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UTILIZATION OF SCHOOL NURSES DURING THE EVALUATION AND IDENTIFICATION OF CHILDREN WITH AUTISM SPECTRUM DISORDERS

CONSTANCE E. MCINTOSH AND CYNTHIA M. THOMAS

Ball State University

This study explored school nurses’ involvement during the identification and treatment of children with autism spectrum disorder (ASD). The extent of school nurses’ collaboration with school psychologists and other educators also was studied. Participants included 100 school nurses, representing 18 states, who completed a survey on ASD. The response rate was 16.45%. The most common involvement (17.87%) reported by school nurses during the evaluation process of children with ASD was the review of medical records. A small percentage of school nurses (13.19%) noted that they collaborated with school psychologists during the evaluation process. In general, it appears that school nurses have more involvement with children with ASD after they have been classified than during the evaluation/identification process. C© 2015 Wiley Periodicals, Inc.

The National Association of School Nurses (NASN, 2005) and Council on School Health (American Academy of Pediatrics, Council on School Health [AAP CSH], 2008) have indicated that one of the primary roles of school nurses is to provide supports that lead to students’ health and academic success. The NASN also noted that school nurses should be involved with health program development and implementation, including preventative education and counseling. Although the aforementioned school nurses’ roles include only a few responsibilities outlined by the NASN and AAP CSH, they point to the need for school nurses to be involved during the evaluation and identification of children with special needs. In fact, Galinat, Barcalow, and Krivda (2005) indicated that collaboration between school nurses and other school professionals (e.g., school psychologists, school counselors, teachers, and social workers) is needed when developing and implementing Individual Education Plans (IEPs) and Individual Health Plans (IHPs). The AAP CSH (2008) also advocates for the inclusion of other school professionals, including school psychologists, as members of the school health services team.

The collaboration between school nurses and school psychologists is not surprising, given the percentage of children with chronic health issues within schools. Specifically, approximately 15.1% of children aged 0 to 17 years have special health care needs (Data Resource Center for Child and Adolescent Health, 2009/10), and many of these health conditions (e.g., seizure disorders, asthma, diabetes, and congenital disorders) impact academic performance. There also are an increasing number of school-aged children (ages 6–17 years) classified with autism spectrum disorders (ASDs; Blumberg et al., 2013). Blumberg et al. (2013) reported a significant increase, from 1.16% in 2007 to 2.0% in 2011–2012, in the prevalence of parent-reported ASDs. With the increasing number of children with ASDs presenting with comorbid conditions (e.g., depression, allergies, obesity, or seizures), it is not surprising that Sweeny and Sweeny (2001) noted there is a growing expectation for school psychologists to become involved with children with health-related issues and stressed the need for school psychologists to work with nurses regarding referral, treatment, and follow-up.

More recently, Grier and Bradley-Klug (2011) described how the use of a Biopsychoeducational Model promotes collaboration among school psychologists and other health care professionals. The model emphasizes incorporating both education and health-related issues when improving the school performance of children. Although Grier and Bradley-Klug (2011) recognized that school

Correspondence to: Constance E. McIntosh, Ball State University, School of Nursing, Cooper Science Building (Office #459D), Muncie, IN 47306. E-mail: cemcintosh@bsu.edu

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nurses have traditionally been viewed as the primary health care providers when meeting the needs of children with chronic health issues within schools, school psychologists’ background and training in consultation and problem-solving are ideal for them to take the lead in implementing a Biopsychoeducational Model within the school setting. However, school nurses should be considered a vital member of the collaborative team.

Over the last 10 years, only a few studies (e.g., Galinat et al., 2005; Grier & Bradley-Klug, 2011) have focused on or even mentioned collaboration between school nurses and school psychologists when meeting the health care needs of children. This is surprising because of the overlap in the children being served by both professions. Both school nurses and school psychologists serve children in regular education and those receiving special education services, both work with children with chronic health issues, and both work closely with teachers and parents. Ultimately, the primary goal of school nurses and school psychologists is to improve the school performance of all children.

Research exploring the involvement of school nurses during the evaluation and identification of children with special needs is even more limited, although school nurses spend a significant amount of their time addressing their health care needs. The few articles published have focused on the role (e.g., Kruger, Radjenovic, Toker, & Comeaux, 2009; NASN, 2005) and perceptions (e.g., Leier, Cureton, & Canham, 2003) of school nurses when working with children with special needs rather than exploring their actual involvement in the evaluation and identification process of children with special needs.

SCHOOL NURSES AND ASDS

A significant amount of research on the assessment, diagnosis, and treatment of ASDs has been published over the last 20 years (American Psychological Association, 2013; Rosenberg, Daniels, Law, & Kaufman, 2009). The continued increase in the prevalence rates of ASDs (1 in 68; Centers for Disease Control and Prevention [CDC], 2014) most likely has contributed to the proliferation of research. However, the field of school nursing has lagged behind other professions (e.g., psychology and education) in publishing research related to ASDs. Only one study (Strunk, 2009) that explored school nurses’ knowledge of ASDs was found. Specifically, Strunk (2009) showed that the majority of the Virginia school nurses surveyed reported having a good understanding of autism symptomology and the medications often prescribed to treat the associated symptoms (e.g., anxiety, hyperactivity, irritability, seizures, and depression). Interestingly, the survey also determined that school nurses were less knowledgeable about how to assist parents with accessing information and resources, dietary needs, and the difficult behaviors often displayed by children with ASDs. Strunk (2009) also noted that several school nurses indicated the need to be included when developing an IEP. Lastly, Strunk (2009) recommended that school nurses collaborate with school psychologists when addressing difficult behaviors of children with ASDs.

A few studies (Bellando & Lopez, 2009; Galinat et al., 2005) have been published outlining the role of school nurses when providing health care to children with ASDs. Specifically, Bellando and Lopez (2009) provided practical suggestions on the treatment of ASDs for the school nurse. These suggestions included in-depth discussions related to associated conditions (e.g., seizure disorders, gastrointestinal problems, sleep disturbances, and comorbid mental health conditions). They also outlined a step-by-step process for developing an IEP or IHP when working with children with ASDs. Galinat et al. (2005) utilized a similar approach in their article but included an in-depth discussion on family support and resources. They also addressed communication, safety, nutrition, and behavioral concerns school nurses need to be aware of when providing health care to children with ASDs.

In summary, school nurses work with all children, including children with special needs. Therefore, given the high percentage of children classified with ASDs within the school setting, it is

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surprising that minimal research has been published exploring the actual involvement and activities of school nurses when providing health care to children with ASDs. Although limited, prior research (Strunk, 2009) also suggests that school nurses have limited involvement during the development of IEPs, although they have indicated a desire to be involved. Specifically, little has been published exploring the actual training, knowledge, and experience of school nurses related to children with ASDs. There also is limited research studying school nurses nationally. Because Strunk’s (2009) study focused on school nurses in the state of Virginia, results may not be representative of school nurses nationally.

The current study utilized a national sample, with the goal of gaining a better understanding of school nurses’ training, knowledge, and experiences related to children with ASDs. Specifically, this study sought to understand (a) school nurses’ experience of the special education process related to providing services to children with ASD; (b) how involved school nurses are in the assessment and evaluation process when classifying children with ASDs; (c) and what the involvement of school nurses is once children are classified with an ASD within the school.

METHODS

Participants

A total of 608 school nurses were sent an e-mail with a link to a survey exploring their involvement with children and adolescents with ASDs who were receiving special education services. The percentage of school nurses who completed the entire survey was 16.45% (n = 100). The majority of the school nurses responding were female (n = 95), with 1 male and 4 others who did not indicate gender. A large percentage indicated they were Caucasian (91%), whereas 2% (n = 2) were African American, 1% (n = 1) was Native American, and 1% (n = 1) was “other.” Five (5%) respondents did not indicate their ethnicity.

School nurses from Indiana completed the highest number of surveys (n = 20) compared with other states. In addition, Indiana had one of the highest percentages (50%) of respondents compared with the number of surveys e-mailed to each state. Wyoming (n = 12) and Ohio (n = 10) both had 10 or more school nurses responding to the survey. The majority of states had at least 2 school nurses who completed the survey. Interestingly, none of the school nurses sent e-mails in Delaware (n = 40), Kansas (n = 14), or Nevada (n = 20) completed the survey. Only 1 school nurse from Colorado completed the survey. The majority (n = 63; 63%) of school nurses surveyed held a registered nurse (RN; Bachelor of Science in Nursing [BSN], 4-yr.) license. Twenty-one percent surveyed had an Associate Degree in Nursing RN (2-yr.) or RN (3-yr.) license. A small percentage (n = 7; 7%) were licensed practical nurses, whereas only 1 was a nurse practitioner. Sixteen respondents (16%) had earned a master’s degree (advanced degree). None of the school nurses surveyed held doctoral degrees.

The largest percentage (31%) of nurses who completed the survey had worked in a school from 1 to 5 years. Approximately 18% (n = 18) of the respondents had worked in schools for more than 20 years. The majority (n = 54; 54%) of the school nurses were from rural school districts. In contrast, only 14% (n = 14) of the school nurse participants worked in urban schools, whereas 27 (27%) worked in suburban schools. Five participants did not indicate their work setting. The highest percentage of respondents came predominantly from the midwest and rural states (e.g., Indiana, Ohio, New Hampshire, and Wyoming).

The majority (76%) of school nurses were assigned to work in three or fewer school buildings. Surprisingly, 7% (n = 7) were assigned to work in five or six buildings, whereas 11% (n = 11) were assigned to work in four buildings. Forty-two percent (n = 42) of school nurses were responsible for administering medication to 30 or fewer students, which included children with ASDs as well as

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children with other classifications (e.g., attention deficit hyperactivity disorder [ADHD], emotional disability, or anxiety). Interestingly, 32% of the nurses were responsible for administering medication to 101 or more students. Of the 32%, 11% (n = 11) were responsible for administering medication to more than 751 students.

Procedures

School nurses were randomly selected to participate in the study. A list of school districts for 18 states was obtained from state Department of Education websites. Then, schools districts were randomly (i.e., every other school district) selected from the list, which was in alphabetical order. The majority of school districts listed employees’ (e.g., teachers’, administrators’, staff’s, school counselors’, and school nurses’) names and e-mail addresses. However, some school districts only provided a list of names. When this occurred, the next school district on the state Department of Education list was used. In many school districts, school nurse e-mail addresses were found by searching the web pages for each school within the district. Participants were individuals listed as nurses or school nurses on each school’s website.

An e-mail was sent to each of the participants selected to receive the survey, which included a short introductory statement about the researcher and the study. A link to the study was embedded within the e-mail. The survey was maintained on the QuestionPro (2012) website. All data could only be accessed through the QuestionPro website by the survey owner using a username and password. In addition, the data were keyed directly to the owner and could only be accessed by the owner (QuestionPro, 2012).

Participants’ responses and nonresponses to the survey questions remained anonymous to the researcher. A reminder e-mail was sent once each week for 2 consecutive weeks. The data collection was limited to 4 weeks, which resulted in a total of 100 completed surveys.

Instrumentation

A questionnaire was developed to collect demographic and descriptive data. Survey items were designed to answer the study’s research questions. Specific demographic questions were included in the survey to gather descriptive and frequency data on gender, level of education, licensure, and school setting. Additional descriptive data were collected to determine the caseloads and percentage/number of children with autism that school nurses served within the individual schools. The questionnaire also was designed to identify the amount and type of training school nurses had received in the area of ASDs and school nurses’ knowledge of the diagnostic criteria and medication used with children with ASDs.

Survey questions explored the school nurses’ experiences of the special education process related to providing services to children with ASD. In addition, the survey asked school nurses how involved they were during the assessment and evaluation process when classifying children with ASD. Finally, school nurses’ involvement once children were classified with an ASD was studied.

RESULTS

The most common involvement (17.87%) reported by school nurses during the evaluation process of children with ASD was the review of medical records (see Table 1). In addition, a small percentage of school nurses (13.19%) noted that they collaborated with school psychologists during the evaluation process. It appears that school nurses were involved in a variety of ways during the evaluation process; however, in general, their involvement was fairly limited, with only a small percentage indicating they contributed during the evaluation of children with ASD. In fact, a fair percentage (15.32%) indicated they were not involved during the evaluation of children with

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Table 1 School Nurse Involvement While Children Are Evaluated and Classified for ASD

Involvement No. of Nurses Reporting Percentage of Nurses Reporting

Participation in Evaluation Team 22 9.36 Participation in Case Conference Committee 21 8.94 Review of Medical Records 42 17.87 Consultation with Primary Teacher 24 10.21 Consultation with Parent or Caregiver 27 11.49 Consultation with Pediatrician 12 5.11 Collaboration with School Psychologist 31 13.19 Collaboration with Behavior Specialist 13 5.53 I Am Not Involved 36 15.32 Other 7 2.98

Total 235 100

ASD. There were several written responses for the “other” category in relation to involvement in the identification process, which included “perform health care screenings (e.g., vision and eye exams),” “teaching medications to teachers, principals, and school staff,” “only involved when medical questions arise,” “only involved when medication questions occur, yet feel I should be more involved,” “rarely involved because children older,” “nurses are rarely involved in identification process,” and “hearing screenings.”

Table 2 shows the percentage and types of involvement that school nurses had after children with ASD had been classified and were receiving special education services. The highest number (n = 83; 83%) of school nurses indicated that they were primarily responsible for administering medication after children had been classified with an ASD diagnosis. In addition, a high number

Table 2 School Nurse Involvement Once Children Are Identified to Receive Special Education Services under the Classification of an ASD

Involvement No. of Nurses Percentage of Nurses

Intervention Development 12 3.41 Intervention Implementation 11 3.13 Monitoring of Classroom Performance 8 2.27 Consultation with Primary Teacher 28 7.95 Consultation with Caregiver 9 9.94 Participation in Case Conference Committee 9 2.56 Case Management 19 5.40 Collaboration with Pediatrician 18 5.11 Collaboration with Behavior Specialist 15 4.26 Medication Administration 83 23.58 Nursing Care (e.g., Treatments) 76 21.59 Not Involved 6 1.70 Other 5 1.42

Total 352 100

Note. Respondents were asked to indicate all areas of involvement.

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(n = 76; 76%) reported that they provided medical treatments to children with ASD after they had been classified. Twenty-eight nurses indicated that they provided consultation with the primary teacher, and an even smaller number (n = 19) indicated they were involved in case management after children were classified with an ASD. There appeared to be limited involvement of school nurses in the development of interventions, implementation of interventions, participation with the primary caregiver, participation in the case conference committee (CCC), and monitoring of classroom performance. A small number (n = 6) of participants were not involved after children had been classified with an ASD.

In general, it appears that school nurses have more involvement with children with ASD after they have been classified than during the evaluation/assessment process. School nurse involvement with children with ASD before and after the identification of the ASD diagnosis tends to be pre- dominantly medical in scope, including the review of medical records, administration of medication, or administering of medical treatments. It is promising that a small percentage of school nurses are providing some medical treatments after children are identified with ASD. For example, nurses are collaborating with pediatricians, consulting with teachers, and joining forces with behavior spe- cialists. Five comments related to the “other” category, including “work with teachers to watch for specific side effects of medications,” “care and collaboration,” “medication plan,” “medication in schools,” and “I have been restricted by SPCED [special education] director.”

DISCUSSION

School nurses’ roles and level of collaboration with other professionals when children with ASD are being identified or when services are being provided appears limited. Although this study should be considered a preliminary examination of the level of involvement school nurses report when working with children with ASD, the limited involvement and collaboration reported by the current sample of school nurses is disconcerting. Specifically, it appears that a small percentage of school nurses are involved in a variety of ways (e.g., record reviews and consultation with school psychologists, teachers, or parents) during the evaluation process, whereas approximately 15% indicated that they were not involved at all during the evaluation process.

School nurses indicated that their primary involvement during the assessment and evaluation process involved the review of records. Most likely, school psychologists, special education teachers, or teachers are asking school nurses to review medical records, define medical terminology, discuss medications, or discuss co-occurring medical conditions (e.g., seizure disorders). In fact, approx- imately 13% of the school nurses sampled noted that they collaborate with school psychologists during the identification process. However, the low percentage of school nurses indicating that they are actively involved during the identification process continues to support the need to educate school nurses on how they can collaborate and share their medical knowledge of children with ASD with school psychologists.

By becoming familiar with different methods of assessment (e.g., standardized measures of cognitive and academic functioning) and techniques (e.g., behavioral observations, student inter- views, and rating scales) used by school psychologists during the classification process, school nurses can become more effective when consulting. For example, by helping school psychologists understand how some medications will result in drowsiness and when the medication is at its peak would help school psychologists to determine the best time to administer and interpret measures of attention and concentration. School nurses also could help school psychologists interpret behavior rating scales, depending on the time they were completed by teachers and parents. For example, rating scales completed right before lunch and after medication has worn off may result in very different profiles compared with rating scales completed within the first hour of school.

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In addition to conducting a review of medical records and consulting with school psycholo- gists, school nurses can become actively involved during the classification process, for example, by monitoring behavior (e.g., aggression, self-stimulation, vocalizations, etc.) before and after medica- tion administration, sharing information on medication and medication interactions, and discussing comorbid medical conditions and their influence on the psychological and educational functioning of children with ASD.

Although there is a lack of empirical research on the roles and responsibilities of school nurses and the amount of time spent on the various responsibilities of school nurses, Krause- Parello and Samms (2011) found that school nurses typically treated eight chronic conditions: asthma, allergies, ADHD, diabetes, depression, seizures, cerebral palsy, and sickle cell anemia. Krause-Parello and Samms’s study also supports the idea that school nurses are treating medical conditions commonly found among children with autism, which includes three of aforementioned eight conditions (i.e., depression, ADHD, and seizures). School nurses’ knowledge of these health conditions and their influences on student learning can be of valuable assistance to the school psychologist during the evaluation process. School nurses also can consult with school psychologists regarding how the sleep patterns and dietary needs of children with autism impact their cognitive functioning.

Fewer than 12% of the school nurses reported consulting with the teacher or parent during the identification process, which is consistent with prior research (Strunk, 2009). Most likely, school nurses are hesitant to consult during the identification process because many are limited in their knowledge of the signs and symptoms of ASD (Strunk, 2009). This is surprising because research has determined that screening for ASD by pediatric primary care nurses can assist in identification of the primary signs and symptoms of ASD (Pinto-Martin, Souders, Giarelli, & Levi, 2005). Therefore, it is logical that school nurses’ participation in the identification process could lead to similar results within the schools. Although it is evident that school nurses have much to offer during the identification process, tackling the barriers (e.g., lack of knowledge, high caseloads, and school philosophy on nurse involvement during the evaluation process) to successful collaboration and involvement will need to be a priority.

This study also found that a small number (n = 9) of school nurses were actively participating in the CCCs for children with ASDs. This was particularly surprising because a large number of school nurses indicated that they were involved in providing medical treatments (n = 76) and medication administration (n = 83) after a child was identified with an ASD. Therefore, the primary involvement of school nurses appears to occur after the CCC meets and develops the IEP.

Although it is unclear what type of medical treatments school nurses are providing to children with ASD within the school setting, it is promising that a large number of respondents indicated that they provided some type of medical treatment. It is likely that they are providing medical treatments that are addressing the many comorbid conditions/symptoms (e.g., eating problems, seizure disor- ders, asthma, allergies, etc.) that occur among children with a primary diagnosis of an ASD. There is a need for educators and school nurses to recognize the importance of considering health issues and medication management during the development of the IEP (Galinat et al., 2005). The collab- oration between school psychologists and school nurses when developing IEPs and implementing treatments (e.g., behavioral, educational) also can result in valuable assistance to teachers and par- ents. By collaborating, school psychologists can develop educational interventions that consider children’s health issues (e.g., seizure disorders, headaches, diabetes, dietary restrictions). School nurses can also develop IHPs after consulting with school psychologists that consider the cogni- tive, psychological, and behavioral functioning of children with ASDs. Ultimately, the collaboration between school psychologists and school nurses should result in an IEP and IHP that facilitates learning.

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School Nurses’ Unique Contributions

School nurses are in a unique position to treat a variety of conditions found among children with ASDs, including allergies, nutritional issues, gastrointestinal disorders, and seizures. Children with autism may experience additional mental health issues, including emotional disturbances and ADHD, and school nurses could assist in the treatment of these disorders. For example, these disorders often result in sleep deprivation and, therefore, medical management should address sleep disturbances (Cade & Tidwell, 2001). Furthermore, children with ASD often experience abdominal pain, cramping, constipation, and diarrhea (Kuddo & Nelson, 2003). Nursing interventions may need to be implemented (e.g., monitoring fluid to prevent dehydration), which readily assists with gastrointestinal issues.

School nurses also are in a unique position to recognize potentially harmful behavior and implement medical treatments to prevent these harmful behaviors from occurring. For example, to minimize self-injurious behaviors (e.g., head-butting and self-biting), school nurses should consult with school psychologists or behavior specialists to assist in implementing behavior programs. Collaboration with school psychologists and behavior specialists when developing, implementing, and monitoring specific behavior programs is recommended.

Because many children with ASD have impairments in communication, school nurses must be specific in their language. For instance, rather than asking a child with ASD “How are you feeling?” questions must be clear and concise, such as “Does your head hurt?” School nurses also could use picture charts to help assess pain levels or to help children with ASD understand medical procedures. Individuals with autism may be alarmed by voice inflection; therefore, school nurses should use simple repetitive instructions in a calm, pleasant tone (NASN, 2012).

Individuals with autism can experience sensory disturbances, including sensitivity to sounds, odors, and touch. This can make simple nursing treatments (e.g., applying a bandage) challenging, and alternative treatments should be considered (e.g., liquid bandage). Due to some behaviors, special nursing interventions need to be considered, such as bandaging open wounds or scabs to prevent individuals with ASD from picking at them, causing bleeding or scarring. Loud noises, unfamiliar surroundings, and excessive lighting can be disturbing to individuals with ASD; therefore, reducing noises and lights evokes a calming effect (Van der Walt & Moran, 2011).

Limitations and Future Research

The present study has several limitations that often are found with survey research (Creswell, 2009). However, the contributions of this study are considered to outweigh the limitations. There have only been a few studies exploring the role of school nurses related to serving children with ASD. In addition, only one study was found that discussed the collaboration between school psychologists and school nurses.

One limitation is that school nurses with e-mail addresses published on their school’s website were asked to participate. Therefore, although the sample was randomly selected from schools that published e-mails of their staff, the selection process did not follow a formalized (every fifth school or every eighth school nurse) random selection procedure. Future research should strive to implement a formal process for participant selection; however, school nurses have historically not responded well to survey requests. It also is becoming more difficult to access e-mail on school websites. Requesting e-mails from state school nurses associations might be one option.

A small number of school nurses completed the survey. Although 608 e-mails were sent to school nurses, only 100 completed the survey. Not all states were represented within the sample, with the majority of the respondents coming from Indiana. Compared with prior research (e.g., Strunk, 2009), this study collected surveys from more than one state, expanding the research in this

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area. Future research needs to consider different sampling methods, with the goal of more fully representing the 60000 school nurses within the United States.

It is important to note that although more sophisticated statistical analyses (e.g., chi-square tests, t tests, and one-way analyses of variance) were not conducted, the descriptive results were considered significant in that they provided important insights into school nurses’ work with regard to children with ASDs. Furthermore, the small sample size and sample consisting predominantly of RNs (BSN, 4-yr. license) did not allow for more sophisticated analyses. For example, although it would have been interesting to compare involvement during the identification process based on the type of nursing license or school size, the distribution of the sample did not allow this. Specifically, the comparison groups based on licensure type or school size would have been too small to generate meaningful results.

CONCLUSIONS

Prior to this study, research exploring how school nurses worked with children with ASD was relatively uncharted. Also, only a few studies examined the collaboration between school psychologists and school nurses. With the prevalence of ASD continuing to grow, with one in every 68 individuals diagnosed with the disorder (CDC, 2014), there is a continued need for research exploring the role of school nurses in providing health services to children with ASDs. The best and most effective methods for educating school nurses about the special education process, collaboration, diagnostic process, and treatment of children with ASD should be a focus of future research.

In summary, there is limited involvement of school nurses during the assessment and evaluation process. There appears to be more involvement after children have been identified with an ASD. However, this involvement is primarily limited to the administration of medication and medical treatments. School nurses can provide a variety of medical treatments after children have been diagnosed with an ASD, suggesting expanded roles for school nurses.

Prevention, consultation, and collaboration are areas where school nurses can increase their involvement after children are classified with ASD. It is promising that some school nurses reported collaborating with school psychologists, consulting with the primary teacher, or collaborating with the behavior specialist during the assessment and evaluation process. However, the low number of school nurses participating in the assessment and evaluation process needs to be addressed. School nurses may need to take the lead and request participation in the CCC for ASD-diagnosed children within their care.

REFERENCES

American Academy of Pediatrics, Council of School Health. (2008). AAP Council on School Health. Retrieved from www2.aap.org/sections/schoolhealth

American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bellando, J., & Lopez, M. (2009). The school nurse’s role in treatment of the student with autism spectrum disorders. Journal for Specialists in Pediatric Nursing, 14, 173–182.

Blumberg, S. J., Bramlett, M. D., Kogan, M. D., Schieve, L. A., Jones, J.R., & Lu, M. C. (2013). Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012. National Health Statistics Reports, (65), 1–11.

Cade, M., & Tidwell, S. (2001). Autism and the school nurse. Journal of School Health, 71, 96–100. Centers for Disease Control and Prevention. (2014). Retrieved from http://www.cdc.gov/ncbddd/autism/data.html Creswell, J. W. (2009). Research design: Qualitative, quantitative, mixed methods approaches. Thousand Oaks, CA: Sage

Publications. Data Resource Center for Child & Adolescent Health. (2009/10). National Survey of Children with Chronic Health Care

Needs. Retrieved from http://www.childhealthdata.org/learn/NS-CSHCN

Psychology in the Schools DOI: 10.1002/pits

Utilization of School Nurses 657

Galinat, K., Barcalow, K., & Krivda, B. (2005). Caring for children with autism in the school setting. Journal of School Nursing, 21, 208–217.

Grier, B. C., & Bradley-Klug, K. L. (2011). Collaborative consultation to support children with pediatric health issues: A review of the Biopsychoeducational Model. Journal of Educational and Psychological Consultation, 21, 88–105.

Krause-Parello, C. A., & Samms, K. (2011). School nursing in a contemporary society: What are the roles and responsibilities? Issues in Comprehensive Pediatric Nursing, 34, 26–39.

Kruger, B., Radjenovic, D., Toker, K., & Comeaux, J. (2009). School nurses who only care for children with special needs: Working in a teacher’s world. The Journal of School Nursing, 25, 436–444.

Kuddo, T., & Nelson, K. (2003). How common are gastrointestinal disorders in children with autism? Current Opinion in Pediatrics, 15, 339–343.

Leier, J., Cureton, V., & Canham, D. (2003). Special day class teachers’ perceptions of the role of the school nurse. The Journal of School Nursing, 19, 294–300.

National Association of School Nurses. (2005). Retrieved from www.nasn.org National Association of School Nurses. (2012). Retrieved from www.nasn.org Pinto-Martin, J., Souders, M., Giarelli, E., & Levy, S. (2005). The role of nurses in screening autistic spectrum disorder in

pediatric primary care. Journal of Pediatric Nursing, 20, 163–169. QuestionPro. (2012). Security and privacy. Retrieved from www.questionpro.com/security Rosenberg, R. E., Daniels, A. M., Law, J. K., & Kaufman, W. E. (2009). Trends in autism spectrum disorder diagnoses:

1994–2007. Journal of Autism Development Disorder, 39, 1099–1111. Strunk, J. A. (2009). School nurses’ knowledge of autism spectrum disorders. The Journal of School Nurses, 25, 445–452. Sweeney, J., & Sweeney, D. (2001, April). Frequent visitors to the school nurse: The school psychologist’s role. Paper

presented at the annual meeting of the National Association of School Psychologists, Washington, DC. Van der Walt, J., & Morgan, C. (2011). An audit of perioperative management of autistic children. Paediatric Anaesthesia,

11, 401–408.

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