A Nationwide Survey of School Health Services Delivery in Urban Schools

Article excerpt

School nursing has existed in this country for more than 100 years. Health services in schools in the early 1900s consisted of communicable disease control and health screening. In the 1940s and 1950s, interest in provider's qualifications and program evaluation increased. By the 1970s, the broader comprehensive view of school health began to emerge,[1] and in 1976, School Health in America, the first national assessment of the status of school health, was published. Most recently, the fifth such survey was conducted to provide information about the current status of state support for school health programs.[2]

School health is a rapidly changing field. The concept of comprehensive school health programming in which direct services, education, and improvement of school environment are considered complementary and coordinated efforts, is now being accepted throughout the public health and education communities.[3,4] Several models for school health incorporate all aspects of health promotion, community linkages, and school environment. School departments are seriously considering these models as important supports for children throughout the educational process.[5]

At present, although school nursing remains the cornerstone of school health, new and more expansive models are developing to meet the growing needs of schoolchildren. School clinics and other collaborative efforts with community agencies represent creative attempts to increase the scope and number of services provided. However, development of new models has been met with obstacles. For example, parents and community leaders may equate clinics with distribution of birth control devices and, implicitly, with promotion of adolescent sexuality.[6] Interinstitutional political or financial issues such as poorly coordinated systems, territorialism, and dwindling resources, may prevent implementation of programs. Despite these barriers, the pressing need to address the wide ranging health and human service needs of schoolchildren is not being ignored. School health initiatives are at the forefront of state and local efforts to improve and expand child and adolescent health care.

The school-based health center model first appeared about 20 years ago. Since then, more than 400 school-based health centers have been developed across the country.[7,8] These centers provide acute care for minor illnesses, reproductive care, screening for and treatment of chronic illnesses, psychological counseling, immunizations, and health promotion.[9] Health education programs are evolving and new programs are enjoying publicity. Within the past few years, more than 25 reports have discussed the link between health and education,[10] and numerous comprehensive health education curricula now exist. Despite the recent interest in school-based health centers and comprehensive health education, there have been few attempts to compile information on school health programs in general. In School Health: Helping Children Learn,[4] the National School Boards Association examined examples of programming. State policies and programs have been reviewed[2] and multiple reports on recommendations, model programs, and implementation strategies exist.[10] The Center for Population Options and others surveyed school-based health centers as to services delivered, funding resources, and populations served.[6,7,11] Publications from the Robert Wood Johnson Foundation's School-Based Health Center Initiative[12] include extensive information on this model.

Little information has been gathered in a standardized fashion comparing different school health programs in urban areas. One of the few studies, conducted in 1992 by Fox Health Policy Consultants, reviewed comprehensive school health programs in 14 cities ranging from rural to metropolitan. This study found that community-based health care providers played a key role in school health services, while school nurses continued to operate in traditional fashion. …