Historical, current, and future models of schools as health care delivery settings.

Explores existing models of the school as a health care service delivery setting and considers the implications of these models for the practice of psychology in schools. Since the delivery of health services in schools in the present has emerged in response to social needs from the past, the issue of schools as health care settings is examined from both a historical and contemporary perspective. Emphasis is limited in scope to the school as a bureaucratic structure in which models of health service delivery are situated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building the capacity of schools to improve the health of the nation: A call for assistance from psychologists.

During the past several years, about two dozen major reports have called for the nation to reconceive and regenerate its school health programs. Proposals to reform health, education, and social services have included means to improve such programs. This article (a) identifies the leading causes of mortality and morbidity in the United States, (b) delineates 6 categories of behavior established during youth that contribute to these causes, (c) outlines ways in which a modern school health program might prevent such behaviors and address critical health and social problems among students, (d) describes practical research and development strategies that are being established to help schools implement effective school health programs, and (e) suggests how psychologists might help improve these programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social reforms and the future of school practice: Implications for American psychology.

Social reforms in American education are setting the stage for a paradigm shift in our nation's schools. The convergence of education and health care reform and the movement in the human services arena toward service integration models provide an unprecedented opportunity to redefine psychological services related to schools for the next century. Whereas school psychological services historically have been linked to changes in special education legislation, social reforms in education and health care that emphasize educational achievement and whole-child development offer promise for expanding and enhancing the roles of psychologists whose practices relate to schools and children. This article explores the foundations for change and highlights critical areas in which psychological practice in the schools may develop in the 1990s and beyond. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk behavior in adolescence: Methodological challenges in school-based research.

Presents the 1st phase of a school-based project to begin the identification of factors associated with risk and resiliency in urban African-American youth, as well as evaluate the role of school-based adolescent health centers for this population. A cross-sectional moderated risk design is employed. The participants are students at 6 inner-city public high schools. Three of the schools have school-based clinics offering comprehensive adolescent health care services, including mental health services; the other 3 schools served as comparison schools. Methodological challenges are identified, and strategies for resolution are discussed. Methodological challenges pertinent to school and community entry, characteristics of the school setting, obtaining informed consent, the use of incentives, confidentiality assurance, and the relevance of instrumentation for the study population are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care, school health programs, and adolescent health services: opportunities for health promotion

The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care--and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs.     

Adolescent health, school health activities, community contexts, and health surveys in Sweden

School health activities have been very important in improving adolescent health in Sweden for almost 200 years. In the 1800s, emphasis was on medical services. Vaccination programs and medical examinations became the key issues. Deterioration of adolescent health in the 1960s changed the objectives of both school education and health services to health promotion. Important members of the community followed suit and involvement of the local community has remained a hallmark, even though the extent and direction varies. The subsequent period was characterized by substantial improvement in adolescent health behavior. The latter years of the 1980s and the 1990s saw deterioration of adolescent health behavior. Less emphasis on health promotion, decentralization of school health responsibility from physicians to administrators, and heavy savings directed toward schools were important mediators. Adolescents were also more engaged in international youth cultures with liberal practices, such as drug use. Community surveys of adolescent health behaviors have proven to be important in mobilizing broad local involvement in adolescent health promotion. The lesson learned is that health promotion has to involve as many community members as possible. Coordinating resources and having unified objectives is cost efficient     

Availability of school health services for young children

A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children.     

Managed community health: an integrated health model

As hospitals and physicians pursue integrated health delivery models, they may be overlooking the most effective locations and partnerships for maintaining and improving health outcomes: those in the community. Since the early 1990s, a St. Louis area group known as the Archbishop's Commission on Community Health has been involved in implementing community-based health and wellness programs and services. The programs have been successful because they focus on keeping people healthy in homes, schools, churches, and neighborhoods. This article describes these holistic approaches that include attention to the physical, mental, social, and spiritual needs of members of the community.     

Preventing and managing adolescent health problems.

Reviews the book, Health-promoting and health-compromising behaviors among minority adolescents by D. K. Wilson, J. R. Rodrique, and W. C. Taylor (1997). Although this book was not written specifically for the school-based practitioner, this edited volume provides a comprehensive review of the health-related behavior of diverse adolescent populations and describes empirically validated intervention and prevention models that are very useful to school mental health professionals, particularly those working in urban settings with culturally diverse youth. The editors have divided the text into four sections. The first section provides a useful theoretical framework encompassing developmental, biological, social, and cultural perspectives. The second section describes behavioral patterns among culturally diverse adolescents that compromise and promote health, including drug use, eating habits, physical activity, and sexual behavior. The third section describes several intervention models that have been demonstrated to be effective with minority adolescents. The concluding section provides insight into health policy issues impacting minority adolescents, including access to adequate health care. This volume represents an important contribution to the literature in the area of pediatric, prevention, and community psychology. Although the text generally fails to highlight sufficiently the power of the school as a protective context for adolescents, the conceptual models and examples of community-based programs presented offer the school psychologist very useful information about designing and implementing prevention and intervention programs in schools. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing a comprehensive program for the prevention of conduct problems in rural communities: the Fast Track experience. The Conduct Problems Prevention Research Group

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Characteristics of health education among secondary schools--School Health Education Profiles, 1996

PROBLEM/CONDITION: School health education (e.g., classroom training) is an essential component of school health programs; such education promotes the health of youth and improves overall public health. REPORTING PERIOD: February-May 1996. DESCRIPTION OF SYSTEM: The School Health Education Profiles monitor characteristics of health education in middle or junior high schools and senior high schools. The Profiles are school-based surveys conducted by state and local education agencies. This report summarizes results from 35 state surveys and 13 local surveys conducted among representative samples of school principals and lead health education teachers. The lead health education teacher is the person who coordinates health education policies and programs within a middle or junior high school and senior high school. RESULTS: During the study period, almost all schools in states and cities required health education in grades 6-12; of these, a median of 87.6% of states and 75.8% of cities taught a separate health education course. The median percentage of schools that tried to increase student knowledge on certain topics (i.e., prevention of tobacco use, alcohol and other drug use, pregnancy, human immunodeficiency virus [HIV] infection, other sexually transmitted diseases, violence, or suicide; dietary behaviors and nutrition; and physical activity and fitness) was > 72% for each of these topics. The median percentage of schools that tried to improve certain student skills (i.e., communication, decision making, goal setting, resisting social pressures, nonviolent conflict resolution, stress management, and analysis of media messages) was > 69% for each of these skills. The median percentage of schools that had a health education teacher coordinate health education was 33.0% across states and 26.8% across cities. Almost all schools taught HIV education as part of a required health education course (state median: 94.3%; local median: 98.1%), and more than half (state median: 69.5%; local median: 82.5%) had a written policy on HIV infection among students and school staff. A median of 41.0% of schools across states and a median of 25.8% of schools across cities had a lead health education teacher with professional preparation in health and physical education, and < 25% of schools across states or cities had a lead health education teacher with professional preparation in health education only. Across states, the median percentage of schools, whose lead health education teacher had received in-service training on certain health education topics, ranged from 15.6% for suicide prevention to 51.4% for HIV prevention; across cities, the median percentage ranged from 26.2% for suicide prevention to 76.1% for HIV prevention. A median of 19.7% of schools across states and 18.1% of schools across cities had a school health advisory council. Of the schools that received parental feedback (state median: 59.1%; local median: 54.2%), > 78% reported receiving positive feedback. INTERPRETATION: More than 75% of schools have a required course in health education to help provide students with the knowledge and skills they need to adopt healthy lifestyles. ACTIONS TAKEN: The School Health Education Profiles data are being used by state and local education officials to improve school health education and HIV education.     

Flunking kindergarten after Head Start: An inquiry into the contribution of contextual and individual variables.

The author examined the extent that nonpromotion to 1st grade after kindergarten can be predicted from information about school and family contexts as well as Head Start children's individual characteristics. The sample comprised 261 Head Start children and parents who were participating in a study on the transition to school. Children who lagged behind their peers on academic achievement and social adjustment indicators were more likely to be in the nonpromoted group. Parental school involvement, parental estimates of children's school adjustment, and parental satisfaction with school programs were predictive of risk for nonpromotion. Head Start children were less likely to be retained in public schools that provided educational as well as family services intended to support the transition to public school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enrichment programs to create a pipeline to biomedical science careers

The Student Educational Enrichment Programs at the Medical College of Georgia in the School of Medicine were created to increase underrepresented minorities in the pipeline to biomedical science careers. Eight-week summer programs are conducted for high school, research apprentice, and intermediate and advanced college students. There is a prematriculation program for accepted medical, dental, and graduate students. Between 1979 and 1990, 245 high school students attended 12 summer programs. Of these, 240 (98%) entered college 1 year later. In 1986, after eight programs, 162 (68%) high school participants graduated from college with a baccalaureate degree, and 127 responded to a follow-up survey. Sixty-two (49%) of the college graduates attended health science schools, and 23 (18%) of these matriculated to medical school. Of college students, 504 participated in 13 summer programs. Four hundred (79%) of these students responded to a questionnaire, which indicated that 348 (87%) of the 400 entered health science occupations and/or professional schools; 179 (45%) of these students matriculated to medical school. Minority students participating in enrichment programs have greater success in gaining acceptance to college and professional school. These data suggest that early enrichment initiatives increase the number of underrepresented minorities in the biomedical science pipeline.     

Consultant and client outcomes of competency-based behavioral consultation training.

One barrier to the systematic provision of consultation services in the schools may be the lack of applied training provided to preservice individuals in graduate preparation programs. A model of behavioral consultation training which extends previous competency-based progams is presented. Five doctoral students in school psychology were trained in behavioral consultation procedures using written manuals, videotape models, behavioral rehearsal, performance feedback, self-monitoring, and generalization training. Following university-based practice with trained consultees and student teachers, consultants were assigned consultation cases with teachers who presented actual cases. Behavioral consultation services were effective at remediating behavioral and academic difficulties in 4 of 5 target clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of general health care and STD services use among high-risk youth in Denver participating in community-based urine chlamydia screening

BACKGROUND: In the United States, youth are at highest risk for STDs, and innovative programs have been called for to increase their access to essential STD-related services. To guide the development of such programs, locally relevant information is needed on current use of general health care and STD services in this population. GOAL: To study access to and use of general health care and STD services in a purposive sample of high-risk youth in inner-city Denver. STUDY DESIGN: An interview-based survey conducted as part of a community program for urine chlamydia screening targeting black and Hispanic youth 13 years to 25 years. RESULTS: Of 221 sexually experienced youth in the survey, 72% had accessed general health services in the past year and 39% reported an STD evaluation at any time in the past. Community and school clinics were reported by 50% as a source for general health care and by 62% as a source for STD services. STD clinics were reported by only 14% as a source for STD services. Routine checkups were the most important reasons to seek general health care, yet of those who went for a routine checkup, only 34% reported an STD evaluation. Although few barriers appeared to exist in accessing general health care, anticipated anxiety about procedures and results formed the major barrier to accessing STD services. CONCLUSIONS: Use of general health services was common in this population of high-risk adolescents; however, the provision of STD services as part of general health care visits appeared to be low. On the basis of these findings, a comprehensive STD prevention strategy may be envisioned, which would include provider interventions to increase the provision of STD prevention services in general health care settings; community interventions to enhance access to general health care and STD services; and community-based screening programs for those not able or willing to seek clinic-based services.     

Investing in our future: Unrealized opportunities for funding graduate psychology training.

Purpose: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Conclusion: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emory L. Cowen.

Presents an overview of the career contributions of Emory L. Cowen. For his remarkable contributions to conceptual, empirical and human service advances in the fields of community and clinical psychology, community mental health and education. He has been instrumental in the creation of a field for an entire generation of psychologists. His work has changed public schools throughout the United States. His ideas, research, model programs, program evaluations, and workshops have inspired others to generate new programs that provide affordable human services to thousands of children who are otherwise unlikely to receive help. He pioneered early detection and secondary prevention research. His clear thinking and conceptual challenges have fostered the study of primary prevention and wellness in mental health, both as a field for research and as a social policy. His tireless efforts as President of APA's Division of Community Psychology, a member of the Prevention Task Panel of the President's Commission on Mental Health, and the APA Task Force on Promotion, Prevention and Intervention Alternatives in Psychology are examples of his energetic contributions to psychology in the public interest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)