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


 "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).

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