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.


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


 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.

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