Children with Special Health Care Needs in School

An increasing number of children and youth enrolled in public schools have severe psychiatric disturbances, yet few school systems are adequately prepared to meet the needs of this population (Rones & Hoagwood, 2000). This unfortunate scenario arises in Part from a relative dearth of school-based models that are effective and affordable for working with youngsters with serious emotional disturbances. Developing and garnering financial support to implement evidence-based models for helping youth with serious emotional disturbances succeed in school and other domains represents a significant and immediate challenge facing school systems, but also social services, mental health agencies, and, increasingly, the juvenile justice system (Osher, Osher, & Smith, 1994)

It is estimated that between 15 and 20% of children in the United States have a significant ongoing need for health care (Newacheck et all 1998). In order to clearly define the group of children and youth discussed in this paper, the term “children with special health care needs” as defined by the Federal Bureau of Maternal and Child Health will be used. “Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that required by children generally” (American Academy of Pediatrics (aap), 1993). This definition includes children with chronic illness that is defined as a condition that lasts at least 3 months and requires extensive hospitalization or in-home health services (aap, 1993)

Paradoxically, this high prevalence of children with special health care needs is related to advances in medical science, which have greatly increased survival rates for a number of health conditions. For example, the median survival age for children with cystic fibrosis has more than doubled in the last 3 decades, up from 11 years in 1966 to 29 years in 1993 (Cystic Fibrosis Foundation, 1994). Similarly, acute lymphoblastic leukemia (all), a disease that was once almost uniformly fatal, now has an average childhood survival rate of 5 years or more (Mulhern & Friedman, 1990). Moreover, while accidents remain the most common cause of childhood death, more children are surviving them—but often with permanent disabilities and complex medical needs (U.S. DePartment of Health and Human Services, 1994). Schools around the country are feeling the impact of these trends, as they are faced with more children with special health care needs than ever before

In addition to inherent illness-related stressors (e.g., complying with complicated regimens, coping with physical limitations and discomfort), children with special health care needs face considerable stress in negotiating the multifaceted aspects of attending school. These include preparing for and getting to school, adjusting to being around peers (and often coping with questions, teasing, or rejection) and teachers, moving around the building, and facing academic demands while continuing to monitor and manage their illness. Related to these compounding stressors, children with special health care needs are at high risk for low educational attainment, poor adjustment to school, and a range of emotional and behavioral problems (Boekaerts & Roeder, 1999). In turn, these emotional and behavioral problems may exacerbate physical problems, in a negative snowballing effect leading to school avoidance and dropout

Physical, emotional, and behavioral functioning is closely intertwined in youth with special health care needs. This complexity requires that programs address children's physical, emotional, and behavioral needs in an integrated fashion. One of the best ways to deliver such integrated care is through school-based health centers (sbhcs). The ideal sbhg provides a full range of care, including treatment of illnesses and accidents, management of chronic conditions, physical and laboratory assessment, and a continuum of mental health services (Juszcak et al, 1995). Due to their intuitive appeal (i.e., bringing needed services to youth “where they are”) and to their demonstrated impacts on health and mental health outcomes, sbhcs are growing throughout the United States so that they now number over 1200 (Dryfoos, 1999). Importantly, sbhcs can be a critical resource for youth with special health care needs, enabling ongoing assessment, intervention, and support to address their physical, emotional, and behavioral issues

In this chapter, we review the physical and mental health issues common to children with special health care needs and discuss how sbhcs and related school-based mental health programs can be instrumental in addressing these needs. Although specific medical conditions in children can be associated with unique stressors and issues, many common features also exist. In this paper, we provide a more general review based on the presumption that the psychosocial needs of children with various medical conditions are more similar than they are different (Rinehart, 1998)