School Health Services for Children With Special Health Care Needs in California.

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California's school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services.

The Mismatch Between Children's Health Needs and School Resources.

There are increasing numbers of children with special health care needs (CSHCN) who require various levels of care each school day. The purpose of this study was to examine the role of public schools in supporting CSHCN through in-depth key informant interviews. For this qualitative study, the authors interviewed 17 key informants to identify key themes, provide recommendations, and generate hypotheses for further statewide survey of school nurse services. Key informants identified successful strategies and challenges that public schools face in meeting the needs of all CSHCN. Although schools are well intentioned, there is wide variation in the ability of schools to meet the needs of CSHCN. Increased funding, monitoring of school health services, integration of services, and interagency collaboration are strategies that could improve the delivery of health services to CSHCN in schools.

Accountability for services for young children with disabilities and the assessment of meaningful outcomes: the role of the speech-language pathologist.

PURPOSE: This article describes the federal accountability requirements related to young children with disabilities and the contribution of the speech-language pathologist (SLP) to provide these data through the use of authentic, functional assessments. METHOD: The article summarizes recent state and federal developments related to assessment for accountability and draws on the recommendations of national organizations, including the American Speech-Language-Hearing Association, to underscore the importance of high-quality assessment for guiding practice and for documenting child outcomes for accountability. CLINICAL IMPLICATIONS/CONCLUSION: The widespread use of recommended practices for assessment will provide children, families, and practitioners, including SLPs, with the highest quality assessment information, at the same time providing states and the federal government with much-needed valid data on child outcomes for accountability purposes.

Current state of knowledge: outcomes research in children with mild to severe hearing impairment--approaches and methodological considerations.

This paper will provide a backdrop to the others in this section on outcomes of children with mild to moderate sensorineural hearing loss. Our objective here is to provide an overview of the research approaches used to study the outcomes of these children to provide guidance for future studies of children with mild to severe sensorineural hearing impairment (HI). During the past 20 yr there has been a gradual coalescence of research practices concerned with examining outcomes. Those who have done this work have come from different disciplines and in many cases were motivated by different circumstances. As a result, terminology and perspectives on outcomes research often still bears the features of these different disciplines and objectives of this research. This paper is an effort to provide the reader with an overview of this research endeavor that will highlight the diversity of the work being conducted on outcomes but also emphasizes the common properties. This overview will emphasize the kinds of research questions that are asked in this area of research and the associated evidence obtained to address these research questions. After this initial section there will be a consideration of the methodological issues that need to be considered, particularly for outcome research in children with HI.

Dimensions of behavior of toddlers entering early intervention: child and family correlates.

This study examined the nature and correlates of the behavioral characteristics of a nationally representative sample of 1612 toddlers 18-31 months of age entering Part C early intervention services in the U.S. Factor analysis of 15 items describing child behavior collected as part of an extensive telephone interview of parents yielded four dimensions of behavior: difficult behaviors, lack of persistence, distractible, and withdrawn. Demographic and personal characteristics of the child and family were found to be related to the four behavioral dimensions. Parent reports of behavior of toddlers with fair or poor health or those with communication difficulties were less positive for all behavioral dimensions, suggesting the development of toddler behavioral characteristics is influencing or being influenced by other facets of development.

ICF and ICD codes provide a standard language of disability in young children.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention. METHODS: The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors). RESULTS: The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively. CONCLUSIONS: The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Thirty-six-month outcomes for families of children who have disabilities and participated in early intervention.

OBJECTIVE: Infants and toddlers with disabilities in the United States and their families are eligible for early intervention services under Part C of the Individuals With Disabilities Education Act. The purpose of this study was to assess family outcomes at the end of early intervention (near the child's third birthday). METHODS: A nationally representative sample of 2586 parents in 20 states completed a 40-minute telephone interview on or near their child's third birthday. This article summarizes data related to perceived family outcomes at the end of early intervention. RESULTS: At the end of early intervention, most parents felt competent in caring for their children, advocating for services, and gaining access to formal and informal supports. They also were generally optimistic about the future. Most (82%) parents believed that their family was better off as a result of early intervention. Parents were somewhat less positive in their perceived ability to deal with their child's behavior problems or gain access to community resources, and lower family outcome scores were found for parents of minority children, children with health problems, and children who were living with a single adult. CONCLUSION: Results suggest that Part C early intervention provides important supports for families of young children with disabilities. The findings reinforce the need for experimental research to identify factors that are most likely to lead to successful outcomes for all families. In the meantime, early identification and expeditious referral are important so that maximum benefit can be realized for children with disabilities and their families.

First experiences with early intervention: a national perspective.

BACKGROUND: Families of young children with disabilities are eligible for early intervention services as mandated by Part C of the Individuals With Disabilities Education Act. Although prior research has shown that families are generally satisfied with early intervention, this research has not been based on a nationally representative sample of families, nor has it systematically examined perceptions of the initial experiences entering early intervention. OBJECTIVE: This study was designed to determine families' initial experiences in determining their child's eligibility, interactions with medical professionals, effort required to obtain services, participation in planning for services, satisfaction with services, and interactions with professionals. METHOD: We interviewed a nationally representative sample of 3338 parents of young children with or at risk for disability. All the children had recently entered an early intervention program operated under the auspices of Part C of the Individuals With Disabilities Education Act. RESULTS: The average age at which families reported a concern about their child was 7.4 months. A diagnosis was made, on average, 1.4 months later, the child was referred for early intervention an average of 5.2 months after the diagnosis, and the individualized family service plan was developed 1.7 months later or at an average age of 15.7 months. Most families were very positive about their entry into early intervention programs. They reported discussing their concerns with a medical professional and finding that person helpful. Families reported relative ease in accessing services, felt that services were related to their perceived needs, rated positively the professionals working in early intervention, and felt that they had a role in making key decisions about child and family goals. A small percentage of families experienced significant delays in getting services, wanted more involvement in service planning, or felt that services were inadequate, and nearly 20% were unaware of the existence of a written plan for services. Minority families, families with limited income, and families with less-educated mothers were more likely to report negative experiences. CONCLUSIONS: We conclude that the beginning of early intervention services generally is highly successful and responsive, a finding that should give pediatricians more confidence in referring families for early intervention services. However, research and local evaluation efforts are needed to develop strategies to assure that all families receive services in a timely and appropriate fashion.