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Community circles are a wonderful way for students to support each other in their classrooms and unite as a schoolwide community.

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The purpose of community circles are to build, maintain and repair relationships while celebrating our shared values. Community circles help to form a healthy, supportive and inclusive classroom and school-wide climate that communicate to all members of the classroom that they belong and are significant. They help to create a supportive classroom environment for maximal learning. Our counseling program regularly uses community circle formats and use restorative practice in classrooms, in small skill-building groups and also to facilitate repair of relationships among students in the Duniway community.

As school counselors, our individual counseling approach is solution-focused and strength-based. Students are identified for individual services by the counselors, teachers, and administrators in consultation with parents. We meet with individual students to positively coach, problem solve, offer support and set personal goals.

As school counselors, we are not therapists and as such, seek to support students with short-term, goal-oriented and brief, solution-focused counseling services that relate to skill-building at school.

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When students are in need of mental health support beyond our scope of practice, resources for outside support can be offered. Counselors are available by phone, email, or appointment. We welcome your questions and look forward to working with you in supporting your child. Our services to parents, like our individual services for students, are brief, targeted and solution-focused.

As parents and school counselors we know it takes a village to raise happy and healthy children. We welcome your inquiries and look forward to helping you find what you need. Jessy Gretzinger: 1. The District is committed to equal opportunity and nondiscrimination in all its educational and employment activities. Laws pertaining to special education students 2 require that schools provide the services necessary for these students to receive an appropriate education.

Such services might include monitoring vital signs, changing dressings, catheterization, tube feeding, or administering oxygen. The school must also provide services to non-special education students with chronic health problems—such as asthma, diabetes, and seizures—in order that they can be educated.

Schools have little or no choice in providing such services, for they are dictated either by legislative mandate or by precautions pertaining to risks and liability.

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Services such as screenings and immunizations are also widely accepted as belonging in the schools, with the motivation having to do more with access, efficiency, and economies of scale than with liability. Since schools are where children spend a significant portion of their time, schools are seen by many observers as the logical site for services that are based on public health principles of population-based prevention.

There is some debate, however, about the relative benefits and disadvantages of a population-based versus a selective high-risk approach, which targets preventive services only toward children at high risk.

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The population-based approach has the advantage of producing a large potential impact on the population as a whole, but a major disadvantage is that the benefits are frequently very small for the individual. Another potential disadvantage is that all interventions have a finite risk of unintended adverse side effects, which are also amplified along with benefits in the population-based approach, possibly resulting in an unfavorable benefit-risk ratio.

Depending on the health issue, one approach may be superior to the other, or a combination of the two may be appropriate. For example, the National Cholesterol Education program recommends a population-based approach for implementing dietary guidelines for children, combined with a high-risk approach to blood lipid screening targeted only at children considered at risk based on family history Starfield and Vivier, Further, schools are strategically positioned to serve in the public health battle against the resurgence of infectious diseases, such as tuberculosis and hepatitis.

Another feature of school health services—one that is often overlooked—is its potential for expanding the knowledge base. School health services can be a rich source of data for studying the relation between health status and learning capacity, and for assessing unmet needs and monitoring the health status of children and adolescents.


Given the above needs and benefits, a basic health services program must be in place in all schools. The issues currently generating much discussion and debate, however, are the role of the school in providing access to primary care, the appropriate lead agency for the more traditional basic school health services, the advantages and disadvantages of a population-focused versus a high-risk approach to the delivery of health services in schools, and the need to develop an integrated system of school health services.

The role of the school in providing access to primary care is a particularly difficult and critical issue.

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Since schools are a public system whereas health care is predominately private, there appears to be a fundamental mismatch between the two systems. Many students already have their own source of primary care, but a significant and growing segment of the student population does not. Those students without access to primary care are usually poor and are often at greatest risk of academic failure.


Chapter 1 of this report documents some of the major problems facing children and adolescents in this country—the new social morbidities, changing family structures, limited access to health care, and lack of health insurance. Poverty is the common denominator among many of these problems. Research has identified an explicable link between poverty and health outcomes. Children in poverty are much less likely than their affluent peers to receive an excellent or very good health rating, and they visit their health care provider fewer times in a year.

Low-income families, facing routine pediatric care costs that consume a large fraction of their annual income, may decide they cannot afford health care until their children's treatment leads to unnecessary hospitalization and valuable days lost from school see Table For example, preventable hospitalizations for pneumonia, asthma, and ear, nose, and throat infections are up to four times higher for poor children than for who are not poor children Center for Health Economics Research, Poor children are also more likely to be limited in school or play activities by chronic health problems and to suffer more severe consequences than their more affluent peers when afflicted by the same illness Newacheck et al.

It is estimated that as many as 12 million children under the age of 18 have no health insurance, or approximately 17 percent of all children in that population American Medical Association Council on Scientific Affairs, Millions more have inadequate plans that fail to cover even basic preventive services, such as immunizations National Health Education Consortium, Although progress has been made in establishing publicly financed community health centers in inner cities and rural areas, school-age youth rarely visit these facilities until their health problems reach crisis stage.

Although Medicaid is intended to provide services for poor children, variations in state Medicaid policies have left almost 40 percent of children who live in poverty without access to basic primary and preventive care Solloway and Budetti, Possible changes in the system imply even greater uncertainty about the role Medicaid will play in providing universal coverage for poor children and adolescents Newacheck et al.

Absenteeism among students is clearly associated with school failure Wolfe, Research has shown that students who miss more than 10 days of school in a day semester have trouble remaining at their grade level Klerman, In particular, children who are poor are two to three times more likely to miss school due to their illnesses Starfield, Indeed, children with health problems are disproportionately poor students on the verge of academic failure.

Youth frequently must miss valuable class time in order to get care for their illnesses during the regular office hours of public and private health professionals. In fact, a recent study found that students utilizing public clinics missed entire days of school per appointment Kornguth, Thus, "health-related risk factors often set in motion a cycle of absenteeism and school failure" Lewis and Lewis, Studies have also found that people living in poverty are twice as likely to have mental health problems; hence, low-income children are especially affected by the absence of accessible mental health care Starfield, Given these findings, it appears that the lack of accessible primary care has a high cost, in terms of both health and education outcomes.

Providing primary care to needy students at the school site has been proposed to be efficient and cost-effective in the long run, in order to improve academic performance and detect health problems early before they require more expensive treatment. Then the difficult question naturally follows: Would all students, not only those in poverty, benefit from availability of convenient, accessible basic primary care services at school, provided by professionals specially trained to deal with their age level?

In their studies of school-based health centers SBHCs in northern California, Brindis and coworkers found that a higher proportion of students who already had conventional private insurance or health maintenance organization HMO coverage utilized the SBHC than those without other coverage, suggesting that ease of access and an understanding staff are perhaps more important factors in utilization than the mere lack of other source of care Brindis et al.

The surprisingly greater rate of utilization for students who already have insurance may possibly be attributed to their greater awareness of the importance of health care, parental encouragement, or understanding how to access the system. Also, many working parents apparently appreciate the convenience of their children being able to receive basic health care at school U.

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General Accounting Office, b. If the school is seen as the most effective site for providing a set of basic primary services, how can these services be organized? Who will pay? How will these services be connected with the traditional "core" services of the school? These are questions without easy answers—or possibly, with different answers depending on the community. Some of these issues are considered in greater depth later in this chapter. The following section provides a summary of typical services found in the school setting.

These services tend to be the most common and basic, although many schools may not provide all of the services described in this section.

For the sake of organization, services have been divided into three categories: health care services, mental health or pupil services, and nutrition and foodservice. It should be emphasized that boundaries between categories are not sharp, and considerable overlap and interaction among services exist.

For each category, there is a description of the service, information about the personnel who provide the service, and a review of some of the important issues in that field. Much of the material in this section came from the discussion at the committee's third meeting and was contributed by representatives of various professional organizations who served on a panel on services at that meeting. The committee has not attempted to assess the professional standards, recommended student-professional ratios, or other issues in this section for validity or adequacy; instead, this section is intended simply to transmit the contributed information.

For further details, the professional organizations can be contacted directly. Additional information may also be obtained from the University of Colorado School Health Resource Services project, which maintains an extensive reference collection of profiles of school health services programs from school districts throughout the country. Services Provided. School nurses are the traditional "backbone" of school health services and are often the only health care providers at the school site on a regular basis.

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As mentioned earlier in this chapter, standards for school nursing have been established by the National Association of School Nurses. The school nurse typically provides population-based primary prevention and health care services, including. The traditional model for school nursing provides for a school nurse, typically in an office or health room, with or without an aide.