and new professionals will need to be cross-trained. Educators will have to better understand youth and family development issues, become more culturally sensitive, and further master their own specialties. Human service workers will have to learn how to function in schools and understand the culture of educational institutions. New types of coordinators and directors for school-based services will have to be able to interrelate with both schools and community agencies and help everyone bridge the gap. In addition, they will need strong fiscal management skills to handle the complexities that go along with multiple funding sources and accountability.

Even when staff can be identified, turnover rates are often high. Working with disadvantaged children and families is labor intensive and can lead to burn out if the management does not address personnel issues with care and grace. In addition, practitioners in some areas report that the greatest difficulty is recruiting trained professionals who are bilingual.

The need for appropriately trained personnel stands as a major barrier to replication. This issue is already being addressed on a small scale in a few university settings, where there are efforts to change curricular offerings and coordinate master's level requirements. The major professional organizations for pupil personnel services (school nurses, school psychologists, school social workers, guidance counselors) are already working together to define the roles of their constituencies in new program models.


It has been observed that the phrase "school-based clinic" is like a red flag for those waiting to raise community tensions over sexuality issues. The most highly publicized school-based health programs in the early 1980s were heralded as pregnancy prevention programs, leading to attacks from the opposition that schools were opening "sex clinics" and "abortion mills." When later replications of these models were shown to have little effect on pregnancy rates because they did not include family planning services, the attack shifted and the opposition organized against bringing any kind of services into school buildings, even elementary schools. For example, at the time that the Kentucky Youth and Family Centers were first proposed, the Eagle Forum put out brochures referring to the proponents as "child snatchers."

In reality, few programs have been stopped in their tracks because of organized opposition. Accounts of these events are elucidating. Parents invariably surface as the most articulate and credible advocates for school-based services. National and local polls have documented the high level

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