BARRIERS TO PROVIDING SCHOOL- BASED HEALTH CARE: INTERNATIONAL COMPARISONS. Dr. Denise Seigart

Transcription

1 BARRIERS TO PROVIDING SCHOOL- BASED HEALTH CARE: INTERNATIONAL COMPARISONS Dr. Denise Seigart

2 Barriers to providing school-based health care: International case comparisons This research involved interviewing 73 nurses, teachers, school administrators, community leaders, parents, and nursing faculty members in Canada, Australia and the U.S., as well as observing care provided in schools, and reviewing pertinent documents.

3 Data analysis Grounded theory approach NVivo8 qualitative analysis software Colleagues; Thanks to Michele Parent, Nipissing University, Elaine Dietsch, Charles Sturt University and Cheryl Armistead, McGill University assisted with research, interpretation of the data, and writing of articles.

4 Current health needs of children United States Canada/Australia Acute and Chronic Illness-bronchitis, strep, ear infections, asthma, diabetes Acute and Chronic Illness-bronchitis, strep, ear infections, asthma, diabetes Injuries Injuries Emotional needs-mental health drug/ alcohol abuse, family problems Emotional needs-mental health drug/ alcohol abuse, family problems Neglect Neglect Dental Dental (limited) Insurance needs Insurance needs (limited) Educational needs-personal hygiene, nutrition, obesity, sexuality, health promotion Educational needs-personal hygiene, nutrition, obesity, sexuality, health promotion Disabilities GT feeds, catheterizations, behavioral problems Disabilities GT feeds, catheterizations, behavioral problems

5 For example--australian skin cancers

6 Medication administration in schools 50 million children in the US in K thousand public schools in the US 13 million children take medications in the USA in any 2 week time period 57% of school districts have an RN 35,000 school nurses 1:1,350, average ratio of school nurse to students (1:750 recommended)

7 Current healthcare provision via schools United States- GPs, pediatricians School nurses Recommended Ratio 1:750 (depending on acuity) Varies widely state to state School Based Health Centers-NPs in US Community Health Nurses-- Well child clinics Immunization clinics Canada/Australia GPs, pediatricians Community Health Nurses-- Well child clinics Immunization clinics School nurses- limited, varies by district, private schools more likely to have NPs scarce

8 Barriers to providing school-based health care: Identified Themes. 1-Limited resources and physician control of nurses practice. 2-Teacher stress, increasing expectations. 3-Lack of understanding/valuing of the nurses role. 4-Rural vs. urban (rural areas often correlate with conservative/ religious attitudes)-limited access to practitioners and certain types of care. 5-Influence of conservative/religious organizations (which can restrict access to care). 6-Other structurally and culturally embedded issues-racism, classism (the deserving vs. the undeserving poor).

9 Progress in providing healthcare through schools The importance of dialogue to promote reform/inclusion of social justice issues examples from U.S. health care reform efforts town meetings, participatory evaluations Co-opted by conservative groups, propaganda, tea party express, the very vocal minority, funding issues

10 Selected References Couzos, S, Murray, R. Aboriginal Primary Health Care: An evidence-based approach. New York: Oxford University Press; Healthy children-strengthening promotion and prevention across Australia. National public health strategic framework for children National Public Health Partnership. Melbourne: NPHP MacDougall, C. Healthy schools: Overview and opportunities. Presentation made to North Bay Community, March Winnail, S, Bartee, T, Kaste, S. Existence of School Health Coordinator in a Frontier State. J Sch Health, 2005; 75(9); Additional references available upon request.