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.


 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.

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