Motivating Pediatricians to Become Involved in
School Health

A brief review of school health in the United States shows that substantial growth has been experienced in health promotion and services at schools in its 100-year history.

1. The 1800s

By the end of the 19th century

• School attendance had become mandatory in many states
• Large numbers of poor immigrant children were entering the public schools
• State public health departments were being established
• Physicians and nurses began working at schools to screen children for contagious diseases-excluding children from school when necessary-and vaccinating children in large numbers at school

2. Early 1900s

By the end of World War I

• Nearly every state had passed legislation related to school health
• School nurses were regularly helping families obtain health care for children excluded from school and providing continuous health care for school children
• Many medical, dental, and social services were provided through schools

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3. Mid-1900s

From the 1920s through the 1970s

• Separation of preventive services from medical treatment became the standard practice
• State public health departments were becoming politically cautious, limiting their agendas to health education, personal hygiene, and environmental health while curative services were left to private physicians
• School health became primarily classroom-based health education and physical education
• School nursing services grew to include emergency care, first aid, documentation of compliance with state or district health requirements, and periodic student assessments

Despite this growth, school health programs and services needed substantial improvement. Problems identified in schools were not always linked to appropriate services and, hence, not always solved.

4. Recent Decades

The 1960s and 1970s saw some pivotal developments in the national health care scene that increased the role of schools in providing health education and services. For instance:

• The political and social climate pressured schools to improve school health programs.
• The war on poverty increased awareness of health care and access problems in the general population.
• In 1966, Medicaid initiated health insurance coverage for underprivileged children, specifying that insured services should include Early Periodic Screening, Detection, and Treatment (EPSDT) services.
• The Education for the Handicapped Act in 1975 required schools to provide services to children with special health care needs.
• The term "new morbidity" was coined to describe adolescent health concerns.
• Training programs for nurse practitioners were initiated and paved the way for mid-level providers in school-based health centers.

In the 1970s, funding from the Maternal and Child Health Bureau (MCHB), Federal Resources and Services Administration, and the Robert Wood Johnson Foundation helped establish the first school-based health centers. These programs served as family resource centers, assisted pregnant and parenting teens, and provided school-based mental health services.

As we end the 20th century, schools are seen as an important access point for children to receive health education and health services.

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