This report presents findings from Periodic Survey #26 which explores pediatricians' a) perception of the existence of and the need for age-appropriate specific health-related programs for grades K-12 in their community, b) current participation in local school health programs, c) views on school-based clinics, and d) awareness of the existence of an integrated system of health care for children in their practice community. PS#26 was an eight-page self-administered questionnaire sent to a random sample of 1,602 active U.S. FAAPs. The original mailing and five follow-up mailings to recontact nonrespondents were conducted from July to November 1994. After six mailings we received a total of 1034 completed questionnaires for a response rate of 64.5%.

Local School Health Programs:

More than one-half of pediatricians say there are school programs in their practice community that address substance abuse (58%), human sexuality (57%) and HIV/STD prevention (52%). However, many did not know what programs their local schools provide. Sixty percent or more of respondents said they do not know whether or not their school has a program in the following areas: violence prevention, conflict resolution, mental health, community or environmental health, and disease prevention. Regardless of whether or not pediatricians know of such programs, the majority believe there is a great need for programs in all of these areas. A majority of pediatricians report that school nurses provide screening and referral services in the schools in their practice community (71%), as well as on-site primary care (63%).

Participation in Local School Health Programs:

About one in five pediatricians (22%) participate in a professional capacity in local school health programs, usually without pay: most of these pediatricians teach a class, consult on school health services/curriculum, or treat children with special needs referred by the school. Older pediatricians, those in general pediatrics, in rural or suburban practices and in solo or group practices are more likely to participate in local school health programs. About half of participating pediatricians (52%) say they are satisfied with the amount of time they currently spend in school health, while nearly as many (48%) would like to spend more time in these activities More younger than older pediatricians say they would like to spend more time in school health programs. The reason for not participating or limiting participation in school health given by most pediatricians is lack of time (74% so reporting).

Most pediatricians (70%) are interested in participating in school health programs. Among those interested pediatricians, 54% say they would like to serve as a consultant on the health education curriculum and 45% would like to consult on school health services; 43% would like to teach a class or serve on a community child health council/school health advisory committee. In order to begin or increase their involvement in school health programs, about two-thirds of these pediatricians say they need information on 1) how they can make a meaningful contribution with the limited amount of time they have available, 2) how to get started in local school health, 3) their local school's health education curriculum so that they can reinforce these messages during preventive care visits, and 4) the components of an optimal comprehensive school health program.

Views on School-Based Clinics:

Half or more of pediatricians believe school-based clinics 1) provide care unavailable elsewhere for teens, 2) are not just appropriate for teens who have no other source of care, 3) should extend services to preteens, and 4) should dispense contraceptives to teenagers. An overwhelming majority of pediatrician agree that schools are an appropriate setting for health education in HIV prevention (91%) and human sexuality/pregnancy prevention (87%), that pediatricians should serve as a resource for school health education programs (85%), and that medical schools and residency programs should train pediatricians in school health (79%).

Local Integrated Services for Children:

Most pediatricians (85%) are not aware of any council or group in their community that has developed or is working on the development of an integrated delivery system for children that coordinates educational, health and social services; 8% say such a group is in place, and 6% say such a group is being discussed. Among those who say such a group is in place or is being discussed, nearly half (46%) say they participate in that group.

About 55% of all respondents say they are interested in becoming involved or more involved in initiating or implementing an integrated system of care for the children in their practice community. Among those pediatricians, 69% say they need basic information on what is an optimal integrated services program; 64% say they need information on how to network with schools and social services providers in the community. While 37% of pediatricians say they need to be convinced of the necessity of a community integrated services program, when asked about the effectiveness of various community services and resources (components of an integrated service system), more than half of pediatricians believe these services are very effective in improving outcomes for children with multiple health and social service needs.