New Study: The ‘Hidden Health Care System’ in California Schools and Children with Special Health Care Needs

The recent controversy over who is permitted to administer diabetes injections to children in school underscores a larger issue: Health services for California students with special health care needs vary greatly by school district, are provided by a variety of school staff, operate under a confusing patchwork of regulations, and are often underfunded, according to a new study.

See preliminary findings from the study>>

Researchers from California State University-Sacramento’s School of Nursing analyzed 2011-2012 state education data, interviewed school education experts, and conducted a large-scale survey of certified school nurses who are members of the California School Nurses Association. The research, which will be presented today at the California School Nurses Association conference in Sacramento, was funded by the Lucile Packard Foundation for Children’s Health.

California is home to an estimated 1.4 million children with chronic health issues, ranging from mild to life-threatening. About 16% of 6-to-11 year-olds and 20% of 12-to-17 year-olds have a special health care need that may require additional health services at school to allow for their full participation.

Among the study’s findings:

• 57% of California public school districts report having no school nurse personnel. These districts serve about 1.2 million students, about 20 percent of all public school students in the state.
• School nurse responsibilities have become more complex, including inserting urinary catheters, helping children with their feeding tubes, changing ostomy bags, monitoring oxygen tubes, testing blood sugar, and administering anti-seizure medication.
• Unlicensed school staffers provide sometimes complex medical care in the absence of school nurses. While many staffers are trained by nurses, there is little statewide regulation or monitoring of their training.
• Children with special health care needs aren’t always identified by school staff and may not receive services that could help them stay and succeed in school.

“California has very weak requirements governing school health and provides little data or guidance for school nurses and administrators to manage the care of children with special health care needs,” said the study’s lead author Dian Baker, a pediatric nurse practitioner and associate professor of nursing at CSU-Sacramento. “We can do better.”

See student-to-school nurse ratios by county>>

California has the largest population of children with special health care needs of any state. The federal Education for All Handicapped Children Act (1975), as amended in the Individuals with Disabilities Act (2004), was designed to ensure that children with disabilities have the opportunity to receive a free appropriate public education.

The study’s authors recommend several statewide policies and local practices that could help improve the hidden health system in California schools, not just for children with special health care needs, but for all students.

• Require systematic data collection and reporting systems in school districts to identify and serve children with special health care needs, and to monitor their health and educational outcomes.
• Require that all personnel delivering health services in schools receive mandatory training, including first aid, CPR and procedures needed to serve specific children in each school.
• Require that funds generated through Medi-Cal Administrative Claiming be earmarked to support school health services in the same manner as are Local Education Agency funds.

Posted by Barbara Feder Ostrov

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