The establishment of school-based health centers provides an effective way to advocate for children. The National Association of Pediatric Nurse Practitioners (NAPNAP), as a professional organization that advocates for children and provides leadership for Pediatric Nurse Practitioners (PNPs), supports the use of pediatric nurse practitioners in school-based health centers to eliminate access to care barriers for children by providing comprehensive primary care and linking these services with other community resources (Jones & Clark, 1997). PNPs, collaborating with school personnel, improve health care delivery and promote effective, timely, and accessible services for children (Gaffrey & Bergen, 1998). Although school-based health centers are located on the grounds of the target school, they serve a broader population and geographic area.
There are major gaps in today's health care system for children; inaccessibility to health care, lack of preventive services for youth (Nader, 1998), and lack of a stable funding stream that affects sustainability (Brindis, 2003). School-based health centers fill these gaps by providing comprehensive physical and mental health services to children in need of care at locations accessible to children. School-based health centers are not designed to replace an ongoing relationship a child may have with a primary provider. Rather, the centers are designed to overcome social and economic barriers to accessing health care (Levy & Shepardson, 1992).
NAPNAP supports the following:
•The availability of school-based health centers for all school aged children, from infancy through high school.
•A multidisciplinary team, consisting of nurse practitioners, educators, school nurses, physicians, social service, and other professionals, should collaborate to best meet the needs of children and adolescents.
•With parental involvement, children and adolescents should receive comprehensive primary care, including social services and mental health and health education with a focus on wellness.
•School-based health care should be delivered in the context of family and community.
•All students should receive the health-related programs and services necessary for them to derive maximum benefit from their education (Allenworth et al., 1997).
•School-based health centers should meet standards of care similar to those of community health centers, including certification, credentialing of providers, and a systematic evaluation of the outcomes of services (Gance-Cleveland et al., 2003).
•Legislative support for school-based health centers.
•Health carriers to provide coverage for services provided in school-based health centers if the services would be covered under the policy in another setting.
•Managed care plans to provide coverage for services provided in school-based health centers without requiring prior app-roval from a primary care provider.
In summary, school-based health centers and services are an important and necessary component to health care for children that provide a comprehensive range of services that specifically meet the needs of children. They are located where the children are, thus increasing access to health care. School-based health services provide a means to deliver health care to all children, including the many children who have inadequate or no health insurance (Edmunds & Coye, 1998). The school-based health care setting provides a unique opportunity to implement a multidisciplinary team approach, utilizing integrated services to effectively treat problems affecting a child's health, school performance, and school attendance.
Acknowledgements
The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution made by the NAPNAP School-Based Health Care Special Interest Group in the development of this statement.
References
References
Allenworth et al., 1997.
1.In:
Allenworth D, Lawson E, Nicholson L, Wyche J editor. Schools and health: Our nation's investment. Washington, DC: Institute of Medicine; 1997;.
Brindis et al., 2003.
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Brindis CD, Klein J, Schlitt J, Santelli J, Juszczak L, Nystrom RJ.
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Edmunds & Coye, 1998.
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Edmunds M, Coye MJ editor. America's children: Health insurance and access to care. Washington, DC: Institute of Medicine; 1998;.
Gaffrey & Bergren, 1998.
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School health services and managed care: A unique partnership for child health. Journal of School Nursing. 1998;14:14–20. MEDLINE
Gance-Cleveland et al., 2003.
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Gance-Cleveland B, Costin DK, Degenstein JA.
School-based health centers: Statewide quality improvement program. Journal of Nursing Care Quality. 2003;18:288–294. MEDLINE
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Increasing access to health care: a study of pediatric nurse practitioner outcomes in a school-based clinic. Journal of Nursing Care Quality. 1997;11:53–59. MEDLINE
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Levy JE, Shepardson W.
A look at current school-linked service efforts. The Future of Children. 1992;2:44–55.
Nader, 1998, June 8.
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Nader PR.
School health: A bridge between public health and health care. Keynote Address from Proceedings of the School Health Initiative. Washington, DC: George Washington University; 1998, June 8;.
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☆ No part of this statement may be reproduced in any form or by any means without prior written permission from the National Association of Pediatric Nurse Practitioners except for one copy for personal use.
Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on June 25, 2004.
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