[Child health services, school health services and day care centers. Coordinated health check-ups of 6-year-old children make the planning of school supportive measures easier].
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This statement offers guidelines on the integration of expanded school health services, including school-based and school-linked health centers, into community-based health care systems. Expanded school health services should be integrated so that they enhance accessibility, provide high-quality health care, link children to a medical home, are financially sustainable, and address both long- and short-term needs of children and adolescents.
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The school nurse has a crucial role in the provision of school health services. This statement describes the school nurse as a member of the school health services team and its relation to children with special health care needs. Recommendations for the professional preparation and education of school nurses also are provided.
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The school health and community primary health care contacts were studied for a group of elementary school children who have sociodemographic characteristics often associated with poor access to primary health services. The school system is engaged in a demonstration project that attempts to link the home with community and school services. Visits to the school health room accounted for 85% of all contacts. A visit rate of 1.13 visits/child/year occurred at primary care sites. Ethnicity is the single most important predictor of use of school health services, followed by family status and number of visits for primary health care in the community. In contrast, use of community primary care facilities is best predicted by socioeconomic status (SES), family status, and sex. The patterns of care received by the population were characterized. Children whose care was initiated, referred, or facilitated by the school were designated as receiving "interactive" care, which occurred mostly among minority and lower SES children. The data suggest that the school provides access to preventive health care for all children and facilitates care for segments of the population that usually have difficulty achieving access to the health care system.
To understand school health service delivery models, and to plan for reorganization of a local school health service, a telephone survey of school-based health programs from around the country was conducted in 1992. Responses were elicited from 33 school departments in some of the largest American cities. Respondents described their current programs, obstacles they face, and approaches they have chosen to address the needs of urban schoolchildren. City size did affect amount of services provided overall, but a clear relationship existed between number of providers employed, and the number/amount of screening services available. Cities employed a range of strategies to enhance services, including collaboration with local health authorities, creation of school clinics, and billing for services.
When integrated school health services are implemented according to an assessment of community needs and resources, and with adequate attention to quality assurance and evaluation, they may be a way to expand access to health care services for underserved populations. They can also become a coordinated extension of an ongoing medical care home. This approach may be an effective vehicle for integrating psychosocial care and education with medical care. Pediatricians practicing in public and private sectors should become actively involved in any community effort to develop an integrated school health services initiative. The well-designed integrated health services program, when coupled with comprehensive school health education, could significantly advance the state of health of the nation's children, youth, and families.
School as a place of learning and living for children has also recognised the responsibility for children's health. For effectively supporting the schools in health promotion, it will be necessary to assist and expand. Special need of development exists in the health care of school beginners. Therefore, three initial phases in school health care for school beginners are suggested. Recent reform policy in primary schools has been taken into consideration. Especially the dialogue between teachers and school physicians must be promoted. Focus is also on the "Jugendsprechstunde" (youth consulting hours) in secondary schools. Guidelines for youth consulting in school are reported. This part of school health care cannot be successful without considering the interests and needs of school children. To achieve the goals of development School Health Service receive support by the present national "KJGD-Campaign"): In addition small-scale service organisations should assist each other. Questioning of schools may also stimulate further development. Demands made by teachers on school health care development are therefore reported.
The School Nurse Impact Committee of the Columbus Public Schools in Columbus, Ohio, initiated a survey to determine staff satisfaction with the delivery of health services. School nurses need the cooperation and support of the staff to successfully deliver school health services, therefore, the staff's satisfaction with school health services is crucial to the school nurses' ability to fulfill their role. The objectives of the survey were to (a) determine staff satisfaction with school nurse interventions, (b) determine staff satisfaction with the effectiveness of interventions, (c) identify areas of health service delivery which may need improvement, and (d) determine areas of school health services where school nurses may need to more effectively communicate their involvement. Critical elements of school nurse practice included staff health, safety and environment, classroom education, medication, school system collaboration, and program management. Several key issues were identified through the survey. School system collaboration issues need more school nurse involvement. School nurses also need to improve their visibility regarding school system collaboration, and in classroom and individual pupil education. Traditional school nurse functions were adequately covered. Results indicate that staff would be more satisfied if they had more nursing support in the classroom and more nurse time in their building.
School health service programs underwent rapid changes to meet the health needs of today's students. These needs stem largely from: a) increased number of students with special health care needs attending school, b) increased stress and time pressure on families, c) rapid restructuring of the health care system serving children, and d) recognition that schools provide opportunities to identify students with health risks. This paper describes seven components of a statewide Massachusetts plan to develop school health services by: a) setting standards, b) reviewing and revising statutes and regulations, c) promoting credentialing of school health personnel, d) providing continuing education on subjects pertinent to school health, e) exploring reimbursement systems and new funding sources, including funds from the tobacco settlement, f) exploring new models of care, and g) implementing data systems. The plan focuses on developing school nurse-managed school health services within a public health model.