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This article traces the inception and implementation of school-based health centers in the WinstonSalem/Forsyth County (NC) school system. The challenges that arose during implementation are discussed, along with the opportunities that SBHCs provide to enhance the provision of comprehensive services for children. The involvement of the several school psychologists in the initial planning, organization and implementation of these centers is delineated as an example for other school psychologists who are interested in working with school-based health centers. Schoolbased health centers represent an opportunity for school psychologists to assume a leadership role in the delivery of enhanced health and mental health services for children and families.

The mucopolysaccharide disorders are a group of rare genetic abnormalities of mucopolysaccharide metabolism (Cervantes & Lifshitz, 1990). Mucopolysaccharides act as both an intercellular cement and a ground substance for connective tissue, and they are found in bone, connective tissues, and major organs. In the course of normal body metabolism, the mucopolysaccharides are broken down by a series of enzymes. The disorders are caused by a genetic defect, which leads to a deficiency in enzymes responsible for the breakdown of mucopolysaccharides. Excess quantities of incompletely metabolized mucopolysaccharides accumulate in the cells of bone and connective tissues, producing the characteristic patterns of features and complications. Mucopolysaccharidosis Q p e I (Hurler Syndrome, Scheie syndrome, and Hurler-Scheie Syndrome)Children with these disorders have characteristic skeletal effects known as dysostosis multiplex (Goldberg, 1996). Specific features include (a) enlarged head; (b) progressive curvature of the lower spine (lumbar kyphoscoliosis); ( c ) significant shortening of stature; (d) shortened neck with widened collar bones and ribs; (e) clawlike hand deformities; (f) contractions of the joints; ( g ) flattening of the bridge of the nose, wide nostrils, thick lips, and large and protruding tongue with open mouth; and (h) thick hair and excessive body hair. Hurler syndrome is the most severe of the three syndromes; Scheie and Hurler-Scheie syndromes have less severe expressions. Children with Hurler syndrome appear normal at birth and grow rapidly during their first year (R. P. Nelson & Crocker, 1992). Growth deceleration usually occurs between 6 and 18 months of age (Neufeld & Muen-442

OverviewOtitis media (OM) is inflammation and effusion (fluid, referred to as OME) in the middle ear. It is the second most frequent medical diagnosis for persons of all ages in the United States, and the most frequent medical diagnosis for children under the age of 15 (Schappert, 1992). In 1990, the number of doctor office visits for treatment of OM among children up to age 2 years was 102.1 visits per 100 children per year; for children between 2 and 5 years, the rate was 47.8 visits per 100 children and was 18.2 visits per 100 children between 6 and 10 years old.The middle ear includes the inner surface of the eardrum and three bony ossicles, known as the hammer (malleus), anvil (incus), and stirrup (stapes). The ear funnels sound waves to the eardrum that vibrates as the waves strike its outer surface. The middle ear ossicles vibrate in response to the ear drum vibrations. Their movements pass vibrations to the inner ear, where sense receptors transmit messages to the brain through the acoustic or auditory nerve. The inner ear is connected to the mouth by the eustachian tube and to the outside of the body by the external auditory canal. Inflammation can extend to the eustachian tube and mastoid (the part of the skull just behind the ear). Hearing can be adversely affected by reduced flexibility of the eardrum, reduced mobility of the ossicles, or damage to the ossicles.OM tends to be more prevalent in the winter months when there are increased numbers of upper respiratory (head, nose, throat, and sinus) infections. When the eustachian tube becomes blocked by infection, secretions from the middle ear are prevented from draining, resulting in a negative pressure in the middle ear space. The negative pressure increases the aspiration of secretions from the nose and mouth, resulting in bacterial infections of the middle ear. Young children have shorter and more horizontally placed eustachian tubes than do older children and adults. This results in poorer drainage when they have a cold and the tendency to develop more serious dysfunction of the auditory tube and more frequent infections (Berman & Schmitt, 1995). Additional causes of earaches that are not attributable to OM might include mumps, toothache, external ear infections, and temporomandibular joint dysfunction (Berman & Schmitt, 1995). Environmental risk factors that appear related to increased inci-494