School Health Services

In most areas of the country, the role and scope of school health services have evolved according to the changing social environment of the population. School health services' main objectives are to foster the whole student physically and mentally so students can work toward lifelong success and health. In the past, some of the major health problems school school-age children faced included contagious diseases often unheard of today, such as tuberculosis, diphtheria, measles, mumps, rubella, and whooping cough. School health services often incorporated separating those with contagious diseases from the healthy school population. Today, however, most contagious diseases have been eradicated and school children's health risks may oftentimes have their origins in social or behavioral conditions.

Keywords Behavioral Problems; Budgetary Constraints; Bullying; Childhood Obesity; Children's Diseases; Guidance Counselor; Health Curriculum; Health Services; Intervention; Nutrition; Physical Education; Physical Health; School Nurse; Smoking Cessation; Vision Screening

School Safety > School Health Services

Overview

In most areas of the country, the role and scope of school health services have evolved according to the changing social environment of the population. School health services' main objectives are to foster the whole student physically and mentally so students can work toward lifelong success and health. To that end, school health services promote health and safety, work to prevent certain health problems, get involved with present health issues, manage individual cases as needed, and work with family members and others when appropriate (American Academy of Pediatrics, 2004). Striving for individual optimum health should be a prime goal of students, their families, school personnel, and the community at large.

In the past, some of the major health problems school school-age children faced included contagious diseases often unheard of today, such as tuberculosis, diphtheria, measles, mumps, rubella, and whooping cough. School health services often incorporated separating those with contagious diseases from the healthy school population.

Today, however, most contagious diseases have been eradicated and school children's health risks may oftentimes have their origins in social or behavioral conditions. These roots can include a multitude of situations that may hinder learning, such as a general lack of preparedness, social, emotional, and health deficiencies or handicaps, poverty, smoking or living with a smoker, alcohol consumption by students or their family members, the threat of weapons in school, attempted suicide or otherwise causing or considering physical harm to oneself, physical, emotional, and sexual abuse; assault and the threat of assault, an assortment of mental, emotional, and behavioral disorders; and homelessness. They may also face stress of many types-pressure from peers, studying and test anxiety, real or perceived competition for academic and extracurricular accolades, and full schedules throughout the week (McKenzie & Richmond, 1998).

In some schools around the country serious obstacles such as those mentioned above are more commonplace than others, and less serious problems are routine. When any of these types of problems do come up in a school, it is almost certain the situation will disrupt individual students' lives and can be a distraction in classrooms. Depending on its severity, the problem can affect the entire school community. When students are less than mentally and physically healthy and their attendance at school wanes, learning at school will suffer (McKenzie & Richmond, 1998). A comprehensive school health services program is designed to be proactive and attempt to troubleshoot these types of situations.

Good health is best defined not just as the lack of sickness and disease. Instead, it is the total physical, mental, and social well-being of each person (McKenzie & Richmond, 1998). Good health is a mandatory ingredient for successful learning and many factors can weaken it. School health services work toward that goal.

Today's School Health Program

School health services are found in some form in every school throughout the United States. Each school's distinctive community, its wants and needs, the available resources, unique challenges, and its budgetary constraints will determine the framework of its coordinated school health program. No two schools' programs of services are alike as needs, budgets, and concerns can vary significantly throughout the country (McKenzie & Richmond, 1998).

Most children in the United States spend more than half their waking hours at school. Besides an already-full school day, many students are also involved with regular sports and social activities before and after school while older students often have part-time employment during those hours they are not in high school. For school-aged children and youth, staying in good health is tantamount to keeping up their routine (McKenzie & Richmond, 1998). Since students at school are a captive audience, schools should be important providers of health services. A school health program tailored to the unique population of the school will consist of many components, some of which will overlap in form and function (McKenzie & Richmond, 1998).

School health services are generally described as preventive services, education, emergency care, referral and management of acute and chronic health conditions (Duncan & Igoe, 1998). Each school's package of services is designed to adequately satisfy the health requirements of its students and staff. To do this, the health services should be able to diagnose and prevent various health problems and preventable injuries as they strive to make certain those attending school receive the type of health care they need.

Components of a school health services program will ideally include an on-site health office, a comprehensive health education curriculum, a physical education program, an attention to school nutrition, available student counseling services, a wholesome school environment, and family and community involvement in schools (McKenzie & Richmond, 1998).Taken individually, each component has unique and important characteristics.

Applications

The School Health Office

The staff of the school health office provides the core services of screening, diagnostic treatment, and health counseling services within the school. At given times, this office will also provide:

• Urgent and emergency medical care (ideally, all school staff, not just those in the health office will hold first aid certification),

• Prompt diagnosis and needed intervention for all degrees of medical and health problems,

• Various health screenings for all students,

• Medication dispensing throughout the school day,

• Individualized services for students with special health needs,

• Student and staff health counseling and prevention education, and

• Educating students about methods of promoting good health.

The school health office staff will also provide networking as needed with other community health providers (Duncan & Igoe, 1998). In addition, to comply with the Individuals with Disabilities Education Act of 1990 and the Education for all Handicapped Children Act of 1973, all schools have been required to provide individual health care for those students with exceptionalities who qualify (Duncan & Igoe, 1998).

Since most U. S. children older than five are enrolled in school, the school health office often ends up being the logical place for them to obtain preventive health services, to include vision screening, hearing tests, and other gaps in health and social services. School administrators, nurses, and teachers are aware that although the responsibility for a child's health care is the parents', this is not always possible. Poor and uninsured families are often able to fill their children's health care needs only because of the services available through their school's health office. Some schools with a large student immigrant population may offer immunization clinics with community health organizations (American Academy of Pediatrics, 2004). Annual vision and dental screenings and referrals are most valuable to those families who would otherwise not seek this preventive health care (American Academy of Pediatrics, 1987). In some schools, a specially trained nurse may provide physical examinations for those students who may have no other way to get this well-child health care.

The school health office can also provide preventive counseling services to students, addressing such concerns as cigarette smoking, drugs and alcohol, HIV and AIDS, eating disorders, issues having to do with puberty and adolescence, and health-related learning disorders. Some students may have severe emotional and physical challenges for which they need special health counseling and the school nurse and health office will work to accommodate these students as necessary (Duncan & Igoe, 1998). Some students may have behavioral and health concerns that are severe enough to hamper their ability and motivation to learn (Duncan & Igoe, 1998) The school health office can provide services to work with these students' problems and strive to prevent loss of school class time as much as possible.

The School Nurse

Most school health offices have just one staff member: the school nurse. In some schools, the school nurse may also teach in the classroom and will be the one to implement many of the health education programs within a school. The scope of services the school nurse is able to provide is dictated by the other school duties under the health office umbrella, but for the most part school nurses bear at least some of the responsibility for creating and maintaining a safe school environment (Espelage, et al., 2000; Salmivalii, 1999).

School nurses must be prepared for all types of health-related situations, for example, head lice is one persistent health problem these health care professionals often have to deal with. No-nit policies in some schools state that students with signs of head lice or nits must not be permitted in school until the infestation is eliminated. Particular schools may require medical documentation of medical treatment, creating a hardship for some students and causing them to miss school (Grassia, 2004). School nurses can often find avenues for students to obtain needed treatment and return to school.

School nurses must also be aware of those students for whom asthma is a problem. Asthma is a leading chronic health condition in school-age children and a leading cause of school absence (American Academy of Pediatrics, 2004). Asthmatic students and others with particular health needs may require medication or treatments while in school. The school health office must ensure that strict guidelines are followed and the appropriate documentation is filed. Similarly, those with other chronic health conditions, such as diabetes, cancer, arthritis, emotional disorders, and post-traumatic head injuries, may require individualized attention from the school health office (Duncan & Igoe, 1998).

Additionally, the school health office has many administrative duties, such as:

• Maintaining student health records,

• Working to prevent sickness throughout the school,

• Overseeing school lunch programs,

• Raising awareness of good health and nutrition practices,

• Providing individualized services as needed,

• Identifying underlying health problems, and as appropriate,

• Providing referrals to their community health care providers for diagnosis and treatment (Duncan & Igoe, 1998).

The Health Education Curriculum

Although a rigorous health education curriculum should ideally be part of the schedule in all schools, time and budget constraints may be the reason some schools today offer only brief (or sometimes no) instruction in the area of health.

Health education can take place casually, during individual health counseling by the school nurse, or more formally, through classroom health instruction programs. Some schools are still able to offer a sequential, comprehensive health curriculum for all students from kindergarten through grade twelve. Units covering dental health, personal hygiene, and nutrition are presented in varied formats in the primary grades, to address important ideas that may include reinforcement of good practices of hand washing, choice of and good health procedures concerning classroom pets, and ensuring individuals with contagious illnesses are not infecting the school population. Students are reminded that these and other parts of the health curriculum are crucial components of a healthy school community. Continued modeling of best practices by teachers and staff will reinforce these ideas to the students (American Academy of Pediatrics, 2004). Older students can benefit from discussions of accident prevention and first aid, maintaining good physical and mental health, and topics having to do with general growth and development (American Academy of Pediatrics, 1987).

Kegley & Cottrell (1993) say that school health education is more than just a good kindergarten through high school health curriculum. An ideal school program also takes into account the entire community and will ensure such things as school buses having seat belts (in areas where this is appropriate), that smoke-free areas are established and adhered to, that recycling programs are in place, and that there are appropriate health services for all students and staff.

A strong health education program will ideally include helping all students and staff to work toward and all-around healthy lifestyle, providing smoking cessation programs as needed and instituting exercise programs for teachers and staff. Whenever possible, all of those working and learning in a school should feel a part of the health education program. Proper nutrition is important to maintaining students' growth, development, fitness, and motivation to learn. Student awareness and attention to the importance of proper nutrition can be a part of the health education curriculum and making healthy food choices is often taught from the earliest grades.

Physical Education Programs

School health services usually include some form of organized physical education program. Although physical education remains a part of many students' school schedule in the U. S., some parents and educators are still not convinced that physical exercise enhances brain function and that this type of curriculum should be incorporated into what is perceived as a more academic school day. Since physical education programs have been greatly reduced in some schools in the country, it's an opinion that may need to be considered and responded to (Tremarche, Robinson, & Graham, 2007).

Although there is continuing national awareness of the growing problem of childhood obesity in the United States, it hasn't seemed to change the depth and scope of physical education classes and curriculum at most schools (American Academy of Pediatrics, 2004). Physical education classes can enhance good health behaviors as they contribute to the academic success of all students (Langford & Carter, 2003).

School Counseling Services

A strong school health service menu will always include school guidance services. In recent years, school guidance professionals have responded to research and become more focused on learning outcomes that have been shown to be a result of good school attendance. Students who are actually in attendance at school tend to experience lower dropout rates, better grade point averages, and overall higher standardized achievement test scores. Counselors who work toward these ends are valuable to schools today. Although counselors can contribute greatly to helping students stay in school, this area of school health services can often be eliminated or greatly reduced when money is an issue (Gerler, 1992).

Wholesome School Environment

A good measure of the strength of a school's health services can be a safe, clean, and well-maintained school. A healthy school atmosphere means first a safe and comfortable building in which students can learn. It should be noted that about half of all public school buildings in the U. S. have some sort of environment hazard that can present a danger to students and staff. These risks may include the presence of radon gas, contaminated heating and ventilation systems, asbestos, peeling and chipping lead-based paint, and water contaminated with lead (Kowalski, 1995). Strong school health services will make these problems a priority and find ways to eradicate the building's hazards to maintain the school population's health.

Just as important as a well-maintained physical building is a positive social climate throughout the school. This favorable type of environment contributes to students' willingness to attend school and may enable all students to attempt to succeed and consistently do their best work. A positive social environment takes into account the feelings, values, and attitudes of everyone at the school. Strict attention to how certain policies are implemented and consistency in imposing practices and procedures is important to maintaining a positive school environment (Henderson & Rowe, 1998).

Supportive teachers and staff and policies designed to minimize hazards and distractions maximize expectations for all students as they contribute to a strong social climate in a school. These policies are best broad in scope, from those that help to ensure the health of all students to those safeguards that help make certain the security of students while they are in school. This includes clear rules about weapons, alcohol and tobacco, drugs, and bullying. Student achievement can be linked strongly to this type of healthy school environment (Henderson & Rowe, 1998).

High expectations and standards for all students is a crucial ingredient for student success, and those schools and families valuing academic achievement typically have students who work hard toward these expectations. Part of a strong and healthy school environment is also having families' health and safety expectations for their children mirror closely those that are being presented and modeled at school: nutrition, exercise, and healthy behaviors that are reinforced at home strengthen the school environment, too (Henderson & Rowe, 1998).

Family & Community Involvement in Schools

To be sure, behaviors at home may sometimes conflict with standards at school. The most committed parents and family members are those who attempt to weave school expectations into home life. Healthy food choices, regular exercise, lack of tolerance for drugs, tobacco, and alcohol misuse at home make conflicts with school expectations more natural for children and youth. Conflicting messages are at a minimum when families, schools, and the community work together to reinforce good health practices (Henderson & Rowe, 1998).

Many in the community may not be aware of the scope of school health services and how a strong health program can prevent risk behaviors, provide needed medical attention to all students, ensure students are aware of healthy and unhealthy lifestyles, and promote student success. Those in the community who are aware of the importance of the health program should voice their opinion as much as they are able, raise awareness of those who may not be in the know, and become involved with the school board in an attempt to raise awareness of the necessity of a strong health program in every school in the country (Newton, 1987).

Viewpoints

The main goal of schools is to help students become successful in whatever endeavor they may ultimately choose: the job market, higher education, or another life choice. To meet this end, schools must not simply meet their students' academic needs, they must work toward strong mental, physical, and social health (American Academy of Pediatrics, 2004). Many administrators, teachers, school nurses, and students and their families are in agreement that school health services are important to overall student health, even as budget constraints remain a problem. Often health services in schools are the first part of a budget that is reduced. This directly and indirectly affects students' success academically (American Academy of Pediatrics, 2004).

School health services will include any or all of the above-mentioned components, and in a variety of formats. It is important for schools to create and promote the strongest package of health services they can with their resources. Staff and administrators should work toward ensuring that with the school health system they have in place, they are able to optimize students' needs as much as possible. Strong school health services require the commitment and awareness of everyone involved with the school, from the students, teachers, and administrators, to the maintenance staff and health services workers: the school nurse, food service workers, and guidance counselors (Henderson & Rowe, 1998).

Terms & Concepts

Behavioral Problems: Behavioral problems are conduct disorders that may affect a student's ability to learn or be taught effectively in school.

Budgetary Constraints: Budgetary constraints are the amount of funds able to be allocated to a certain area or department of a school.

Bullying: Bullying is the persistent, deliberate attempt to hurt another person or place a person in a situation where they feel stress.

Childhood Obesity: Childhood obesity describes a situation where a child's weight is approximately ten percent higher than the norm for his or her body type.

Guidance Counselor: A guidance counselor typically works with students in a school to counsel, teach, and provide resources to aid their academic, personal, and career development.

Intervention: Intervention is an attempt to intercede on another's behalf.

Physical Education: Physical education is a school course incorporating physical skills in an assortment of ways, usually sports-related, to help students maintain a healthy and active lifestyle.

Physical Health: Physical health is the general condition of being free from disease and sickness.

Smoking Cessation: Smoking cessation means finding an effective way for an individual to quit smoking.

Vision Screening: Vision screening is an examination intended to identify vision problems and refer these to vision specialists.

Bibliography

American Academy of Pediatrics. (2004). School Health Policy & Practice. Elk Grove Village, IL: American Academy of Pediatrics.

Dang, M. T., Warrington, D., Tan, T., Baker, D. & Pan, R., (2007). A school-based approach to early identification and management of students with ADHD. Journal of School Nursing, 23 , 2-12.

Denny, S., et al. (2012). Association between availability and quality of health services in schools and reproductive health outcomes among students: A multilevel observational study. American Journal Of Public Health, 102, e14-e20. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=82052695&site=ehost-live

Duncan, P. & Igoe, J. (1998). School Health Services. In Eva Marx (Ed.), Health is academic: A guide to coordinated school health programs. New York: Teachers College Press.

Espelage, D. L., Bosworth, K., & Simon, T. R. (2000). Examining the social context of bullying behaviors in early adolescence. Journal of Counseling and Development, 78, 326-333.

Gerler Jr., E. R., (1992). What we know about school counseling: a reaction to Borders and Drury. Journal of Counseling and Development, 70 , 499-501. Retrieved September 10, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=9206290426&site=ehost-live

Grassia, T. (2004). No-nit policies subject of debate. Retrieved September 10, 2007, from HeadLice .org http://www.headlice.org/news/2004/debate.htm

Henderson, A. & Rowe, D. (1998). A healthy school environment. In Eva Marx (Ed.), Health is academic: A guide to coordinated school health programs. New York: Teachers College Press.

Kang-Yi, C. D., Mandell, D. S., & Hadley, T. (2013). School-based mental health program evaluation: Children's school outcomes and acute mental health service use. Journal of School Health, 83, 463-472. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=88266493&site=ehost-live

Kegley, C. & Cottrell, R., (1993). Comprehensive school health: A narrative explanation. Wellness Perspectives, 9 , 47. Retrieved September 10, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=9311220942&site=ehost-live

Kowalski, T. (1995). Chasing the wolves from the school house door. Phi Beta Kappan, 76, 486-489.

Langford, G. A., & Carter, L., (2004). Academic excellence must involve physical education. Physical Educator, 60 , 28. Retrieved September 10, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=9349586&site=ehost-live

Luthy, K. E., Thorpe, A., Dymock, L., & Connely, S. (2011). Evaluation of an intervention program to increase immunization compliance among school children. Journal of School Nursing (Sage Publications Inc.), 27, 252-257.Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=63248702&site=ehost-live

McKenzie, F., & Richmond, J. (1998). Linking health and learning: an overview of coordinated school health programs. In Eva Marx (Ed.), Health is academic: A guide to coordinated school health programs. New York: Teachers College Press.

Newton, J., ed. (1987). School health: A guide for health professionals. Elk Grove Village, IL: American Academy of Pediatrics.

Salmivalli, C. (1999). Participant role approach to school bullying: Implications for interventions. Journal of Adolescence, 22, 453-459.

Tattum, D., & Tattum, E. (1992). Social education and personal development. London: David Fulton.

Tremarche, P. V., Robinson, E., & Graham, L., (2007). Physical education and its effect on long term testing results. Physical Educator, 24 , 48-64. Retrieved September 9, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=25338323&site=ehost-live

Vernon, T. M., Conner, J., Shaw, B. S., Lampe, J. M. & Doster, M. E. (1976). An evaluation of three techniques for improving immunization levels in elementary schools. American Journal of Public Health, 66 , 457-460. Retrieved September 9, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=5666383&site=ehost-live

Suggested Reading

Atkinson, M. (2002). Mental health handbook for schools. London: RoutledgeFalmer.

Clay, D. (2004). Helping schoolchildren with chronic health conditions. New York: Guilford Press.

Kegley, C. & Cottrell, R., (1993). Comprehensive school health: A narrative explanation. Wellness Perspectives, 9 , 47. Retrieved September 10, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=9311220942&site=ehost-live

Lear, J., Isaacs, S., Knickman, J. (2006). School health services and programs. Hoboken, NJ: Jossey-Bass.

Marx, E. , Ed. (1998). Health is academic: A guide to coordinated school health programs . New York: Teachers College Press.

Newton, J. (1997). The New School Health Handbook. Hoboken, NJ: Jossey Bass.