Currently, there are sources of external funds for school-affiliated services, but many of these sources tend to be transient and categorical. External funds are often designated for establishing ''model programs" that test the feasibility and effectiveness of interventions on small populations of students for short periods of time. Some external funds are for politically charged services such as family planning, diagnosis and treatment of sexually related conditions, and programs for teen parents. External funding to provide ongoing health services designed to address identified needs of the overall student population and to monitor student outcomes is rare. The result is a often patchwork of "here today and gone tomorrow" funding for short-term, problem-specific and/or population-specific services.
Some federal funds authorized by Congress are available for health services, some funds are entitlements; others require periodic reauthorization. Health care for eligible children living in poverty can be reimbursed by Title XIX (Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program [EPSDT]); maternal and child health services are financed by Title V; health care of educationally disadvantaged children is funded by Title I of the Elementary and Secondary Education Act; specialized health services for children with disabilities are mandated but only partially financed by the Individuals with Disabilities Education Act; services to prevent Human Immunodeficiency Virus (HIV) infections and hepatitis B infections are funded by cooperative agreements with the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (DHHS); drug use can be addressed with funds from the Safe and Drug-Free Schools and Communities Act; and model comprehensive school health programs that may include health services may be supported by grants from the U.S. Department of Education.
States often funnel the federal funds to schools through state departments of health, human services, and/or education. State tax funds may be added to federal money or dispersed separately for health services. For example, some states provide financial support to schools for health screening, tobacco use prevention, health care for children and families living in poverty, dental health care, or models of integrated health and social services delivery. Various states have also developed special initiatives and funding for school services; examples include California's Healthy Start and Florida's Full-Service Schools (Dryfoos, 1994a; Schlitt et al., 1994; Shearer and Holschneider, 1995).
Locally, funds may be available from service clubs, volunteer health organizations (such as the American Cancer Society, March of Dimes, and the American Red Cross), and private providers of health care. Managed care systems are emerging and evolving as centerpieces of health care delivery in communities throughout the United States. Arrangements for