substantive preparation in health education content and methodology during their preservice college training. This preparation should give elementary generalist teachers strategies for infusing health instruction into the curriculum and prepare upper elementary teachers to lay the groundwork for the intensive middle or junior high health education program.
Although the scope of school health services varies from one school district to another, many common elements exist throughout the country. Most schools provide screenings, monitor student immunization status, and administer first aid and medication. Schools are also required to provide a wide range of health services for students with disabilities and special health care needs.
There is agreement among virtually all school districts that a core set of services is needed in schools, but the topic currently generating a great deal of discussion is the role of the school in providing access to "extended services" that go beyond traditional basic services, such as primary care, social, and family services. The committee believes that extended services should not be the sole—or even the major—responsibility of the schools; instead, the school should be considered by other community agencies and providers as a partner and a potentially effective site for provision of needed services—services that will ultimately advance the primary academic mission of the school.
Although the demands and complexity of basic school services have increased, these services are often supervised by education-based administrators who have no clinical preparation in the delivery of health services. 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 (SBHCs) and other extended services are a relatively new phenomenon, and research in this area is in its 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