an even greater portion of our community.

The directory was given to schools (public and private), libraries, and agencies in the community. With libraries and school systems, the process for providing the directory was coordinated with their respec- tive central offices. Another way of announcing the directory’s avail- ability was to encourage neighbor- hood newspapers to reproduce a page of the directory and “spot- light” an agency for each publica- tion. An accompanying story about

the agency and the directory helped increase awareness of their existence and helped disseminate the collected data into the community.

Our particular directory was so well received by the community that we were asked to present it to the mayor of Cleveland and to the Cleveland Board of Education.

Stephen R. Sroka, II, MEd, is Supervisor of Student Teachers, Office of Teacher Education, Case Western Reserve University, Cleve- land, Ohio 44106.

THE SCHOOL PHYSICIAN IN SPECIAL EDUCATION PROGRAMS

Elizabeth Bryan, MD; Vivian K. Harlin, MD, MSPM; Zaiga A. Phillips, MD; Clifford J. Sells, MD, MPH;

Alfred L. Skinner, MD.

In 1973 the state of Washington passed a mandatory education law requiring all school-age children, regardless of the degree of handicap, be provided with an appropriate education through their local school districts.

Since this law went into effect, school districts have been enrolling children who are handicapped far more severely than children pre- viously enrolled in public schools.

During the last few years in Washington, school financing has become increasingly difficult. More and more districts have curtailed or dropped medical consultation serv- ices. This has been of real concern to school physicians working with the schools. They have been aware of the value, even the necessity, for adequate, pertinent information from the physicians providing medi- cal care to handicapped children and for medical consultation to school

staff in order to plan school management and safe supervision for these children.

When the Washington State Special Education Advisory Council appointed a task force to recom- mend that support services be provided in special education, school physicians asked that they be included with the other professional disciplines-communication dis- order specialists, nurses, occupa- tional therapists, physical therapists, psychologists, and social workers.

The Support Services Task Force developed an outline to be used for the report from each discipline. This form was followed in the report of the physicians. It is hoped that this information will give each special education administrator a clearer idea of the possible contributions of a physician working with a special education program (other than pro-

viding direct medical care to stu- dents) and of the estimated amount of time for the specific activities recommended.

Report of the School Physicians to the Support Services Task Force Population Served

All children referred as a focus of concern for Special Education placement.

All children with known or suspected medical problems who are placed in Special Education programs.

Services Provided I . Assistance in formulating and evalu-

ating medical policies and procedures and in implementing Special Education Rules and Regulations as they relate to medical matters (eg, WAC - 392 - 171 - 065 and 055)

2. Consultation on noninstructional opera- tions of program.

3. Liaison between school and medical profession in the community. 4. Medical contribution to instructional

program. 5 . Review records and/or situations for

medical significance. Take part in insuring that appropriate observations are made avail- able to child’s health care provider and that appropriate information is furnished back to school. Work with staff to increase their medical knowledge and recognition of possi- ble medical significance of observations.

Case Load Data Time necessary to fulfill certain functions

is on a district basis. For other functions time is estimated on basis numbers of students or staff or sessions necessary. Service (I) above requires at least 4 hours/week or 20 dayslyear. Time for (2) (3) (4) depends on expectations of the district. For service ( 5 ) at least 32 hours/year/100 children assessed are needed. For service ( 5 ) an additional 25 hours/year/l00 children already in Special Education programs and having known or suspected medical problems.

Unique Factors Influencing Delivery of Service

Since the educator is the primary decision maker in the educational setting, the school physician must be willing and able to work in the role of advisor and consultant. Although a physician has been trained to work for the best interests of an individual patient, the school physician must always consider the interest, interaction, and welfare of children in groups.

Ability of the physician to serve as a consultant will depend to some extent on the availability of qualified professional person-

486 THE JOURNAL OF SCHOOL HEALTH OCTOBER 1977

nel in schools, such as school nurses, and on the sophistication of staff members in health matters.

School physicians may be recruited from several sources:

1. Physicians whose primary interest is in schools and “school medicine,” and who spend all their working time in schools.

2. Staff physicians at medical schools, children’s hospitals, and governmental Health Departments may serve as school medical consultants.

3. Physicians in private practice may be recruited.

A school district interested in obtaining the service of a school physician from any re- source should make a formal arrangement with the physician for a certain specified amount of time on a paid basis. It is likely that a negotiated decision regarding priorlties between the school district and the physician will result in the best service. Certain factors such as continuity of service influence the ease with which the physician can work effectively.

Role and Qualifications of School Physician to Support Services Task Force

I . Role and Function Because of the extraordinary physical and

emotional needs of children enrolled in Special Education, the tontributlon of a school physician is even more valuable than in the regular school program, regardless of the size of the district and of the number of children eligible for special education.

The school physician brings from the medical profession useful skills in enhancing relationships between students and teachers, and in promoting healthful situations for students and staff. The school physician works within the ethics of the medical

profession recognizing the rights, privileges, and responsibilities of parents to their own children; the confidential nature of medical information; and the courtesy due gther persons who may be working with a fahily.

The functions of the school physician in Special Education are in at least three areas:

1. Policy: To provide the School District with assistance in formulating and evaluating medical policies and procedures and to participate in implementing Special Educa- tion Rules and Regulations as they relate to medical matters (WAC - 392 - 171).

2. Noninstructionol: To provide the School District with medical consultation on non- instructional operations through advice on the medical significance of information obtained on students; procedures for first aid and emergency care; in-service training; safety; handling of medical records; avail- ability of adequate emergency information on students. To provide liaison between school and the medical profession and the official and voluntary health agencies in the community; representation of the school district at committees and conferences which have educational-medical significance.

3. Instructional: To provide the district with medical consultation to instructional program through medical advice regarding probable effects on students of new or changed activities; consultation to the pro- cesses of planning and implementation of curriculum; medical resource assistance to the teaching program.

11. Qualifications A school physician not only must be

licensed to practice in the State, but must understand the structure, responsibilities, and authority of the school administration; understand school programs and operations; possess current medical knowledge and skills, particularly in regard to the handicapped child; be aware of community resources.

He/She should have an interest in children and training or experience in working with them; should know the scientific basis and techniques of various school health screening tests and examinations and general provisions of laws and regulations governing school health. He/She needs a working knowledge of the functions of other school personnel such as psychologists, guidance counselors, special teachers. He/She should be able to assist with identification and management of school related emotional and learning problems. He/She needs to be aware of standards for the school physical environ- ment, desirable employee health practices and programs, organization of emergency plans, safe athletic practices, and equipment.

The school physician must be willing and able to work in the role of advisor and consultant, and to consider the interest, inter- action, and welfare of children in groups as well as individually.

Elizabeth Bryan, MD, is School Physician, Edmonds School Dis- trict, 8500-200th S W, Edmonds, Washington 98020 (corresponding author). Vivian K. ffarlin, MD, MSPM, is Director of Health Serv- ices, Seattle School Dktrict, 815- 4th Avenue N, Seattle, Washington 98109. Zaiga A. Phillips, MD, is School Physician, Bellevue School District, 31 0-102nd NE, Bellevue, Washington 98004. Crifford J . Sells, MD, MPH, is Director Clinical Training Unit, Department of Pedi- atrics, University of Washington, Seattle, Washington 981 95. A rfred L. Skinner, MD, is a Pediatrician and School Doctor, Mercer Island School District, 3236-78th SE, Mercer Island, Washington 98040.

OCTOBER 1977 THE JOURNAL OF SCHOOL HEALTH 407