Thus, the levels of the Progression Model indicate a progression from serving SSHCN completely in a non-restricted regular education setting with no modifications required in their educational programming (Level 1), to a more restrictive service level for the child in which a need for special education services has been established (Level 4).
SSHCN are referred to the program from a variety of sources including community physicians, school teachers, school nurses, parents, and Texas Children's Hospital physicians and allied health providers.
These time study data suggest that educational liaison with schools for SSHCN requires a significant time commitment for health providers.
Valuable resource materials have been developed by these programs and others on the subject of integrating SSHCN into educational settings.[12-16]
For purposes of the survey, a health procedure was defined as "a treatment required by a child for at least three months on a routine basis." Respondents indicated 66,629 SSHCN required at least one of 22 specified health procedures at school (Table 2).
Sixty-seven percent of respondents indicated they routinely developed student-specific health care plans or documented the health care delivered to SSHCN in the schools where they were employed.
These findings indicate Texas public school nurses have responsibility for a range of health services delivered daily to SSHCN. A number of issues brought forth by the survey have implications not only for the future scope of school nursing practice in Texas in an era of health and education reform, but most importantly for the safety of students with special health care needs in educational settings.
A third issue surrounds parents as the primary source of information and training concerning SSHCN. While the role of parents as case managers for the health needs of their SSHCN generally is appropriate, the medical community has a large responsibility in equipping parents in their role as case manager and collaborating with schools. This goal can be accomplished through health education, written documentation of health needs during the school day, and prescriptions for home and school.
Finally, the survey demonstrates a gap between the school nurse developing the health plan and subsequent translation of the health needs into educational programming through involvement in the special education process for eligible SSHCN. Although this finding reinforces results from a Louisiana study which showed that official education documents did not contain health information on SSHCN, it is nonetheless very troubling.
While time constraints and variations in the medical complexity of SSHCN may make participation of the school nurse in all components of the special education process impossible or impractical, Todaro and Benjamin (according to personal communication) developed a model which allows active, limited, and consultative participation.
Second, the data on school nurse involvement in the health and education management of Texas school-age SSHCN were made available for program planning purposes to state agencies including the Texas Education Agency and the Texas Dept.