Health Services for Special Needs Children in Pennsylvania Schools
Bradford, Bradley J., Heald, Pamela, Petrie, Shirley, Journal of School Health
School health programs traditionally encompass health services, health instruction, and fostering a safe school environment. Historically, school health services were provided by nurses, nurse assistants, physician consultants, and appropriate administrative personnel. Specific services included mandated screening for such conditions as tuberculosis and scoliosis, verification of immunizations, and meeting the needs of children with chronic illnesses in the school setting. In the 1990s, integration of primary care services through school-based clinics has added to activities of school health programs which traditionally offered only mandated screenings.
Recent public policy debates centered on both the efficacies of traditional school health programs and their positioning for management of chronically ill students who come to school with a new set of morbidities and technological dependencies. Reports from school personnel as well as the literature support the fact that more chronically ill children, particularly technology dependent children, are present in regular school settings. The individuality of chronically ill children in schools must be understood: some have chronic illnesses with disabilities that create medical and educational problems; other have conditions with attendant treatments which affect the school environment. While the number of such children has not been documented, the effect these children have on school health programs is significant and will continue to grow.
Recent school health literature has addressed the impact that chronically ill, technology dependent children have on programmatic, administrative, and legal issues in schools. Children who are graduates of NICUs or who have cancer or other complex medical disorders present challenges to educators, schools, nurses, and physicians interfacing both within and outside the school setting.[5,6] Little data exist on the growing population of chronically ill children in schools or on the preparedness of the present school nurse and existing school health programs to deal with them. Coordination of multidisciplinary care, education of school personnel, and actual costs of integrating such students are issues just now being addressed.
This survey determined the number and kind of special needs children in regular school settings in Pennsylvania. A 15-item questionnaire was mailed to all school nurses in Pennsylvania (N = 1,934)in spring 1992. Surveys were coded to assure anonymity of respondents. After two mailings, 965 (50%) questionnaires were returned. Questions were designed to elicit information about the nature and characteristics of the school's population and personnel. Responses were subjected to a standard descriptive statistical analysis.
Responses revealed several interesting observations regarding special needs children in Pennsylvania public schools and the attendant nursing and school health-related services. Roughly 40% of nurses (N = 388) worked in rural areas or small towns, 208 (22%) in urban areas, and 245 (25%) in the suburbs.
School health program personnel and the nature of their association are reporte in Table 1. Most programs reported employing a full-time registered nurse and a part-time physician. Only 164 (17%) respondents reported pediatricians affiliated with their schools with 69% using a general practitioner or family practitioner. School physicians are primarily involved in performing physical examinations (n = 901, 93%) and athletic physicals (n = 437, 45%). Only a minority of physicians are involved in health education (7%), family planning (9%), or consultation in a school district (9%). Few respondents reported providing services (other than state-mandated screenings) such as mental health counseling (n = 227, 24%), family planning (n = 54, 6%), and physicals for a driver's license (n = 93, 10%).
Table 2 defines the population of chronically ill children using school health services. …