Standards for public agencies

2020 Edition

Out-of-School Time Services (PA-OST) 18: Health and Safety

The agency protects and promotes the health and safety of children and youth.
2020 Edition




Children and youth who participate in Out-of-School Time programs gain the personal, social, emotional, and educational assets needed to support healthy development, increase well-being, and facilitate a successful transition through childhood and adolescence, and into adulthood.
Note: While the health-related aspects of this core concept are largely focused on practices pertaining to physical health, COA does recognize the interconnectedness of physical and mental well-being, as well as the importance of focusing on the overall wellness of children and youth. Accordingly, it is important to note that other practices that contribute to overall wellness are included within other core concept standards. For example, PA-OST 5 addresses the importance of social and emotional learning, including helping children and youth understand and manage their emotions; PA-OST 4 and PA-OST 5 address the importance of developing caring relationships with adults and peers; and PA-OST 4 and PA-OST 9 address the importance of providing the opportunities and support that can help children and youth build skills and develop a positive self-concept.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Policy and/or procedures regarding screen time
  • Procedures for ensuring personnel are prepared to meet the health/mental health needs of individual children and youth
  • Procedures for cleaning and sanitation, including expectations for hand washing
  • Procedures for notifying families that their children may have been exposed to an infectious disease
  • Procedures for reporting, responding to, and recording health problems and injuries
  • Smoking policy
  • Menus for the previous six months 
  • Daily schedules for the previous month
  • Information provided to families regarding health promotion and the types of food/drink that may be brought to the program
  • Attendance guidelines that address when sick children and youth should not come to the program
  • Accident, injury, and illness reports
  • CPR and first aid certifications
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Children, youth, and families
  • Review files of children and youth
  • Observe facility 
  • Observe snack and/or meal time
  • Observe program interactions and activities

PA-OST 18.01

The agency promotes healthy eating and good nutrition by: 
  1. serving unsweetened beverages such as water or plain milk; 
  2. serving a variety of healthful and minimally-processed foods that do not contain artificial ingredients, unhealthy fats, added sugars, or high levels of sodium (e.g., fruits, vegetables, whole grains, nuts, beans, and lean meats);
  3. making an effort to ensure that celebrations for birthdays, holidays, and other special events include healthy options; and
  4. considering the preferences and input of children and youth when deciding what foods to offer, to the extent possible and appropriate.

PA-OST 18.02

  1. make drinking water readily available at all times, including when children and youth are outdoors or on field trips;
  2. encourage children and youth to drink more water in hot weather;
  3. provide snacks and meals at appropriate times;
  4. provide children and youth with enough time to eat;
  5. offer amounts of food that are appropriate for the ages and sizes of children and youth; and
  6. support children’s and youth’s need to self-regulate the amount they eat.

PA-OST 18.03

The agency supports and encourages the physical fitness of children and youth by: 
  1. designing the activity schedule so that children and youth do not sit for more than one hour at a time, and incorporating short physical activity breaks into sedentary activities and transition times; and
  2. providing opportunities for children and youth to engage in physical activity for at least 30 to 60 minutes per day.


When programming is not designed to include 30 to 60 minutes of physical activity (i.e. due to the type of activity offered), the agency should be prepared to explain why this is the case. If a program operates for a relatively brief period of time each day (e.g., for an hour or two), it may not be possible to engage children and youth in a full 30 to 60 minutes of physical activity, but at least 20 percent of program time should be set aside for physical activity (i.e. 12 minutes of a one-hour program).
Examples: The type of physical activity offered may vary depending on the nature of the program and the ages, abilities, and interests of participating children and youth. For example, while an agency serving younger children might offer unstructured free play on the playground, an agency serving older youth might facilitate a variety of structured activities, from dance classes, to competitive intramural sports, to walking groups.

PA-OST 18.04

The agency creates an environment that supports and encourages healthy eating and physical activity by ensuring: 
  1. personnel model healthy eating and physical activity while on the job;
  2. posters, displays, and other program materials convey positive messages about healthy eating and physical activity;
  3. food and physical activity are not offered or withheld as a reward or punishment;
  4. screen time is limited; and
  5. there is adequate access to the facilities needed to support healthy eating and physical activity (e.g., kitchen, storage, and recreational facilities).


Regarding element (d), screen time that is not academic or educational should typically be limited to 30 minutes per day, and children and youth should not be permitted to watch television or movies except on special occasions. When children or youth are exercising along with a video or DVD that provides physical activity instruction (e.g., an aerobics DVD), the time does not count towards the daily screen time limits.
Note: See PA-OST 9.18 for more information regarding screen time and the use of technology.

PA-OST 18.05

Children and youth are helped to understand the importance of developing healthy habits that support both physical and mental wellness.
Examples: Topics can include:
  1. obtaining adequate sleep, nutrition, and exercise; 
  2. devising healthy strategies for coping with stress; and
  3. developing reasonable expectations for one’s self. 
Agencies may also explain how habits and routines in these areas may work together to impact both physical and mental well-being. It may also be relevant to convey how these topics tie into a program’s areas of focus. For example, an organization that emphasizes academic readiness might make a concerted effort to help children and youth understand how eating healthfully, and obtaining sufficient sleep, can support readiness to learn.

PA-OST 18.06

In an effort to support children and youth in developing and maintaining healthy habits, the agency provides families with information regarding: 
  1. the importance of a healthy lifestyle, including ways to encourage healthy habits at home; and
  2. the types of food that may be brought to the program, considering factors related to both nutritional content and food allergies.
Examples: Information may be provided in a variety of ways, from communications at family events to materials sent home. As referenced in PA-OST 18.05, it may be especially relevant to provide information about how health and wellness ties into a program’s areas of focus.

PA-OST 18.07

Children and youth have frequent, regular opportunities to participate in outdoor activities, weather permitting.


Children and youth should ideally have a chance to be outdoors for at least 30 minutes out of every three-hour block of time at the program.
Note: When programming is not designed to include outdoor activities, the agency should request an NA.

Fundamental Practice

PA-OST 18.08

When children and youth have particular health or mental health needs, the agency: 
  1. specifies the role it will play in meeting those needs; and
  2. ensures that personnel are informed about children and youths’ needs and prepared to carry out any related responsibilities.
Examples: Relevant health and mental health needs can include, but are not limited to, needs related to diet, allergies, asthma, physical limitations, medication needs, and a history of trauma.

Fundamental Practice

PA-OST 18.09

There are adequate supplies and facilities for hand washing and personnel, children, and youth are encouraged to wash hands frequently, especially before preparing food or after using the bathroom.


COA recognizes that in some situations, such as field trips or outdoor activities, hand washing supplies and facilities (e.g., running water, soap) may not be available. When that is the case, hand sanitizer may be an appropriate alternative.
Examples: The agency can demonstrate implementation of this standard by filling soap dispensers regularly, ensuring there are sanitary methods for drying hands (e.g., disposable paper towels or electric dryers that turn on and off automatically), and posting signs or pictures that show proper hand washing techniques and emphasize the importance of hand washing.

Fundamental Practice

PA-OST 18.10

To protect children and youth from accidents, injuries, and illnesses, the agency ensures: 
  1. families are provided with attendance guidelines that address when sick children and youth should not come to the program;
  2. procedures address when families should be notified that their children may have been exposed to an infectious disease;
  3. health problems and injuries are promptly documented, and proper health precautions are followed when supervising children and youth who are ill or injured;
  4. parents or legal guardians are notified when health or safety issues arise; and
  5. an automated external defibrillator (AED) is maintained in a well-marked, accessible location proximate to the areas where sports/fitness areas are held, as appropriate.


Please note that element (e) applies only when an agency provides sports/fitness activities as covered in PA-OST 11. Further, while COA strongly recommends that all agencies providing sports/fitness activities maintain an AED in order to ensure proper emergency response to sudden cardiac arrest, an agency that does not maintain an AED can still demonstrate satisfactory implementation of the standard overall as long as the agency does not operate in a state that requires access to an AED. It is also important to note that: (1) personnel should be trained on how to use an AED, as per PA-ASE 6.03; and (2) any AED in operation should be maintained according to the manufacturer’s specification and regularly inspected, as per PA-ASE 4.01.

Fundamental Practice

PA-OST 18.11

There is at least one person certified in basic first aid and age-appropriate CPR on duty and available at all times the program is in operation, including on field trips away from the program site.


An agency should consider adult-child/youth ratios, the type of activities offered, and the distance between activities when determining the number of persons who will be certified. When some children will attend a field trip while others will remain on site, more than one person will need to be certified in order to meet the expectations of the standard. While not required by the standard, COA recommends that agencies strive to have all OST personnel certified.

Certification courses with an online component are acceptable as long as they include a hands-on, in-person skills evaluation by an instructor.

Fundamental Practice

PA-OST 18.12

Smoking is prohibited anywhere on the premises, including outside entrances, outdoor play areas, and program vehicles.