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State-level school nursing infrastructure supports are essential for building equitable, evidence-based, quality school nursing services. Two recently published instruments, the State School Health Infrastructure Measure (SSHIM) and the Health Services Assessment Tool for Schools (HATS), provide opportunities to assess the extent of state-level infrastructure supports for school nursing and school health services. These instruments can be useful for planning and prioritizing to address needs to improve system-level quality and equity in school health services for the preK-12 population in each state.

States have key roles and responsibilities in protecting and promoting the health of all of school-age youth. Though assessment and planning instruments exist to support quality school nursing service delivery at individual school building, community, and district levels, no comparable measure was available to assess state-level support for the delivery of quality school nursing. This project, conducted in three phases, resulted in the development of a novel measure to identify state-level infrastructure supports for school nursing services delivery. The State School Health Infrastructure Measure is comprised of seven domains with 24 indicators and demonstrated initial content validity and test-retest reliability. States can use this measure to self-assess, identify, benchmark, prioritize, and address state-level infrastructure strengths and gaps related to supporting the delivery of high-quality, equitable school nursing services.