xt7xsj19pw5k https://exploreuk.uky.edu/dips/xt7xsj19pw5k/data/mets.xml Kentucky. Department of Education. Kentucky Kentucky. Department of Education. 1955-09 bulletins English Frankford, Ky. : Dept. of Education This digital resource may be freely searched and displayed in accordance with U. S. copyright laws. Educational Bulletin (Frankfort, Ky.) Education -- Kentucky Educational Bulletin (Frankfort, Ky.), "A Program of Health Services for Kentucky Schools", vol. XXIII, no. 3, September 1955 text
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Commonwealth of Kentucky

EDUCATIONAL HLLETIN

A PRQGRAM OF HEALTH SERVSCES
FOR KENTUCKY SCHOOLS

Published by
DEPARTMENT OF EDUCATION

WENDELL P. BUTLER.
Superintendent of Public Instruction
Frankfort, Kentucky

ISSUED QUARTERLY

Entered as second-class matter March 21, 1933, at the post office at
Frankfort, Kentucky, under the Act of August 24, 1912.

VOL. xxm SEPTEMBER,]955, "NQ- 3

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FOREWORD

The purpose of this bulletin is to assist local school and public
health officials in the joint planning and administration of local
school health programs. It has been prepared jointly by the State
Department of Education and the State Department of Health as a
guide and is not to be considered a rigid plan. It is recognized that

adJustments and changes will be necessary to meet varying local
Situations and needs.

' Local education and health officials are urged to work closely
With all the interested official, professional, and voluntary agencies

and groups in the county to achieve the best possible local school
health program.

Consultation service is available from the State Department of
Education and from the State Department of Health in planning

and administering local school health programs and should be used
as needed.

f; It is recognized that revisions of this bulletin will be necessary
.1011} time to time as needed. Comments and suggestions for its
improvement are invited.

Wendell P. Butler
Superintendent of Public Instruction
Kentucy State Department of Education

Bruce Underwood, M.D.
State Commissioner of Health
Kentucky State Department of Health

123

TABLE OF CONTENTS

PAGE
FOREWORD ........................................................................................................ 123
CHAPTER I
ORGANIZATION OF THE SCHOOL HEALTH SERVICE PROGRAM
General Policies _______________________________________________________________________________________ 125
Objectives ____________________________________________ 125
District School Health Committee .......................................................... 126
Individual School Health Committee ................................................... 127
County Citizens Health Committee ..... _. 128
School Health Coordinator _____________________________________________________________________ 128
CHAPTER II
SCHOOL HEALTH SERVICES
Control of Communicable Diseases _____________________________________________________ 131
School Responsibilities _____________________________________________________________________ 131
Teachers’ Role _______________________________________________________________________________ 132
Local Health Department ......
Necessary Control Measures ..
Immunization Program ___________________________________________________________________
Health Appraisal of School Children ______________________ 134
Preschool and School Health Examinations _______________________________ 134
Teacher Observation and Screening _________________________________ 135
Health Records _________________________________________________________ . 137
Follow-up Activities .. ,,,,,,,,,, . 138
Mental Health ___________________________________________________________________________________ 140
Nutrition _____________________________________________________ _ ______________________________________ 141
Health of Teachers and Other School Personnel ............................... 142

CHAPTER III
EMERGENCY CARE OF ACCIDENTS AND SUDDEN ILLNESS

Immediate Care _________________________________________________________________________________________ 143
Informing Parents _________________________________________________________________________ 143
Standing Orders ________________________________________________________________________________________ 143

CHAPTER IV

PROVISION OF A HEALTHFUL SCHOOL ENVIRONMENT

Factors, Standards, Location, etc. ________________________________________________________
School Lunch Program ........................

School Sanitation ______________________________________________________________________________________ 147
APPENDIX
School Health Record _____________________________________________________________________ 148 — 149
Teacher’s Observation Check List _____________________________________________ 150 -151
Teacher’s Check List for Referring Children
For Hearing Tests and Hearing Evaluations ______________________________ 152

124

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123

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125
125
126
127
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131
131
132
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134
134
135
137
138
140
._ 141

142

143
143
A, 143

,,,,, 145
_____ 145
_____ 147

13 — 149
30 — 151

15?

CHAPTER I

ORGANIZATION OF THE SCHOOL HEALTH
SERVICE PROGRAM

Children of school age are a part of the total community and the
school health program should be thought of as a part of the total
community health program. It is therefore essential that school
Officials, public health officials, and representatives of other official
agencies, professional groups, voluntary agencies and the public
plan together to provide an adequate health service for the children
of the community.

GENERAL POLICIES

1. Parents are primarily responsible for the health of their
children but school authorities, health departments, physicians,
dentists, nurses, other social and welfare agencies, as well as medical,
dental, and nursing societies, are all rightfully concerned with
school health activities in their communities.

2. The school health program in each county is planned and
administered jointly by the local school and health officials with
the participation of other local official agencies, voluntary agencies,
Drofessional groups and the public. The close cooperation of all
concerned is essential to the best possible program.

3. School health services should be organized so as to utilize
fully the resources of the schools, the health department, medical,
dental and nursing professions, and other agencies and groups
Without duplication of facilities or services. School health and
COmmunity health services should complement and supplement

each other.

OBJECTIVES

Some of the objectives of the school health program are:

1. To teach children the rudiments of personal and community
health, establishing good clean health habits in the child, and in-
stilling in the child the desire for a clean, healthy life, both for him-
self and others.

2- To protect the child from communicable diseases.

3. Insofar as possible, to give assurance that each child is
PhYSlcally and mentally fit for the school routine.

125

4. To detect diseases or physical defects that may impede
normal growth and development.

5. To provide follow-up services by nurses and teachers, to
promote the health of the child, apply preventive measures, and
secure corrections of physical and mental defects.

6. To assure frequent dental examinations to disclose any
early dental defects.

(a) Secure corrections of these defects in their early stages. ‘

(b) Teach the child good dental health habits.

7. To provide a clean, sanitary, safe and Wholesome en-
vironment.

8. To determine that the teachers and other school employees
are free of communicable diseases.

9. To promote the nutritional status of the school child, school
personnel, and the community.

DISTRICT SCHOOL HEALTH COMMITTEE

Each school district should have a school health committee to
function as a coordinating agency for all health activities in a school
system.

The committee should be as representative and comprehensive
as possible and should include school health officials, and members
of the medical, dental and teaching professions, as well as repre—
sentatives from the various community health organizations and the

public. \Vhere proper leadership is provided, school health com—i

mittees can do much to improve health instruction, health services
and school environment.
Functions of the district school health committee are to:
1. Serve in an advisory capacity to school and health officials.
2. Assist in coordinating all the health activities in the schOO1
system it represents. '
3. Assist in coordinating the'school health activities with the
health activities of the community.
4:. Study local school and community needs, problems7 and
available local and state resources so that any policmS
recommended are reasonable, sound and feasible.

5. Study school health problems in the district and appraise
health needs of children as a basis for program rec/0111‘
mendations.

IN DIV]

Eat
compose
students
commur
member
larger si
mittee 11

Son
1.

C:
my—Ji—rm

mpede

:rs, to .

s, and

e any

stages.

16 en-

tloyecs

school

ttee to
school

Lensive
embers

repre-
.nd the

1 com- 1

:rvices
'ficials.

school
ith the

l5, and
policies

ppralSC
recom-

Provide schools with a roster of available professional re-
source people and materials to implement their health
program.

Aid schools in obtaining follow—up and correction, when
possible, of defects found and aid in securing medical at-
tention for medically indigent children.

Make a periodic evaluation of the program to see what has
been accomplished and what remains to be done.

INDIVIDUAL SCHOOL HEALTH COMMITTEE

Each community may benefit from a school health committee
composed of school and health officials, teachers, representative
students, and interested lay and professional individuals in the
community. This committee may vary in size from two or three
members in small rural schools to fifteen or twenty members in
larger schools: Where Parent—Teacher Associations exist, this com-
mittee may be the health committee of the Association.

Some of the duties and responsibilities of this committee are to:

Make an evaluation study to determine the health needs of
their school.

Interpret and carry out the general policies and plans of the
district school health council.

Assist in coordinating the school health activities of the
community.

Make recommendations to the district school health council
on the basis of findings in that particular school.

Provide volunteers for school health activities in which they
are needed, such as vision screening, hearing screening,
community work days for the improvement of school en-
vironment, summarizing food habit records, interpretation
of nutrition needs to the community, and participation in
program planning.

Make periodic evaluations of the actual development of the
school’s health program.

Provide a plan for the correction of defects found in
medically indigent children.

Other follow—up activities.

1‘27

COUNTY CITIZENS HEALTH COMMITTEE

The purpose of the county citizens health committee is to work
with the local health department in developing, initiating and
conducting health activities for the benefit of everyone in the
county, based on the recognized health needs of the county. The
district school health committee can and will often be a branch of the
citizens health committee. As a minimum, they should be affiliated

organizations working together to coordinate school and community i

health activities.
The citizens health committee may:
1. Advise and counsel the school health committee in the

development of more adequate school health programs as related to
the total community health program.

2. Assist in coordinating various community health agency
activities with the school health program.

3. Aid in making the various health services and facilities of
the community available to the schools.

SCHOOL HEALTH COORDINATOR

A member of each school’s faculty with approved preparations
should be designated as health coordinator, in order that the entire
faculty may cooperate in realizing the potential health teaching
values of the school program In the larger schools this person should
be allowed to spend full time with the school program. In small

schools, the coordinator may have other duties in addition to the ,

administration of the health program. It is suggested that count)”
systems having small one to four room schools employ a count.V
school health coordinator to serve several schools.

Among the responsibilities of the school health coordinator 5211‘9
the following:

1. Cooperate with the local health department staff in all
matters pertaining to the school health program in which the 10031
health department has responsibilities.

2. Present to the school administrator for his consideration
any measures which may be needed to bring the school health p1'0‘
gram up to currently accepted standards of adequacy and qualit.“

3. Represent the school administrator at committee meetings
in the school and at community meetings and functions having to
do with health.

4.
health

a.
health

6.
needed

1.
and sti

8.
their 11:

9.
student

10.

11.

0 work
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aching“
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. small
to the
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county

'01‘ are

in all
e local

aration
11 pro—
ualit.“
aetingS
ing to

4. Represent the school on school health councils or citizens
health committees.

5. Help to secure an integrated and functional program of
health teaching suited to the needs of all children.

6. \Vork with committees and with individual teachers on
needed revisions of the health curriculum.

7. Secure background materials in health for use by teachers
and students.

8. Secure audio-visual aids on health topics and assist in
their use.

9. Assist in arranging student field trips on health and for
student participation in community health projects.

10. Assist in the conducting of workshops in health education.

11. Assist the staff in planning a unified, sequential program.

129

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CHAPTER II

SCHOOL HEALTH SERVICES

This chapter deals with school health services which are
necessary to attain the objectives listed in Chapter I. With the
exception of first aid in emergencies, diagnostic and treatment
services are provided through the family or community by physicians
and dentists in private offices, hospitals, community clinics and
other local facilities established for the purpose. The school’s re—
sponsibility is in aiding the individual child or family in obtaining
such services. Plans for the promotion and execution of school health
services will vary from one county to another because of differences
in local resources and needs.

CONTROL OF COMMUNICABLE DISEASE

Every school should provide adequate means for protecting the
health of pupils and school personnel. Every effort should be made
to reduce the possible spread of communicable disease.

A school’s program for the prevention and control of com-
municable disease should be based on the most recent and au-
thoritative public health practices.

School health personnel should become familiar with state health
pOIieies regarding communicable diseases. The State Department of
Health and all local health departments are legally authorized to
take whatever steps are. necessary to control the spread of these

diseases.
1. SCHOOL RESPONSIBILITIES
The school’s chief responsibilities in the control of com-
municable diseases are:

a. Encourage parents to make full use of all available pre—
ventive measures and immunization procedures.

b. See that sick children do not come to school. Children who
are ill cannot learn at full capacity.

0- Arrange to return to their homes children who become sick
at school.

d. Protect pupils as far as possible from exposure to com-
municable diseases through isolation of suspect cases. This is
a responsibility of the teacher in charge.

1 31

e. Report promptly to the health department all suspected
cases of communicable disease.

All the above measures require close cooperation between
schools, parents, and local health departments.

TEACHERS’ ROLE

Teachers should be constantly alert to the possibility of
pupils displaying signs and symptoms of communicable disease
at any time. The teacher may refer to the communicable disease
wall chart published by the State Department of Health, and
available at the local health department, as a guide in observing
for symptoms of communicable disease. Observation should be
continuous and is far more important than a routine morning
inspection.

The teacher does not diagnose, but, when suspicious that
a communicable disease may be present, she should refer the
child to the nurse or school physician, if available. If not, the
child should be isolated and arrangements made to send or
take him home. Parents should be notified promptly.

3. LOCAL HEALTH DEPARTMENT

Community control of communicable disease is the special
and legally designated responsibility of the local health officer,
or administrator, and his staff who are in the best position to
know and understand the application of the latest approved
practices.

NECESSARY CONTROL MEASURES
All schools and local health departments should adopt
joint policies to implement the entire communicable disease
control program in schools. The local responsibilities of all the
school personnel and public health personnel will depend 011
these policies. Policies should include the following:
a. Provision for a place of isolation.
b. Notification of parents or guardians of the illness.
c. Methods of transporting a sick child to his home. A suscht
child should not be sent home alone, nor transported home
on the school bus. The nurse. if available, the teacher, 01‘ the

school administrator should determine when to take the
child home.

5. IMI

OFAJi—r‘r—Ff‘H‘JHI—Ji—Ji—J‘

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mt
:he
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ase
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Procedure for excluding from school non—immunized c011—
tacts, in accordance with the current public health recom-
mendations.

Standing orders should be set up for handling com-
municable diseases.

Policies concerning readmission of a child to school after
absence for communicable disease.

IMMUNIZAT [ON PROG RA M

E1.

(l.

Immunity to certain communicable diseases can be de-
veloped through the use of proven vaccines, toxoids, and
other substances. Every child should be protected against

those diseases for which dependable immunization is avail-
able.

All preschool and school children should be immunized
against smallpox, diphtheria, tetanus, and whooping cough.
Protection against typhoid is highly desirable and should
be provided as the need and demand arises.

Smallpox vaccination is mandatory in Kentucky for infants
before they are one year of age. Re—vaccination should be
done before entry to school.

Triple toxoid can be used for diphtheria, whooping cough,
and tetanus. Primary immunizations are usually given in
three doses at one month intervals beginning at the age of
two or three months. Booster doses should be given one year
after the completion of the primary series and again when
the child enters school. Thereafter, booster doses should be
given at two to three year intervals through age twelve.

Parents should be encouraged to take their children to
their family physician for immunization who should make
proper certification to school authorities for recording.

Immunization services should be provided by the school,
medical society, or health department as indicated by local
policies. Definite planning not only for the time, but also
for the routine of such clinics, is essential. The best method
of providing immunization should be decided jointly be-
tween the local medical society, school officials, the local
health department, and the local board of health.

No child should be immunized in the school without the
consent of the parent or guardian.

1 3‘3“

HEALTH APPRAISAL OF SCHOOL CHILDREN

One of the objectives of the school health program is the
periodic appraisal of each child’s health condition. Such appraisals
are obtained and recorded in order to discover children’s health
needs and to initiate steps for meeting these needs.

/' 1. PRESCHOOL AND SCHOOL HEALTH EXAMINATIONS

Quality, thoroughness, and adequacy of health examinations
should be emphasized rather than quantity or frequency.

The Code for Health and Physical Education, published by the
State Department of Education, states that “schools must provide
for . . . medical examination of each pupil prior to entering or upon
entering school for the first time, and physical examinations at
least every fourth year thereafter.”

The medical examination should be done before the pupil enters
school for the first time and should be made early enough to permit
adequate follow—through and any needed treatment before opening
of the school.

The examination should be a community project supported by
the schools, health department, and lay and professional groups in

‘ the community. Schools should supply physicians and dentists with

forms to be used in reporting the results of the examinations to the
schools. This information is to become a part of the child’s permanent
record.

The pupils preferably should be examined by their family
physicians. In examining first grade children, it is recommended
that a tuberculin test be done and that a chest X-ray film he made
on any children who show positive. The local health department

should screen family contacts to locate the source of any positive
tuberculin reactions.

Children should receive a dental examination at least once a
year. Non-indigent children needing dental care should receive such
treatment from their local dentist.

Parents should be present during medical and dental examina—
tions of preschool or grade-school children. Their presence is 95‘
sential to give the doctor the child’s health history or to supplement
a previous health history Also, the nurse can gather information
from the parent as to the child’s health and food habits. The parent’5
presence also allows the doctor to point out any condition that needs
treatment. and indicate possible results of neglect. This is also a good

134

time t(
sweets
of dent

Th
experi(
should
describ
the val

If
other t]
to the 1

Va
when ii

2. TE.

Th
pupils :
havior
the hea
should

Th:
should
practim
emotion
pearane
aid in i

4//,.»” Th(
I to detec

referral
need is

Pre
teacher
inform
The pul
carrying
Will resc
screenin
medical

As;

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ils

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ers
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ith
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ent

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led
ade
ent
,ive

e a
uch

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es-
.ent
zion
nt’s
BCdS
ood

time to point out the need of proper dental care and to discourage
sweets in a child’s diet as much as possible since this is a big cause
of dental caries.

The medical and dental examinations should be an educational
experience for both the parent and the child. Parents and teachers
should carefully prepare younger children for the examinations by
describing what the doctor and dentist will do, and the reason for
the various steps in the examinations.

1f the findings of the health examination are recorded on forms
other than the school health record, the results should be transferred
to the pupil’s school health record by the teacher. (See Exhibit I.)

Vaccination, immunization, and screening tests should be done
when indicated and noted on the child’s permanent record.

2. TEACHER OBSERVATION AND SCREENING

There should be continuous observation by the teacher of all
pupils in the classroom. Teachers must be alert to changes in be-
havior or appearance that may indicate something is wrong with
the health of the child. Total growth and development of the child
should be as carefully watched as his academic achievement.

Throughout each day, the teacher, in her strategic position,
should observe all her pupils for personal cleanliness and health
Practices, possible signs of communicable disease, evidence of
emotional or social problems, and any deviations from normal ap-
pearance and behavior. The Teacher’s Observation Check List will
aid in making these observations. (See Exhibit 2.)

//f The teacher’s role is not to make a medical diagnosis but simply

/” to detect signs and symptoms of possible defects and to make proper

referrals through the parents to the physician or dentist when the

K need is indicated.

Preliminary screening of all pupils should be conducted by the
teacher or volunteer health worker. Local health departments should
inform schools of recommended screening procedures and devices.
The public health nurse should assist in the techniques of properly
Carrying out the screening procedures. In most instances, the nurse
Will rescreen children suspected of having a defect as the result of the
screening by the teacher or volunteer before she refers them for
medical attention.

As a minimum, screening programs should include:

’135

\VEIGIHNG AND MEASURING

During the period of growth, a child should periodically
show gains in height and weight. As part of teacher observation
and screening, the teacher should weigh and measure the pupils
at intervals determined by the health council 011 the advice of
the school physician or health officer. This will probably be three
or four times annually in the elementary grades and at least an-
nually in the secondary school. The results should be recorded on
the health record. Such information will help the physician in
determining the health status of a child. If the teacher observes
that a child is not making normal gains, or if a child appears
too much overweight or underweight—always allowing for
known individual differences—the condition should be discussed
with the nurse or with the child’s parents.

VISION TESTING

Eye health is essential to success at school. The teacher and
the public health nurse need to keep watch to see if children in
school show signs of eye strain or faulty vision.

The teacher may suspect difficulties in vision if a child:
(1) Rubs his eyes frequently.
(2) Squints and strains to see the blackboard.
(3) Holds a book too close or too far away from his eyes.
(4) Complains of headaches, or blurred print.
(5) Appears cross-eyed.

A child with any of these difficulties should be referred to
the nurse, and the parents should be advised to secure profes—
sional service for the child.

Each child’s visual acuity should be tested at least once a
year with a Snellen chart. Use of the Snellen chart by teachers,
combined with teacher observation, is a recommended method of
mass vision screening. It must be remembered that the chart has
certain limitations. Nevertheless, this simple test, together with
observation for symptoms, will help to discover most visual
difficulties that may be starting in one or both eyes and will
indicate to teachers those children who should be referred for
further check.

HEA
h
dren.
throa
lefl!
1
teste(
indiv
adeqr
each
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losses
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HEARING TESTING

Many conditions may indicate hearing difficulties in chil-
dren. (See Exhibit 3.) The most common are a cold or sore
throat, running ear, mouth breathing, frequent earaches, etc.
Difficulty in understanding conversational speech is often a clue.

All elementary school children should have their hearing
tested annually. Students in secondary schools should be tested
individually in alternate years. Since both trained personnel and
adequate equipment are limited, it is recommended that
each year in a school, as a minimum, grades 2, 4, and 6 be
screened and all children in other grades be referred by their
teachers when certain symptoms are noted. Teachers should learn
to do the preliminary hearing screening.

Various screening methods for the detection of hearing
losses are in wide use. The most reliable, if properly applied, and
the most highly recommended procedure is the “Individual Pure
Tone Sweep Cheek Test,” which is administered by means of a
specially constructed electronic instrument called the Pure Tone
Audiometer. After training and practice, volunteer testers from
the school health council or other civic groups can readily ad-
minister the preliminary test.

In brief, the test simply involves the child’s responding to
tones of various pitches at a predetermined level of loudness.
If the child fails to hear the tones at that setting he should be
scheduled for a retest at a later date. At the time the retest is
given, an audiogram will be made if the child still appears to
have a hearing loss. Further recommendations will be made on
the basis of the information recorded on the audiogram, (medical
treatment, speech and/or hearing therapy).

HEALTH RECORDS

‘ v . .
Cumulative and uniform health records on each pupil are a

necessity if the health program is to be complete and effective,
(See Exhibit 1). Some of the characteristics of good school health
records are as follows:

The record is started when the child enters school and includes
as much of the child’s previous medical history as is pertinent.
The responsibility for obtaining the initial health history remains
with the school authorities.

137

The record contains findings significant to the school, whether
made in the school or elsewhere, and thereafter is filed with the
child’s cumulative school record, accessible for use by teachers
and health department personnel.

Records are kept current and used for effective guidance of
pupils.

Screening and observation tests by the teacher or volunteers are
recorded periodically.

Pertinent medical data are kept up to date.

The information contained on school health records is con-
fidential and when used by the teacher, nurse, physician, dentist,
or other authorized person, is treated in a confidential, pro
fessional manner.

The health record of the pupil is forwarded to the new school ’

when he transfers from one school to another.

All school health records are kept for as long a period as ‘

scholastic records are kept.

FOLLOVV—UP ACTIVITIES

The school and health department are responsible for main

taining constant follow-up of children whose screening test, 01‘
medical examination indicate that they need further medical at-
tention including correction of defects found.

TEACHER-NURSE CONFERENCES

Conferences between the classroom teacher and the nurSe :

are important in that they provide an excellent opportunity for
understanding and joint planning to meet the individual needS
of each child.

Four major objectives of teacher—nurse conferences are:

(1) To emphasize the total health needs of each child and the I

importance of health guidance.

(2) To develop the child’s responsibility for his own health.

(3) To broaden the public health and social understanding 0f

both the teacher and nurse