serving as public health officials to university teachers and researchers and as generalist and specialist providers of direct patient services. The services they provide include consultation on health policy, health curricula, and evaluation of programs and services; direct consultation regarding individual patients or groups of patients; and participation in provision of health services at the school site. Asthma specialists have set up asthma education programs, orthopedic surgeons have set up scoliosis screening and sports medicine programs, and pediatricians have advocated for and helped to develop sexuality education and health education programs. With the recent emphasis on education for all students with disabilities, the diagnosis of conditions and review of programs for these students have become additional responsibilities. Community primary care physicians (pediatricians and family physicians) frequently interact with the schools' health programs as linkages to ancillary services for their patients' medical, learning, and behavioral problems. They also assist with assessing community health needs and resources and devising mechanisms to coordinate school and community services.

Personnel. The training and certification of physicians who interact with the schools depends on their own discipline and specialty rather than standards of the school health program. Many pediatric residencies now offer community pediatrics experiences that often include school health. New residency requirements, which were put into effect in 1996, specify a defined community pediatrics experience in order for a program to meet American Academy of Pediatrics Board requirements. Physicians are typically not employees of the school system; instead, their services are usually provided by contractual agreements with hospitals, universities, clinics, and HMOs. Insurance and malpractice issues usually dictate that their source of employment be able to handle such coverage for physician activities routinely.

Important Issues. As described in Chapter 2, physicians have been active in school health programs to varying degrees since the mid-nineteenth century. The boundaries between private medical practice and school health programs, which arose during the period of the National Education Association–American Medical Association alliance from the 1920s to the 1960s, are now beginning to disappear, and schools are receiving increased attention as strategic sites for health promotion and access points for primary care. In order to meet these demands, expanded and improved education in school health is needed in the medical and residency education of physicians. In addition, mechanisms and incentives are needed for effectively involving community providers of primary and



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