Before examining the steps implied by each goal, the following basic premises should be emphasized. Regardless of program structure or community characteristics, programs should be based upon a thorough assessment of community needs and resources, and this assessment should involve all stakeholders who will be impacted by the program—parents, students, educators, health and social services providers, insurers, and business and political leaders.⁷ Who should convene and administer this process—the school system, health department, or other community entity—will depend on the situation; the crucial requirement is strong and committed leadership in the convening organization. Programs and services should be preventively oriented and family centered, avoid duplication, and be based on best practices gained from research.

Although schools represent relatively barrier-free systems for reaching children and youth about health issues, communities should recognize that not all populations may be comfortable with the school setting and school personnel (Chaskin and Richman, 1992). If this is the case, then steps must be taken to interact with those populations in ways with which they are comfortable, either by utilizing a more neutral setting or by altering the school environment to provide a climate with more trust.

The school health service should be considered an integral part of a community's preventive health system. Utilizing the school health service for screening and detection of problems, follow-up, and the coordination or provision of services can make the community's primary care system more efficient, effective, and accessible. Although the extent of services provided at the school site will differ from one community to another, mechanisms must be developed so that school health services are coordinated with the community's mainstream health services to ensure efficiency, continuity, and quality of care (American Academy of Pediatrics, 1994).