The Buddy System

The education for all Handicapped Children Act (Public Law 94-142) is both an education and civil rights law. As a result of the civil rights perspective of the law, students with chronic illnesses and disabilities are demanding access to public education. These students often require multiple services designed to meet their special health needs. It has become the responsibility of school personnel to assess these students and determine the best type of school health plan for them. This article is about the creation of a Buddy System used in an urban, middle school in grades six-eight for students ages 10-13.     

P.L. 94-142 and P.L. 99-457: Considerations for Coordination Between the Health and the Education Systems

In 1986 P L 94-142 the Education of the Handicapped Act, was reauthorized and P L 99-457 was signed into law Many similarities exist between P L 99-457 and the maternal and child public health legislation of Title V in the provision of services to children with disabling conditions The focus of this paper is an examination of aspects of the troublesome mesh that has occurred between Title V and P L 94-142, the first designed to cover medical-health needs, the second, educational needs The paper was prepared in hopes that the experiences of implementing P L 94-142, especially in relation to coordination between the education system and the health care system, can provide guidance in implementing P L 99-457 The paper will examine how these laws model both the difficulties and benefits of trying to coordinate two separate yet complementary forces into a coherent solution to the problems of providing services to children with special needs.     

P.L. 94-142 and P.L. 99-457: Considerations for Coordination Between the Health and the Education Systems

In 1986 P L 94-142 the Education of the Handicapped Act, was reauthorized and P L 99-457 was signed into law Many similarities exist between P L 99-457 and the maternal and child public health legislation of Title V in the provision of services to children with disabling conditions The focus of this paper is an examination of aspects of the troublesome mesh that has occurred between Title V and P L 94-142, the first designed to cover medical-health needs, the second, educational needs The paper was prepared in hopes that the experiences of implementing P L 94-142, especially in relation to coordination between the education system and the health care system, can provide guidance in implementing P L 99-457 The paper will examine how these laws model both the difficulties and benefits of trying to coordinate two separate yet complementary forces into a coherent solution to the problems of providing services to children with special needs.     

A Nationwide Survey of Financing Health-Related Services for Special Education Students

The Individuals with Disability Education Act (IDEA) requires state educational systems to provide school-based, health related services (RS). This survey determined the financing arrangements used by states for health-related services for school-aged children with disabilities. A survey was sent to directors of special education, Medicaid, and public health departments in each of the 50 states. Financial patterns for RS were sought at the state level for children ages 3-21 with disabilities for the 1993-1994 school year, the most recent year for which complete financial data were available. Univariate analyses probed the relationship between systems' variables and the extent of Medicaid usage by local education agencies. Respondents reported that schools tapped traditional health resources to supplement educational dollars in paying for related services in schools. Medicaid was by far the most common source with 29 states reporting established mechanisms for recouping Medicaid dollars and 10 states reporting phase-in activities. Seventeen states reported that departments of public health played some role in administration, training, and demonstrations, but only six states provided specific dollars for related services through the department. Use of private insurance was reported sporadically with only one state indicating a specific state-level program. Correlates of increased Medicaid usage were presence of interagency agreements (IAAs) (OR 11.1, p = 0.002), having specific personnel for school-based medical assistance (OR 17.7, p = 0.001), and utilizing school nursing services as a Medicaid optional service (OR 4.2, p = 0.048).     

Day care, public education and exceptional children

Day care and early education teachers are being challenged more than ever before by children who may have exceptional needs. Following enactment of the Handicapped Children's Act of 1975, #opPublic Law 94-142#cp public education programs and services for exceptional children from age 3 on up have become mandatory throughout the United States. Additionally, most of the states have passed similar laws for special children that may be more or less restrictive than the Federal Law. Day care and early education teachers can be helpful to the development of special educational programs and related services for exceptional children. Too often they are overlooked when public school specialists and parents meet to discuss multidisciplinary team findings for purposes of IEP development. Day care and early education teachers can add information to more completely outline the child's needs with follow-up programming recommendations. Important elements of the law are presented to help day care personnel more effectively serve each special child in their program.     

Screening and referral outcomes of school-based health services in a low-income neighborhood.

A school health program, conducted by the Division of Community and Social Pediatrics of Harlem Hospital Center at two elementary schools in central Harlem, provides screening, followup, and health education services. The children attending these schools are largely dependent on public medical care, with low accessibility and lack of continuity of care. The effectiveness of the program''s services were evaluated with respect to screening and referral outcomes. During the spring of 1974, the school health records were reviewed for the 221 children who had been in the program for 1 year in one of the schools. The evaluation results indicated that although major health conditions were not commonly disclosed by the screening component of the program, the examining physicians noted that 57% of the children had one or more health problems. Children with dental caries were the most frequently observed as well as the most frequently referred for care. Children with two-thirds of the medical problems who were referred for further care received medical attention. The program demonstrates the capability of relevant school-based health services in a low-income neighborhood to address the medical needs of elementary school children.     

The rural dental health program: the effect of a school-based, dental health education program on children's utilization of dental services.

Eighteen-hundred rural children ages five through thirteen were randomly assigned for dental treatment to a school-based practice, and to private practitioners in the community. Simultaneously, five of the nine public schools attended by the children offered an enriched program of dental education while the remaining schools taught the regular health education courses. All children participated in a school based fluoride program and their dental treatment was provided without charge. Data indicating how the children utilized dental services were collected over the three-year treatment phase of the study. Evidence from the third treatment year indicates that children assigned to the school based practice who also attended a school offering enriched dental health education used dental services on a more regular basis than children in the other three groups. Evidence obtained from log-linear modeling supports the hypothesis that dental health education had a positive effect on children's utilization of dental service.     

Where There is a Way, There is Not Always a Will: Technology, Public Policy, and the School Integration of Children Who are Technology-Assisted

Children who are technology-assisted have been excluded from school in part because of conflict over payment for health care services This paper reviews educational and Medicaid policy regarding school health care services, as well as recent litigation over payment for these services, in order to highlight some of the current conflict and debate over who should pay Yet the full integration and inclusion of technology-assisted children in schools will necessitate increased cooperation between education and health care systems in terms of payment, service delivery, and public policy.     

Developing a strategic plan for school health services in Massachusetts

School health service programs underwent rapid changes to meet the health needs of today's students. These needs stem largely from: a) increased number of students with special health care needs attending school, b) increased stress and time pressure on families, c) rapid restructuring of the health care system serving children, and d) recognition that schools provide opportunities to identify students with health risks. This paper describes seven components of a statewide Massachusetts plan to develop school health services by: a) setting standards, b) reviewing and revising statutes and regulations, c) promoting credentialing of school health personnel, d) providing continuing education on subjects pertinent to school health, e) exploring reimbursement systems and new funding sources, including funds from the tobacco settlement, f) exploring new models of care, and g) implementing data systems. The plan focuses on developing school nurse-managed school health services within a public health model.     

Students with chronic diseases: nature of school physician support

Background: To educate children with chronic diseases in the least restrictive environment, schools must prevent, recognize, and react appropriately to symptom exacerbations. Schools are often pushed to their limits of knowledge, resources, and comfort level. This study determined the health conditions of students for whom districts seek school physician consultation and the nature of school physician consultants’ involvement. Methods: A retrospective record review was performed on 250 of the most recent records of school‐elicited referrals from an academic center that provides physician consultation to school districts. Referrals were sent from 8 school districts in southern California (July 1996 to October 2006). Data collected were nature of student’s special health need, the school physician consultant’s intervention required to satisfy schools’ needs, student grade level, enrollment in special education, and health‐related excessive absenteeism. Results: No single chronic condition, symptom, or special health care need predominated. Six types of school physician consultant activities were used to overcome hurdles schools faced when accommodating students with special health care needs. The 3 most common were direct communication with students’ own physicians (70% of students), recommending an appropriate level of school health services when this was a matter of controversy (42%), and formulating portions of students’ individualized school health plans (38%). Conclusions: A portion of students with special health care needs benefited from district referral to a school physician consultant. Whether some of these referrals can be avoided if school personnel and students’ own physicians are supported and trained to communicate more effectively with one another needs to be explored.     

Students with chronic illnesses: guidance for families,schools, and students

ABSTRACT: Developed by a work group representing several nonprofit and federal health and education organizations, Students with Chronic Illnesses: Guidance for Families, Schools, and Students provides cross-cutting action steps to facilitate full participation in learning and other school activities by students with chronic diseases. Between 10% and 15% of children in the United States are affected by at least one chronic disease. This guide offers practical tips to help ensure that schools are responsive to the health needs of children with chronic illnesses.
Children with chronic health conditions are more likely to miss days from school, need specialized health care, and require special education services or homebound teaching. School health advocates agree that meeting the needs of these children requires collaboration among the students, their families, school personnel, and community health care providers. Such efforts can help students establish better attendance, improve their alertness and physical stamina, and face fewer restrictions on physical activity at school and fewer medical emergencies.
The guide addresses issues such as routine and urgent care needs of students, medication access and administration, and school personnel training to ensure compliance with applicable local, state, and federal regulations. While emphasizing the value of adopting general policies for supporting students with chronic conditions, the guide also encourages schools to develop and implement condition-specific and individualized protocols. The responsibilities of family members, school district officials, teachers and school administrators, and students are outlined to help each constituent fulfill these objectives.
The guide is available online at http: www.nhlbi.nih.gov health public lung asthma guidfam.htm .     

Health Services for Special Needs Children in Pennsylvania Schools

ABSTRACT: School health programs traditionally have involved health services, health instruction, and a safe school environment. Likewise, school health services have been provided by nurses, physicians, and appropriate administrative personnel. In the 1990s, increased integration of primary care services through school-based clinics expanded traditional activities of school health programs. Consequently, more chronically ill children, particularly technology dependent children, have entered the regular school setting, requiring that schools be prepared to manage these chronically ill students who come to school with new morbidities and technological dependencies. This statewide survey examined the number and kind of special needs children in the regular school setting in Pennsylvania, as well as the personnel, programs, policies, and resources available to support these children. ( J Sch Health. 1994;64(6):258–260 )     

Health Services Utilization and Special Education: Development of a School Nurse Activity Tool

Increasing competition exists for resources to support health services for children receiving special education. Consequently, management tools to document services when claiming these resources need to be developed. The purposes of this study were to develop a time study instrument based on nursing activities in the school, compare nursing time provided to special education children and their nondisabled peers in general education settings, compare nursing process activities in traditional settings and in special education settings, and elicit feedback from nurses to improve the validity and reliability of the time study process. Eighteen nurses representing rural, urban, and suburban schools completed a time study for two weeks, quantifying services provided in the health room. Nurses recorded student educational status, special education category or not, nursing process activity, and the time utilized per student contact. Results indicated 48.2% of school nursing time was attributed to services for special education students during the study period. Most nursing process activities for both settings were in assessment of problems and in direct services. Findings indicate the instrument can provide objective documentation of special education health services, providing a base for claiming important resources for school health services.     

Parent knowledge and opinions of school health services in an urban public school system

Health services, provided through schools for more than 100 years, increasingly have expanded to meet preventive as well as acute health care needs of children. This article reports on a survey of parents of third-grade children in an urban public school system. The authors examined what parents know about school health services, what value they place on the services, and what barriers exist to health care access. Results indicated parents place a high value on health services offered in schools, but they know little about service availability and use. Parents often were unaware their children received many of the services listed, such as review of school health records, vision and hearing screening, and health education by school nurses.     

Mental health and social services: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position not only to identify mental health problems among children and adolescents but also to provide links to appropriate services. This article describes the characteristics of school mental health and social services in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study (SHPPS) every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states and the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: Although states and districts generally had not adopted policies stating that schools will have mental health and social services staff, 77.9% of schools had at least a part-time counselor who provided services to students. Fewer schools had school psychologists or social workers. Consequently, counseling services were more common in schools than were psychological or social services. Few schools delivered mental health and social services through school-based health centers. Arrangements with providers not located on school property were more common. CONCLUSIONS: SHPPS 2006 reveals that linkages with the community need to continue and grow to meet the mental health needs of students. Efforts must be made to build systematic state agendas for school-based mental health, emphasizing a shared responsibility among families, schools, and other community systems.     

Predicting needs for special education resources for mental retardation from birth defects records.

Planning of service delivery systems for children with special health care needs would be enhanced by knowledge of numbers of cases anticipated in defined geographic areas. A method is described for predicting numbers of children who will likely have mental retardation sufficient to require special education services, based on the birth prevalence of birth defects and clinicians' estimates of the likelihood of mental retardation associated with each specific birth defect. This method is applied to the 1980-82 birth cohort of a 28-county area of south and central Arkansas, and it is compared with special education enrollment data for children ages 6 to 8 in academic year 1988-89. According to this estimate, children with birth defects may account for 32 to 56 percent of the cases of mental retardation among 6- to 8-year-olds reported by the public schools.     

Does the School Nurse‐to‐Student Ratio Make a Difference?

Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services. Data from school years ending in 2000-2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = -.52, p = .000) and asthma (r = -.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = -.38, p = .006), and more follow-up for school-related injuries (r = -.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = -.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference.     

The social maladjustment exclusion in educational policy: Implications for multiagency coordination of services

Educational policy within Public Law 94-142 dictates exclusion of socially maladjusted children from eligibility as seriously emotionally disturbed. The history of this exclusion, various state education agency attempts to serve or exclude children with behavioral problems, and major assessment issues surrounding interpretation of the exclusion are described. Substructural issues involving the conceptualization of disability and related funding exigencies are also presented. The differences between P.L.94-142 and Section 504 of the Rehabilitation Act, in terms of the definition of handicap, and the implications of these differences for the exclusion are explored. Major approaches to serving the burgeoning numbers of children in need of mental health services through multiagency collaboration are reviewed with respect to a proposal for a paradigmatic shift in redefining the role of education.     

Integration of health into the school curriculum in Botucatu, São Paulo

This study focuses on the drafting and development of a public health program aimed at strategies to integrate health activities and the school curriculum. The program is based on three main lines of activity: full health care for schoolchildren, with special emphasis on the public school system; training of personnel in the fields of health and education by means of internships allowing participants to experience, work, and reflect critically on the activities with an interdisciplinary team; and work with teachers from the public elementary school system to implement and develop innovative measures in the fields of health and education to respond to the demand by schools and the community.     

Project School Care: Integrating Children Assisted by Medical Technology into Educational Settings

The increasing number of children assisted by medical technology in the U.S. has led to a need for systematic planning for the children's care in community settings such as schools. Project School Care in Massachusetts provides consultation to school systems as schools respond to the challenge of integrating children assisted by medical technology into educational settings. The model of practice described includes the step-wise planning process and the ensuing training, enrollment, and monitoring procedures. Implications are explored with particular emphasis on upgrading of skills at all medical and educational levels. More input from school health personnel in administrative decision-making around enrollment of children with special health care needs is recommended. For these children, a health care plan should be incorporated into their Individualized Education Plans and into their school records.