The Effectiveness of Health Screening in a School Program for Migrant Children

Abstract

This program shows again the price paid for fragmented health services. The provision of screening teams outside of normal channels of health care resulted in the discovery of many health defects, but in the treatment of less than half of them. Several ways might be found to improve the program. At the present time we believe that an effective school health assessment can be made without physical examinations. Instead, if it is felt that heart disease should be detected in school, heart-sound screening could be added to the test battery. Teacher observation should be utilized by emphasizing the teacher-nurse conferences. This would result in referral not only of physical abnormalities, but of children with behavioral symptoms, and children with such conditions as hyperactivity and dyslexia. Such a procedure has been advocated for nearly 30 years. It would leave unsuspected hernias, which are rare, and inapparent otitis without pain, fever, or hearing loss which is probably of little significance, as the major abnormalities liable to be overlooked in health assessment. The program described here would have been far more effective had nursing time been used in the follow-up of health defects rather than in physical examinations. For instance, two of the four nurses on the screening teams might have worked with community nurses and school personnel to reach the parents. In our opinion, abandoning physical examinations and redirecting nursing time into coordination and follow-up would result in better health care for the children in the program.