Special health care needs SBHCs

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). 

Although special education services are certainly warranted and valuable for many children with special health care needs, school-based health centers (sbhcs) offer another mechanism to address the needs of these students. As mentioned, SBHCS now number over 1200 in the United States and have expanded to include a range of preventive, primary care, and mental health services. A common staffing pattern for an sbhc would include a medical assistant, nurse coordinator (often an rn), nurse practitioner or physician assistant, a mental health professional (usually master s-level or doctoral trainee), and a consulting physician. Some centers have additional staff, including health educators, outreach workers, and dentists (Juszcak et al., 1995). 

School-based health centers are uniquely positioned to provide services to students who are most in need. Most sbhcs are established in low-income communities with inadequate health care resources and many unmet health care needs. This is reflected in a 1998-1999 survey of sbhcs nationally two-thirds of the population served by the centers were members of a minority group (National Assembly on School-Based Health Care, 2000). Studies of children with special health care needs reveal that those who face the most serious problems in accessing health care are children who live at or below the federal poverty line, live in single-parent families, are uninsured, are older children and teens, or members of a racial or ethnic minority group, sbhcs are designed to provide easily accessible health care services to this population. 

In the following, we present ideas for school-based programs to better address the health and mental health needs of children and adolescents with special health care needs. Recommendations are built upon studies and articles on sbhcs and expanded school mental health as reviewed earlier. We also draw on studies and articles that have generally discussed interdisciplinary collaboration in pediatric settings (e.g., Drotar, 1995 Roberts, 1995 Schroeder, 1996). 

Interventions that target a student s entire classroom can also contribute greatly to the adjustment of children with special health care needs. For example, SBHC staff can educate students about a child s illness to reduce the stigma and fear that classmates often convey. Carefully implemented classroom education and support programs have been found to enhance the reintegration of children back into the school after hospitalization (Katz et al., 1992). In addition, simulation exercises that allow classmates to experience an aspect of the child s condition (e.g., ride in a wheelchair, try on a heavy cast) can increase classmate sensitivity toward and admiration for the impaired child. 

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