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Assessing Community Needs
E. RECOMMENDATIONS FOR SCHOOL HEALTH SERVICES
Once data have been gathered and the community's needs have been determined, an action plan can be developed that recommends the types of services the school should provide.
1. Core Services Only
The coalition might recommend that schools provide only "core health services" when a community assessment demonstrates that most students have access to and obtain health care from community providers. In this model, the school:
- Employs a nurse who may also supervise health aides.
- Provides special health services, such as speech or physical therapy, for students entitled to such services through federal legislation.
- Employs counselors and psychologists primarily for academic advising and testing rather than personal counseling or administering support groups.
- Refers students to other resources in the community for primary health care, dental care, and behavioral problems.
2. Core Plus Expanded Services
When students are unable to access community-based services easily, or when the community lacks sufficient providers, schools can provide services beyond "core" services to help meet students' needs. These expanded services might include assistance in meeting students' needs for behavioral, mental health, and substance abuse treatment. Under the "core plus expanded services" model, most primary care continues to be provided in the community. Schools may take an expanded role by:
- Increasing efforts to identify behavioral, mental health, or substance abuse problems and making appropriate referrals.
- Hiring nurses skilled in performing early and periodic screening, diagnosis, and treatment (EPSDT) physicals in school for students with no other source of well-child care.
- Contracting with community providers or agencies to provide additional services.
Ideally, school-employed professionals and community professionals work together as part of an interdisciplinary team.
3. School-linked Health Centers
Some school systems collaborate with student health centers that are "linked" to their schools. In this model, the health center:
- Is located beyond school property.
- Serves one or more schools.
- May also serve young people from the area that are not students.
- Provides services such as primary health care, screening and treatment, mental health counseling, health promotion, referral, and follow-up.
- Can have formal or informal ties to the schools, which might include accepting referrals from school personnel, providing priority appointments for students, marketing the services of the center in the school, and offering classroom health education.
4. School-based Health Centers
More and more communities and school systems are developing school-based health centers to meet the needs of their students. The National Health and Education Consortium defines a school-based student health center as "a health center located in a school or on school grounds that provides, at a minimum, on-site primary and preventive health care, mental health counseling, health promotion, and referral and followup services for young people enrolled." Some school-based health centers are components of larger organizational units, such as family resource centers. More information on school-based health centers follows in section F.
According to the Making the Grade Program at George Washington University, Washington, DC, more than 1100 school-based health centersto provide primary care services for a select group of the school population, most often students who need a variety of health services (Making the Grade, 1996). Others are part of the Communities in Schools initiative, in which health center personnel from a variety of community agencies come to the school (Communities in Schools, 1991).
