Some aspects of child health care: contacts between children, general practitioners and school doctors

Summary Since the Report of the Committee on Child Health Services there has been discussion of the child health services from professionals but not from parents. In a survey carried out in 1977 parents were asked about their children's use of the health services and their views about this. The parents' general practioners were also questioned about children's health care. The children's contact with the services is described, and the relationship between general practitioners and school doctors. A similar survey was carried out in 1964 and changes in children's use of the services over the intervening years are examined. In 1977 nearly all children (91 per cent) were registered with a ‘family doctor’ who also looked after the parent interviewed, and most parents were registered with a doctor who looked after all their children. The concept of a family doctor conflicts with the Court Report's proposal for a specialist paediatrician in primary care. However, nearly a third of parents would prefer a specialist. The idea was not popular with doctors, of whom 81 per cent said they preferred the present system. Three-quarters of the children had seen their general practitioner in 1977, and this proportion had not changed since 1964. The main change was a striking drop in home visits which had its most marked effect on children of pre-school age. Children aged under 5 had a lower consultation rate than in 1964. The overall consultation rate for other age groups had not changed. Similar proportions of children had seen a school doctor in 1977 as in 1964, but communication between the school doctor and general practitioner did not appear to have improved. Parents attended less than half the school medicals and were less likely than in 1964 to discuss with their general practitioner a problem about which the school doctor had offered them advice. The introduction of specialist care might jeopardize vital parts of the primary care system. However, to ensure that relevant information is directed to where it is needed, some integration of health services for children, or of their medical records, seems essential.     

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)     

Elementary school parents'/guardians' perceptions of school health service personnel and the services they provide

BACKGROUND: The school nurse, the school social worker, and the school counselor play an important role in promoting the health of children. Health services in the school setting provide opportunities to appraise, protect, and promote student health. The purpose of this study was to identify parents' or caregivers' perceptions and beliefs regarding the importance of schools providing various health services to their elementary school-aged children. In addition, the study examined the levels of parental support for, perceptions of, and contact with school health service personnel. METHODS: In 2005, a nationally representative random sample of 369 (51% return rate) parents of elementary school-aged children completed the questionnaire developed for this study. RESULTS: A majority of parents/caregivers reported that their child's school had a school nurse (78.8%) and counselor (60.5%), but only 22.6% reported their school had a social worker. A majority of parents/caregivers perceived full-time school nurses (86.3%), school counselors (78.6%), and school social workers (56.3%) as important or extremely important and that schools should be held responsible for having each in their child's elementary school. A majority of parents/caregivers were willing to pay an increase in yearly tax dollars to have full-time school health personnel. CONCLUSIONS: This study established a level of parental support for, perceptions of, and contact with school health service personnel. Parents were most supportive of school nurses and should be perceived as allies in ensuring job security.     

Health for the school aged: a fledgeling concern

Despite acknowledging India's crucial need for health education for school aged children, government institutions have failed to provide the necessary support. Past experience has shown that while the government has drafted policy statements concerning school health, scant action has followed. What little has been done consists primarily of perfunctory medical check-ups of school children, a service mostly limited to urban centers. Evident from the current status of health education for the school aged, several changes must take place: 1) Government institutions must reach a consensus regarding the content of school health services. Since school health is intended to improve both children's health status and cognitive capability, such a service demands a comprehensive program that includes regular and complete health surveillance. And it also means that the schools themselves must be healthy environments, and that teachers must serve as role models of good health. 2) School health efforts must involve and be supported by the parents and the community. 3) Government policies must take into account children who are not attending school. This means both a long-term policy to solve the problem of drop-outs and a short-term policy of providing non formal education -- including health education -- for these children. 4) Of critical importance, the health and education sectors need to work together; they must have "joint responsibility." 5) A related issue is that both the health and education sectors accord a low priority to the issue of school health -- something that needs to change. 6) Finally, the government must change its generally weak commitment to providing school health services.     

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.     

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.     

中小学家长对学生身心健康管理的现状及需求分析

目的了解中小学家长对学生身心健康管理的现状与需求,为制定促进青少年身心健康的干预策略和措施提供依据。方法采用分层多阶段抽样方法对杭州市区9所中小学的936名家长进行了匿名式问卷调查。结果81.6%的学生家长能经常关注学生的身心健康,70.6%的家长了解孩子的心理状况,主要途径是通过孩子本人主动述说和与孩子交谈了解;40.7%的家长平均每天与孩子交流时间在30分钟以上。18.3%的家长经常对学生进行健康保健知识的教育,不足1/2的家长会传授给孩子突发事件的处理方法。21.6%的家长不会对学生进行急救处理。91.6%的家长希望学校系统地来管理学生的身心健康,32.9%的家长了解学校学生身心健康的管理工作,52.3%的家长对孩子所在学校或班级突发性公共事件的管理工作满意。结论家长普遍重视学生身心健康,但其管理缺乏充分性和持续性。需要对家长开展相关教育与培训,学校、家庭与社会应加强三方协调,实现学生身心健康管理效益最大化。     

Parental Expectations of School Health Services

ABSTRACT: Parents, as consumers of health care for their children, have the opportunity to incorporate available school health services as part of their child's total health care. This study investigated whether parental expectations of school health services supported the role of health services in the school as part of a total health care delivery system. It also sought to establish differences in the level of parental expectations of school health services as they relate to family size, parental structure in the home, method of family medical payment and current mode of health care management. A three-part questionnaire was developed to elicit data about parental expectations of school health, family characteristics and current choice of health care. Data analysis showed that parents do expect and accept school health services to be a part of their child's total health care management. No significant relationship was found between parental expectations and family demographic factors or if the child's current health management was maintenance-oriented or crisis-oriented. The study suggests that opportunities for parental input into school health programming should be provided. Positive perceptions of school health services may be incorporated into program advocacy in the event of political and financial threats.     

Impact of publicly available vaccination rates on parental school and child care choice

ObjectiveSeveral states require schools and child cares to report vaccination rates, yet little is known about the impact of these policies. Our objectives were to assess: (1) predicted impact of vaccination rates on school/child care choice, (2) differences between vaccine hesitant and non-hesitant parents, and (3) differences by child’s age.MethodsIn 2016, a cross-sectional email survey of Colorado mothers with children ≤12 years old assessed value of vaccination rates in the context of school/child care choice. A willingness-to-pay framework measured preference for schools/child cares with different vaccination rates using tradeoff with commute time.ResultsResponse rate was 42% (679/1630). Twelve percent of respondents were vaccine hesitant. On a scale where 1 is “not important at all” and 4 is “very important” parents rated the importance of vaccination rates at 3.08. Respondents (including vaccine-hesitant respondents) would accept longer commutes to avoid schools/child cares with lower vaccination rates. Parents of child-care-age children were more likely to consider vaccination rates important.ConclusionsThis study shows parents highly value vaccination rates in the context of school and child care choice. Both hesitant and non-hesitant parents are willing to accept longer commute times to protect their children from vaccine-preventable diseases.     

Immunization Services for Adolescents Within Comprehensive School Health Programs

ABSTRACT: Every school day, more than 95% of the nation's five- to 17-year-olds attend one of almost 110,000 elementary and secondary schools where they receive instruction in how to avoid major health-threatening behaviors. School is also the place where children and adolescents can be given preventive health care services, including administration of vaccines and monitoring of immunization levels. This article addresses how expanding school health services could improve immunization levels of school-aged youth.     

‘It's very hard to find what to put in the kid's lunch’: What Perth parents think about food for school lunch boxes

Aim: To describe the factors affecting school food selection by parents of young children attending low socioeconomic schools in Perth and recommend the features of resources parents need to make healthier choices. Methods: Nine focus groups of parents of young children attending low socioeconomic status schools in Perth were conducted where parents were asked about the food their children ate at school and their opinions of school food resources. Results: Focus group discussion centred on the themes of the challenge of being a good parent by providing healthy lunch box food; making compromises in what their children eat at school and the barriers to healthy eating in the school environment. Parents were concerned about what their children were eating at school but the barriers of convenience, child preference, cost and food safety prevented them from including healthier food in the lunch box. The amount of time allowed for eating and lack of refrigeration were school‐based barriers that impacted on the type and amount of food selected. Parents liked colourful, practical school food resources with recipes and nutrition information aimed at children. Conclusions: Parents want help with selecting lunch box food/drinks that are nutritious, convenient, inexpensive and appealing for children to eat. Schools need to be supported to introduce healthy eating programs and should review the time given for young children to eat at school. Dietitians need to consider the home food environment and what motivates parents to make food choices for their children.     

The school of the 21st century: Creating opportunities for school-based child care

Shifts in the structure and needs of families in the United States are prompting public schools to expand their role by offering school-based child care and family support services. This article describes a national initiative—the School of the 21st Century—in which the public school serves as a hub for the delivery and coordination of services for families and children. Factors related to providing comprehensive, quality child care and family support and concerns regarding school-based child care are discussed. Included are preliminary evaluation results of 21st Century School programs. Findings indicate that schools can play a role in the delivery of a comprehensive system of child care and parents favor the use of schools for this purpose.     

Australian teachers' understandings of the health promoting school concept and the implications for the development of school health

The health promoting school has emerged as a comprehensive framework to enhance the health status and health potential of school students. It requires teachers to be proactive in a number of areas beyond the formal curriculum. The success of health promoting schools will depend largely on what teachers know about its building blocks and the likelihood that they will be adopted. A number of teachers were interviewed and surveyed in a sequential study to ascertain their understanding of what constitutes a health promoting school. The findings indicate that teachers think mainly about school health in terms of the curriculum; have little understanding of how community partnerships might work; are very supportive of the concept; and have limited preservice and inservice training in health issues. It is argued that the growth of health promoting schools will be dependent on comprehensive professional development programmes; the production of resources which link teachers' perceived core business - teaching the mandated curriculum - to the building blocks of the health promoting school; closer collaboration between the health and education sectors; and a recognition by the community that schools cannot easily address (and solve) society's health concerns.Keywords: health promoting school; school health; teachers understandings      

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.     

The School Food Trust: transforming school lunches in England

School food has been provided to pupils in England for many decades. From the mid‐1970s, however, both the number of meals provided and the quality of food have declined. Legislation was introduced in 2001 to ensure that school catering services provided healthy options, but surveys of consumption in 2004–2005 and in 1997 showed that improved availability of healthy options in school had little or no impact on children's eating habits. In February 2005, Jamie Oliver presented a series of television programmes highlighting the poor quality of school food. The government responded by setting up the School Meals Review Panel to make recommendations on how to improve school food and the School Food Trust, a non‐departmental public body to promote the education and health of children and young people by improving the quality of food supplied and consumed in schools. Legislation was introduced in 2006–2008 that set out what caterers could and could not provide for children in schools. At the same time, the Trust worked with caterers, schools, pupils, parents, manufacturers, food distributors, institutions providing further education for catering staff and others in a coordinated programme of change. This paper reports clear evidence of the improvements in provision, choice and consumption of food in schools following the introduction of legislation and a national programme of work to change catering practices and the attitudes of pupils, parents and others to healthier food provision in schools. It also provides objective evidence of the impact of healthier food on children's learning behaviour in the classroom, and overall costs and benefits. It concludes by outlining the future work of the Trust as it moves from being a non‐departmental public body to a not‐for‐profit social enterprise.     

Parental views about services for children attending schools for the emotionally and behaviourally disturbed (EBD): a qualitative analysis

AIM: This study examines the views of parents of children attending schools for the emotionally and behaviourally disturbed (EBD). The study aims to gain an understanding of the journey through the educational system taken by these children and to explore their families' experience of services along the way. METHODS: Thirty parents of 25 children attending primary and secondary EBD schools in three South London boroughs took part in focus group discussions. Parents were asked about their experiences of services, including educational, health and social services, as well as how they thought services should be improved. RESULTS: Qualitative analysis identified a complex web of individual, professional and organizational factors which contributed to social exclusion of children with EBD problems and their families. These factors included children receiving inadequate education because of long periods of exclusion or inappropriate placements whilst waiting for a statement of special educational needs. Parents also felt personally socially excluded because of lack of childcare provision out of school hours. Many parents felt that their children did not fit into services and were constantly being passed on to other professionals. The analysis identified aspects of services that promote social inclusion and provide support to families, including acceptance of children into EBD schools, help from voluntary organizations and support from other parents with children with EBD problems. Parents particularly stressed the value of working in collaboration with professionals to achieve shared goals. CONCLUSION: EBD schools provide a valuable resource for parents. However parents often lack emotional and practical support in coping with their children's complex needs. Agencies need to improve communication and joint working to provide effective services for these families.     

Bullied children: parent and school supports

Family interviews were conducted with 28 7–12-year-old children who had experienced various forms of bullying and relational aggression by their peers, as well as with their parent and with an older sibling. Interviews explored possible supportive strategies of older siblings, parents, and teachers. All bullied children reported negative feelings about their experiences. Boys reported more physical bullying than girls. Bullies of boys were significantly more likely to experience consequences as a result of their behaviours. About half of the parents said that they had contacted the school about the bullying. Specific suggestions are given for how schools together with parents can create a climate that decreases bullying in schools.     

Communicating about pupils in mainstream school with special health needs: the NHS perspective

AIM: To add to previous research carried out with young people, parents and teachers, by investigating health staff's perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability. RESEARCH DESIGN AND METHODS: A qualitative research study was carried out in one NHS Trust. Twenty semi-structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists). RESULTS: The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals' roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants' recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff. DISCUSSION: Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.     

Older school children are not necessarily healthier: analysis of medical consultation pattern of school children from a territory-wide School Health Surveillance

It is important to maintain the health of our school children as health is a major factor affecting learning. In developed countries, we assume that school children, especially in higher grades, are healthy because they are relatively free of diseases. However, many of the health problems encountered by school children are not reported in routine health data as they seek help in primary care or by self-medication. In this paper, the medical consultation pattern of school children in Hong Kong was analyzed. It was revealed that school children had a high rate of consultation and self-medication, and the health status of older school children is not better. They were not offered adequate preventive advice. The piecemeal approach to focus on curative medicine will only lead to a high rate of episodic consultation and self-medication without empowering the young people with the skills of self-care and self-help, and positive health behavior. The concept of a health-promoting school with emphasis on more extra-curricular health promotion activities, improved communication between health and education sectors, active involvement by pupils and parents, and changing policies and practices would help to make the co-ordinated school health program a greater success.