A School-Based Clinic for Elementary Schools in Phoenix, Arizona

ABSTRACT: A community hospital, a school district, and a private pediatrician's office collaborated to ensure all children enrolled in five elementary schools had access to health care services. The school nurse at each school identified children needing health care services and obtained parental consent. The school nurse referred children to a nurse practitioner who visited one school each day. School nurses and space in the nurse's office were provided by the school district. The hospital provided a nurse practitioner as well as pharmacy, radiology, laboratory, and emergency department services. The pediatrician as medical director for the program provided vision, training, and community connections, and served as collaborating physician for the nurse practitioner.     

A School-Based Clinic for Elementary Schools in Phoenix, Arizona

ABSTRACT: A community hospital, a school district, and a private pediatrician's office collaborated to ensure all children enrolled in five elementary schools had access to health care services. The school nurse at each school identified children needing health care services and obtained parental consent. The school nurse referred children to a nurse practitioner who visited one school each day. School nurses and space in the nurse's office were provided by the school district. The hospital provided a nurse practitioner as well as pharmacy, radiology, laboratory, and emergency department services. The pediatrician as medical director for the program provided vision, training, and community connections, and served as collaborating physician for the nurse practitioner.     

''Health assessment'' at school entry: performance of a system based on school nurse interviews

OBJECTIVES: To describe the performance of a school entry 'health assessment' based on school nurse interviews. BACKGROUND: Universal medical examination at school entry has largely been replaced by a 'health assessment' led by the school nurse, based on screening tests, a health interview, eliciting parental and professional concern and past history. As a result children with possible problems are selected for school medicals, reviewed in school or referred to a range of health professionals and other agencies. SETTING: Inner city south-east London. SUBJECTS: Children born between 1/3/89 and 31/8/89 who were on the class lists of 21 randomly selected primary schools. DATA COLLECTION: A form for each subject was distributed to the school nurse and completed as children were invited for screening, school health interviews and medical examinations. MAIN OUTCOME MEASURES: Proportion of subjects attending, patterns and proportions of reviews and referrals. RESULTS: 426 children were eligible for inclusion and 419 (98%) forms were returned. 232 children were seen for a health interview and a further 50 were screened for vision, hearing and growth problems only. 124 had no contact with the school nurse or doctor. Following health interview or screening, 180 children were reviewed and/or discussed with other health professionals. 71 external referrals were made. CONCLUSION: Adequate coverage at school entry is difficult to obtain. The objectives of school entry health assessment and the relationship between selection criteria and health needs require clarification.     

Technical assistance offered to community health programs through a resource model.

A multidisciplinary unit in the Department of Community Medicine, Mount Sinai School of Medicine, consists of a core group of specialists who plan, develop, and evaluate community health care programs. The primary tools used by the staff of the Services Coordination Unit, epidemiology and behavioral and management sciences, result in improved organization and coordination of health services and community resources. The small unit of specialists functions as a resource group, helping community groups address the complex problems of planning, organization, delivery, and financing of health services. By offering technical assistance rather than day-to-day health care services, the unit has established an education and training program in New York''s East Harlem, which surrounds the medical school. Over the last 10 years, that approach has enhanced the administrative and financial viability of existing health programs in East Harlem. Since the unit''s establishment, it has collaborated with a broad variety of community groups. More than 20 programs have resulted. The income generated by the unit completely covers the expenses and has done so since 1976; "seed money" was used for startup and the first 3 years of operation. The unit is paid for long-term services and for most consultations.     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

Medical examination of school entrants: later school problems and absenteeism of attenders and non-attenders

Children who were scheduled for medical examination before entering school were followed in school one or two years later. Non-attenders had a two-fold risk of repeating grades, special class placement, referral for speech/language problems, teacher-reported learning or behavior problems, failure of vision or hearing screening, and transfer between schools. Absenteeism was also significantly more common. Children not brought in for preventive health care are at greater risk than others for difficulties in school.     

Models for delivering school-based dental care

School-based health centers (SBHCs) often are located in high-need schools and communities. Dental service is frequently an addition to existing comprehensive services, functioning in a variety of models, configurations, and locations. SBHCs are indicated when parents have limited financial resources or inadequate health insurance, limiting options for primary care and preventive services, or within low-access areas such as dental health professional shortage areas. Poor health and concomitantly poor oral health can lead to attendance problems. Oral health services in school-based setting are often the only access to services a child may have. Children who attend schools with SBHCs have immediate access to services that are coordinated with the student'sfamily and school personnel or administrators. Comprehensive services can be collaborative, with support or administration provided by more than 1 organization. For example, the Children's Aid Society (CAS), Columbia University School of Dental and Oral Surgery (CUSDOS), and Columbia University Mailman School of Public Health developed, implemented, and currently operate SBHCs in 2 communities in the northern Manhattan section of New York City (Central Harlem and Washington-Heights/Inwood). The clinics operate in or are affiliated with public schools in New York City. All CAS and Columbia University sites include dental components, using a variety of delivery models. Determining which dental delivery system to use for a particular community or population is a complex decision. The models, reasons for selection, and sustainability of each system are described.     

Asthma and respiratory dysfunction among urban, primarily Hispanic school children

A screening program identified children with poorly managed asthma or respiratory dysfunction. Children in grades 2-5 in all Passaic, New Jersey, schools were eligible for screening with questionnaires and a biometric test. Those with risk factors or failed biometric screening were referred to primary care providers. Of the 6,579 eligible children, 3,657 (56%) had parental questionnaires returned and 3,834 (58%) were biometrically screened. Over the 4-yr study period, 6-22% of children were previously diagnosed with asthma. Approximately 20% of children demonstrated peak flow measures <75% of predicted values. Predictors of a prior diagnosis of asthma and a medical treatment plan for asthma management were health care coverage and ethnicity. Predictors of peak flow test failure were the presence of roaches and mold in the home, pesticide use, and a family member with asthma.     

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.     

Health and special education: a study of new developments for handicapped children in five metropolitan communities

Since the implementation in 1977 of the Education for All Handicapped Children Act (Public Law 94-142), public school systems have provided special education and related services to students with a wide range of handicapping conditions, including some children served previously in hospitals or other institutions. Although the Federal law does not require physician participation in the special education process, it does imply an active new role for the medical care community, both public and private, in helping schools to identify and diagnose children with disabilities and in ensuring that those children have adequate access to health services. This study explores the experience of five nationally dispersed urban school systems in implementing P.L. 94-142, with particular reference to the interaction of physicians and the schools. The findings highlight continued problems with early identification of certain types of childhood handicaps, classification of children's functional disorders, and adequate participation of practicing physicians in the program, especially with regard to developmental and behavioral issues. In addition, inequities in community health services are documented for a substantial number of the children studied. Improved collaboration between the health and education sectors is needed to address these concerns in order to fulfill the intent of national special education policy and to maximize the potentialities of these children and their families.     

School-Based Mental Health Prevention Activities for Homeless and At-Risk Youth

Children who are homeless or who live in poverty face increased exposure to risk factors. Participating in mental health prevention activities may serve as a buffer against stress for these children. Schools are an optimal setting for providing prevention services. In this paper, we describe the implementation of and results from the Empowerment Zone (EZ) project, which involved providing mental health and health prevention services to children during small group and classroom activities. The EZ Project was incorporated into character education activities for a summer school program designed to improve reading and math skills for at risk elementary school age youth. The character education program is a key component in the Baltimore City schools where character traits, such as honesty, are taught through small group and classroom activities. Teachers were trained to implement mental health prevention activities; they also reported on the quality and utility of the program, after watching activities implemented by clinicians in their classrooms. Parents also had opportunities to participate in classes, which focused on teaching discipline techniques and discussing ways to improve parent-child relationships and foster children's socioemotional development. Results were positive, supporting project activities. Future empirical research evaluating the effectiveness of mental health prevention programs delivered in schools is needed.     

Audit of school entry health assessments: to maximise efficient use of health personnel at school entry assessments at 5 years

During the last 3 years in which doctors saw all school entrants, the decisions made about each child on examination were recorded and a protocol about decision-making to support children with health needs was drawn up. In September 1994, school entry health care assessments by the school nurses were introduced. Having previously recorded the numbers in each school who required medical interest and support, it was possible to rationalise which schools should be the primary responsibility of the nurses, which should retain medical contact for all children and in which schools assessments should be shared.The outcomes in decision making after introducing nurse assessments were recorded in the same format as used by thedoctors, so that the effect of passing responsibility to nurse colleagues could be assessed. The findings suggested that an equivalent number of children were referred to other services or selected for continuing review. However, the proportion of children whose needs were discussed with the headteacher without the children being selected for review was reduced. Issues to take forward were identified.     

Screening for asthma in an inner-city elementary school in Minneapolis, Minnesota

To the extent that the asthma morbidity so prevalent in children today is due to underdiagnosis or lack of appropriate treatment, schools are increasingly faced with the issue of defining their role in the care of children with asthma. This paper describes efforts to conduct schoolwide screening for asthma in an inner-city elementary school over the past two years. Screening methodology adopted for the project resulted in a simple and noninvasive approach for identifying children with current asthma in a school setting. While not as medically comprehensive as would be required to conclusively diagnose asthma, the simple screening approach proved efficient in identifying a population of elementary school children with a significant level of asthma morbidity. The paper discusses the effectiveness and feasibility of the screening efforts and proposes how such a screening program might be incorporated into the routine health activities undertaken at any elementary school.     

Availability of School Health Services for Young Children

ABSTRACT: A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children. (J Sch Health. 1997;67(8):327–332)     

Children with a tracheostomy: experience of their carers in school

OBJECTIVE: Tracheostomies in children are increasingly performed for chronic medical conditions. There are no published studies reporting the experience of children with a tracheostomy in school. Such information would be valuable in planning the care and education of these children. The aims of this study were to identify those children with a tracheostomy in Nottinghamshire schools and determine the support they were receiving. DESIGN, SETTING AND PARTICIPANTS: Questionnaire survey to families and school carers of 11 children with a tracheostomy. RESULTS: All children of school age were in full-time education (five mainstream, five special schools). One preschool child attended a Family Centre. Four had problems finding suitable carers, delaying return to school in three. Four parents were dissatisfied with aspects of the child's experience at school: two felt the teaching staff were unsupportive, one was unhappy with the care of the tracheostomy, and one had problems funding a carer. Ten out of 11 school carers were satisfied with their training; 10 would have liked regular update sessions. The amount of care required varied. Those with complex medical problems in a special school setting needed frequent care, and one had required admission to hospital from school. One child had time off school because of lack of carer availability. Those who were severely disabled had less time off school for ill health after the tracheostomy than before the tracheostomy. CONCLUSION: Children with tracheostomies can successfully and safely achieve full-time education in both mainstream and special schools. A dedicated multidisciplinary team, including input from the parents, is essential to achieve this goal. Regular revision of skills and information sessions for the teaching staff would be beneficial.     

Comprehensive Health Screening in Elementary Schools: An Outcome Evaluation

A health screening program, piloted in 14 school districts in Texas from 1977 to 1979, was evaluated to determine the outcome of the screenings. Outcome measures used were the number of completed referrals, the number of conditions judged by health care providers not to exist and the number of problems of potential educational significance identified. While several problems were detected, the high rate of false positives and low referral completion reported from community health care providers leads to questions concerning the effectiveness of comprehensive health screening in the schools. However, the emphasis placed on identification during the screening of children with educationally significant problems may enable the schools to better serve these children. Referral follow-up in the community and schools to address identified problems would assure that the expenditure of funds for screening would not be futile.     

Addressing the childhood asthma crisis in Harlem: the Harlem Children's Zone Asthma Initiative

OBJECTIVES: We determined the prevalence of asthma and estimated baseline asthma symptoms and asthma management strategies among children aged 0-12 years in Central Harlem. METHODS: The Harlem Children's Zone Asthma Initiative is a longitudinal, community-based intervention designed for poor children with asthma. Children aged 0-12 years who live or go to school in the Harlem Children's Zone Project or who participate in any Harlem Children's Zone, Inc, program were screened for asthma. Children with asthma or asthma-like symptoms were invited to participate in an intensive intervention. RESULTS: Of the 1982 children currently screened, 28.5% have been told by a doctor or nurse that they have asthma, and 30.3% have asthma or asthma-like symptoms. To date, 229 children are enrolled in the Harlem Children's Zone Asthma Initiative; at baseline, 24.0% had missed school in the last 14 days because of asthma. CONCLUSION: The high prevalence of asthma among children in the Harlem Children's Zone Project is consistent with reports from other poor urban communities. Intensive efforts are under way to reduce children's asthma symptoms and improve their asthma management strategies.     

Coverage and patterns of ambulatory medical care use in Tlalpan, Mexico City

Health officials planned a stepped care system (regionalized) for Tlalpan, in the Federal District of Mexico (D.F.), to address problems of duplicated services, inappropriate use of available resources, increasing costs of medical care, and unmet health needs in the population. Cross-sectional surveys were carried out in the community, in health centers and in hospital based ambulatory services (outpatient department and emergency department) to obtain current, specific and valid information about need and utilization patterns. Users of the various services differed from each other and from the community by age, educational level, occupation, rights to prepaid care and utilization patterns. Emergency department users came back for care repeatedly and sought preventive services from the emergency department. Major reasons for attending the emergency department included respiratory and gastrointestinal problems, plus poisonings, accidents, and complications of pregnancy. Outpatient department users arrived without referral from medical sources and continued to return frequently for care. Users were mostly adults, particularly older adults, with problems of a more chronic nature, e.g. nervous system problems, genitourinary problems, etc. The health centers attended clients from the designated area of influence who had referred themselves to the center for care. Children were the most frequent clients with acute, common problems, e.g. diarrhea and respiratory problems. Health maintenance activities were assessed for which children received the most complete coverage, but some women lacked the necessary care for perinatal health and family planning. In general, health centers seemed to be functioning appropriately, although the magnitude of unattended need in their areas of influence must be investigated further.(ABSTRACT TRUNCATED AT 250 WORDS)     

The efficacy of asthma case management in an urban school district in reducing school absences and hospitalizations for asthma

Abstract: Pediatric asthma rates are reaching epidemic proportions, adversely affecting children's quality of life, educational potential, and health care costs, especially those in the inner city. This study evaluated the effectiveness of a school-based asthma case management (CM) approach with medically underserved inner-city children attending Memphis City schools. Fourteen elementary schools with high rates of asthma-related hospital utilization were grouped according to school size, percentage of children with asthma enrolled, and percentage of children eligible for free or reduced-price lunch. Schools were randomized to either a nurse CM intervention or a usual care (UC) condition. The CM group included 115 students; 128 students were in the UC group. A longitudinal design was used to follow students' progress. Students were primarily African-American children diagnosed with asthma. In CM schools, nurse case managers conducted weekly group sessions incorporating the Open Airways curriculum, followed up on students' school absences, and coordinated students' asthma care with families, school personnel, and medical providers. In UC schools, students received routine school nursing services. CM students had fewer school absences than their counterparts in UC schools (mean 4.38 vs 8.18 days, respectively) and experienced significantly fewer emergency department visits (p < .0001) and fewer hospital days (p < .05) than UC students. No such differences existed before program initiation. Replication and follow-up in year 2 showed continued significant improvements. School-based nurse CM can achieve significant improvements in school attendance and medical utilization. (J Sch Health. 2006;76(6):320-324)     

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.