School Health Services for Children with Chronic Health Conditions in California Public Secondary Schools: Findings from the 2018 School Health Profiles Survey

Background: More than 20% of school districts in the United States do not have policies on identification and case management for students with chronic health conditions (CHCs), suggesting that these students’ health needs may not be met during the school day. Prior research reports a gap in policy implementation and the actual provision or operationalization of the policy into action. Significance: While there is limited research on school health policies, little is known about the actual provision of the services that such policies indicate should be provided. Notably, the actual provision of health services in U.S. schools, particularly regarding CHC management and its association with school nurse employment, is underreported. Methodology: Using data from the 2018 School Health Profiles (SHP) Survey, health services including administering daily medication, providing stock rescue medication, providing case management, facilitating community partnering, and providing disease-specific education were examined in California public secondary schools together with school nurse employment. Complex sampling analysis and chi-square statistics were used to examine the statistical associations. Results: A significantly greater proportion of schools with a full- or part-time nurse compared with schools with no nurse provided: (1) daily medication administration (82.1% vs. 68.1%; p = .014); (2) case management services (75.8% vs. 62.0%; p = .031); (3) disease-specific education for parents and families (44.9% vs. 25.7%; p = .016); and (4) parent and student connection to health services in the community (83.7% vs. 72.2%; p = .035). Conclusion: Findings suggest that nationally representative data, such as SHP, contain important information for states to review regarding school health policies and provision of services. Further research needs to expand these findings to better understand school health policy and practice and its alignment with state and federal laws to support all children, especially those with CHCs.