  • identification of risk and need for early help
  • targeted work
  • formal child protection processes

Children and young people need:

  • a supportive environment where they feel comfortable expressing themselves and seeking help when needed. This includes access to mental health resources and interventions that promote positive coping mechanisms and resilience
  • access to safe spaces, recreational activities and community resources that promote positive development
  • open communication with trusted adults who are willing to discuss sensitive topics. This will help them learn and develop the skills to identify and respond to potentially harmful situations, developing personal boundaries, building resilience and understanding how to manage risk

Why safety is important 

As of 31 March 2025, national Statistics: children in need and child protection data showed that the number of children and young people requiring safeguarding support has remained stable, with over 400,000 classed as ‘in need’ (needing help and protection as a result of risks to their development or health) and over 49,000 children subject to child protection plans in England. Abuse or neglect remains the most common reason for needing support from social care, as the primary need in around 58% of cases. The police, schools and health professionals are the top sources of safeguarding referrals with children aged 10 to 15 the most represented group among children in need and on child protection plans. 

The ‘Working together to safeguard children’ guidance acknowledges online harms as a significant and growing risk to children’s safety and wellbeing. Services need to consider online harm within a broad framework of extra-familial harm, which covers risks that occur outside the home, such as:

  • from adults or children within the community
  • online
  • in peer groups
  • at school
  • within institutions or organisations

Safeguarding is essential, and strengthening prevention and public health approaches can:

  • reduce the likelihood of safeguarding issues arising
  • support early identification of concerns and risks to prevent escalation

Prevention and public health approaches form a central tenet of the government’s health and opportunity Plan for Change missions and the 10 Year Health Plan. 

The role of the school nurse in keeping children and young people safe and well

Led by the qualified SCPHN, the service is delivered through a wider school nursing team comprising registered nurses, support staff and practitioners working under delegated responsibilities. The qualified SCPHN provides strategic and clinical oversight, ensuring universal services are safe, equitable and responsive to local needs.

Within school nursing services, safeguarding should be led by qualified SCPHNs, supported by skill mix teams. 

Qualified SCPHNs play a vital leadership role in safeguarding children and young people, ensuring that the appropriate practitioner is involved at the right time and that there is clear clinical supervision and oversight. Their public health expertise, combined with regular access to education settings and communities, places them in a unique position to identify early signs of abuse, neglect or unmet needs, often through trusted relationships and routine contact.  

Safeguarding is an essential component of the ages 5 to 19 healthy child programme, and school nursing teams play a major role in prevention, early identification and response. School nurses:

  • are trained in safeguarding procedures
  • understand thresholds for intervention
  • know how to escalate concerns appropriately
  • engage in regular safeguarding updates on contextual safeguarding and online harms
  • ensure they stay informed about changes in legislation, guidance and local safeguarding arrangements

School nurses are well-placed to act as advocates for school aged children and young people - particularly for vulnerable children who are part of complex multi-agency systems. They combine clinical knowledge with excellent communication skills, enabling them to engage with and offer emotional support to children and young people, and build effective relationships with multi-agency colleagues 

Statutory legislation and guidance

Recent updates to the ‘Working together to safeguard children’ guidance and the Supporting Families: early help system guide (see page 11) clarify that health professionals, including qualified SCPHNs, may act as the lead practitioner for children receiving support under section 17 of the Children Act 1989 , where appropriate. However, the ‘Working together to safeguard children’ guidance says this should be:

  • based on a clear assessment of the practitioner’s capacity and capability
  • determined through local agreement
  • only when it is right for the child and family

The lead practitioner for child protection (section 47) inquiries should always be a social worker.  

Decisions about who will act as lead practitioner in support children and families under section 17 should be agreed locally and set out in a clear, shared protocol (see paragraph 141 of the ‘Working together to safeguard children’ guidance). The local authority remains publicly accountable for:

  • ensuring these protocols are in place
  • the delivery of support and services to children in need

SCPHNs should retain their capacity to lead and co-ordinate public health nursing within schools and communities. ‘Role drift’ into areas beyond their scope or capacity should be avoided to protect both the integrity of the healthy child programme and the safety of children and young people.  

The ‘Working together to safeguard children’ guidance reinforces that looked-after children require co-ordinated, child-centred support across agencies and at all levels of the healthy child programme, particularly when the decision is made for a child to return home.

Aligned with National Institute for Health and Care Excellence (NICE) guideline [NG205] Looked-after children and young people, school nurses play a vital role in promoting emotional wellbeing, continuity of care and advocating for the child’s needs within education and health settings - ensuring that safeguarding is proactive, relational and responsive to individual vulnerabilities. 

Supervision

Supervision is a critical enabler of effective safeguarding practice. Regular reflective supervision supports school nurses and their teams to make confident, balanced and objective decisions in complex cases. This helps to mitigate emotional impact, and strengthens professional judgement and development. Using one of the multiple clinical supervision models available can support and enhance self-awareness, reflection and learning, providing structure to critical analysis.

The value of good supervision cannot be overstated for practitioners who are assessing the impact of, and working with, emotionally laden and often unresolved issues in the lives of families. These issues are central to risk assessment, safety planning and risk management, and are both professionally and emotionally demanding. For school nurses, supervision also:

  • underpins leadership of the healthy child programme
  • supports effective oversight of skill mix teams
  • ensures consistency across universal, targeted and specialist work

Providers should ensure that structured, reflective supervision is available to all practitioners delivering the healthy child programme. This should include:

  • scheduled sessions
  • appropriately trained supervisors
  • protected time to reflect on practice

Supervision should be embedded as a core component of service delivery, with clear lines of accountability and quality assurance to support professional development and safe, effective care. 

The 4 levels of service offered to keep children and young people safe and well

Community-level offer 

The community offer includes: 

  • acting as a bridge between home, school and community health services, and collaborating with members of the multidisciplinary team to ensure children and young people are protected
  • carrying out whole-school assessments to understand the needs, inequalities and risks in their schools and local communities. This information helps build a picture of contextual safeguarding risks, such as:
    • peer-on-peer abuse
    • gang culture
    • child sexual exploitation
    • digital environments
  • delivering evidence-based interventions and health promotion messaging to support whole-school approaches to wellbeing, including anti-bullying and mental health
  • leading health education on topics like healthy eating, puberty, sexual health and substance misuse. This supports children and young people to make informed choices, which will keep them safe and well
  • sharing relevant, timely and proportionate health information with safeguarding partners, when it supports the child or young person’s welfare. School nurses document decisions and ensure alignment with local safeguarding protocols

Universal-level offer 

Universal services remain essential for keeping children safe and primary prevention. 

At the universal level, school nursing teams:  

  • build trusting relationships with children and families, communicating with professional curiosity and trauma-informed approaches to identify risk and vulnerability that may otherwise go unnoticed
  • use their clinical, observational and motivational interviewing skills to interpret their findings in context. They work with the child or young person and their family, taking a strengths-based approach, to determine the most appropriate course of action
  • use a Making Every Contact Count approach to daily interactions, including health needs assessments, with children and families to:
    • notice signs of neglect, abuse or emotional distress
    • raise sensitive subjects
    • act swiftly through safeguarding protocols
  • can support schools with delivery of relationships and sex education, ensuring there is a focus on:
    • consent
    • contraception use for both preventing unplanned pregnancy and sexually transmitted infections
    • online safety
    • healthy relationships
  • advocate for the needs of children and young people with additional vulnerabilities such as young carers, those with additional mental, physical health or learning needs, care-experienced and looked-after children, and those from minority groups. They:
    • promote emotional wellbeing and continuity of care
    • ensure that safeguarding is proactive, relational and responsive to individual vulnerabilities
  • share relevant, timely and proportionate health information with safeguarding partners, when it supports the child or young person’s welfare. They document decisions and ensure alignment with local safeguarding protocols

Delivery of safeguarding within a public health framework and as part of a multi-agency response is vital to ensuring upstream prevention is not overshadowed by crisis response.

Targeted-level offer 

The targeted level offer includes the following: 

  • prioritising prevention and early intervention to meet the needs of all children and young people, particularly vulnerable groups such as:
    • care-experienced and looked-after children
    • young carers
    • those affected by domestic abuse or exploitation
    • those with SEND
  • using tools like the early help assessment or Signs of Safety framework to support objective decision-making and ensure rigorous identification of risks and protective factors
  • providing one-to-one support for children and young people involved in risky behaviours. School nurses help them develop strategies to:
    • identify and manage risk
    • seek appropriate help when needed
    • make safer choices
  • giving children and young people access to a safe space where they can:
    • talk through issues
    • seek help when needed
    • learn how to keep themselves safe from harm
    • build resilience
  • sharing relevant, timely and proportionate health information with safeguarding partners, when it supports the child or young person’s welfare. School nurses document decisions and ensure alignment with local safeguarding protocols
  • advocating for children with complex needs, ensuring they receive appropriate care and support in school and beyond
  • advocating for the needs of children who may be less visible or overlooked, such as those not in school or from marginalised communities
  • personalising practice according to local population needs and ensuring cultural, linguistic and neurodiverse needs are respected
  • working collaboratively with social services and families to ensure vulnerable children are protected
  • collaborating with safeguarding partners and other relevant agencies, including contributing to multi-agency safeguarding meetings (such as child protection conferences or team around the child meetings). School nurses actively work with a child or young person and have a good understanding of their strengths and needs

Specialist-level offer 

At the specialist level, school nursing teams are responsible for: 

  • identifying concerns through health needs assessments and regular contacts with children and young people, and escalating these appropriately, while maintaining open and honest communication with the child or young person and their family
  • sharing relevant, timely and proportionate health information with safeguarding partners, when it supports the child or young person’s welfare. They document decisions and ensure alignment with local safeguarding protocols
  • collaborating with safeguarding partners and other relevant agencies, including contributing to multi-agency safeguarding meetings (such as child protection conferences or team around the child meetings). They actively work with a child or young person and have a good understanding of their strengths and needs
  • supporting children or young people on child protection or child in need plans, ensuring their health needs are addressed
  • taking the role of lead practitioner, as defined within ‘Working together to safeguard children’ guidance and locally agreed protocols

4. Making transitions 

Overview of high-impact area 4: ages 5 to 19

School nurses play a vital role in supporting children and young people through major transitions such as:

  • starting school
  • progressing through year groups
  • moving into secondary and further education
  • preparing for adulthood
  • coping with significant life events such as bereavement, family breakdown or changes in care arrangements

Transitions are not isolated events - rather, they are dynamic processes shaped by relationships, environments and support systems. School nursing teams are uniquely positioned to offer continuity, reassurance and timely intervention. Their work is trauma-informed and strengths-based, guided by proportionate universalism, ensuring support is available to all, with additional input for those who need it most. 

Why transitions are important 

Transitions are sensitive developmental periods when children and young people are especially receptive to growth and change - but also more vulnerable to disruption. These moments can significantly influence:

  • emotional wellbeing
  • educational attainment
  • long-term health outcomes

A systematic review found that transitions often coincide with declines in wellbeing and academic performance, particularly when peer and teacher relationships are disrupted (see reference 15 in the Annex). Vulnerable groups - including those with SEND, care experience or complex health needs - are at greater risk of negative outcomes and often underrepresented in transition planning. 

School attendance is a key indicator during transitions. Data from ImpactEd Group’s national study Mind the engagement gap: a national study of pupil engagement in England’s schools shows a particularly sharp drop in attendance between years 7 and 8 - more so than between years 6 and 7. This decline is especially pronounced among vulnerable pupils, including those with SEND and those eligible for Pupil premium funding, further deepening existing inequalities. Pupil premium is a government funding initiative aimed at improving outcomes for children from disadvantaged backgrounds, including those eligible for free school meals, in care or with a history of care

Attendance patterns also correlate with pupils’ sense of belonging, safety and engagement. Lower-attending pupils report reduced emotional wellbeing and weaker peer relationships, particularly during the transition into early adolescence. These findings highlight the importance of proactive, inclusive support before disengagement escalates. 

School nursing teams help children, young people and families navigate the support system when facing school challenges, including attendance. Their flexible service delivery, such as drop-ins or virtual consultations, minimises disruption to education and ensures continuity of care. Their consistent presence across educational stages enables timely, holistic support that bridges health and education.

By working with schools to interpret attendance data as a source of health intelligence, school nurses can help identify pupils who may benefit from targeted support. This approach:

  • allows for early intervention, particularly during known vulnerable transitions
  • contributes to whole-school strategies that promote belonging, routine and resilience

The role of the school nurse in transition planning

School nursing teams are central to supporting children and young people through a wide range of transitions: not only the commonly recognised stages - such as starting school, moving to secondary education, or preparing for adulthood - but also through less visible or more personal transitions. These may include changes in:

  • health status
  • family structure
  • care arrangements
  • migration
  • identity development

Transitions can occur at any age and are often shaped by social, emotional and environmental factors. 

School nurses are SCPHNs who provide strategic leadership and clinical oversight across the school-aged population. They work in partnership with families, schools, health visitors, mental health support teams and wider services to ensure children are emotionally and physically prepared for change. Their role is especially critical for those with additional needs or vulnerabilities, where early identification and co-ordinated support can prevent escalation and promote resilience. 

They also support transitions from children’s to adult services, particularly for young people with long-term conditions, safeguarding concerns or complex needs, ensuring continuity of care and clear communication across systems. 

As part of integrated neighbourhood models of care, school nurses collaborate with professionals such as paediatricians, therapists, social workers and youth services to ensure health needs are recognised within wider transition planning.

Their consistent presence across educational stages enables timely, proportionate support, whether through universal health promotion, targeted input or specialist care. As trusted practitioners, they help reduce inequalities and promote continuity across the life course.

The 4 levels of service offered to support transitions

Community-level offer 

School nursing teams play a crucial role in promoting health and wellbeing at the community level, particularly during major transitions in children’s lives. Their work aligns with the government’s 10 Year Health Plan, which emphasises care closer to home through neighbourhood health clinics (local hubs offering integrated services including nursing, mental health, diagnostics and social care). 

At the community level, school nursing teams: 

  • promote awareness of major transitions and available support through school and community channels
  • work with schools, neighbourhood health clinics, Best Start Family Hubs, youth services and community groups to co-deliver messaging and activities that build resilience and readiness for change
  • support whole-school approaches that foster inclusive, nurturing environments where all children feel safe and supported through transitions
  • influence policy and practice at local level through participation in education, early help and integrated care partnerships
  • maintain visibility in community settings through health promotion events, local campaigns and youth engagement activities

Universal-level offer 

Transitions are not isolated events, but dynamic processes shaped by relationships, environments and support systems. Universal interventions help build resilience, promote emotional wellbeing and ensure continuity of care.

The universal offer includes health input at major transition points: 

  • school entry health needs assessment (ages 4 to 5): supporting the transition from early years to school and identifying any early health or developmental concerns
  • year 6 health needs assessment (ages 10 to 11): addressing physical or emotional challenges before secondary education, including early signs of school disengagement
  • year 8 health needs assessment (ages 12 to 13): strengthening health literacy and lifestyle awareness during early adolescence - a stage where attendance often declines sharply, particularly among pupils with SEND and those eligible for Pupil premium
  • year 10 health needs assessment (ages 14 to 15): promoting self-care and preparing for adulthood
  • health and wellbeing questionnaires to identify emerging needs and guide follow-up, including digital options such as the Lancaster Model
  • youth-friendly access through drop-ins and digital messaging (such as ChatHealth) for timely advice and reassurance
  • whole-school personal, social, health and economic (PSHE) education contributions, supporting sessions on:
    • managing change
    • building resilience
    • preparing for life milestones
  • health information-sharing during induction and transition processes, including signposting to local services and digital resources
  • proactive advice to help children, young people and families navigate health services and manage developmental changes
  • promotion of regular attendance as a protective factor for physical and mental health, including guidance for staff and parents on mild illness
  • use to attendance data to identify patterns and trends, enabling early intervention, particularly during vulnerable transitions such as from years 7 to 8
  • collaboration with schools to interpret attendance data as health intelligence, distinguishing between universal and targeted needs. Persistent absence may signal underlying health issues, while good attendance supports resilience and belonging
  • flexible service delivery (such as drop-ins, virtual consultations or outreach) to minimise disruption to education

Local areas may adapt the timing and delivery of health needs assessments to meet specific needs, provided changes are evidence based and regularly evaluated. 

This universal offer reflects the 10 Year Health Plan vision of early intervention, integrated care and neighbourhood-based support, ensuring transitions are safe, supported and equitable for all. 

Targeted-level offer 

The targeted offer provides additional, time-limited support to children, young people and families identified as vulnerable or at greater risk of poor health and wellbeing outcomes during transitions. This includes those with emerging physical, emotional or social needs that cannot be met by universal services alone.

The school nurse plays a vital role in early identification, intervention and co-ordination, working closely with families, schools and multi-agency partners to ensure transitions are supported in a timely and proportionate way. 

Children experiencing anxiety, persistent absence or difficulty adjusting to new environments may benefit from targeted support to help them feel safe, confident and connected. 

Targeted support is informed by structured assessments and evidence-based tools, such as the Strengths and Difficulties Questionnaire (SDQ) and the Lancaster Model, helping guide proportionate interventions. Delivery is matched to the child’s level of need and context, typically over the course of 4 to 8 weeks, and reviewed by the SCPHN to ensure safety and effectiveness. 

The targeted offer includes the following: 

  • follow-up after universal health questionnaires, where additional need is indicated
  • individualised support for children who may find transitions challenging due to factors such as:
    • SEND
    • ACEs
    • persistent absence or anxiety about school
    • identified emotional or mental health needs
    • recent bereavement, parental separation or housing instability
  • joint working with mental health support teams to deliver interventions or refer to higher-tier services
  • use of attendance data to flag pupils needing support, especially during vulnerable transitions
  • engagement with Best Start Family Hubs, neighbourhood health clinics and early help services
  • support during transitions between settings (such as primary to secondary or mainstream to alternative provision)
  • parent engagement through direct contact or referral to parenting or wellbeing programmes
  • outreach to children not in mainstream education (such as those who are excluded, home educated or persistently absent)
  • support for schools facing population-level transition challenges
  • collaboration with school staff and mental health support teams to ensure joined-up care and consistent messaging

Examples of targeted support by skill mix include: 

  • a staff nurse offering one-to-one support to a pupil with anxiety about attending school
  • a nursery nurse running group sessions for year 8 pupils on emotional regulation and healthy routines
  • a support worker organising peer-led wellbeing clubs or buddy schemes
  • a healthcare support worker providing outreach to home-educated or excluded pupils
  • a nursery nurse leading on parent engagement such as signposting to support programmes
  • another staff nurse following up with a year 6 pupil who has been flagged as having low mood and sleep issues

Targeted support may be prioritised for pupils eligible for Pupil premium. These pupils are statistically more likely to experience poorer health and educational outcomes, and may require additional support during transitions to reduce inequalities and promote engagement. 

This targeted offer builds on universal insight and ensures that children and young people with emerging needs receive timely, compassionate and proportionate support. It reflects the principles of proportionate universalism and contributes to reducing health inequalities across the school-aged population.

Specialist-level offer 

The specialist offer addresses the needs of children and young people with complex or enduring health, developmental or psychosocial challenges who are undergoing or anticipating significant transitions. These may include:

  • care-experienced or looked-after children
  • those with complex SEND
  • children known to safeguarding teams
  • young people with persistent disengagement from education

Support at this level is typically longer term, requiring sustained input, multi-agency co-ordination and careful planning to ensure continuity across services and settings. 

School nurses, particularly those in SCPHN roles, advocate for and co-ordinate care around the child or young person, ensuring that transitions are safe, supported and person centred. They work as part of a multidisciplinary team to ensure that health needs are recognised and addressed within wider transition planning.

For some children, transitions are not discrete moments, but part of a broader journey shaped by ongoing health, developmental or social challenges. In these cases, school nurses may provide sustained input over months or years, contributing to long-term planning, monitoring and advocacy to ensure that support remains responsive, co-ordinated and centred on the child’s evolving needs. 

The specialist offer includes the following: 

  • active involvement in EHCP processes and child in need or child protection plans
  • supporting transitions into, between or out of education settings. In line with the ‘SEND code of practice: 0 to 25 years’
  • contributing to year 9 annual reviews of EHCPs and preparation for adulthood
  • leading or contributing to multi-agency transition planning meetings, particularly for children with complex health needs, including transitions from children’s to adult services, or between mainstream and specialist provision
  • providing tailored transition packages, in collaboration with professionals, based on the child’s specific needs. This may include colleagues from the following groups:
    • specialist CAMHS
    • children’s social care
    • youth offending teams
    • substance misuse services
    • virtual school teams (for looked-after children)
    • children’s disability services
    • community children’s nurses
    • speech and language therapists, occupational therapists and physiotherapists
  • ensuring timely transfer of relevant health records and support plans (including care plans, EHCP health contributions and safeguarding documentation) across educational, health and social care settings
  • advocacy to ensure the voice of the child is central to planning, using communication tools, digital surveys or one-to-one engagement to capture views, preferences and aspirations
  • providing sustained outreach for children who are persistently disengaged from education, including those in alternative provision or at risk of exclusion, to ensure they remain connected to health services and transition planning

This specialist offer ensures that children and young people with the most complex needs are not only safeguarded during transitions but actively supported to thrive. It reflects the school nurse’s role as a consistent, trusted professional within the wider system, helping to reduce inequalities and promote continuity across the life course. 

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