give acces to education health social services etc. in cities
Answers
The current state of organization of health and social services in schools does not lend itself to orderly description. In any given school, one might find a complex program that includes a mental health team, a school-based clinic, case management, and a family resource center. In another school a nurse may be carrying the full responsibility with only part-time visits from a school district social worker, counselor, and/or psychologist. Out of this broad landscape, several major trends are discernible. In many communities where the school system serves primarily disadvantaged students who lack access to health services, community agencies are relocating their services into schools to augment the work of school staff. In a few places, school health efforts have been integrated with school reform initiatives to create a completely different kind of community or full-service school that is responsive to the needs of the local population. Both school systems and community agencies are open to making new administrative arrangements that will improve the status of child and family health.
Research and evaluation findings demonstrate that low-income families and their children do indeed gain access to needed health services through school-based programs. Among adolescents, those with the greatest needs (measured by high-risk behaviors) are using the services the most. Users of school-based health services are less likely than others to have health insurance. Mental health and dental services are particularly in demand in communities with marginal resources; however, clinics in schools are also finding many previously undocumented cases of chronic diseases (asthma, heart problems) and illnesses. Use of hospitals and emergency rooms has declined in a few places with school-based health services. It has been more difficult to document the impact of these school-based services on high-risk behaviors, such as substance abuse, unprotected sexual intercourse, or violence. School attendance and achievement have improved in some schools with support programs. The data suggest that intense and targeted programs produce the most measurable effects.
Broad replication of comprehensive health and social service programs in schools will require many systemic changes in both the educational establishment and community agencies that supply the services. A number of issues must be addressed, such as financing, governance, turf, staffing, controversy, community input, and parent involvement. A strong movement is under way to create new kinds of arrangements for the delivery of primary health care and social services in schools in conjunction with upgrading the quality of education. States and foundations have taken the lead and will probably have to continue to do so. Leadership at the federal level, as well as opportunities for technical assistance in planning, training, evaluation, and research, would contribute to the growth of this emerging field. Organization Of Services In Schools
Traditionally, when we think of school health services, we remember the school nurse who was on hand to take temperatures of sick children, call their families, and keep reports on absences. The nurse also measured students' heights and weights every year and examined their posture for signs of scoliosis.
Today's picture of school health services is vastly changed. First of all, the domain of "health" has stretched to include mental health, social services, and social competence—whatever is needed to enhance the lives of children and families. As a result, the number of different health, mental health, and social services available on school property has greatly increased and the organizational arrangements have become much more complex. Tyack (1992) has shown that despite the growing shift toward academic concerns in recent years, the proportion of school staff who are not teachers has grown significantly, from 30 percent in the 1950s to 48 percent in 1986. He believes that schools are increasingly becoming "multipurpose agencies" despite the push toward academic testing and standards.
Just how complex this picture of school health services has become can be seen in the vast array of issues that are being addressed by different kinds of interventions. Table D-1 displays the diverse goals and components of current programs based in schools. Table D-2 reveals that at least 40 types of personnel enter into schools to provide services; some are employed by the school districts, others by community agencies. Table D-3 presents the assortment of organizations that bring services into schools, including local public health departments, voluntary agencies, businesses, and foundations.
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