Motivating Pediatricians to Become Involved in
School Health

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1. Differences in the Educational and Health Care Systems

Many pediatricians may not have been in an elementary or high school since they were students themselves. They may have become so involved in the medical world that they have forgotten that the people and policies that form the educational system represent an entirely different culture, which has changed significantly during the last few decades.

Pediatricians should be aware of the differences between the education and health care systems, as well as those aspects of the education system that make it unique.

• Each system has a set of distinct yet related priorities.
• Each system has its own language.
• Each system has its own timeline. For instance, teachers are often unable to leave a class unattended to answer the telephone, but often have a "planning period" when they can be easily reached. Pediatricians should not try to call a school nurse at lunch time; the nurse will be busy attending to students. Important conferences should not be planned for late afternoons on Friday if the school staff is expected to attend.
• Each system has its own structure and hierarchy.

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2. General Guidelines for Pediatricians Working With Schools

The following are some general principles that pediatricians should follow when working with school personnel, health staff, and school board members.

Timing is important.

• When contacting a school for the first time, contact the principal.
• When calling a teacher, determine in advance a convenient time for the teacher to talk.
• Set up relationships with all levels and departments of the school system in order to communicate with the school board, the superintendent, and the classroom teacher.

Respect your colleagues' interests and abilities.

• Approach all school personnel as professionals with skills and interests that complement your expertise and as colleagues who can provide information that you do not have. Recognize their interest in helping the children in their charge.
• Respect the authority of others. Learn the rules of the school setting and play by them-remember, "It's not your sandbox!"
• Be understanding of the limits and abilities of others. What seems straightforward to you may be difficult or impossible for someone else. Even people with PhDs can faint at the sight of a needle (epinephrine auto injector).

Facilitate open communication.

• Always inform parents and obtain permission to communicate with the school staff about a specific student's health care needs. Keep the parents informed as to any progress or new developments.
• Encourage direct school-to-parent and parent-to-school communication.
• Be willing to attend a meeting at the school to share information or make treatment plans.
• Listen carefully to ascertain the main concerns and questions of school personnel and attempt to respond directly to them.

Do some homework.

• Become aware of laws and regulations that affect schools, including those related to school finance, education for children with disabilities, bilingual education, and other mandates.
• Become knowledgeable about the formal and informal decision-making processes in schools.
• Put yourself in the shoes of school personnel when you are helping to solve a student's problem. Does the medication absolutely need to be given at noon, or can the schedule be changed slightly so the student does not have to leave his favorite class to go to the nurse?

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3. Working With School Personnel

The pediatrician should learn the roles of each of the school professionals and meet them in the professionals' community. Some of the key players in the school system are:

• School superintendent
• Assistant superintendent
• Principal
• Vice principal
• School nurse
• Classroom teacher
• Special educators and resource teachers
• Speech and language specialists
• Counselor
• School psychologist
• Social worker
• Outreach worker
• Health educator
• Health office aide and teaching aide
• PTA member

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In particular, pediatricians should know the school nurses in the local schools. The pediatrician should ask:

• Who are the health personnel employed by the district, or who is on the school nursing team?
• What is the education level of the school nurse? LPN, RN, bachelor's degree, master's degree? Aide?
• What are the school nursing requirements and the regulations for your state? Contact your state school nurses' association.

The pediatricians should also become familiar with the specific responsibilities of the school nurse. These responsibilities can vary significantly and might include

• Providing emergency and first aid services
• Dispensing medications
• Educating students and staff on health issues
• Dealing with asthma, diabetes, and cancer
• Dealing with pregnancy, sexually transmitted diseases, eating disorders, depression, and suicide
• Providing a sympathetic ear to students with personal problems

The school nurse is often the most valuable partner for the pediatrician working with schools because of the nurse's knowledge of health issues and daily contact with the individual children.