An YEP” for a School Health Service Elizabeth Bryan

“School Health,” “Comprehensive School Health Program,” “Health of the School Age Child,” “Health Services,” “Preventive Health Services,” “Nursing Services,” “Primary Health Care,” “Screening” are familiar terms to all of us. Yet probably there are as many versions of what each means as there are persons defining. During the past few years, there have been several national confer- ences and much talk about “School Health Services” - the need for, value of, expectations from - and the services to be provided by persons from different backgrounds of training.

Since the passage of Public Law 92-142, “IEP” has become almost a household expression. Profes- sional literature and popular articles in magazines and newspapers have proliferated on the subject. There may be a lesson to be learned from the “IEP” approach for those of us who are in a continuing struggle to sell the idea of certain services in which we believe to the school authorities who make decisions and the members of the public who pay the costs. Maybe we could look at approaches used to devise an Individual Educational Program for a handicapped child and apply these to development of an individual school health program for a school.

What are some of these basic beliefs about handi- capped children behind the IEP? Included are that children are different even when they have the same handicap; individual children have different specific requirements; certain observations and tests are necessary to recognize common factors among children; certain observations and tests are necessary to recognize individual attributes of each child; each need a child has requires specific management, treat- ment or teaching; each person required to perform the needed activities must be trained for the specific function; each part of the program is toward a specific result; each activity is evaluated periodically as to whether the desired result is approached or attained; plans are changed as needs change.

What are the possible parallels in considering “Health Services” to be provided for children in a

school district? In general terms, the desire is to have each child develop, grow and learn to hidher highest degree of capability. As the result of combined efforts of home and community, including school, we wish for all children a safe, pleasant, caring, stim- ulating environment; adequate food, rest and activity; supervision and fostering of normal growth and development; intelligent observation to detect any beginning deviations from normal; excellent curative medical care when necessary; expert help in adapting to non-remedial conditions. Granted the above as general wishes, how can this be individualized for an “IEP” for a specific school health service?

A start a t individualization might be to look at the community and the concerned district. What are the economic and cultural living standards of the school district? What services are available in the commun- ity? Are use of community services equal among schools? Are all schools in the district similar in above respects or should there be an “IEP” for each school?

The first decision might be for which of the wishes for all children does the particular school or district plan to assume responsibility: Safe environment? Pleasant environment? Caring environment? Stimulating environment? Adequate nutrition? Adequate rest? Observations to detect deviations? Curative medical care? Fostering of normal growth and development? Freedom from disease?

Consideration of above factors corresponds in part to an individual assessment process with a handi- capped child. Decisions about responsibilities to be accepted might be compared to results of assessment preparing for an “IEP.”

After responsibilities to be accepted by a school are decided, following the “IEP” plan requires that decisions be made as to what activities are necessary to each responsibility and how they can be per- formed. For instance, suppose an accepted responsi- bility is to provide a safe environment and to send a child home in as good condition as he or she arrived

FEBRUARY 1981 THE JOURNAL OF SCHOOL HEALTH 127

at school. Activities would include the evaluation of possibly hazardous conditions such as playground, stairs, drinking fountains, laboratories and physical education equipment. Adequate emergency instruc- tions in case of accidents, compilation of emergency information for each student and provision of first aid when necessary must be arranged.

For each responsibility accepted, a similar action program would be determined. Following the outline of the action program comes the decisions regarding staff necessary to provide the activities. The training, experience and knowledge necessary for the per- formance of each specific job that needs to be done must be determined, the personnel recognized and job assignment made.

It would seem that this progression from agree- ment about what could be available to all children to

the responsibility the school is willing to take leads to an outline of program followed by recognition of staff necessary. This “IEP” approach might lead to greater understanding of what each program is p r e p a r e d t o a c c o m p l i s h . P e r h a p s a l s o individualization and variation according to differences in community in which a school is located and the clientele it serves is more realistic and productive than a total “comprehensive” standardized program in all situations. Maybe we should consider an “IEP” approach, deciding first of all which specific service(s) for children are acceptable and appropriate for an individual school in a specific community and build to activities, then to staff . . . thus, an “IEP” for a school health service.

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

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128 THE JOURNAL OF SCHOOL HEALTH FEBRUARY 1981