Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 153
School & Health: Our Nation's Investment 4 School Health Services INTRODUCTION Common Elements of School Health Services Although a universally accepted definition of the term ''school health services" has not been adopted, the School Health Policies and Programs Study (SHPPS) has described school health services as a "coordinated system that ensures a continuum of care from school to home to community health care provider and back" (Small et al., 1995). The goals and program elements of school health services vary at the state, community, school district, and individual school levels. Some of the factors that contribute to these variations include student needs, community resources for health care, available funding, local preference, leadership for providers of school health services, and the view of health services held by school administrators and other key decisionmakers in the school systems. There is similarity, however, in the types of services offered from one school system to the next, which is likely the result of several factors. A majority of states have state school nurse consultants, many of whom have distributed sample policy and procedure manuals from their state department of health or education or both, to guide the development and delivery of health services in local settings. The National Association of School Nurses has defined roles and standards for school nurses (Proctor et al., 1993) and provides a system for disseminating information and
OCR for page 154
School & Health: Our Nation's Investment training to nurses who practice in schools. The American School Food Service Association has recently released standards for school foodservice and nutrition practices (American School Food Service Association, 1995). Similarly, organizations such as the National Association of School Psychologists, the American School Counselor Association, and the National Association of Social Workers have published position statements and standards for their professions. The American School Health Association (ASHA), through its interdisciplinary committees, has studied the advantages and disadvantages of different services, the organization and delivery of services, and the roles of various school health service providers. Subsequently, ASHA publications have brought this information to the attention of state and local health and education agencies. The American Academy of Pediatrics, working closely with national representatives of the school health services sector as well as the community health system, periodically updates a school health manual, School Health: Policy and Practice , that serves both as another unifying force and as an informal mechanism for ensuring local program quality (American Academy of Pediatrics, 1993). Within this document are the following seven goals of a school health program: Goal 1 Ensure access to primary health care.1 Goal 2 Provide a system for dealing with crisis medical situations. Goal 3 Provide mandated screening and immunization monitoring. Goal 4 Provide systems for identification and solution of students' health and educational problems. Goal 5 Provide comprehensive and appropriate health education. Goal 6 Provide a healthful and safe school environment that facilitates learning. 1 It should be noted that the IOM (IOM) Committee on the Future of Primary Care has distinguished between the terms "primary care" and "primary health care" (Institute of Medicine, 1994). According to its definition, "primary care" refers to personal health services, whereas "primary health care," as originally described by the World Health Organization, goes beyond personal health services to include such public health measures as sanitation and ensuring clean water for populations. This report attempts to be consistent with this distinction, but other sources—particularly those that appeared before 1994—may use the two terms interchangeably. The IOM Committee on Comprehensive School Health Programs in Grades K–12 assumes that in Goal 1, the American Academy of Pediatrics is referring to personal health services, or ''primary care" as recently defined. Consistent with the view of the IOM Committee on the Future of Primary Care, primary care should include screening and referral for oral health problems, and treatment of and, if appropriate, referral for mental health problems.
OCR for page 155
School & Health: Our Nation's Investment Goal 7 Provide a system of evaluation of the effectiveness of the school health program. Goals 1–4 and 7 are of particular relevance to school health services. Recently, findings from national surveys conducted by the Division of Adolescent and School Health (DASH) of the Centers for Disease Control and Prevention (CDC), the Office of School Health at the University of Colorado Health Sciences Center in Denver, and other groups show that most schools do provide some type of school health services and that a degree of consistency does exist in the kinds of services delivered from one school system to the next. According to SHPPS (Small et al., 1995), 86 percent of all middle or junior high and senior high schools provide some type of school health services (first aid, screening, medication administration), although 32 percent of all middle/junior and senior high schools do not have a dedicated health services facility, such as a separate health room or clinic. SHPPS reports that most school districts require screening and follow-up in at least one grade, with vision (96 percent), hearing (95.4 percent), and scoliosis (88.2 percent) being the most common of the required screenings. Almost all districts keep student health records on file and monitor student immunization status, and most districts also keep student medical emergency and medical information forms on file. The University of Colorado Health Sciences Center's survey, entitled A Closer Look, examined a systematic random sample of public school districts nationwide for the 1993–1994 school year (Davis et al., 1995). One goal of the survey was to determine the type of health services provided in schools, types of school health services personnel, methods of governance and financing, organizational structures for the delivery of services in and outside of school, and barriers to services. The Closer Look survey provided the profile of the types of school health services currently delivered across the country, as shown in Table 4-1. According to A Closer Look, two health services appear to be provided almost universally by school districts, first aid (98.7 percent) and administration of medications (97.1 percent). Other commonly provided services include such health screenings as height, weight, vision, and hearing (86.8 percent); child abuse evaluations and follow-up (82.8 percent); and evaluation of emotional or behavioral problems (80 percent). The three next most commonly provided services are for children with special needs: monitoring of vital signs (77.7 percent), application and cleaning of dressings (76.8 percent), and development of the health component of the Individualized Education Plan (75.6 percent). In view of the health problems cited in earlier chapters of this report, it is interesting to note that only slightly more than half of the districts were found to provide mental health counseling and nutrition counseling, and less than 40 percent con-
OCR for page 156
School & Health: Our Nation's Investment TABLE 4-1 Health Services Provided in the Schools Type of Service Percentage of Districts Providing Service Administer first aid 98.7 Administer medication 97.1 Provide screening (height/weight) vision, hearing 86.8 Child abuse evaluation and follow-up 82.8 Evaluate emotional or behavioral problems 80.0 Monitor vital signs 77.7 Clean and change dressings 76.8 Health component of Individualized Education Plan (IEP) 75.6 Case management for chronic health problems 58.1 Provide nutritional counseling 57.5 Provide mental health counseling 56.2 Conduct cardiovascular screenings 49.6 Provide complex nursing care to students with special needs 49.6 Employee wellness programs 48.6 Physical fitness screenings 45.2 Perform urinary catheterizations 40.2 Conduct health risk appraisals to determine life-style practices 35.7 Process worker's compensation claims 33.4 Provide immunizations at school 33.3 Physical exams 33.1 Provide family counseling 31.8 Tube feedings 28.1 Irrigations 25.3 Perform dental services 24.3 Conduct alcohol and drug screenings 23.9 Health component of Individualized Family Service Plan (IFSP) 21.4 Administer or monitor oxygen 20.7 Provide alcohol and drug treatment 16.3 Provide physicals, other primary health care services for school employees 14.4 Provide prenatal care 10.4 Collect and test blood samples 9.3 Throat cultures 6.6 Provide prenatal testing 4.6 Other 16.6 SOURCE: From Davis et al., 1995.
OCR for page 157
School & Health: Our Nation's Investment duct health risk appraisal to determine life-style practices. The committee has not attempted to reconcile these figures with those reported by SHPPS, which states that 89.2 percent of senior high schools and 84.4 percent of middle or junior high schools provide individual counseling. The latter figures could refer to counseling with primarily an academic focus, which schools may be more inclined to offer, although there is certainly overlap between academic and mental health problems. Data from A Closer Look indicate that the types of services available to students do not appear to vary substantially by the size of the school district. The Need for School Health Services Since schools bring large numbers of students and staff together, prudence dictates that—as in any workplace—a system must be in place to deal with such issues as first aid, medical emergencies, and detection of contagious conditions that could spread a group situation. Unlike other workplaces, however, a system must also be established in schools to provide routine administration of medications, since students—especially young students—may not be able to assume this responsibility themselves, and concern for substance abuse has led to policies in most schools that prohibit older students from administrating their own medication. Laws pertaining to special education students2 require that schools provide the services necessary for these students to receive an appropriate education. Such services might include monitoring vital signs, changing dressings, catheterization, tube feeding, or administering oxygen. The school must also provide services to non-special education students with chronic health problems—such as asthma, diabetes, and seizures—in order that they can be educated. Schools have little or no choice in providing such services, for they are dictated either by legislative mandate or by precautions pertaining to risks and liability. Services such as screenings and immunizations are also widely accepted as belonging in the schools, with the motivation having to do more with access, efficiency, and economies of scale than with liability. Since schools are where children spend a significant portion of their time, schools are seen by many observers as the logical site for services that are based on public health principles of population-based prevention. There is some debate, however, about the relative benefits and disadvantages of a population-based versus a selective high-risk approach, which targets 2 "Special education" students are those with a wide range of disabilities, including mental retardation; hearing, visual, and speech impairment; serious emotional disturbances; orthopedic impairments; and learning disabilities (Walker, 1992).
OCR for page 158
School & Health: Our Nation's Investment preventive services only toward children at high risk. The population-based approach has the advantage of producing a large potential impact on the population as a whole, but a major disadvantage is that the benefits are frequently very small for the individual. Another potential disadvantage is that all interventions have a finite risk of unintended adverse side effects, which are also amplified along with benefits in the population-based approach, possibly resulting in an unfavorable benefit-risk ratio. Depending on the health issue, one approach may be superior to the other, or a combination of the two may be appropriate. For example, the National Cholesterol Education program recommends a population-based approach for implementing dietary guidelines for children, combined with a high-risk approach to blood lipid screening targeted only at children considered at risk based on family history (Starfield and Vivier, 1995). Further, schools are strategically positioned to serve in the public health battle against the resurgence of infectious diseases, such as tuberculosis and hepatitis. Another feature of school health services—one that is often overlooked—is its potential for expanding the knowledge base. School health services can be a rich source of data for studying the relation between health status and learning capacity, and for assessing unmet needs and monitoring the health status of children and adolescents. Given the above needs and benefits, a basic health services program must be in place in all schools. The issues currently generating much discussion and debate, however, are the role of the school in providing access to primary care, the appropriate lead agency for the more traditional basic school health services, the advantages and disadvantages of a population-focused versus a high-risk approach to the delivery of health services in schools, and the need to develop an integrated system of school health services. The role of the school in providing access to primary care is a particularly difficult and critical issue. Since schools are a public system whereas health care is predominately private, there appears to be a fundamental mismatch between the two systems. Many students already have their own source of primary care, but a significant and growing segment of the student population does not. Those students without access to primary care are usually poor and are often at greatest risk of academic failure. Special Needs Due to Poverty Chapter 1 of this report documents some of the major problems facing children and adolescents in this country—the new social morbidities, changing family structures, limited access to health care, and lack of health
OCR for page 159
School & Health: Our Nation's Investment TABLE 4-2 Relative Frequency of Health Problems in Low-Income Children Compared with Other Children Health Problem Relative Frequency in Low-Income Children Low birthweight Double Delayed immunization Triple Asthma Higher Bacterial meningitis Double Rheumatic fever Double–triple Lead poisoning Triple Neonatal mortality 1.5 times Postneonatal mortality Double–triple Child deaths due to accidents Double–triple Child deaths due to disease Triple–quadruple Complications of appendicitis Double–triple Diabetic ketoacidosis Double–triple Complications of bacterial meningitis Double–triple Percentage with conditions limiting school activity Double–triple Lost school days 40 percent more Severely impaired vision Double–triple Severe iron-deficiency anemia Double SOURCE: Starfield, 1982, 1992. insurance. Poverty is the common denominator among many of these problems. Research has identified an explicable link between poverty and health outcomes. Children in poverty are much less likely than their affluent peers to receive an excellent or very good health rating, and they visit their health care provider fewer times in a year. Low-income families, facing routine pediatric care costs that consume a large fraction of their annual income, may decide they cannot afford health care until their children's treatment leads to unnecessary hospitalization and valuable days lost from school (see Table 4-2). For example, preventable hospitalizations for pneumonia, asthma, and ear, nose, and throat infections are up to four times higher for poor children than for who are not poor children (Center for Health Economics Research, 1993). Poor children are also more likely to be limited in school or play activities by chronic health problems and to suffer more severe consequences than their more affluent peers when afflicted by the same illness (Newacheck et al., 1995).
OCR for page 160
School & Health: Our Nation's Investment Relative Frequency of Health Problems in Low-Income Children Compared with Other Children It is estimated that as many as 12 million children under the age of 18 have no health insurance, or approximately 17 percent of all children in that population (American Medical Association Council on Scientific Affairs, 1990). Millions more have inadequate plans that fail to cover even basic preventive services, such as immunizations (National Health Education Consortium, 1992). Although progress has been made in establishing publicly financed community health centers in inner cities and rural areas, school-age youth rarely visit these facilities until their health problems reach crisis stage. Although Medicaid is intended to provide services for poor children, variations in state Medicaid policies have left almost 40 percent of children who live in poverty without access to basic primary and preventive care (Solloway and Budetti, 1995). Possible changes in the system imply even greater uncertainty about the role Medicaid will play in providing universal coverage for poor children and adolescents (Newacheck et al., 1995). Absenteeism among students is clearly associated with school failure (Wolfe, 1985). Research has shown that students who miss more than 10 days of school in a 90-day semester have trouble remaining at their grade level (Klerman, 1988). In particular, children who are poor are two to three times more likely to miss school due to their illnesses (Starfield, 1982). Indeed, children with health problems are disproportionately poor students on the verge of academic failure. Youth frequently must miss valuable class time in order to get care for their illnesses during the regular office hours of public and private health professionals. In fact, a recent study found that students utilizing public clinics missed entire days of school per appointment (Kornguth, 1990). Thus, "health-related risk factors often set in motion a cycle of absenteeism and school failure" (Lewis and Lewis, 1990). Studies have also found that people living in poverty are twice as likely to have mental health problems; hence, low-income children are especially affected by the absence of accessible mental health care (Starfield, 1982). Given these findings, it appears that the lack of accessible primary care has a high cost, in terms of both health and education outcomes. Providing primary care to needy students at the school site has been proposed to be efficient and cost-effective in the long run, in order to improve academic performance and detect health problems early before they require more expensive treatment. Then the difficult question naturally follows: Would all students, not only those in poverty, benefit from availability of convenient, accessible basic primary care services at school, provided by professionals specially trained to deal with their age level? In
OCR for page 161
School & Health: Our Nation's Investment their studies of school-based health centers (SBHCs) in northern California, Brindis and coworkers found that a higher proportion of students who already had conventional private insurance or health maintenance organization (HMO) coverage utilized the SBHC than those without other coverage, suggesting that ease of access and an understanding staff are perhaps more important factors in utilization than the mere lack of other source of care (Brindis et al., 1995). (The surprisingly greater rate of utilization for students who already have insurance may possibly be attributed to their greater awareness of the importance of health care, parental encouragement, or understanding how to access the system.) Also, many working parents apparently appreciate the convenience of their children being able to receive basic health care at school (U.S. General Accounting Office, 1994b). If the school is seen as the most effective site for providing a set of basic primary services, how can these services be organized? Who will pay? How will these services be connected with the traditional "core" services of the school? These are questions without easy answers—or possibly, with different answers depending on the community. Some of these issues are considered in greater depth later in this chapter. OVERVIEW OF BASIC SCHOOL SERVICES The following section provides a summary of typical services found in the school setting. These services tend to be the most common and basic, although many schools may not provide all of the services described in this section. For the sake of organization, services have been divided into three categories: health care services, mental health or pupil services, and nutrition and foodservice. It should be emphasized that boundaries between categories are not sharp, and considerable overlap and interaction among services exist. For each category, there is a description of the service, information about the personnel who provide the service, and a review of some of the important issues in that field. Much of the material in this section came from the discussion at the committee's third meeting and was contributed by representatives of various professional organizations who served on a panel on services at that meeting. The committee has not attempted to assess the professional standards, recommended student-professional ratios, or other issues in this section for validity or adequacy; instead, this section is intended simply to transmit the contributed information. For further details, the professional organizations can be contacted directly.3 3 Participants in the panel discussion on services at the committee's third meeting included representatives from the National Association of School Nurses, American Academy of Pediatrics, National Association of School Psychologists, American School Counselor Association, National Association of Social Workers, and American School Food Service Association.
OCR for page 162
School & Health: Our Nation's Investment Additional information may also be obtained from the University of Colorado School Health Resource Services project, which maintains an extensive reference collection of profiles of school health services programs from school districts throughout the country. Health Care Services Nurses and Nurse Practitioners Services Provided. School nurses are the traditional "backbone" of school health services and are often the only health care providers at the school site on a regular basis. As mentioned earlier in this chapter, standards for school nursing have been established by the National Association of School Nurses. The school nurse typically provides population-based primary prevention and health care services, including physical and mental health assessment and referral for care; development and implementation of health care plans for students with special health care needs; health counseling; mandated screenings, such as vision, hearing, and immunization status; monitoring the presence of infectious conditions among students and enforcing public health precautions to prevent spread of infections and infestations; skilled nursing services for students with complex health care needs; case management of students with chronic and special health care needs; outreach to students and their families; interpretation of the health care needs of students to school personnel; development and implementation of emergency care plans and provision of emergency care and first aid; serving as liaison for the school, parents, and community health agencies; collaboration with other school professionals—particularly counselors, psychologists, and social workers—to address the health, developmental, and educational needs of students; and
OCR for page 163
School & Health: Our Nation's Investment for nurse practitioners only, the provision of primary care, including prescribing medications when allowed under the State Nurse Practice Act. The traditional model for school nursing provides for a school nurse, typically in an office or health room, with or without an aide. The National Association of School Nurses and other organizations in the National Nursing Coalition for School Health have prepared and distributed standards of nursing practice that guide the services nurses deliver in schools (Proctor et al., 1993). A single nurse may also be shared among several schools. In School Health: Policy and Practice, the American Academy of Pediatrics has analyzed the various nurse staffing patterns which are listed in Table 4-3. Personnel. The professional training required for school nurses varies, depending on location and changing economic conditions. The American Academy of Pediatrics (1993) reported in 1993 that only 38 states required school nurses to be registered nurses, and only 19 required the attainment of specific school nurse certification. SHPPS found that although only 8 percent of all states required school nurses to be certified through the American Nurses Association or the National Association of School Nurses, 62 percent of states offered their own certification for school nurses. Of those states offering certification, 66 percent required it for employment as a school nurse. Health aides are employed in 76 percent of states, but only 8 percent of these states required prior technical training for health aides (Small et al., 1995). The Closer Look investigation reports similar findings. In some school districts, school nurses are employees of the school system; in others, school nurses are provided by the local health department or another agency. The National Association of School Nurses recommends a ratio of one school nurse per 750 students. In recent years, there has been interest in expanding the school nursing function through the use of nurse practitioners, nurses with additional training (generally at the master's level) who are certified by state laws to provide a range of primary care services. School-based nurse practitioners can perform physical examinations, prescribe certain medications with physician protocols, and frequently serve as the anchor provider in school-based clinics. The drive for independence from physicians has characterized the nurse practitioner movement (Clawson and Osterweis, 1993); however, school-based nurse practitioners usually have a backup relationship with a licensed physician in the community. Other graduate programs prepare school nurses for administrative and management roles, as well as for mental health positions in schools.
OCR for page 226
School & Health: Our Nation's Investment vices. Thus, it is important to develop closer links between the school and community health systems and to encourage greater involvement of community health care professionals in the planning and implementation of basic services. School-based health centers and other extended services are a relatively new phenomenon, and research in this area is in the early stages. Studies have shown that SBHCs provide access to care for needy students and increase students' health knowledge significantly. However, it has been difficult to measure the impact of SBHCs on students' health status or high-risk behavior, such as sexual activity or drug use. This is consistent, however, with other interventions to reduce high-risk behavior—increased knowledge has little effect unless the environment and perceived norms are changed. The committee believes that access, utilization, and possibly a reduction in absenteeism may be more appropriate measures of the impact of SBHCs than change in health status or high-risk behavior. RECOMMENDATIONS School health services should be formally planned, and the quality of services should be continuously monitored as an integral part of the community public health and primary care systems. In the planning process, school health services should be considered an integral part of the overall community public health and primary care system. The range of services actually provided at the school site must be determined locally, based on community characteristics and needs. Special concerns should be emphasized about two areas of services that a significant proportion of students need—mental health or psychological counseling and school foodservice. The committee believes that mental health and psychological services are essential in enabling many students to achieve academically; these should be considered mainstream, not optional, services. The committee also believes that the school foodservice should serve as a learning laboratory for developing healthful eating habits and should not be driven by profit-making or forced to compete with other food options in school that may undermine nutrition goals. Many questions remain unanswered about school services, particularly questions regarding the relative advantages, disadvantages, quality, and effectiveness of providing extended services at the school rather than at other sites in the community. Thus the committee recommends the following:
OCR for page 227
School & Health: Our Nation's Investment Research should be conducted on school-based services, particularly on the organization, management, efficacy, and cost-effectiveness of extended services. In order to facilitate school health research of all kinds, all school health providers should immediately institute uniform data collection protocols and standards. So that the privacy of families and adolescents be maintained, the committee recommends the following: Confidentiality of health records should be given high priority by the school. Confidential health records of students should be handled and shared in the school setting in a manner that is consistent with the manner in which health records are handled in nonschool health care settings in the state. The lack of a consistent and adequate funding base has been a barrier to establishing school health services. Thus, the committee recommends the following: Established sources of funding for school health services should continue from public health, agriculture, and education funds, and new approaches must be developed. Strategies that have shown promise and should be further explored include billing Medicaid for services to eligible students, developing school-based insurance groupings, forming alliances with managed care organizations and other providers, instituting special taxes, and placing surcharges or special premiums on existing insurance policies. REFERENCES Abt Associates. 1990. Final Report: Study of Income Verification in the National School Lunch Program . Arlington, Va: Abt Associates. Adelman, H., and Taylor, L. 1991. Mental health facets of the school-based health center movement: Need and opportunity for research and development. Journal of Mental Health Administration 18:272–283. Adelman, H., and Taylor, L. 1997. Addressing barriers to learning: Beyond school-linked services and full-service schools. American Journal of Orthopsychiatry 67(3):408–421. Adelman, H., Barker, L., and Nelson, P. 1993. A study of a school-based clinic: Who uses it and who doesn't? Journal of Clinical Child Psychology 22(1):52–59. Alpha Center. 1995. State Initiatives in Health Care Reform. Washington, D.C.: Alpha Center, September/October, No. 14. American Academy of Pediatrics. 1993. School Health: Policy and Practice , 5th ed., P.R. Nader, ed. Elk Grove Village, Ill.: American Academy of Pediatrics.
OCR for page 228
School & Health: Our Nation's Investment American Academy of Pediatrics. 1994. Principles to Link By: Integrating Education Health and Human Services. The National Consensus Building Conference Final Report, Centers for Disease Control and Prevention. Washington, D.C.: U.S. Department of Health and Human Services. American Dietetic Association. 1991. Position of the American Dietetic Association: Competitive foods in schools. Journal of the American Dietetic Association 93:334–336. American Dietetic Association, Society for Nutrition Education, and American School Food Service Association. 1995. Joint position of American Dietetic Association, Society for Nutrition Education, and American School Food Service Association: School-based nutrition programs and services. Journal of American Dietetic Association 95(3):367–369. American Medical Association. 1992. Guidelines for Adolescent Preventive Services. Chicago: American Medical Association, Department of Adolescent Medicine. American Medical Association Council on Scientific Affairs. 1990. Providing medical services through school-based health programs. Journal of School Health 60(3):87–91. American School Food Service Association. 1994. Creating Policy for Nutrition Integrity in Schools. Alexandria, Va.: American School Food Service Association. American School Food Service Association. 1995. Keys to Excellence: Standards of Practice for School Foodservice and Nutrition. Alexandria, Va.: American School Food Service Association. Appelboom, T.M. 1985. A history of vision screening. Journal of School Health 55(4):138–141. Bachman, J. 1995. A university's response to a need for school nurse education. Journal of School Nursing 11(3):20–22, 24. Barnett, S.E., Niebuhr, V.H., Baldwin, C., and Levine, H. 1992. Community-oriented primary care: A process for school health intervention. Journal of School Health 62(6):246–248. Barrett, D.C., Radke-Yarrow, M., and Klein, R.E. 1983. Chronic malnutrition and child behavior: Effects of early caloric supplementation on social and emotional function at school age. Developmental Psychology 18(4):541–556. Basco, D. 1963. Evaluation of school nursing activities. Nursing Research (Fall):211–212. Berg, A.O. 1993. Screening for adolescent idiopathic scoliosis: A report from the United States Preventive Services Task Force. Journal of the American Board of Family Practice 6(5):497–501. Brellochs, C. 1995. School health services in the United States: A 100-year tradition and a place for innovation. Paper prepared by School Health Policy Initiative, Montefiore Medical Center, New York, N.Y., May. Brellochs, C., and Fothergill, K., eds. 1993. 1993 School Health Policy Initiative Special Report: Current Issues of Comprehensive School-Based Health Centers. New York: Columbia University School of Public Health. Bricco, E. 1985. Impacted cerumen as a reason for failure in hearing conservation programs. Journal of School Health 55(6):240–241. Brindis, C., Starbuck-Morales, S., Wolfe, A.L., and McCarter, V. 1994. Characteristics associated with contraceptive use among adolescent females in school-based family planning programs. Family Planning Perspectives 26:160–164. Brindis, C., Kapphanhn, C. McCarter, V., and Wolfe, A. 1995. The impact of health insurance status on adolescents' utilization of school-based clinic services: Implications for health reform. Journal of Adolescent Health Care 16:18–25. Brown, J.O., Grubb, S.B., Wicker, T.E. and O'Tuel, F.S. 1985. Health variables and school achievement. Journal of School Health 55(1):21–23. Bryan, D.S. 1970. Skin problems of school age children and youth—A nursing responsibility? Journal of School Health 40(October):437–439.
OCR for page 229
School & Health: Our Nation's Investment Burghardt, J.A., and Devaney, B.L. 1993. The School Nutrition Dietary Assessment Study: Summary of Findings. Princeton, N.J.: Mathematica Policy Research. Burghardt, J.A., and Devaney, B.L., eds. 1995. American Journal of Clinical Nutrition 61(1):Suppl. Cauffman, J.G., Affleck, M., Warburton, E.A. and Schultz, C.S. 1969. Health care of school children: Variations among ethnic groups. Journal of School Health 39(5):296–304. Center for Health Economics Research. 1993. Access to Health Care: Key Indicators for Policy. Princeton, N.J.: Robert Wood Johnson Foundation. Center on Hunger, Poverty, and Nutrition Policy. 1993. Statement on the Link Between Nutrition and Cognitive Development in Children. Medford, Mass.: Tufts University School of Nutrition. Centers for Disease Control and Prevention. 1996. Guidelines for school health programs to promote healthy eating. Morbidity and Mortality Weekly Report 45(RR-9). Chaskin, R.J., and Richman, H.A. 1992. Concerns about school-linked services: Institution-based versus community-based models. In The Future of Children: School Linked Services, R.E. Behrman, ed. Los Altos, Calif.: Center for the Future of Children, David and Lucille Packard Foundation 2(1):107-117, Spring. Chen, S.C. 1975. Role relationships in a school health interdisciplinary team. Journal of School Health 45(3):172–176. Cities-in-Schools. 1988. Fact Sheet and Questions About Cities-in-Schools . Washington D.C.: Cities-in-Schools. Citizens' Commission on School Nutrition. 1990. White Paper on School Lunch Nutrition. Washington, D.C.: Center for Science in the Public Interest. Clawson, D.K., and Osterweis, M., eds. 1993. The Roles of Physician Assistants and Nurse Practitioners in Primary Care. Washington, D.C.: Association of Academic Health Centers. Committee for Economic Development, Research and Policy Committee, ed. 1994. Putting Learning First: Governing and Managing the Schools for High Achievement. Washington, D.C.: Committee for Economic Development. Cook, B.A., Schaller, K. and Krischer, J.P. 1985. School absence among children with chronic illness. Journal of School Health 55(7):265–267. Crowley, E.A., and Johnson, J.L. 1977. Multiprofessional perceptions of school health: Definition and scope. Journal of School Health 47(Sept):398–404. Davis, M., Fryer, G.E., White, S. and Igoe, J.B. 1995. A Closer Look: A Report of Select Findings from the National School Health Survey 1993–1994. Denver: Office of School Health, University of Colorado Health Sciences Center. DeAngelis, C. 1981. The Robert Wood Johnson Foundation National School Health Program: A presentation and progress report. Clinical Pediatrics 20:344–348. Dryfoos, J. 1994a. Full-Service Schools: A Revolution in Health and Social Services for Children, Youth, and Families. San Francisco: Jossey-Bass. Dryfoos, J. 1994b. Medical clinics in junior high school: Changing the model to meet demands. Journal of Adolescent Health 15(7):549–557. Dungy, C.I., and Mullins, R.G. 1981. School nurse practitioners: Analysis of questionnaire and time/motion data. Journal of School Health 51(Sept):475–478. Edwards, L.E., Steinman, M.E., Arnold, K.A., and Hakanson, E.Y. 1980. Adolescent pregnancy prevention services in high school clinics. Family Planning Perspectives 12(1):7. Eisner, V. 1970. Health services under the Elementary and Secondary Education Act. Journal of School Health 40(Nov.):464–466. Elias, M.J., Kress, J.S., Gager, P.J., and Hancock, M.E. 1994. Adolescent health promotion and risk reduction: Cementing the social contract between pediatricians and the schools. Bulletin of the New York Academy of Medicine 71(1):87–110.
OCR for page 230
School & Health: Our Nation's Investment Ellison, C., Capper, A., Goldberg, R., Witschi, J., and Stare, F. 1989. The environmental component: Changing food service to promote cardiovascular health. Health Education 16(2):285–297. Employee Benefit Research Institute. 1993. Source of Health Insurance and Characteristics of the Uninsured: Analysis of the March 1992 Current Population Survey. Issue Brief No. 133, January. English, A., Matthews, M., Extavour, K., Palamountain, C., and Yang, J. 1995. State Minor Consent Statutes: A Summary. Cincinnati, Ohio: Center for Continuing Education in Adolescent Health, Children's Hospital Medical Center. Food Research and Action Center. 1996. School Breakfast Score Card: A Status Report on the School Breakfast Program 1995-1996 (Sixth Edition). Food Research and Action Center. Washington, D.C. p. 2. Forbes, O. 1965. The role and functions of the school nurse as perceived by 115 public school teachers from three selected counties. Journal of School Health 34:101–106. Frank, G., Vaden, A., and Martin, J. 1987. School health promotion: Child nutrition programs. Journal of School Health 57:451–460. Freedman, S., Klepper, B., Duncan, P., and Bell, S. 1988. Coverage of the uninsured and underinsured: A proposal for school enrollment-based family health insurance. New England Journal of Medicine 381(July):843–847. Frels, L. 1985. Employment trends of school personnel and staff 1980–1990. Journal of School Health 55(4):142–144. Frerichs, A.H. 1969. Relationship of elementary school absence to psychosomatic ailments. Journal of School Health 39(2):92–95. Fryer, G.E., and Igoe, J.B. 1995. Report: A relationship between availability of school nurses and child well–being. Journal of School Nursing 11(3):12–16, 18. Fryer, G.E., and Igoe, J.B. 1996. Functions of school nurses and health assistants in U.S. school health program. Journal of School Health 66(2):55–58. Goldberg, C.J., Dowling, F.E., Fogarty, E.E., and Moore, D.P. 1995. School scoliosis screening and the United States Preventive Services Task Force: An examination of long-term results. Spine 20(12):1368–1374. Goodwin, L.D., and Keefe, M.R. 1984. The views of school principals and teachers on the role of the school nurse with handicapped students. Journal of School Health 54(3):105–109. Gordon, A., and McKinney, P. 1995. Sources of nutrients in students' diets. American Journal of Clinical Nutrition 61(S):232–240. Greenhill, E.D. 1979. Perceptions of the school nurse's role. Journal of School Health 49:368–371. Hack, M., Breslau, N., Weissman, B., Aram, D., Klein, N., and Borawski, E. 1991. Effect of very low birth weight and subnormal health size on cognitive abilities at school age. New England Journal of Medicine 325(4):231–237. Harrelson, O.A., Ferguson, D.G., Killian, G.P., and Zimmer, I. 1969. Comparison of hearing screening methods. Journal of School Health 39(March):161–164. Hauser-McKinney, D., and Peak, G. 1995. Update 1994: Advocates for Youth, Support Center for School-Based and School-Linked Health Care . Washington, D.C.: Advocates for Youth. Hilmar, N.A., and McAtee, P.A. 1973. The school nurse practitioner and her practice: A study of traditional and expanded health care responsibilities for nurses in elementary schools. Journal of School Health 43(7):431–441. Hobbs, N., Perrin, J.M., and Ireys, H.T. 1983. Summary of Findings and Recommendations: Public Policies Affecting Chronically Ill Children and Their Families. Nashville, Tenn.: Vanderbilt University Institute for Public Policy Studies.
OCR for page 231
School & Health: Our Nation's Investment Howell, K.A., and Martin, J.E. 1978. An evaluation model for school health services. Journal of School Health 48(Sept.):433–441. Igoe, J.B., and Campos, E.L. 1991. Report of a national survey of school health nurse supervisors. School Nurse 6:8–20. Igoe, J.B., and Giordano, B. 1992. Expanding School Health Services to Serve Families in the 21st Century. Washington, D.C.: American Nurses Publishing. Igoe, J.B., and Stephens, R. 1994. School health activities within educational service agencies. Unpublished final report submitted to the Robert Wood Johnson Foundation. Innui, T.S. 1992. The social contract and the medical school's responsibilities. In The Medical School's Mission and Population Health: Medical Education in Canada, the United Kingdom, the United States and Australia, K. White and J. Connelly, eds. New York: Springer-Verlag. Institute of Medicine. 1993. Emergency Medical Services for Children . Washington, D.C.: National Academy Press. Institute of Medicine. 1994. Defining Primary Care: An Interim Report . Washington, D.C.: National Academy Press. International Food Information Council. 1995. The healthy attitude of today's kids. In Food Insight: Current Topics in Food Safety and Nutrition . Washington, D.C.: International Food Information Council Foundation, May/June. Jenne, F.H. 1970. Variations in nursing service characteristics and teachers' health observation practices. Journal of School Health 40:248–250. Johnson, J.L., Spellman, C.R., Cress, P.J., Sizemore, A.C. and Shores, R.E. 1983. The school nurse's role in vision screening for the difficult-to-test student. Journal of School Health 53(6):345–350. Kagan, S.L. 1991. United We Stand: Collaboration for Child Care and Early Education Services. New York: Teachers College Press. Kalisch, B.J., Kalisch, P.A., and McHugh, M. 1983. School nursing in the news. Journal of School Health 53(9):548–553. Kaplan, D. 1995. School HealthCare ONLINE!!!. Denver: National Center for School-Based Health Information Systems, Children's Hospital, Version 4.1. Kirby, D. 1994. Findings from other studies of school-based clinics. Presentation given at Meeting on Evaluation sponsored by the Robert Wood Johnson Foundation, Washington, D.C., September 23. Kirby, D., Resnick., M.D., Downes, B. Kocher, T., Gunderson, P., Potthoff, S., Zelterman, D., and Blum, R.W. 1993. The effects of school-based health clinics in St. Paul on school-wide birth rates. Family Planning Perspectives 25:12–16. Kisker, E.E., Brown, R.S., and Hill, J. 1994a. Healthy Caring: Outcomes of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program. Princeton N.J.: Mathematica Policy Research. Kisker, E.E., Marks, E.L., Morrill, W.A., and Brown, R.S. 1994b. Healthy Caring: An Evaluation Summary of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program. Princeton, N.J.: Mathematica Policy Research. Klerman, L. 1988. School absence—A health perspective. Pediatric Clinics of North America 35:1253–1269. Kornguth, M.L. 1990. School illnesses: Who's absent and why? Pediatric Nursing 16:95–99. Korup, U.L. 1985. Parent and teacher perception of depression in children. Journal of School Health 55(9):367–369. Knitzer, J. 1989. Collaborations Between Child Welfare and Mental Health: Emerging Patterns and Challenges. New York: Bank Street College of Education.
OCR for page 232
School & Health: Our Nation's Investment Larson, C.S. 1992. Confidentiality. In The Future of Children: School Linked Services, R.E. Behrman, ed. Los Altos, Calif.: Center for the Future of Children, David and Lucille Packard Foundation 2(1):131–134, Spring. Leonard, W. 1992. Keeping kids in school. Focus: June 4–5. Levine, M.D., Palfrey, J.S., Lamb, G.A., Weisberg, H.I., and Bryk, A.S. 1977. Infants in a public school system: The indicators of early health and education need. Pediatrics 60(4 pt 2):579–587. Lewis, C., and Lewis, M.A. 1990. Consequences of empowering children to care for themselves. Pediatrician 17:63–67. Lewis, C.E., Lorimer, A., Lindeman, C., Palmer, B.B., and Lewis, M.A. 1974. An evaluation of the impact of school nurse practitioners. Journal of School Health 44(6):331–335. Lewit, E.M., Schuurmann-Baker, L., Corman, H., and Shiono, P.H. 1995. The direct cost of low birth weight. In The Future of Children: Low Birth Weight , R.E. Behrman, ed. Los Altos, Calif: David and Lucille Packard Foundation 5(1):35–56, Spring. Lowis, E.M. 1964. An appraisal of the amount of time spent on functions by Los Angeles city school nurses. Journal of School Health 34:254–257. Luepker, R.V., Perry, C.L., McKinlay, S.M., Nader, P.R., Parcel, G.S., Stone, E.J., Webber, L.S., Elder, J.P., Feldman, H.A., Johnson, C.C., Kelder, S.H., and Wu, M. 1996. Outcomes of a field trial to improve children's dietary patterns and physical activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH). Journal of the American Medical Association 275(10):768–776. MacBriar, B.R., Burgess, M. Kottke, S. and Maddox, K. 1995. Development of a health concerns inventory for school-age children. Journal of School Nursing 11(3):25–29. Marcinak, J.F., and Yount, S.C.W. 1995. Evaluation of vision screening practices of Illinois pediatricians. Clinical Pediatrics 34:353–357. Marks, E.L., and Marzke, C.H. 1993. Healthy Caring: A Process Evaluation of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program. Princeton, N.J.: Mathtech. McCord, M.D., Klein, J.D., Foy, J.M., and Fothergill, K. 1993. School-based clinic use and school performance. Journal of Adolescent Health 14:91–98. McKaig, C., Hindi-Alexander, M., Myers, T.R. and Castiglia, P. 1984. Implementation of the school nurse practitioner role: Barriers and facilitators. Journal of School Health 54(1):21–23. Meeker, R., DeAngelis, C., Berman, B., Freeman, H.E., and Oda, D. 1986. A comprehensive school health initiative. Image 18:86–91. Meyer, J.S., and Regenstein, M. 1994. How to Fund Public Health Activities . Washington, D.C.: Partnership for Prevention. Meyers, A.F., Sampson, A.D., Weitzman, M., Rogers, B.L., and Kayne, H. 1989. School breakfast program and school performance. American Journal of Diseases and Children 143:1234. Miller, D.F., and Shunk, S. 1972. A survey of elementary school health services with emphasis on preparation for emergency care procedures of sick and injured students. Journal of School Health 42(2):114–117. Missouri School Children's Health Services Committee. 1993. Opening doors to Improved Health for Missouri's School Age Children: Recommendations of the Missouri School Children's Health Services Committee. Jefferson City: Missouri Department of Health. Murray-Garcia, J. 1995. African-American youth: Essential prevention strategies for every pediatrician. Pediatrics 96:132–137. Nader, P.R. (ed.) 1993. School Health: Policy and Practice. Elk Grove Village, Ill.: American Academy of Pediatrics. Nader, P.R. 1995. San Diego Unified School District, personal communication.
OCR for page 233
School & Health: Our Nation's Investment Nader, P.R., and Brink, S.G. 1981. Does visiting the school health room teach appropriate or inappropriate use of health services? American Journal of Public Health 71:416–419. National Adolescent Health Resource Center Evaluative Review. 1993. Findings from a Study of Selected High School Wellness Centers in Delaware. University of Minnesota, Division of General Pediatrics and Adolescent Health. National Alliance of Pupil Services Organizations. 1992. Mission statement. Washington, D.C. December 9. National Health Education Consortium. 1992. Creating Sound Minds: Health and Education Working Together. Washington, D.C.: National Health Education Consortium. National Health Education Consortium. 1993. Eat to Learn, Learn to Eat: The Link Between Nutrition and Learning in Children. Washington, D.C. National Health Education Consortium. National Institute of Dental Research. 1995. Personal communication. National Nursing Coalition for School Health. 1995. School health nursing services: Exploring national issues and priorities. Journal of School Health 65(9):370–389. National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, D.C.: National Academy Press. Nestle, M. 1992. Societal barriers to improved school lunch programs: Rationale for recent policy recommendations. School Food Service Research Review 16(1):5–10. Newacheck, P.W., Hughes, D.C., English, A., Fox, H.B., Perrin, J., and Halfon, N. 1995. The effect on children of curtailing Medicaid spending. Journal of the American Medical Association 274(18):1468–1471. New York State Department of Health. 1994. Unpublished data from School Health Division. Albany: New York State Department of Health. Nicklas, T., Forcier, J. Farris R., Hunter, S., Webber L., and Berenson, G. 1989. Heart Smart School Lunch Program: Vehicle for cardiovascular health promotion. American Journal of Health Promotion 14(2):91–100. Oda, D.S., Barysh, N., and Setear, S.J. 1979. Increasing role effectiveness of school nurses. American Journal of Public Health 64:591–595. Oda, D.S., DeAngelis, C., Berman, B., and Meeker, R. 1985. The resolution of health problems in school children. Journal of School Health 55(3):96–98. Office of Technology Assessment, Congress of the United States. 1991. Adolescent Health. Washington, D.C.: U.S. Government Printing Office. O'Neil, S.L., Barysh, N., and Setear, S.J. 1985. Determining school programming needs of special population groups: A study of asthmatic children. Journal of School Health 55(6):237–239. Palfrey, J.S., Haynie, M., Porter, S., Bierle, T., Cooperman, P., and Lowcock, J. 1992. Project school care: Integrating children assisted by medical technology into educational settings. Journal of School Health 62(2):50–54. Palfrey, J.S., Mervis, R.C., and Butler, J.A. 1978. New directions in the evaluation and education of handicapped children. New England Journal of Medicine 298(15):819–824. Pateman, B.C., McKinney, P., Kann, L., Small, M.L., Warren, C.W., and Collins, J.L. 1995. School food services. Journal of School Health 65(8):327–332. Patterson, J. 1967. Effectiveness of follow-up of health referrals for school health services under two different administrative patterns. Journal of School Health 37:687–692. Perino, J.P., and Brindis, C. 1994. Payment for Services Rendered: Expanding the Revenue Base of School-Based Clinics. San Francisco: Center for Reproductive Health Policy Research, Institute for Health Policy Studies, University of California. Perry, C., Stone, E., Parcel, G., Ellison, R., Nader, P., Webber, L., and Luepker, R. 1990. School-based cardiovascular health promotion: The Child and Adolescent Trial for Cardiovascular Health (CATCH). Journal of School Health 60(8):406–413.
OCR for page 234
School & Health: Our Nation's Investment Piessens, P., King, M.C., Ryan, J., Millette, B., Sheetz, A., Douglas, J.B., and Rissmiller, P.N. 1995. A statewide institute to delivery professional development programs to school health personnel in Massachusetts. Journal of School Health 65(5):176–180. Poehman, B., and Manager, A. 1992. Comprehensive School Health Programs Project: Listings of schools provided. Alexandria, Va: National School Boards Association. Proctor, S.E. 1986. Evaluation of nursing practice in schools. Journal of School Health 56(7):272–275. Proctor, S.T., Lordi, S.L., and Zarger, D.S. 1993. School Nursing Practice Roles and Standards. Scarborough, Maine: National Association for School Nurses. Ratchick, I. 1968. Evaluation of school health services for disadvantaged children under Title I, Elementary and Secondary Education Act. Journal of School Health 38:140–146. Risser, W.L., Hoffman, H.M., Bellah, G.G., and Green, L.W. 1985. A cost–benefit analysis of preparticipation sports examinations of adolescent athletes. Journal of School Health 55(7):270–273. Robert Wood Johnson Foundation. 1988. Serving Handicapped Children: A Special Report. Princeton, N.J.: Robert Wood Johnson Foundation. Roberts, D.E., Basco, D., Slome, C., Glasser, J.H., and Handy, G. 1969. Epidemiologic analysis in school populations as a basis for change in school nursing practice. American Journal of Public Health 59(12):2157–2167. Rosenberg and Associates. 1995. Issues in Financing School-Based Health Centers: A Guide for State Officials. Washington, D.C.: Making the Grade National Program Office, George Washington University. Rousseau, R. 1995. R and I's school giants: Marketing and motivating are keys to excellence. Restaurants and Institutions Report (September):18–30. Russo, R.M., Harvey, B., Kukafka, R., Supino, P., Freis, P.C., and Hamilton, P. 1982. The use of community health aides in a school health program. Journal of School Health 52:425–427. Rustia, J., Hartley, R., Hansen, G. Schulte, D., and Spielman, L. 1984. Redefinition of school nursing practice: Integrating the developmentally disabled. Journal of School Health 54(2):58–62. Sampson, A., Dixit, S., Meyers, A., and Houser, R. 1995. The nutritional impact of breakfast consumption on the diets of inner city African-American elementary school children. Journal of the National Medical Association 87(3):195–202. Santelli, J., Morreale, M., Wigton, A., and Grason, H. 1995. Improving Access to Primary Care for Adolescents: School Health Centers as a Service Delivery Strategy. MCH Policy Research Brief. Baltimore: Johns Hopkins University School of Hygiene and Public Health. Santelli, J., Kouzis, A., and Newcomer, S. 1996. School-based health centers and adolescent use of primary care and hospitals. Journal of Adolescent Health 19(4):267–275. Schlitt, J.J., and Rickett, K.D., Montgomery, L.L., and Lear, J.G. 1994. State Initiatives to Support School-Based Health Centers: A National Survey. Washington, D.C.: Making the Grade National Program Office. Shearer, C.A. 1995. Where the Kids Are: How to Work with Schools to Create Elementary School-Based Health Centers, A Primer for Health Professionals. Washington, D.C.: National Health and Education Consortium. Shearer, C.A., and Holschneider, S.O.M. 1995. Starting Young: School-Based Health Centers at the Elementary Level. Washington, D.C.: National Health and Education Consortium. Shenkman, E., Pendergast, J., Reiss, J., Walther, E., and Freedman, S. 1996. The school enrollment-based health insurance program: Socioeconomic factors in enrollees' use of health care. American Journal of Public Health 86(12):1791–1793.
OCR for page 235
School & Health: Our Nation's Investment Silvetta, M.B., and Swartz, K. 1986. The Uninsured and Uncompensated Care: A Chart Book. Washington, D.C.: National Health Policy Forum. Simons-Morton, B., Parcel, G.S., Baranowski, T., Forthofer, F., and O'Hara, N. 1991. Promoting physical activity and a healthful diet among children: Results of a school-based intervention study. American Journal of Health Promotion 81:986–991. Small, M.L., Majer, L.S., Allensworth, D.D., Farquhar, B.K., Kann, L., and Pateman, B.C. 1995. School health services. Journal of School Health 65(8):319–325. Sneed, J., and White, K. 1993. Continuing education needs of school-level managers in child nutrition programs. School Food Service Research Review 17(2):103–108. Snyder, M., Obarzanek, E., Montgomery, D., Feldman, H., Nicklas, T., Raizman, D., Rupp J., Bibelow, C., and Lakatos, E. 1994. Reducing the fat content of ground beef in a school foodservice setting. Journal of the American Dietetic Association 94:1135–1139. Soler, M.I., Shotton, A.C., and Bell, J.R. 1993. Glass Walls: Confidentiality Provisions and Interagency Collaborations. San Francisco: Youth Law Center. Solloway, M.R., and Budetti, P.P., eds. 1995. Child Health Supervision: Analytical Studies on the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Promotion Services for Infants, Children, and Adolescents. Arlington, Va.: National Center for Education in Maternal and Child Health. Spollen, J.J., and Davidson, D.W. 1978. An analysis of vision defects in high and low income preschool children. Journal of School Health 48:177–180. Starfield, B. 1982. Family income, ill health, and medical care of U.S. children. Journal of Public Health Policy 3(September):244–259. Starfield, B. 1992. Child and adolescent health status measures. In The Future of Children: U.S. Health Care for Children, R.E. Behrman, ed. Los Altos, Calif.: Center for the Future of Children, David and Lucille Packard Foundation. 2(2):25–39, Winter. Starfield, B., and Vivier, P.M. 1995. Population and selective (high-risk) approaches to prevention in well-child care. In Child Health Supervision: Analytical Studies on the Financing, Delivery, and Cost-Effectiveness of Preventive and Health Promotion Services for Infants, Children, and Adolescents, M.R. Solloway and P.P. Budetti, eds. Arlington, Va.: National Center for Education in Maternal and Child Health. Stout, J. 1991. School-Based Health Clinics: Are They Addressing the Needs of the Students? M.P.H. thesis, University of Washington, Seattle. Strickland, O.L. 1995. Executive Summary: Primary Care in Public Schools. Atlanta: Southern Council on Collegiate Education for Nursing of the Southern Regional Education Board. Thurber, F., Berry, B. and Cameron, M.E. 1991. The role of school nursing in the United States. Journal of Pediatric Health Care 5(3):135–140. Tuthill, R.W., Williams, C., Long, G., and Whitman, C. 1972. Evaluating a school health program focused on high absence pupils: A research design. American Journal of Public Health (January):40–42. U.S. Department of Agriculture. 1986. Competitive food service. Federal Register. FNS, 7CFR. Parts 210.2, 210.12, 220.2, and 220.12. January 1. U.S. Department of Agriculture. 1994. Nutrition Objectives for School Meals. Washington, D.C.: USDA Child Nutrition Programs. U.S. Department of Health and Human Services. 1988. The Surgeon General's Report on Nutrition and Health. Washington, D.C.: U.S. Government Printing Office. U.S. Department of Health and Human Services. 1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. DHHS Publication No. (PHS) 91-50213, Public Health Service. Washington, D.C.: U.S. Government Printing Office.
OCR for page 236
School & Health: Our Nation's Investment U.S. Department of Health and Human Services, 1993a. School-Based Health Centers and Managed Care. DHEW Publication No. OEI-05-92-00680, Office of the Inspector General. Washington, D.C.: U.S. Government Printing Office. U.S. Department of Health and Human Services, 1993b. School-Based Clinics That Work. Washington D.C.: Public Health Service, Health Resources and Services Administration, Bureau of Primary Health Care, HRSA 93-248P. U.S. General Accounting Office, 1993a. School-Linked Human Services: A Comprehensive Strategy for Aiding Students At Risk for School Failure . GAO/HRD-94-21, Washington, D.C.: U.S. General Accounting Office. U.S. General Accounting Office. 1993b. Food Assistance: Schools That Left the National School Lunch Program. GAO/RCED-94-36BR. Washington, D.C.: U.S. General Accounting Office. U.S. General Accounting Office . 1994a. School-Based Health Centers Can Promote Access to Care. GAO/HEHS-94-166. Washington, D.C.: U.S. General Accounting Office. U.S. General Accounting Office. 1994b. School-Based Health Centers Can Expand Access for Children. GAO/HEHS-95-35. Washington, D.C.: U.S. General Accounting Office. Wagner, M., Golan, S., Shaver, D., Newman, L., Wechsler, M., and Kelley, F. 1994. A Healthy Start for California's Children and Families: Early Findings from a Statewide Evaluation of School-Linked Services. Menlo Park, Calif.: SRI International. Walker, D.K. 1992. Children and youth with special health care needs. In Principles and Practices of Student Health, Volume One: Foundations, H.M. Wallace, K. Patrick, G.S. Parcel, and J.B. Igoe, eds. Oakland, Calif.: Third Party Publishing. Wallace, H.M., Patrick, K., Parcel, G.S., and Igoe, J.B., eds. 1992. Principles and Practices of Student Health, Volume Two: School Health. Oakland, Calif.: Third Party Publishing. Whitaker, R., Wright, J., Finch, A., and Psaty, B. 1993. An environmental intervention to reduce dietary fat in school lunches. Pediatrics 91(6):1107–1111. Wolfe, B.L. 1985. The influence of health on school outcomes. Medical Care 23(10):1127–1138. Wolk, L.I., and Kaplan, D.W. 1993. Frequent school-based clinic utilization: A comparative profile of problems and service needs. Journal of Adolescent Health 14:458–463. World Health Organization. 1995. The European Network of Health Promoting Schools: A Joint WHO-CE-CEC Project. Denmark: Council of Europe, Commission of the European Communities. Yankauer, A., and Lawrence, R.A. 1961. A study of case-finding methods in elementary schools: Methodology and initial results. American Journal of Public Health 51(Oct.):1532–1540. Zimmerman, D.J., and Reif, C.J. 1995. School-based health centers and managed care health plans: Partners in primary care. Journal of Public Health Management Practice 1(1):33–39.
Representative terms from entire chapter: