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School & Health: Our Nation's Investment
are to establish community linkages and carry out a community needs and resources assessment. These steps will then lead to the implementation and expansion of school health services, school health education, and a healthful school environment.
The ACCESS model—Administration, Community, Curricula, Environment, School, Services—regards the school as an institution that is a microcosm of society where students spend much of their developmental years (Stone, 1990). This model calls for five "keystones" or interrelated areas, with interactive pathways between the areas, as shown in Figure 2-3.
According to this model, the administration and community keystones are overarching and should be developed first to provide an administrative structure and base of support for the other areas. The environmental keystone should be developed next, for it sets a tone for students and school personnel. Once these three areas have been developed, the remaining areas of curricula and services can be added with optimal effect, for then there will be consistency between what is learned in the classroom and what takes place outside the classroom. Another distinguishing feature of this model is that the word "promotion" has been added to its title to give "school health promotion program," to reflect more accurately the nature of the program and of the public health movement in this country.
The Illinois Department of Health has recently developed a model of a CSHP as part of its long-range plan for school health (Edwards, 1992). This model consists of six critical elements: (1) management, (2) health promotion and education, (3) school health services, (4) healthy and safe environment, (5) integration of school and community programs, and (6) specialized services for students with special needs. This model is shown in Figure 2-4.
The distinguishing characteristics of this model include the importance of the management role in coordinating and integrating the other critical elements, and the emphasis on students with special health care needs.
Allensworth (1993) has described a CSHP by what it does, rather than by listing what it contains. According to this model, a comprehensive school health program focuses on priority behaviors that interfere with learning and long-term well-being; fosters the development of a supportive foundation of family, friends, and community; coordinates multiple programs within the school and community; uses interdiscipli-