Tips and Topics . . . for Addressing Educators and Other School Staff

When speaking . . .

• Remember that your audience is composed of dedicated professionals, some with very advanced de.g.rees. Like you, teachers, school administrators, and school nurses are also experts on children and parents, albeit from different perspectives.
• Speak to this audience as you would to your colleagues, collaboratively rather than authoritatively.
• Remember that you are members of different professions aiming for the same outcome. Make sure they appreciate your common goals.

When choosing topics . . .

Fit the nature of your topic to the specific audience.

• Teachers may be interested in learning about manifestations and outcomes of a disorder or disease. They need to know about what might occur in the classroom, how to handle it, and what problems can be treated and cured.
• Administrators (e.g., principals, special education program directors, etc) may be interested in the development of policies re.g.arding diseases and disorders. At what point should the child not attend school? As a speaker addressing this audience, you should be familiar with laws that pertain to children with special health care needs in schools.
• School nurses and counselors may think they are the only representatives of health in the school. As a visiting physician speaker, you may be regarded as their ally. They may be interested in how to access outside support when a health issue arises in school. How to link with community programs may be an important topic. You should feel free to address technical issues with health professionals working in schools, butremember that most are not interested in the details of disease etiology or molecular biology. A summary of traditional and new diagnostic tools and treatments may be appropriate for this audience, as would a sample differential diagnosis using the common manifestations of a disease.

Some suggested topics . . .

The following topics relate to school health processes:

• How to Reach Health Professionals
• School Readiness and Readiness Examinations: The Pediatric Perspective
• Incorporating Health Education in the School Day
• Exclusion Policies Based on Health Problems
• Participating in Physical Activities . . . Who Can? Who Can't?
• How to Address Community Members Who Are Concerned about School Health Issues
• Medical Homes: Why They're Important and How Schools Can Help Students Find Them

The following topics relate to specific symptoms and diagnoses:

• Early Childhood Intervention: Effects as Reported in Medical Literature
• Attention Deficit Disorder
• Sickle Cell Anemia
• Children With Recurrent Symptoms of Mild Illness
• Communicable Diseases in the School Setting (such as tuberculosis, cytome.g.alovirus, HIV [human immunodeficiency virus], hepatitis, lice, gastroenteritis, or STDs [sexually transmitted diseases])
• Cerebral Palsy
• Violence Prevention
• The Unmanageable Child
• The Role of the School in Dealing With Pre.g.nancy and Sexuality Issues

Sample outlines . . .

Pediatricians: Partners in Keeping Students "Available" to Learn

I. Introduction

II. Why pediatricians and schools should collaborate

A. Pediatricians and schools can improve identification, diagnosis, and treatment of medical problems.

1. Discuss medical problems that teachers may not immediately recognize as "medical."
   • Fatigue as a manifestation of anemia, mononucleosis, or sleep apnea.
   • Frequent use of the bathroom as a manifestation of diabetes or urinary tract infection.
2. Explain how such problems affect the education of the student.
3. Stress the importance of having teachers and school staff be able to recognize problems before they are recognized at home, hastening diagnosis and treatment.
4. Emphasize how early recognition and diagnosis makes children more "available" to learn and reduces unnecessary absences.

B. Pediatricians can help schools deal with mental and emotional health problems.

1. Provide data to show that mental and emotional problems are a frequent source of lost learning days.
2. Provide examples of how mental and emotional problems can ne.g.atively affect learning.
   • Depression due to chronic illness can manifest as learning problems, such as distractibility or inattentiveness.
   • Stress due to family discord can manifest as school behavior problems, such as sudden anger or mischievous behavior.
3. Personalize the situation for your audience by discussing how stressful situations might negatively affect an adult's work performance.
4. Stress the ability of pediatricians to treat mental and emotional health problems.
   • Pediatricians are willing to become involved.
   • Training in behavioral pediatrics has increased dramatically.
   • Primary care physicians must often serve as the gateway for referral to psychiatrists, psychologists, and other mental health professionals.

C. Pediatricians can help schools care for children with special health care needs.

1. Discuss difficulties schools have in caring for children with disabilities or special health care needs.
   • Classrooms may be poorly designed for accommodating children who require special medical equipment or procedures into regular classrooms.
   • Teaching time may be lost performing health-related procedures such as the administration of gastric tube feedings or medications.
   • Children with special health care needs may require more attention from school staff, ne.g.atively affecting other students' experiences.
2. Explain how early involvement of pediatricians in school placement decisions can avoid such problems.
   • Pediatricians can work with school health staff, such as nurses.
   • Forethought can be given to prescribing extra medications and ordering special equipment.
   • Schedules, policies, and procedures can be developed with educational objectives and the needs of all students in mind.

III. What schools can do to partner with pediatricians

A. Explain how schools can better share student information.

1. Explain the traditional ways physicians obtain medical histories.
   • Elicit them from the patient and parent
   • Receive reports from the school staff
2. Discuss shortcomings in the traditional model.
   • School personnel provide pediatricians with only that information they think is important.
   • Parents would support improved communication.
3. Provide examples of consent forms.

B. Provide examples of how pediatricians and school staff can better manage individual cases by working together.

IV. Closing Comments and Questions

Children Who Bite

I. Introduction

II. Describe the population.

A. Cite facts from articles that address the incidence of biting.

B. Explain which children typically bite and why.

1. Preschoolers
2. Elementary school-age children
3. Children with mental retardation, hearing or vision impairments, or other disabilities

III. Explore some complications that arise when children bite.

A. What is the risk of common infections?

1. Animal bites and human bites differ.
2. When to recommend antibiotic prophylaxis.

B. What are some special infections to consider?

1. HIV
2. Hepatitis B
3. Herpes simplex, tuberculosis, syphilis, and others

IV. Discuss how school staff can treat, control, and prevent bites.

A. Provide an overview of basic first aid for bites.

B. Suggest ways to prevent further biting incidents.

1. How to respond immediately after the biting incident.
2. How to set up a developmentally appropriate environment that is less conducive to biting behaviors.
3. Discuss what experimental behavioral therapy is available for the developmentally abnormal child.

V. Closing Comments and Questions

Suggested reference material . . .

Garrard J, Leland N, Smith DK. Epidemiology of human bites to children in a day-care center. Am J Dis Child. 1988;142:643-652

Wittmer D. Children who bite. Scholastic PreK Today. March 1992:49-52

Troster H. Prevalence and functions of stereotyped behaviors in nonhandicapped children in residential care. J Abnorm Child Psychol. 1994;22:79-97

McGreevy P, Arthur M. Effective behavioral treatment of self-biting by a child with Lesch-Nyhan syndrome. Dev Med Child Neurol. 1987;29:529-540

Altmeyer BK, Williams DE, Sams V. Treatment of severe self-injurious and aggressive biting. J Behav Ther Exp Psychiatry. 1985;16:159-167

Tips and Topics . . . for Addressing Parents and Community Members

When speaking . . .

• Remember that parents and community members may not understand how the health and educational communities can and do interact on behalf of children.
• Stress that parental and community involvement in school health issues is important, no matter what your topic.
• Encourage parents and community members to consider their personal ability to establish productive links between schools and community organizations through their employers or religious affiliations.

When choosing topics . . .

• Consider addressing the need for advocacy on behalf of childrenin the area of school health issues.
• Stress the need for increased school health resources, such as staff, programs, and funding.
• Carefully define the roles for parents and community members in promoting resources for schools and implementing school health programs.

Some suggested topics . . .

• The Importance of Collaboration Among the Family, the School, and the Physician
• Advocacy for Child Health . . . How Parents and Community Organizations Can Help
• Issues in Teen Sexuality: How a School Program Can Respond to a Concerned Community
• Addressing Local Community Concerns Despite Extremist Minority Pressure
• The Health Environment of Your Schools
• Mainstreaming Children With Special Health Care Needs in Schools

Suggested reference material . . .

Robinson ER, Mastny AY. Linking Schools and Community Services: A Practical Guide. New Brunswick, NJ: Center for Community Education, School of Social Work, Rutgers, State University of New Jersey; 1989

Pietrobono J. Taking health care where the kids are: can physicians lead the charge? Tex Med. 1994:90:14-21

Taras HL. School health clinics: a cause for confrontation or participation? California Pediatrician. Spring 1994:31-33

Tips and Topics . . . for Addressing Legislators and Health Plan Representatives

When speaking . . .

• Many of the issues appropriate for parent and community members apply here as well.
• Stress that the input and participation of le.g.islators and health plan representatives in shaping school health programs in your community is important.
• Avoid presenting an opinion or taking a particular political stand. Use your authority in the community to present the facts, and encourage the political factions and financial interests in your community to develop their own solutions.

Some suggested topics . . .

• The Importance of Supporting School Health Programs
• The Role of the School Physician Consultant
• Working With Schools to Meet the Health Needs of the Local Community

A sample outline . . .

Why and How to Support Linkages Between Schools and Community Health Providers

I. Introduction

II. Address the current needs of the students and families in your community.

A. Present community-specific data on the health needs of students and families

1. From the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance System or other national data sources
2. From personal research using community assessment tools

B. Provide informal statistics on the needs of students from school health clinics and school nurse offices.

III. Provide an overview of the broad range of linkages possible between schools and community health providers.

A. Discuss formal solutions such as school-linked or school-based services.

B. Suggest solutions requiring only the commitment of various parties, such as improving communication, coordinating care, and using parents as "case managers" for their children.

IV. Suggest action for health care plans and le.g.islators.

A. Health care plans can better communicate with schools and share information.

1. Regarding issues such as the services the health care plan permits on a school site
2. Through the establishment of hot lines or key contacts for schools
3. Through support of computers or fax machines

B. Health care plans could investigate the cost effectiveness of supporting on-site school health services.

C. Legislators and health policy staff in government should consider relationships with schools as a factor when awarding Medicaid contracts to managed care plans.

Tips and Topics . . . for Addressing Students

When speaking . . .

• Never underestimate how naive or how sophisticated your audience might be, re.g.ardless of grade level.
• Use personal experiences with children in your practice or family to gauge the level of your presentation.
• Be culturally competent . . . but avoid making generalizations across racially or economically disparate communities.
• Provide a mechanism such as question cards for students to ask questions anonymously. Always address all questions, either during the session or through follow-up activities.

When choosing topics . . .

• Remember that certain controversial topics may not be discussed with students on a school site without permission of school administrators.
• Investigate community concerns and classroom curricula before presenting on a potentially controversial topics, such as teen sexuality.

Some suggested topics . . .

• Choosing a Career in the Health Professions
• How to Best Use Your Doctor
• Divorce, Drugs, or Violence at School or Home: Where Can You Turn?