Health Services Delivery to Students with Special Health Care Needs in Texas Public Schools
Koenning, Gaye M., Todaro, Ann Witt, Benjamin, Jeff E., Curry, Martha R., Spraul, Gayle E., Mayer, Marjorie C., Journal of School Health
Technological advances and reductions in mortality of the past few decades greatly increased the physical presence of students with health-related disabilities in the classroom. As schools have become sites for health care delivery, often to medically complex children such as those who are ventilator dependent, integration of a student's health needs into educational programming has become of paramount importance. That health and education are inextricably linked for students with special health care needs (SSHCN) is clear from the myriad of health-related difficulties which affect their educational performance and participation. Common examples of educational vulnerabilities experienced by SSHCN include absenteeism, truancy, problems with peers, difficulties with life activities such as fine and gross motor skills in the classroom, poor academic achievement, behavior problems, and delays in the acquisition of age-appropriate skills such as possessing a driver's license.[1-8]
Of all school personnel, school nurses in their role as in-school health experts, seem best equipped to speak to the impact of a child's health impairment and necessary school interventions. While several studies and reviews examined the needs of school teachers who serve SSHCN in the classroom setting,[9-11] little information exists about the needs and involvement of school nurses in the health and education management of SSHCN.[12,13]
Survey Objectives. The survey obtained data on the characteristics, needs, and involvement of Texas public school nurses in the health and education management of SSHCN. Specific objectives were: 1) to describe the educational background, licensure, certification, work environment, and identified continuing education topics of school nurses, 2) to determine characteristics of the SSHCN population including grade level grouping and types of health conditions, 3) to ascertain characteristics of health services delivered to SSHCN including number and types of health procedures, persons involved in performing a procedure, and resources for information and training, and 4) to examine the comfort level and participation of school nurses in the special education process for SSHCN.
Definition of SSHCN. The definition of SSHCN included on the survey form was adapted as follows from New England Serve: SSHCN have a broad range of chronic illnesses which may require adaptation in the regular school environment for daily functioning, prolonged or periodic hospitalizations, and/or the delivery of health services at home and school. New England Serve, a project administered by the Massachusetts Health Research Institute, Inc., had developed several documents on health care needs of children with chronic illness and their families.
Survey Procedures. The survey was developed by the authors in 1991 at Texas Children's Hospital in cooperation with the Texas Education Agency Comprehensive School Health Division, the Texas Education Agency Region IV Education Service Center, the Texas Association of School Nurses, the Harris County Dept. of Education, and consultants in health survey research design and statistics. Funding was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Dept. of Health and Human Services, and Texas Children's Hospital. The survey was field tested in March 1992 with 40 school nurses in the Houston, Texas, area. A revised survey then was mailed to 2,875 school nurses in early April using a mailing list of nurses provided by the Texas Education Agency. The first mailing yielded a return rate of 33%. A second mailing was sent in mid-May with a return rate of an additional 22%, yielding an overall response rate of 55%. Data analyses included descriptive statistics with software from the Statistical Analysis System (SAS) Institute.
Respondent Demographics. The 1,574 respondents represented a geographically well-dispersed catchment area in the state of Texas, all 20 Education Service Center Regions of the Texas Education Agency and 53% of the independent non-special statutory school districts. …