Adolescent Medicine: State of the Art Reviews

School-Based Services and Adolescent Health: Past, Present, and Future
Julia Graham Lear

Health programs were introduced into schools approximately 100 years ago. Since that time, changes in school health programs and philosophies have been influenced by trends in the fields of both education and health care. This article describes the beginnings of school health in the United States, suggests the varying roles health and education have played in the evolution of its character, outlines the philosophical and political underpinnings of the system, and identifies three perspectives on school health as it is conceptualized and practiced in the 1990's.

Comprehensive School-Based Health Centers: Implementing the Model
Bruce P. Guernsey and Doris R. Pastore

Increasing numbers of school health centers are being established nationwide as a means of easing access to and increasing utilization of primary health care services for high-risk youth. The multiple issues involved in establishing and maintaining a school-based health center are presented. The authors discuss the steps necessary to assess student needs and build community support, develop the plan for delivery of school-based primary care, implement the school-based health center model, and evaluate the health center program.

School-Based Primary Care in a Managed Care Environment: Options and Issues
Cristel Brellochs, Donna Zimmerman, Therese Zink, and Abigail English

As school-based health centers have established a track record in providing access to primary care services for undeserved school-age populations, financial viability of these programs has become increasingly dependent upon revenues generated from Medicaid and other third-party payers. The introduction of managed care concepts into this situation has created great uncertainty for the future. The authors discuss the various types of managed care models that school-based health centers are being called upon to work with and summarize the key issues (communications, confidentiality, linkages, reimbursement, and quality improvement) around which those relationships are being developed.

Research and Evaluation in School-Based Health Care
Joy G. Dryfoos, Claire Brindis, and David W. Kaplan

With the rapid growth of school-based health centers has come a challenge to produce evidence that they are having an effect on the health and lives of the students they serve. The authors discuss the sources of data that are currently in place to assess the effects of school-based programs, present findings from these sources, address the problems of conducting research and evaluation in school settings, and present ideas about future data collection and research studies.

Issues and Opportunities in the Middle School Years: Implementation of the Turning Points Recommendations
Maria Garza-Lubeck

Educational reforms intended to improve the learning and social environment for middle school students are now under way. These are aimed at making junior high schools student-centered, interdisciplinary, and flexible. The author reviews what has been learned from several major projects undertaken to accomplish middle school reform, presents examples from communities that are successfully implementing these reforms, and concludes with a series of guidelines that can be used by those interested in enhancing the experience of middle school students.

Health Care in College
Harris C. Faigel

Where college health services were once medical offices focused solely on treating disease, these services now are integrated into the mission of the academic village as accountable, responsible, and authoritative partners in the educational enterprise. In this article, the author discusses up-to-date issues in the management of college health services, the medical and mental health care provided, the special care offered to international students, the research and training performed at these health services, and the interdepartmental and coordination issues involved in providing college health care.

Evaluation and Management of Learning Difficulties
Esther H. Wender

The "adolescent with learning difficulties" is a descriptive label that can refer to many different problems and causes for these problems. These can include specific learning disorders, attention deficit hyperactivity disorders, other types of psychiatric disorders, reactions to stressful experiences, the result of temporary crises in development, or any combination of these. This article addresses causal factors, definitions, assessment, and treatment of learning difficulties in adolescents.

Can School-Based Health Services Reduce Absenteeism and Dropping Out of School?
Lorraine V Klerman

Studies have shown that a high school diploma, and preferably some post-high school education, is essential to economic success for most individuals in American society today. With large numbers of adolescents having excessive absenteeism or dropping out of school, programs are being developed to address these issues. The author examines what is known about the impact of health on absenteeism and dropping out, and the effects of programs that have tried to address these problems.

Comprehensive School Health
Mary E. Vernon and Susan Frelick Wooley

The Division of Adolescent and School Health of the Centers for Disease Control and Prevention has developed a model for comprehensive school health programs which consists of eight components that allow for collaboration among Health care providers, educators, community groups, and other professionals concerned about the well-being of adolescents. This article presents the overall comprehensive school health program and offers strategies for health care practitioners who are interested in collaborating with school personnel and community members responsible for the eight components of the program.

Roles and Responsibilities of School Nurses and Physicians in Adolescent School Health Programs
Susan Lordi and Marcie Schneider

Studies indicate that more than 60% of all junior and senior high schools have at least one nurse providing school health services, whereas more than 30% include physicians in their health care programs. The diverse roles played by nurses and physicians in school health care are reviewed, with an emphasis on guidelines developed by the National Association of School Nurses and positions promulgated by the American Academy of Pediatrics.

School-Based Nutrition Education Programs and Services for Adolescents
Mary Story and Diane Neumark-Sztainer

School-based nutrition education programs and services can offer a systematic and efficient venue for promoting health-enhancing eating behaviors among youth. This article reviews priority nutrition concerns of adolescents; guidelines for healthful eating; and plans of action schools can take to improve nutritional health of students, including an integrated model for comprehensive school-based nutrition education consisting of eight interrelated components.

Mental Health in the Schools: Promising Directions for Practice
Linda Taylor and Howard S. Adelman

Discontent with the state-of-the-art of mental health services being provided in schools has led to fundamental shifts in thinking about these services. This article reviews existing programs and highlights emerging trends in school mental health services. The authors demonstrate how mental health programs are changing from narrowly focused to comprehensive, from fragmented to coordinated, from problem-specific to cross-disciplinary, and from being supplementary services in the school to essential components that enable learning.

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