Descriptive text
CSHP AT-A-GlanceConcept to ActionResourcesLinksNewsletter
Concept to Action Making Health Academic Home Concept to Action

Action Steps

Comprehensive School Health Education

School Counseling, Psychological, and Social Services

Healthy School Environment

Family and Community Involvement

School Health Services

School Nutrition

Physical Education

Health Promotion for Staff

Action Steps for Implementing School Health Services

For all students, health problems impair academic performance. Those students who experience health disparities also often experience education disparities. Some of the major health problems that confront American children and adolescents include overweight and obesity, asthma and other respiratory afflictions, HIV/AIDS, and psychosocial and behavioral disorders. Parents worry, for example, that a child who has had an asthma attack may not receive prompt medical attention at school. Adolescent depression may result not only in sadness, but also by irritability or boredom, with implications for school performance.

Schools can meet these student needs by offering prompt and efficient on-site access to school-based health services.  School health services are screening, diagnostic, treatment, and health counseling services provided at the school. Such services are provided by school nurses and by school health centers either on-site or on the campus. Optimally, school nurses and school-based health centers work in partnership, maximizing access to care and use of scarce resources for such care.

School nurses are public health nurses who work in over 50% of America’s schools to provide direct care to students with basic health needs, coordinate health and education services for students with disabilities, and refer to and link with other health providers to ensure that students’ health problems are addressed and do not interfere with their academic activities. There are 58,000 school nurses in the United States. School nursing emerged on October 1, 1902, following the "experimental" placement of a public health nurse, in a New York City school., which resulted in reducing school absenteeism due to communicable diseases, Increasingly, school nurses work on student wellness, disease prevention and health education.

School health centers blend medical care with preventive and psychosocial services as well as organize broader school-based and community-based health promotion efforts. In addition to providing comprehensive primary medical and mental health care, school-based clinic staffs commonly mobilize existing community resources to create referral networks for students, address adolescent sexuality and reproductive health issues, and provide health and nutrition education though comprehensive, multi-disciplinary approaches involving physicians, nurse practitioners or physician assistants, nurses, clinical social workers, and other mental health professionals and counselors. In the 2001-2002 school year, school-based health centers numbered 1,500, a more than ten-fold increase from 120 a decade earlier.

Community health centers are not-for-profit providers of healthcare to America's poor and medically underserved.   For over 30 years, they have been responsible for bringing doctors, basic health services and facilities into the nation's neediest and most isolated communities.   Health centers serve the working poor, uninsured, as well as high-risk and vulnerable populations. 

Below, you will find action steps to help you incorporate school-based health services into a coordinated school health program and links to useful websites and documents.

Actions for Schools and Communities

  • Form a Healthy School Team comprised of students, parents and other caregivers, community representatives, and key school staff to assess student needs, map community and school resources, identify gaps, and develop action plans to improve health outcomes for students
  • Establish an interdisciplinary school health services team comprised of well-qualified, including school nurses, pediatricians, and other school-based health personnel, appropriately educated health providers, providing physical and mental health services that emphasizes prevention and early intervention
  • Ensure that schools employ professional healthcare personnel, such as nurses, based in the school or school-based health center
  • Develop strong school-community health partnerships with a health center, public health entity and/or hospital
  • Appoint a school health services coordinator who has access to the superintendent, principal, or other senior school administrator
  • Work with the school-based health services team and school administration to develop and achieve a shared vision for healthy youth
  • Use the results of mapping to identify the most appropriate school health services configuration
  • Adopt generally accepted guidelines for clinical practice
  • Assess child and adolescent health care needs and available resources through formal evaluation methods
  • Solicit community input to address unmet health needs and support the operations of the program
  • Encourage student's active, age appropriate participation in decisions regarding health care and prevention services
  • Involve parents as supportive participants in the student's health care
  • Coordinate and integrate efforts with existing systems to optimize complementary programs, improve continuity of care, reduce fragmentation, prevent duplication, and maintain affordable services

Actions for National and State Organizations and Colleges and Universities

  • Establish certification processes and educational opportunities that can prepare diverse school health professionals to function effectively as members of interdisciplinary, results-oriented teams
  • Develop and disseminate guidelines, best practices, and model policies for school health services that focus on a range of service delivery models
  • Provide technical assistance and position statements that support the development of a coordinated service system
  • Provide data, funding, training, and statistical support for mapping or community assessment
  • Educate staff to help schools blend funding streams, accept consolidated applications and reports from communities, establish program objectives rather than program design, and ensure that new initiatives relate to and build on one another
  • Conduct or fund research that examines the impact of school health services on student well-being and academic performance
  • Encourage participation in national and local conferences that focus on adolescent and child health

Adapted by permission of the publisher from Marx, E. & Wooley, S.F. (Eds.) (1998). Health is academic: A guide to coordinated school health programs. New York: Teachers College Press. 1998 by Education Development Center, Inc. All rights reserved.

Action steps were updated (2002) and adapted from the National Assembly on School-Based Health Care (NASBHC) resources.

For a more detailed discussion of School Health Services, see the book Health Is Academic.


About School-Based Health Centers, NASBHC

Issue Briefs, National Association of School Nurses

National Principles for School-Based Health Care, NASBHC

Position Statements,National Association of School Nurses

School-Based Health Services: Guidelines for School Health Programs, Center for Health and Healthcare in Schools

Technical Assistance Guide on Medicaid and School Health, Centers for Medicare and Medicaid Services

Related Links

Advocates for Youth

American Academy of Child and Adolescent Psychiatry

American Academy of Pediatric Dentistry

American Academy of Pediatrics

American Medical Association

American Nurses Association

American School Health Association

Association of Maternal and Child Health Programs

Center for Health and Health Care in Schools

Communities in Schools, Inc.

National Association of Pediatric Nurse Practitioners

National Assembly on School-Based Health Care

National Association of School Nurses

National Education Association

Public Education Network

Society for Adolescent Medicine

State Children's Health Insurance Program

University of Colorado Health Sciences Center

For other organizations that support school health, click on Links.


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