vices. Thus, it is important to develop closer links between the school and community health systems and to encourage greater involvement of community health care professionals in the planning and implementation of basic services. School-based health centers and other extended services are a relatively new phenomenon, and research in this area is in the early stages. Studies have shown that SBHCs provide access to care for needy students and increase students' health knowledge significantly. However, it has been difficult to measure the impact of SBHCs on students' health status or high-risk behavior, such as sexual activity or drug use. This is consistent, however, with other interventions to reduce high-risk behavior—increased knowledge has little effect unless the environment and perceived norms are changed. The committee believes that access, utilization, and possibly a reduction in absenteeism may be more appropriate measures of the impact of SBHCs than change in health status or high-risk behavior.

RECOMMENDATIONS

School health services should be formally planned, and the quality of services should be continuously monitored as an integral part of the community public health and primary care systems.

In the planning process, school health services should be considered an integral part of the overall community public health and primary care system. The range of services actually provided at the school site must be determined locally, based on community characteristics and needs. Special concerns should be emphasized about two areas of services that a significant proportion of students need—mental health or psychological counseling and school foodservice. The committee believes that mental health and psychological services are essential in enabling many students to achieve academically; these should be considered mainstream, not optional, services. The committee also believes that the school foodservice should serve as a learning laboratory for developing healthful eating habits and should not be driven by profit-making or forced to compete with other food options in school that may undermine nutrition goals.

Many questions remain unanswered about school services, particularly questions regarding the relative advantages, disadvantages, quality, and effectiveness of providing extended services at the school rather than at other sites in the community. Thus the committee recommends the following:



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