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Making the Connection II
School Health Services

DEFINITION OF COMPONENT

The goal of a school health services team is to ensure that students are healthy, in school, and ready to learn. Models of these services—in terms of policies, staffing, funding, and access—vary across states and schools. Allied health personnel provide school health service on-site in the school
health office, in a school-based or linked health center or clinic, or through
partnerships with community- and public health agencies. (3, 4, 5, 8, 9, 11)

School Nurses

In most schools, the school nurse is the coordinator for school health
services. The school nurse handles first aid and emergency care, referrals for immunizations and care, faculty and staff training regarding health, and promotes student and staff wellness. School nurses screen for barriers to learning. The school nurse is an advocate linking home, school, and the medical community in support of student health and academic success. (1, 4, 16, 17, 19)

School-Based Health Centers

School-Based Health Centers (SBHCs) are primary care clinics located in a school building or near the campus. SBHCs are staffed by nurse practitioners, physician assistants, doctors, nurses, mental health professionals, and health assistants. SBHCs bring the medical clinic to
the school so students may receive the care they need, regardless of their ability to pay. SBHCs minimize time
missed from classes and, for parents, time missed from work. In 2010, there were approximately 2,000 SBHCs in 44 states serving about 1.7 million students. (3, 8, 11, 12)

IMPACT ON STUDENT ACHIEVEMENT

Today’s student population is more medically diverse than in the past, and federal law requires schools to provide safe and supportive learning environments for students School Health Services with a wider variety of disabilities and chronic illnesses than ever before. School health services can provide necessary supports to enable students with a variety of handicaps to
function in school and achieve. In addition, they can work to prevent or reduce risk behaviors and identify and refer students for treatment when necessary, thereby making educational success more likely. (8, 9, 12, 17, 18)

STORIES FROM THE FIELD

Health Services as Part of a Coordinated School Health Approach

The Helfrich Park Middle School in Evansville, Indiana, has been recognized by the CDC as an exemplary coordinated school
health implementation site. In collaboration with area hospitals, Helfrich students receive physicals, dental care, dietary counseling, and routine screenings. Health services dovetail with nutrition, physical activity, and health education offerings. (10, 9)

Examples of School-Based Health Center Results

• In Massachusetts, students had a 50% decrease in absenteeism and 25% decrease in tardiness two months after receiving mental health counseling in their SBHC.
  
• In North Carolina, African American male clients of the SBHC were three times more likely to stay in school than their peers who did not use the clinic services. (10)

RECOMMENDATIONS FOR BEST PRACTICE

By School Nurses:

Student health needs are best addressed by a full-time nurse in every school building. The national standard has been a ratio of one nurse for every 750 students. Increasingly, the professional consensus is that the recommended ratio should be based upon need. The school nurse is a primary contributor to assuring the physical and emotional safety of the school community. (1, 4, 7, 16, 17, 19)

Examples of recommended best practices for school health services by school nurses include to:

• Provide health screenings for vision, hearing, dental, scoliosis, speech, and language
  
• Provide acute care services (e.g., first aid, CPR, epinephrine injection, and others)
  
• Provide chronic disease management (e.g., asthma, diabetes, seizure disorder, and others)
  
• Build regular communication between families, schools, and medical providers
  
• Help staff stay current on topics such as autism, allergies, diabetes, bullying, ADHD, and others
  
• Be part of the school’s crisis management team
  
• Build cultural and linguistic competencies in order to serve the school’s particular population and reduce disparities and inequities
• Interface with academic goals of the school; ensure that adults see the relationships between student health and
  safety, attendance, and achievement By School-based Health Centers:

BIBLIOGRAPHY (selected references)

1. American Academy of Pediatrics. Role of the School Nurse in Providing
   School Health Services. Pediatrics. 2008; 121(5): 1052-56.
   
2. Basch C. Healthier Students Are Better Learners: A Missing Link in School
   Reforms to Close the Achievement Gap. Teachers College, Columbia
   University. 2010.
   
3. Colorado Department of Public Health and Environment. School-Based
   Health Centers, Best Practices, 2011. Available online at http://www.
   colorado.gov/cs/Satellite/Best-Practices-V2/BPV/1216461739070.
   
4. Connecticut State Department of Education. Competency in School Nurse
   Practice, 2009.
   
5. Council of Chief State School Officers. Policy statement on school health,
   October 2004.
   
6. Dunkle MC, Nash MA. Beyond the Health Room. Council of Chief State
   School Officers, Resource Center on Educational Equity. 1991.
   
7. Education Development Center, Inc. What is a Coordinated School Health
   Program? 2001.
   
8. Geierstanger SP, Amaral G. School-based Health Centers and Academic
   Performance: What is the Intersection? National Assembly on School-
   Based Health Care. 2005.
   
9. Lewallen TC. Healthy learning environments. ASCD INFOBrief. 2004; 38.
   
10. Little DM. School-Based Healthcare. Southeast Education Network. 2010; 12(3).
    
11. Maine Department of Human Services, Bureau of Health. The Maine
    School-Based Health Centers Standards. 2003.
    
12. National Assembly on School-Based Health Care. The Role of School
    Based Health Centers in Improving Health Equity and Reducing Health
    Disparities. 2006.
13. National Association of School Nurses. Coordinated School Health
    Programs. 2008.
    
14. National Association of School Nurses. School Nurse/School-Based Health
    Center Partnership. 2001.
    
15. National Association of School Nurses. The Role of the School Nurse in
    School-Based Health Centers. 2001.
    
16. New York State Association of School Nurses. Duties of the School Nurse. 2008.
    
17. Rhode Island Department of Education, Coordinated School Health
    Program. Component: Health Services. 2008.
    
18. Swingle CA. The relationship between the health of school-age children
    and learning: implications for schools. Lansing, MI: Michigan Department
    of Community Health, 1997.
    
19. Robert Wood Johnson Foundation Series on Charting Nursing’s Future.
    Unlocking the Potential of School Nursing: Keeping Children Healthy, In
    School, and Ready to Learn. 2010.
    
20. Vinciullo F, Bradley A. A Correlational Study of the Relationship Between a
    Coordinated School Health Program and School Achievement: A Case for
    School Health. Journal of School Nursing. 2009; 25(6): 466-77.
    
21. Van Cura M. The Relationship Between School-based Health Centers,
    Rates of Early Dismissal from School, and Loss of Seat Time. Journal of
    School Health. 2010; 80(8): 371-77.