Early and Periodic Screening, Diagnosis, and Treatment services is a possible means for expanding resources to provide screening programs for all students. However, Medicaid reimbursement is not an easy process, and possible changes in the system make Medicaid an uncertain future source of funding for screenings.

The following initial questions should be raised in establishing effective screening programs:

  1. What screening programs are mandated, and what are the outcomes?

  2. Are screening practices aligned with current research, knowledge, and technology? (Consider frequency of procedure and any gender-specific procedures.)

  3. What mechanisms exist to ensure that identified problems are followed up and treated?

  4. Do other sources—private health care, health fairs—duplicate school screening efforts? How is information, both positive and negative results, shared among systems? How is confidentiality maintained?

Provide Systems for Identification and Solution of Students' Health and Educational Problems

The school alone cannot identify and solve all problems that affect its students. However, a team approach utilizing the many resources within the school and community can lead to greater progress than will be achieved by separate, isolated efforts. Methods of problem identification from both within and outside the school, tracking of student problem resolution strategies, and suggested categories of classification of problem resolution have been described by the American Academy of Pediatrics (1993).

An example of whether a community is meeting student's health and education needs would be the correction of visual defects identified through routine school screening. Data from one large urban district in southern California, however, illustrate the difficulties involved in assessing whether follow-up and correction are occurring. Data at the district level, drawn from nurses' monthly reports of screening activities, suggested that only about one-half of students failing vision screening actually received care. However, an in-depth review, including parental phone interviews of two school clusters, found that closer to 85 percent of parents had followed through with the referral but did not inform the school (nor did the providers of care) (Nader, 1995). This situation points out the need for improved communication between parents and/or providers and the school. The targeting of 15 percent of those children still needing

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