School children who are in need of essential health care and who lack access to adequate health education are destined to poor academic performance and achievement. A sick child is a compromised child, and there is a pressing need and unavoidable obligation to
improve the health of children in our public schools.

The Dr. John T. Macdonald Foundation School Health Initiative, the second of the foundation's signature programs, creates a comprehensive and coordinated system of health clinics in a single feeder pattern of our public schools. School health clinics were once a staple of public school education experiences. Virtually all public schools enjoyed the presence and security of a school clinic and nurse, which ensured an environment for healthy
and productive students.

Over time, however, these programs have been significantly scaled back. Tight budgets, overcrowding, and substandard space have culminated in a situation that nears a public school health crisis. Students simply cannot perform well academically if they are in poor physical health or if they are not practicing healthy behaviors outside of school.

Providing health care and health education in schools is a cost-effective way to reduce barriers to health services and, ultimately to learning. Despite growing interest among educators and health professionals, it has been difficult to develop and maintain a comprehensive and coordinated school health program in Miami-Dade County, the fourth-largest public school system in the nation.

In July 2000 the Dr. John T. Macdonald Foundation partnered with the University of Miami School of Medicine to develop and implement a comprehensive school-based health program within a single feeder pattern of the Miami-Dade County Public School system. This initiative is designed to provide access to comprehensive primary health care including wellness education and support services all within a school setting. The model utilizes the five schools that comprise the North Miami Beach feeder patter for the provision of these services: Fulford Elementary, Greynolds Park Elementary, G.K. Edelman/Sabal Palm Elementary, John F. Kennedy Middle School, and North Miami Beach Senior High. The primary goal of the School Health Initiative is to provide the most basic health care, health promotion and disease prevention education, and psychosocial services for medically underserved children from elementary to high school in our public school system.

Working in cooperation with Miami Dade County Public Schools and other community-based partners, activities of the project are led by the Program Director Robert Schwartz, M.D., Chair for the Department of Family Medicine and Community Health at the University of Miami’s School of Medicine, and the Initiative’s Medical Director, Joycelyn Lawrence, M.D. Key components of the project include the provision of basic school nursing and social worker services at the three elementary schools and operation of two school based health centers offering comprehensive primary care and mental health services at the middle school and the high school. Age-appropriate care is provided within a holistic framework that takes into account cultural and linguistic differences as well as the developmental needs of students and their families. Services are available to all of the nearly 8,000 children who attend the participating schools regardless of their ability to pay. Furthermore, by using a successful methodology called service learning, the program links academics to community service tasks and, in the case of health professions students, gives learners a chance to acquire knowledge and skills that will help them address patients' real-world problems.

Multidisciplinary teams and innovative health professions education and training are used to create a signature program that can serve as a model for other feeder patterns and other communities. The program seeks to elevate awareness of the need and generate support for a strong school health program among elected and appointed officials, state and federal agencies, school administrators, teachers and counselors, and community members. Collaborative efforts with these groups are essential to the long-term success of the School Health Initiative.

By focusing on risk assessment, prevention, early diagnosis and treatment, the Dr. John T. Macdonald Foundation School Health Initiative has developed innovative approaches to long-term problems such as childhood obesity and asthma. Multidisciplinary teams and community-based health professions education and training are used to create a signature program that is now being considered as the model for Miami-Dade County.

In 2005, the Dr. John T. Macdonald Foundation renewed its commitment to this project by awarding an additional $874,000 to the Initiative. We have been joined by the Batchelor Foundation, which has committed an additional $250,000 a year for three years. We are proud of the partnership we have formed with the Batchelor Foundation, the University of Miami and the other funders who have contributed to this initiative and understand its value. With its future in North Miami Beach more secured, the project is now actively working with elected and appointed officials, state and county agencies, school administrators, teachers and community activists to take the Foundation's original vision to the next level by promoting improved school based health services throughout the district.