Some of the traditional population-focused basic school health services (e.g., screenings) have come under scrutiny. Although there has been little debate about the value of school-based screenings for vision and hearing, the value of growth screenings is uncertain. Furthermore, there is increasing evidence to suggest that scoliosis screening fails to meet the general criteria for screenings and therefore should no longer be recommended (Berg, 1993; Goldberg et al., 1995). Remaining to be evaluated with respect to mass screenings are such issues as the market value of these services and the value of a population-based approach versus a high-risk approach in which only those students needing screenings receive them at school.

Although investigations of the outcomes of traditional basic services have been limited, some of this work was well designed for its day, and the findings have influenced the development and evolution of school health services. For example, Basco (1963) conducted the first large-scale evaluation of school nurse activities. That study's finding of the need to better utilize the nurse's clinical and managerial skills has been confirmed on numerous occasions. Roberts and colleagues (1969) studied absence and attendance patterns of 2,000 students and developed a statistical model to use in evaluating the effects of changes in nursing practice on the functional state of students. By 1972, the focus of school health services research became further focused on students, and Lewis et al. (1974) explored the outcomes in situations in which students were empowered to become active participants in their own care during encounters with school nurses.

During the 1970s and 1980s, one principal area of research had to do with the effectiveness of the school nurse as a primary care provider, and another area of research concerned students with special health care needs. Three large studies during this period yielded valuable results: the Brookline Project, which investigated the developmental readiness of children (Levine et al., 1977); the Collaborative Study of Children with Special Needs (Walker, 1992); and the Vanderbilt study (Hobbs et al., 1983), which investigated the needs of students with chronic diseases. The Vanderbilt study established universal recommendations about the needs of students with chronic health conditions related to the pain they experience, the persistent sense of uncertainty that accompanies chronic health conditions, and the need for appropriate homebound policies and proper medication administration in the schools. Building on this work, Palfrey et al. (1992) developed Project School Care, which provided a comprehensive set of resources for schools regarding the management of students with special health needs.



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