• Overview: Facts about School-Based Health Services
• Improving Access to Health Care
• School-Based Health Services and Maine's Legislators
• The MCA's School-Based Health Initiative
• Problem Behavior Prevention and School-Based Health Centers: Programs and Prospects
• American Academy of Pediatrics Report on School- Based Health Centers
• Maine School-Based Health Center Evaluation Project (I of 2)
• Maine School-Based Health Center Evaluation (2 of 2)Project
• Child Health
• Starting a School-Based Health Center
• School-Based Health - Fast Facts
• School-Based Health Centers In Maine
• Stories: Case in Point
• Resources
• National Assembly on School-Based Health Care

School-Based Health

American Academy of Pediatrics Report on School- Based Health Centers

In addition to the core health services schools have traditionally provided, such as managing medical emergencies, delivering medication, screening for vision and hearing problems, and referrals for common health problems, schools increasingly are used as health access sites for students who are not receiving health care elsewhere, the American Academy of Pediatrics noted in a position statement issued in January. ¹

Among the more comprehensive health services available in many schools, the AAP listed preventive and acute care, including immunizations, full health histories and physical examinations, on-site therapy for children with special mental health needs, screening for acute and chronic health problems, family planning and reproductive health care, substance abuse counseling, dental services, and health counseling and education.

There are benefits and potential benefits of providing such a wide range of health services in schools, the AAP noted, including:

• Students of all ages in rural areas may not have reasonable access to any other medical services.
  
  
• Less classroom time is lost to travel to health sites.
  
  
• Follow-up compliance may be better.
  
  
• Adolescents, for a variety of reasons (emancipation, independence, desire for confidentiality) often will not seek out or take advantage of services in traditional settings.
  
  
• Behavior risk assessments and ongoing preventive strategies that address major causes of youth mortality (suicide, homicide, accidental injury) require a degree of access to health and mental health services that schools can provide on the school site.
  

The position paper notes wide variations in the facilities, hours of operation, and staffing of school-based health centers. "The rich diversity of existing models does not allow for simplistic categorization." But a major challenge for school health centers or any model of expanded school health services, the AAP says, is to integrate not only with other components of the school system (the school nurse, for example) but also with health services available in the community.

Also, "Expanded school health services carry inherent and unique issues of patient confidentiality, consent, compliance, and continuity that need different solutions than they would in traditional health care settings." And there is the problem of fair reimbursement for school-delivered health services, something that "is frequently difficult to achieve."

The position paper outlines "a few basic guidelines" that the AAP believes would avoid "costly redundancies in health care and unnecessary gaps in services."
For one thing, the paper indicates, any decision to expand school health services should be based on a comprehensive community needs assessment. Once an assessment is completed, the extent and type of services to be provided should be decided. Last in the process is setting up formally written agreements and goals. Some communities may choose a nonprofit organization to administer the program, but more typically one or more community health or social entities become the fiscal and lead agency.

In summary, the AAP concluded that schools can successfully expand access to health care services for all students, particularly underserved populations, when the program includes careful community assessment and endorsement, is integrated with the school's existing health program, has a sound plan for financial sustainability, and pays adequate attention to quality assurance, evaluation, promotion, and integration with a medical home. The position paper, which was prepared by the AAP's Committee on School Health, urges pediatricians to "become actively involved in any community effort to develop an integrated school health services initiative."



¹ The AAP statement on "School Health Centers and Other Integrated School Health Services" appeared in the January 2001 issue of the journal Pediatrics, published by the American Academy of Pediatrics.

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