We evaluated a train-the-trainers program for training education staff to assemble adaptive switch mechanisms. The adaptive switches were designed to assist persons with severe mental and physical handicaps in operating various electrical apparata. In Phase 1, a five-step training program (written and verbal instructions, modeling, performance practice and feedback) was used to train four teachers to assemble an adaptive switch. Also in Phase 1 social validity data were collected which supported the importance of adaptive switches for persons with severe physical impairment, as well as the need to train switch assembly skills to human service personnel. In Phase 2, the four teachers used the same five-step training program to train 22 teacher assistants to assemble an adaptive switch. Acceptability measures indicated that training was well received by the teachers (trainers) and assistants (trainees), and time efficiency measures indicated an average of less than two hours of training time was necessary for every two trainees. Effects of the training program were replicated in Phase 3 with two staff from another school. Results of the program are discussed in regard to using a train-the-trainers model as a means of upgrading staff skills, and helping reduce the gap between educational technology presented in the professional literature and that reflected in routine service settings.

A comprehensive evaluation of a train-the-trainers model for training education staff to assemble adaptive switches

Ever since enactment of the· Education for All Handicapped Children Act (PL 94142) in 1975, school districts have been opening their doors to students who pose greater and greater challenges to their teachers and administrators. The newest challenge is that of providing education to students with complex health care needs (Sirvis, 1988; Viadero, 1987). There has been a long tradition of providing education to students with chronic illnesses such as diabetes, asthma, spina bifida, sickle cell anemia, hemophilia, cystic fibrosis, and muscular dystrophy (cf. Hobbs, Perrin & Ireys, 1985; Kleinberg, 1982). But typically when those students' conditions progressed to the point that they needed health care services such as catheterization, respiratory therapy, tube feeding ventilation or oxygen, they were hospitalized or remained at home and did not attend school. The school(s) usually made adjustments for their absences or provided home or hospital instruction until their condition improved. Now students are not automatically removed from schools for prolonged periods when they need complex health care services. After their medical conditions stabilize, students with chronic illnesses or other complex health care needs requiring specialized, skilled care, and possibly medical technology to support them, are coming to today's schools. Schools may have to take measures to ensure that serious communicable diseases are not spread within the school. The special needs student may require apnea monitoring, tube feeding, mechanical or machine suctioning, mechanical ventilation, oxygen; or other health care that is different, and often much more complex, than the schools typically have provided in the past. Kathy, an 8-year-old student, is an example of such a child currently attending a public school. She was a healthy, normally developing child until age 2, when she wandered out of the family's summer cottage and found her way to the lake, where she nearly drowned. Kathy was in a coma for 4 weeks. Upon discharge from the hospital after regaining consciousness, Kathy was no longer able to walk, talk, or eat by herself. Kathy has difficulty swallowing and coughing-processes necessary to deal with food and saliva present in her mouth and throat. Consequently, Kathy cannot eat food by mouth, but instead is fed through a tube that enters directly into her stomach. Because she is unable to deal with the build-up of saliva and mucus in her mouth and throat, especially when she gets a cold, those fluids must be removed frequently by use of a suctioning machine. The machine has a long tube that is inserted into her mouth, and into her throat, when necessary, to remove the ~excessive fluid.

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Providing Education to Students with Complex Health Care Needs.

A statewide survey of 2,875 Texas public school nurses was conducted to determine the characteristics, needs, and involvement of nurses in the health and education management of students with special health care needs (SSHCN). The 1,574 survey respondents (response rate = 55%) were primarily registered nurses (84%) with a mean of 8.6 years (SD = 7.1) of experience in the school setting. Respondents served 1.5 school campuses on average; the mean nurse-to-student ratio per campus was 1:728 (SD = 518). Respondents identified 106,650 SSHCN (6% of total enrollment). Asthma (47%), attention deficit disorder (26%), and seizure disorders (8%) were the most prevalent conditions encountered among SSHCN. Medication administration (54%), diapering (12%), and inhalation respiratory treatments (11%) were the most common of 48,569 health procedures delivered daily to SSHCN by nurses, clerical staff, assistants, and teachers. Parents were identified as the primary source of both child-specific health (70%) and training (68%) information in the school setting. Although nurses, of all school personnel, are likely best able to speak to the impact of a child's health impairment and needed school services, only 32% of respondents reported routine participation in special education eligibility evaluations and only 18% reported routine attendance at special education meetings for SSHCN. Moreover, 84% and 92%, respectively, reported discomfort at participating in special education eligibility evaluations and attending special education meetings.

Health Services Delivery to Students with Special Health Care Needs in Texas Public Schools

Students who require specialized health care procedures at school need school personnel with specific knowledge and skills to promote a safe, healthy environment and to assist with procedures. This comprehensive national study examined the extent to which nonmedical personnel were responsible for performing health care procedures, training and supervising health care procedures, training in basic health skills to promote a safe environment for all students, and involving students in performing their own health care procedures. Results indicated that while teachers and paraprofessionals regularly perform these specialized health care procedures, although only about half reported being very knowledgeable about them. Results raise several issues regarding appropriate service delivery, training, and maintaining an appropriate instructional and healthy environment for students requiring these specialized health care procedures.

Specialized Health Care Procedures in the Schools: Training and Service Delivery

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) generic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical...

Graduate Nursing Education: Developmental Disabilities and Special Health Care Needs

One-hundred fifty teachers of students with severe and multiple impairments were surveyed to identify the prevalence of health-related procedures being used in the classrooms, the person(s) routine...

Lynne Struth

Papers

The Implementation of Health-Related Procedures in Classrooms for Students with Severe Multiple Impairments: