Communicating Health Messages

D. CASE SCENARIOS

Examining case scenarios from different perspectives is an excellent method of exploring the unique concerns and contributions that pediatricians, school nurses, school administrators, school board members, parents, teachers, and the media can bring to school health. This section contains 4 case scenarios that can be discussed in small groups or in a workshop format. In discussing each scenario, facilitators should ask pediatricians to consider how they might try to communicate with each group of professionals involved to ensure a positive outcome. Strategies pediatricians can use to address each situation are included and should be brought out during discussion.

1. Sexuality Education

The school has hired a health educator and would like to implement a healthy sexuality curriculum in the middle school. The curriculum emphasizes prevention of sexually transmitted diseases, but some teachers are uncomfortable with this curriculum. The superintendent invites the pediatrician to review the curriculum and discuss it with the board of education. A religious faction in the community is adamantly opposed to implementing this curriculum. The newspaper editor calls the pediatrician for an interview about the "controversial curriculum." The town budget is about to come up for vote, and the school is concerned the curriculum will become a major issue and will cause the education budget to be rejected.

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Points to consider during the discussion include:

  • A community task force could be assembled of parents, students, health educators, health care professionals, teachers, school nurses, religious leaders, and media representatives to examine the issue.
  • Health education curricula and textbooks could be made available in advance to all community members to solicit their input and evaluation and involve them in the process.
  • Pediatricians could discuss federal and state mandates and local policies.
  • Pediatricians could identify the strengths and weaknesses of sexuality education curricula currently available.
  • Pediatricians should act as a voice of reason and provide facts rather than opinions for radio, television, and newspaper articles.
  • Pediatricians should acknowledge the importance of parents in children's education about sexuality and approach the issue as a parent-school-pediatrician partnership.

2. Asthma and Allergies in Schools


An 8-year-old boy has severe asthma. The mother is concerned that the classroom environment is making this child sick and blames the school for not having the proper facilities. She contends the school should have air conditioning in a particular classroom and produces a note from the boy's pediatrician supporting her viewpoint. The nurse consults the facilities director, who determines that the school cannot install air conditioning in the classroom. The school board offers to have the child transferred to another school. The mother refuses on the grounds that this is too restrictive to the boy's education. The pediatrician and the school medical advisor are invited to attend the meeting of the evaluation team to determine the best course of action. The mother's attorney accompanies her.

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Points to consider during the discussion include:

  • Pediatricians should be prepared. Talking with school medical advisors and school nurses before the meeting is advisable.
  • Pediatricians should explore the school's reputation with advocacy groups for families and children with special needs.
  • Pediatricians should be knowledgeable about the legal aspects of the case, as well as with Section 504 of the Rehabilitation Act of 1973 and with local policies.
  • Pediatricians should offer their medical expertise by helping everyone understand typical expectations for asthma, how this child's asthma may be different, and how this child's medications may affect his ability to learn.
  • Pediatricians should separate the true problem from the expectations of the various parties and help the school make small, incremental steps toward a solution.
  • Pediatricians should suggest an environmental inspection.
  • Pediatricians should welcome all parties to the discussion, including the attorney, but help the group define ground rules for the meeting in advance.
  • Pediatricians should avoid overestimating their influence and taking the attitude that their recommendation or prescription is the most important of any of the participants.

3. ADHD and Ritalin

Mrs Smith approaches you in your role as a private pediatrician and asks you to prescribe Ritalin for her child. You contact the child's school and find out from the school nurse that this child has had significant learning disabilities and there is significant family disruption. You are asked to attend the Individual Education Plan (IEP) conference and advise the school on the best course of action. Because you are concerned about the number of children in the school system taking Ritalin, you seek ways to educate the public about more judicious use of this medication.

Points to consider during the discussion include:

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  • The best person to make medication decisions is the health care professional with the longest ongoing relationship with family and student.
  • Pediatricians should make sure they have all the information they need to make medication decisions, including information from school nurses, teachers, school psychologists, and others.
  • Pediatricians should obtain releases from children's parents before contacting school staff.
  • Pediatricians should try to understand the school psychologist's style and testing methods.
  • Pediatricians should take the opportunity to educate parents, schools, and community members about the judicious use of medications such as Ritalin.