Use of Medical Information in School Planning -

Elizabeth Brvan

ABSTRACT

Student health information is essential for determining the effect of a health problem on school performance. The sharing of information that is pertinent to a child's individual needs requires judgment on the part of both physicians and school personnel. There must be mechanisms for communication and a plan for storage and retrieval of data that is both accurate and accessible. There must be a mutual desire among the professionals to establish a close relationship that is responsive to the needs of the children they serve.

INTRODUCTION Medical information is recognized in the federal law

as valuable in establishing the presence of a handi- capping condition to qualify a student for special education services in the public schools. If students are to be properly served, significant health handicapping problems must be considered in planning school programs.

Obtaining, storing, retrieving and using pertinent medical information from provider sources requires orientation of physicians, I school personnel and parents to the content and value of contributions from this segment of the multidisciplinary team. Also required is the preparation of adequate procedures to accomplish the tasks involved. This paper proposes some practical approaches to integrate medical information into planning a special education program for a child.

VALUE OF MEDICAL INFORMATION

Medical information is valuable for several purposes. In some instances it is necessary to establish the presence of a particular handicapping condition. This use is readily understood and accepted and requires little dis- cussion. While obtaining medical input, an opportunity

exists to inform physicians about the school program and increase their total awareness. This may be done by using a request form which explains that in order to receive special education services, a student must, by law, meet certain diagnostic criteria. A check list of eligibility criteria for which a statement from a physician is required or desirable may serve as the medical response form. Additional explanation of value is that environmental, instructional and service plans are determined according to identified needs of the individual child, not assigned automatically because of diagnostic category.

A vital bit of medical information is whether, for the safe supervision of a child, there needs to be a restriction of usually expected activity at school or adaptations in equipment, environment or program. Examples: A wheelchair-bound student may need to be transported on a bus with a lift. For a student with fragile heart function, there may be need for detailed instructions regarding permissible activities and restrictions. A deaf student may need to have an adult specifically assigned to see s/he is removed from impending danger if the alarm system in use depends on a bell or buzzer. A child with severe, prolonged seizures may need to have arrangements made for immediate removal to a medical care facility. A student with a significant food allergy may need to have party snacks screened and alternatives provided.

There are a number of students with complex medical conditions for whom adequate supervision can be assumed only through knowledgeable observation and awareness of the full range of program options. Included are: 1) students with seizure disorders, 2) those with diabetes whose physical activity schedule should not be significantly altered without attention to insulin and food intake and 3) students with limited visual fields who might need to be placed at the back corner of

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the classroom for more adequate visual range or eliminated from certain activities because of inability to see an object or person approaching from a given direction. A student recently recovering from a severe illness or suffering from anemia may lack energy and stamina for a full academic day. With this information, late afternoon teachers may show more empathy for behaviors attributable to fatigue.

MEANINGFUL COMMUNICATION

Prognosis for students with certain health handicaps can have significant influence on programs planned. For instance, a child with an eye disorder which is progressing toward blindness should have different pro- grammatic expectations than a child with a permanent, stabilized visual impairment. Good physician/school communication is imperative for cases where progressive diseases will result in increasing difficulties in motor, intellectual and/or emotional areas of performance. A possible time estimate of deterioration and other observable signs of difficulty aid in advance planning. Knowledge of the presence of such defects helps school personnel to be more understanding of family members dealing with the total situation. It becomes easier to understand and work with a sorrowing grandmother who may be having difficulty in making reasonable demands on a granddaughter who has a rapidly developing treatment-resistant brain tumor.

In all special education programs, written instructions or clearance from a physician are required for certain specified services such as home/hospital instructions, dispensing of medication at school, physical and occupational therapy and voice training for a child with hoarseness. To obtain such services, there should be specific forms for medical findings, comments and physician signature. Each form should bear an explanation of purpose and ask direct questions relevant to information needed, including directions related to observations to be made and reported back for monitoring purposes.

Another communication which may be of value to school personnel is information relevant to students who are currently receiving medical treatment. Even when program adjustment is not indicated, knowledge that the child has a condition requiring treatment and the possible manifestations of such treatment may make teacher observation of the child more meaningful. In many instances, teacher observations make significant contributions to monitoring the effect of medication. When specific monitoring is desired, details regarding observations and frequency and method of reporting should be precise; and an easy way of reporting should be furnished to the teacher.

Communication between the school and the health

care community should be initiated by someone on the school staff with knowledge of the medical implications pertinent to school program options so that requests may be monitored for appropriateness and information received for adequacy. In general, it may be said that medical information obtained is most useful if translated in terms of student function and capabilities. Evaluations leading to a diagnosis are in the province of the physician, but a meaningful interpretation is vital for school use. These interpretations must be thought of in relation to the anticipated school program. For each program area, consideration must be given to whether or not the child can and should perform and whether adjustments are needed. Examples: If a swimming program is planned for hearing impaired students, some may need medical clearance because of an ear condition. If a student with diabetes wishes to engage in cross-country running, there may need to be an adjustment of diet or insulin. If a child has a cerebral ventriculo-peritonea1 shunt in place, has had recent brain surgery or has a condition with the possibility of retinal detachment, special instructions should be obtained regarding body contact activities.

Medical information may be made more meaningful when offered in response to a written request containing school observations of possible medical significance, a statement of reason for concern and specific questions designed to elicit medical information and physician recommendations. Much of this can be organized on a reporting format that can be used by the physician as a response form. A permission to release information to the school district, signed by the parent, guardian or adult student, must accompany all requests for data sharing.

STORAGE AND RETRIEVAL

To have medical information be of greatest value, a system for adequate storage and retrieval must be in operation. Both manual and computerized systems can be very successful. Regardless of the type, the procedure chosen should be used for all students assessed for special education services; since an attitude that these matters will be considered only “where appropriate,” significant information may be overlooked or lost. When there is a conference regarding educational arrangements for a child and a data summary record is prepared, entries pertinent to “medical status” should be included. Since large numbers of special education students are being served in regular education classes, each Individualized Educational Plan (IEP) should contain a comment relevant to student health. It is particularly important that all medical situations be known to regular program staff who have teaching responsibility for special education children. In pre- paring for placement of a special education student in a

260 THE JOURNAL OF SCHOOL HEALTH MAY 1980

regular class, the responsibility for notifying and recording the notificiation of all appropriate individuals (eg, classroom teacher(s), physical education teacher, secretary, bus driver) of any program adjustments should be specifically and clearly assigned.

One technique for identifying and recording is a numbered medical priority system which is used in the Edmonds, Washington program.* As each child is accepted for special education services, a “medical status’’ number from 0 - 9 is assigned by the school physician to indicate the functional severity of the child’s handicapping condition. A designation of nine indicates the student is subject to almost constant danger of a medical emergency. A zero medical status code indicates no health problem. Codes of 1 - 8 represent intermediate situations. This number is entered on a “medical status rationale” sheet in the student’s file. The medical status number is placed in a designated space on the IEP record. Related services to be provided by the school nurse are designated by a number code for each student requiring special arrange- ments for emergency care, special observation or continuing communication with the child’s physician. The number is entered on the computer card prepared for each special education student. This card also shows the diagnostic category, placement and related services assigned. Thus, class lists prepared from the computer show the medical status numbers of all students and serve to remind staff of attention needed as a result of medical condition.

A NEEDED CHANGE For many years there have been efforts on the part of

medical training facilities to give student health profes- sionals experiences in public schools which would increase their understanding of the educational system. These opportunities have been on a sporadic basis, and many physicians who have accepted medical responsi- bility for school-age children have few if any experiences to call upon for understanding. Similarly, teacher-training institutions rarely provide an oppor- tunity for even graduate level teachers to extend their acquaintance with physicians and their knowledge of health care practices. When education courses contain information about medical conditions or medical practice, this material is often taught by educators other than a physician. Because of these cir-

cumstances, a continuing effort to develop in both educators and physicians some mutual understanding of the capabilities, training, ethics and the constraints under which the other works is worthwhile as an aid to meaningful communication. These efforts may be made more productive through schooVcommunity awareness of the situation, a belief in the importance of such communication, a real understanding and appreciation of both fields of work and a commitment to spend time and energy working together on a continuing basis. The impetus for change might come from a staff member of the school district, a member of the local medical society working through existing committees, a member of a college or university or a staff member of the state health or education authority.

Specific techniques suggested for cultivating a peer relationship among the practicing professionals include continuing education opportunities in which educators and physicians exchange information, and exploring techniques for communication and participating together in activities aimed at improving understanding of health handicapping conditions. “Memos” to school personnel on specific topics of interest from the medical field help keep teachers’ information current. Such topics may include information relevant to those drugs commonly prescribed for behavior control: drug usage, expectations and side effects or a critique of study data on diet and learning disabilities. Similar notes outlining significant changes in program options, related services or personnel in a school district may assist the physician in making more appropriate recommendations to parents. The important ingredient is a mutual desire of professionals in both medicine and education to establish a working relationship that is responsive to the needs of the children for whom they share responsibility.

REFERENCES 1. Bryan E, Harlin VK: The school physician in special education

2. Bryan E: Administrative concerns and schools’ relationship with programs. J Sch Health 47(8):486-487, 1977.

private practicing physicians. J Sch Health 49(3):157-163. 1979.

Elizabeth Bryan, MD, School Physician, Special Services Center, Edmonds School District, 8500 200th Street S W, Edmonds, WA 98020.

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