Health Opportunities in Schools Charles U. Lowe, MD I want to discuss my perception of opportunities in school health that may well signal a substantially more effective role for this neglected part of the Nation’s health resources. The health care I received as a child from my school health unit was episodic. Bandages were dispensed along with advice on how to avoid the presenting condition in the future-a cool, competent hand pressed to my forehead miraculously, as I knew it would, recorded a temperature too high to risk the rigors of an afternoon English quiz. Many school health programs have come a long way since then. But, the public’s image of school health has qot, I’m afraid, reflected the newer and more innovative approaches to providing health care, and health education in school settings. Physicians can have a significant role in designing health services delivered through the schools. The increasing involvement of physicians in community referral networks has beep instrumental in the development of creative and effective school health programs. Their support and professional backup for school nurses and nurse practitioners are invaluable and essential. It is my hope in discussing HEW’S increasing involvement in school health that areas of mutual interest can be identified and exploited by us at the federal level and by you at your various levels of involvemept. Together we must build national support for an integrated approach ta child health care and education. We are working toward this objective on the federal level, and I know you are working toward complementary ends. At the very least we may be able to dispel1 the outmoded perception of school health that has limited endeavors and expectations alike. But I am sure we can do much more than that. To understand our increasing interest in school health, it might be useful to describe briefly the activities of the Office of Child Health Affairs. This office serves a planning and coordinating function for child health matters on behalf of the Assistant Secretary for Health. Essentially it attempts to expand health services to childreg who “fall between the cracks” of our health care systems and to improve the quality of health services for all children. Over the past two years the office has been involved in developing a number of special initiatives for children. Among these efforts are SEPTEMBER 1977
the following: to reduce pregnancy among teenagers; to expand the availability of amniocentesis services for prenatal diagnosis of genetic diseases; and most recently, to increase immunization rates among children. The immunization campaign calls for a united effort by many individuals as well as groups and organizations, public agencies, private providers, commercial organizations, and volunteer social and health organizations to identify unprotected children and see that they we offered all necessary immunizations. These activities emphasize disease prevention, the cornerstone for any child health strategy. Despite the apparent categorical nature of these initiatives, we believefirmly that health services should be delivered on a comprehensive and continuous basis. Although these initiatives serve to highlight specific health problems or, in the case of amniocentesis, the acceptance of a new medical prpcedure, we do not believe that any of these problems is best handled by a narrowly focused program. The visibility and attention which these three initiatives bring to selected problems, along with additional resources, can create a climate for improvement in patterns of delivering comprehensive health services. Schools can provide the locus for an integrated approach to the many health and education problems faced by school-age children. We are hopeful that school health will evolve as still another initiative-a comprehensive initiative-aimed toward improving the health of children. Our health goals for children include the following: 1. To improve the availability and quality of primary health care for all preschool and school-age children and youth. 2. To provide health education through programs that modify life styles of children in ways that will improve health, promote better use of the health care system, and develop an understanding of individual and societal responsibility for environmental quality. Schools have a number of structural characteristcs which suggest that interaction with the health delivery system could be beneficial. These include: responsiveness to the local political process; community involvement; facilities that are used on a part time basis only; a family orientation; a stable institutional structure with THE JOURNAL OF SCHOOL HEALTH
431
federal, state, and local participation; and universal entitlement for all children. Beyond these attributes, there are additional compelling reasons to look at the school system in an effort to improve child health. Serving children in school appears to offer significant opportunities to lower the cost of delivering quality health services. Furthermore, effective health education can be woven into the curriculum, and obviously certain kinds of morbidity can be most readily detected within the school setting-for example, learning disabilities. Among school-age children, the health problems that do not respond to traditional perceptions of medical treatment are indeed cause for alarm. Problems such as teenage pregnancy, alcohol and drug abuse, suicide and accidents are not satisfactorily resolved or prevented by visits to the doctor’s office. One alternative approach might be to reach childen in what is ideally a learning environment, namely, in school. We did not have to look far to find an example of an innovative school health program which seemed to prove that the first goal, improving the availability and quality of primary health care, could, in fact, be sought through the schools. Woodson High School in Washington, DC, offers an example of successful collaboration among local health and education institutions, and private organizations, including Planned Parenthood and the Junior League. This program, in its third year of operation, is a part of the community school which provides a series of activities after school each day for students and other members of the community. The program has three components: training of students in peer counseling, rap sessions led by the peer counselors, and a family planning clinic. The District of Columbia Department of Human Resources contributes a school nurse and mental health workers. The school makes available the services of a social worker, and Planned Parenthood contributes staff support. The Junior League underwrites a portion of the clinic costs. The rap sessions have proven particularly popular. Frequently the staff is called upon to give special classes on family planning during regular school hours. While physicians have a role in this model, it is obvious that their part is supportive and not within the traditional mode. Another example in which health problems are effectively handled in the school is seen in Framingham, Massachusetts. The Woodrow Wilson Elementary School has applied an environmental model to the growth and developmental needs of school children, whereby common health and education objectives can be integrated where they intersect. The principle feature of the Framingham approach is the commitment to meet the child’s total needs, which include: (1) early identification of learning disabilities in children; (2) 432
THE JOURNAL OF SCHOOL HEALTH
tailoring of the school health program to the needs of the child, as defined by background, family structure, specific disabilities, and factors interfering with the capacity for learning or development; (3) coordinating community resources outside the school such as family counseling and special medical services; and (4) evaluating the program’s effect on the participating children. In addition t o the health and social service components of this project, there is an important and new element that begins t o help integrate educational and health objectives: the matching of a child’s characteristics with a teacher’s style. For example, a child who appears to be in the process of ego-body integration, and a teacher who has structure (in that the children know what is expected of them), who is comfortable giving one-to-one instruction, who is loving and warm, but strong, and who is good with aggressive children are considered an appropriate match. At this point, it is reasonable to ask whether schools can be used as a health resource to contain health care costs. Though we have emphasized the need for providing health services for school-age children, it is obvious that the tensions created by limited dollar resources may jeopardize this intention. There is evidence that containment of health expenditures for children occurs when children have ready access to continuous, comprehensive services, and it is to this end that schools might serve. Several sources of data indicate that an annual expenditure of approximately $200 per child will provide comprehensive child health care services for all children 19 years of age and under. A telling statistic is that $200 for each of 70.5 million children would amount to only $14.1 billion, or less than the $15.4 billion spent for all child health purposes in 1975. Yet an estimated 5 to 10 million children are receiving no primary medical care at all, let alone comprehensive care. There may be dollars available, therefore, through reallocation of resources to bring these children into the health system. The school may be the best vehicle to reach this objective. Because comprehensive primary care services are not widely available, parents may take their children to the hospital emergency room for a service that should be available in a health department, physician’s office, or neighborhood health center. The fee for an emergency room visit is expensive. The new approaches to school health offer a way to avoid these expensive practices and deliver service emphasizing preventive care in an ambulatory setting. These considerations suggest that strengthening school health can help contain health care costs without compromising the quality of care. Can the school really do all this? The answer is, some schools are already doing it. SEPTEMBER 1977
One example of a low cost, high quality health program is in Cambridge, Massachusetts. In 1968 local health professionals realized there was much waste in the many categorical and uncoordinated child health programs in the city. Efforts were made by the pediatric staff of the city hospital to consolidate resources from programs such as school health, city health department, Title V, Head Start, Follow Through, and the episodic child health services at the city hospital. The purpose, in addition to providing services, was to demonstrate that by integrating resources in comprehensive health centers located in schools child health costs could be reduced without sacrificing the quality of care. In 1968-1969 episodic care received by children using the hospital emergency room cost about $60 per visit per child. In 1975 the new school-based health centers were spending annually only $96 per capita for high quality primary, secondary, and tertiary care. The five health centers staffed by nurse practitioners with physician backup make available not only comprehensive health services to all Cambridge children ages 0 through 16 but also selected services, such as family planning and counseling for parents. A major bonus has emerged: five-year-olds who arrive in kindergarten have a healthy start and will continue to receive the kind of health support needed to meet the difficult challenges faced in their new learning environment. Obviously, much skillful planning and hard work have gone into making this comprehensive program available and affordable for those who need the services most. Efforts to provide health services to children through new approaches in schools are being carried out in Hartford, Connecticut; Galveston, Texas; Jersey City, New Jersey; Posen-Robbins, Illinois; Nichols County, West Virginia; and in other cities throughout the country. Another approach to health services for school children which may be adaptable in many communities makes the school the organizing link to community health resources, including private practitioners. A number of schools are performing a referral role which includes record keeping and follow-up to ensure that health care is provided. It is increasingly clear that schools can assist this nation in making quality health Care available to all children. Now, let me turn to a second and perhaps more challenging opportunity for the nation’s schoolshealth education. Last summer the Congress made a commitment to increase health information and promotion efforts on a national basis by enacting the Health Information and Promotion Act, PL 94-317. The new Office of Health Information and Health Promotion, which advises the Assistant Secretary for Health, has begun to develop plans and outline preliminary steps to respond to the SEPTEMBER 1977
congressional mandate. One of the activities planned focuses on research and evaluation of health education curricula in the schools. Increasingly health professionals and the public recognize that the behavior of individuals is one of the most important determinants of health, and that the most sophisticated and accessible health care delivery system will be inadequate if the population does not know how to use it wisely. The school offers a unique setting to introduce and practice preventive health concepts and to teach use of the health care system. Although insufficient emphasis has been placed on curricula for health education and health promotion in innovative school health programs, several new concepts have been developed and are being tested. Some of you may be familiar with the work of Charles Lewis and Mary Ann Lewis at UCLA in what they call “Child Initiated Care.” The program seeks to involve children, parents, and health providers in an effort to reach four goals: (1) to foster the child’s sense of responsibility for his or her own care, (2) to affect children’s attitudes about health care, (3) to increase their knowledge in this area, and (4) to encourage more appropriate utilization of services. The initial experimental child-initiated care project, developed and conducted in the University of California Elementary School, permitted children ages 5-12 to act independently of adult control in seeking care from a nurse practitioner. Over 300 children were observed during a period of two years. The patterns of use of services displayed by them were similar to those of adults. Seventeen percent did not make a visit to the nurse during the two-year period, and approximately 15% of the children accounted for over 50% of all of the visits. Rates of utilization were associated with those variables known to affect adult patterns of use; more affluent females who were the youngest or the only child in the family and who were familiar with the health system were the most frequent users of health services. It is important to note, moreover, that the pattern of use was not associated with the presence of known medical problems. Additional testing of this approach, including a newly developed health education curriculum, is being conducted in the Pomona, California school district. Although this concept may appear to be far removed from what we have known in the past as “health education,” it is not. On the contrary, I believe it will have positive effects on the future development of health education methods. Other projects include a newly developed “YMCA” health education curriculum using physical fitness as the central theme for exploring the importance of healthful life styles and behavior. This approach is being tested in several school locations in conjunction with the local THE JOURNAL OF SCHOOL HEALTH
433
“Ys” with much success. The University of Utah is attempting to involve students in the process of self-care through an “activated curriculum.” Far example, the students learn how to test blood pressures, analyze urine, take temperatures, and use a stethescope. Although the projects I have described up to now have evaluated their efforts only to a limited degree and may not yet be able to document any long-term benefits, they demonstrate the potentially rich and varied texture of new approaches to health education in schools. They are a testimonial not only to the creativity of individuals in the field but also to the opportunity that school systems offer for health education as a relatively untapped national health resource. Both health care and education form part of the basic framework of the world of children. Along with the family and the peer group they constitute the key integrative systems which structure and give meaning to children’s lives, and cannot be effectively divorced from each other without loss in the quality of human services. Let me turn briefly to what the federal government is planning to do to improve and expand school health programs. As a first step, we are building a bridge between health and education and social services with the intent of developing a comprehensive approach to improving the health of all children. This federal effort will include identification of a focus for leadership to which you can turn for assistance. It could mean increased flexibility in the use of federal health education and health service funds for school health programs. Moreover, these efforts should foster the development of creative local programs that capture the combined talents of school and health personnel, as well as those of parents and students. As a second step, we will prepare an inventory of all federal programs with resources that could be used for school health activities. There are, at present, 106 federally-sponsored, child health related programs, many of which could be used in school health projects. Included among these are the Maternal and Child Health program (Title V); the Early, Periodic, Screening, Diagnosis and Treatment Program (Title XIX); the Grants to States for Services Program (Title XX); all titles within the Social Security Act; as well as Health and Nutrition grants (Title IV); Education and Training of the Handicapped (Title X); and Financial Assistance to Local Educational Agencies for the Education of Low-Income Families (Title I), under the Elementary Secondary Education Act of 1965. We want to make it easier to apply for and obtain the funds available through these programs. Within the next six
434
THE JOURNAL OF SCHOOL HEALTH
months we should have an inventory of potential sources of support for school health. Among the activities we would like to see supported with these resources are: state and local school health planning and program development workshops. an exploration of expanded roles for school nurses through additional training. expanded health education training for teachers and other professionals as well as parents in the community. identification of specific approaches to be implemented by schools for meeting the pressing health needs of the medically underserved school-age children. improved evaluation of school health programs. We intend to develop and distribute a resource document that describes briefly school health education curricula and innovative school health programs and indicates where additional information can be obtained. For our efforts to be useful and our commitments sound, we need feedback. It would be useful to us if we could learn more about what you are doing and what you would like to do. One way you might begin this communication is to include in your conference recommendations with specific suggestions on activities you would like the Department of Health, Education, and Welfare to undertake. I d o not want to leave you with the impression that HEW will be able to fulfill every request for funding. We have to be realistic. Since the competition for federal dollars is fierce, you may find that the best place to begin looking for program funds is in your own community or state. We may be able to help you identify what those potential resources are. For 40 years this country has been debating the dimensions of our school health programs. As this conference demonstrates, we still d o not know what they are. The challenge is again before us to develop school health programs that will manifest themselves in the innermost reaches of children who can grow up feeling that both education and health can make a difference in how they feel about themselves and about their world and how they function in that world.
Charles U.Lowe, IUD, is Special Assistant for Child Health Affairs, Office of the Assistant Secretary for Health, Department of Health, Education, and Welfae, Washington, DC 20201.
SEPTEMBER 1977
the following: to reduce pregnancy among teenagers; to expand the availability of amniocentesis services for prenatal diagnosis of genetic diseases; and most recently, to increase immunization rates among children. The immunization campaign calls for a united effort by many individuals as well as groups and organizations, public agencies, private providers, commercial organizations, and volunteer social and health organizations to identify unprotected children and see that they we offered all necessary immunizations. These activities emphasize disease prevention, the cornerstone for any child health strategy. Despite the apparent categorical nature of these initiatives, we believefirmly that health services should be delivered on a comprehensive and continuous basis. Although these initiatives serve to highlight specific health problems or, in the case of amniocentesis, the acceptance of a new medical prpcedure, we do not believe that any of these problems is best handled by a narrowly focused program. The visibility and attention which these three initiatives bring to selected problems, along with additional resources, can create a climate for improvement in patterns of delivering comprehensive health services. Schools can provide the locus for an integrated approach to the many health and education problems faced by school-age children. We are hopeful that school health will evolve as still another initiative-a comprehensive initiative-aimed toward improving the health of children. Our health goals for children include the following: 1. To improve the availability and quality of primary health care for all preschool and school-age children and youth. 2. To provide health education through programs that modify life styles of children in ways that will improve health, promote better use of the health care system, and develop an understanding of individual and societal responsibility for environmental quality. Schools have a number of structural characteristcs which suggest that interaction with the health delivery system could be beneficial. These include: responsiveness to the local political process; community involvement; facilities that are used on a part time basis only; a family orientation; a stable institutional structure with THE JOURNAL OF SCHOOL HEALTH
431
federal, state, and local participation; and universal entitlement for all children. Beyond these attributes, there are additional compelling reasons to look at the school system in an effort to improve child health. Serving children in school appears to offer significant opportunities to lower the cost of delivering quality health services. Furthermore, effective health education can be woven into the curriculum, and obviously certain kinds of morbidity can be most readily detected within the school setting-for example, learning disabilities. Among school-age children, the health problems that do not respond to traditional perceptions of medical treatment are indeed cause for alarm. Problems such as teenage pregnancy, alcohol and drug abuse, suicide and accidents are not satisfactorily resolved or prevented by visits to the doctor’s office. One alternative approach might be to reach childen in what is ideally a learning environment, namely, in school. We did not have to look far to find an example of an innovative school health program which seemed to prove that the first goal, improving the availability and quality of primary health care, could, in fact, be sought through the schools. Woodson High School in Washington, DC, offers an example of successful collaboration among local health and education institutions, and private organizations, including Planned Parenthood and the Junior League. This program, in its third year of operation, is a part of the community school which provides a series of activities after school each day for students and other members of the community. The program has three components: training of students in peer counseling, rap sessions led by the peer counselors, and a family planning clinic. The District of Columbia Department of Human Resources contributes a school nurse and mental health workers. The school makes available the services of a social worker, and Planned Parenthood contributes staff support. The Junior League underwrites a portion of the clinic costs. The rap sessions have proven particularly popular. Frequently the staff is called upon to give special classes on family planning during regular school hours. While physicians have a role in this model, it is obvious that their part is supportive and not within the traditional mode. Another example in which health problems are effectively handled in the school is seen in Framingham, Massachusetts. The Woodrow Wilson Elementary School has applied an environmental model to the growth and developmental needs of school children, whereby common health and education objectives can be integrated where they intersect. The principle feature of the Framingham approach is the commitment to meet the child’s total needs, which include: (1) early identification of learning disabilities in children; (2) 432
THE JOURNAL OF SCHOOL HEALTH
tailoring of the school health program to the needs of the child, as defined by background, family structure, specific disabilities, and factors interfering with the capacity for learning or development; (3) coordinating community resources outside the school such as family counseling and special medical services; and (4) evaluating the program’s effect on the participating children. In addition t o the health and social service components of this project, there is an important and new element that begins t o help integrate educational and health objectives: the matching of a child’s characteristics with a teacher’s style. For example, a child who appears to be in the process of ego-body integration, and a teacher who has structure (in that the children know what is expected of them), who is comfortable giving one-to-one instruction, who is loving and warm, but strong, and who is good with aggressive children are considered an appropriate match. At this point, it is reasonable to ask whether schools can be used as a health resource to contain health care costs. Though we have emphasized the need for providing health services for school-age children, it is obvious that the tensions created by limited dollar resources may jeopardize this intention. There is evidence that containment of health expenditures for children occurs when children have ready access to continuous, comprehensive services, and it is to this end that schools might serve. Several sources of data indicate that an annual expenditure of approximately $200 per child will provide comprehensive child health care services for all children 19 years of age and under. A telling statistic is that $200 for each of 70.5 million children would amount to only $14.1 billion, or less than the $15.4 billion spent for all child health purposes in 1975. Yet an estimated 5 to 10 million children are receiving no primary medical care at all, let alone comprehensive care. There may be dollars available, therefore, through reallocation of resources to bring these children into the health system. The school may be the best vehicle to reach this objective. Because comprehensive primary care services are not widely available, parents may take their children to the hospital emergency room for a service that should be available in a health department, physician’s office, or neighborhood health center. The fee for an emergency room visit is expensive. The new approaches to school health offer a way to avoid these expensive practices and deliver service emphasizing preventive care in an ambulatory setting. These considerations suggest that strengthening school health can help contain health care costs without compromising the quality of care. Can the school really do all this? The answer is, some schools are already doing it. SEPTEMBER 1977
One example of a low cost, high quality health program is in Cambridge, Massachusetts. In 1968 local health professionals realized there was much waste in the many categorical and uncoordinated child health programs in the city. Efforts were made by the pediatric staff of the city hospital to consolidate resources from programs such as school health, city health department, Title V, Head Start, Follow Through, and the episodic child health services at the city hospital. The purpose, in addition to providing services, was to demonstrate that by integrating resources in comprehensive health centers located in schools child health costs could be reduced without sacrificing the quality of care. In 1968-1969 episodic care received by children using the hospital emergency room cost about $60 per visit per child. In 1975 the new school-based health centers were spending annually only $96 per capita for high quality primary, secondary, and tertiary care. The five health centers staffed by nurse practitioners with physician backup make available not only comprehensive health services to all Cambridge children ages 0 through 16 but also selected services, such as family planning and counseling for parents. A major bonus has emerged: five-year-olds who arrive in kindergarten have a healthy start and will continue to receive the kind of health support needed to meet the difficult challenges faced in their new learning environment. Obviously, much skillful planning and hard work have gone into making this comprehensive program available and affordable for those who need the services most. Efforts to provide health services to children through new approaches in schools are being carried out in Hartford, Connecticut; Galveston, Texas; Jersey City, New Jersey; Posen-Robbins, Illinois; Nichols County, West Virginia; and in other cities throughout the country. Another approach to health services for school children which may be adaptable in many communities makes the school the organizing link to community health resources, including private practitioners. A number of schools are performing a referral role which includes record keeping and follow-up to ensure that health care is provided. It is increasingly clear that schools can assist this nation in making quality health Care available to all children. Now, let me turn to a second and perhaps more challenging opportunity for the nation’s schoolshealth education. Last summer the Congress made a commitment to increase health information and promotion efforts on a national basis by enacting the Health Information and Promotion Act, PL 94-317. The new Office of Health Information and Health Promotion, which advises the Assistant Secretary for Health, has begun to develop plans and outline preliminary steps to respond to the SEPTEMBER 1977
congressional mandate. One of the activities planned focuses on research and evaluation of health education curricula in the schools. Increasingly health professionals and the public recognize that the behavior of individuals is one of the most important determinants of health, and that the most sophisticated and accessible health care delivery system will be inadequate if the population does not know how to use it wisely. The school offers a unique setting to introduce and practice preventive health concepts and to teach use of the health care system. Although insufficient emphasis has been placed on curricula for health education and health promotion in innovative school health programs, several new concepts have been developed and are being tested. Some of you may be familiar with the work of Charles Lewis and Mary Ann Lewis at UCLA in what they call “Child Initiated Care.” The program seeks to involve children, parents, and health providers in an effort to reach four goals: (1) to foster the child’s sense of responsibility for his or her own care, (2) to affect children’s attitudes about health care, (3) to increase their knowledge in this area, and (4) to encourage more appropriate utilization of services. The initial experimental child-initiated care project, developed and conducted in the University of California Elementary School, permitted children ages 5-12 to act independently of adult control in seeking care from a nurse practitioner. Over 300 children were observed during a period of two years. The patterns of use of services displayed by them were similar to those of adults. Seventeen percent did not make a visit to the nurse during the two-year period, and approximately 15% of the children accounted for over 50% of all of the visits. Rates of utilization were associated with those variables known to affect adult patterns of use; more affluent females who were the youngest or the only child in the family and who were familiar with the health system were the most frequent users of health services. It is important to note, moreover, that the pattern of use was not associated with the presence of known medical problems. Additional testing of this approach, including a newly developed health education curriculum, is being conducted in the Pomona, California school district. Although this concept may appear to be far removed from what we have known in the past as “health education,” it is not. On the contrary, I believe it will have positive effects on the future development of health education methods. Other projects include a newly developed “YMCA” health education curriculum using physical fitness as the central theme for exploring the importance of healthful life styles and behavior. This approach is being tested in several school locations in conjunction with the local THE JOURNAL OF SCHOOL HEALTH
433
“Ys” with much success. The University of Utah is attempting to involve students in the process of self-care through an “activated curriculum.” Far example, the students learn how to test blood pressures, analyze urine, take temperatures, and use a stethescope. Although the projects I have described up to now have evaluated their efforts only to a limited degree and may not yet be able to document any long-term benefits, they demonstrate the potentially rich and varied texture of new approaches to health education in schools. They are a testimonial not only to the creativity of individuals in the field but also to the opportunity that school systems offer for health education as a relatively untapped national health resource. Both health care and education form part of the basic framework of the world of children. Along with the family and the peer group they constitute the key integrative systems which structure and give meaning to children’s lives, and cannot be effectively divorced from each other without loss in the quality of human services. Let me turn briefly to what the federal government is planning to do to improve and expand school health programs. As a first step, we are building a bridge between health and education and social services with the intent of developing a comprehensive approach to improving the health of all children. This federal effort will include identification of a focus for leadership to which you can turn for assistance. It could mean increased flexibility in the use of federal health education and health service funds for school health programs. Moreover, these efforts should foster the development of creative local programs that capture the combined talents of school and health personnel, as well as those of parents and students. As a second step, we will prepare an inventory of all federal programs with resources that could be used for school health activities. There are, at present, 106 federally-sponsored, child health related programs, many of which could be used in school health projects. Included among these are the Maternal and Child Health program (Title V); the Early, Periodic, Screening, Diagnosis and Treatment Program (Title XIX); the Grants to States for Services Program (Title XX); all titles within the Social Security Act; as well as Health and Nutrition grants (Title IV); Education and Training of the Handicapped (Title X); and Financial Assistance to Local Educational Agencies for the Education of Low-Income Families (Title I), under the Elementary Secondary Education Act of 1965. We want to make it easier to apply for and obtain the funds available through these programs. Within the next six
434
THE JOURNAL OF SCHOOL HEALTH
months we should have an inventory of potential sources of support for school health. Among the activities we would like to see supported with these resources are: state and local school health planning and program development workshops. an exploration of expanded roles for school nurses through additional training. expanded health education training for teachers and other professionals as well as parents in the community. identification of specific approaches to be implemented by schools for meeting the pressing health needs of the medically underserved school-age children. improved evaluation of school health programs. We intend to develop and distribute a resource document that describes briefly school health education curricula and innovative school health programs and indicates where additional information can be obtained. For our efforts to be useful and our commitments sound, we need feedback. It would be useful to us if we could learn more about what you are doing and what you would like to do. One way you might begin this communication is to include in your conference recommendations with specific suggestions on activities you would like the Department of Health, Education, and Welfare to undertake. I d o not want to leave you with the impression that HEW will be able to fulfill every request for funding. We have to be realistic. Since the competition for federal dollars is fierce, you may find that the best place to begin looking for program funds is in your own community or state. We may be able to help you identify what those potential resources are. For 40 years this country has been debating the dimensions of our school health programs. As this conference demonstrates, we still d o not know what they are. The challenge is again before us to develop school health programs that will manifest themselves in the innermost reaches of children who can grow up feeling that both education and health can make a difference in how they feel about themselves and about their world and how they function in that world.
Charles U.Lowe, IUD, is Special Assistant for Child Health Affairs, Office of the Assistant Secretary for Health, Department of Health, Education, and Welfae, Washington, DC 20201.
SEPTEMBER 1977
