Part II-Implementation

A picture of the health or fitness needs of school children has been drawn and data presented to show that the needs are not being met.

A program which effectively meets the needs of the school-age child is complex. This complexity results in part from the fact that the school-age child is subject to the concern and influence of numerous agencies, professional groups, and individuals who are interested, officially or unofficially, in programs which affect the health of the community in general and frequently the health of the child in particular. The two official agencies most likely to sponsor health programs for children are the State health and education departments.

Not all but many features of the community health program which affect the school-age child can be more easily and efficiently carried out while he is in school than is possible outside the school. These health activities within the school include examination, immunization, and follow-up leading to corrective services, plus the provision for a safe, sanitary, and healthful school environment.

In addition there must be services and facilities in the community. The teaching of health principles and practices and a well-rounded physical activity and recreational program are essential to a well-developed school health program, which in addition to other school activities should contribute to the best welfare of the school child. Since all experiences of the child condition his behavior, his experiences in the home, the school, and the community must provide opportunities for active pupil participation.

The joint and overlapping responsibility of the agencies involved can be seen if one will fill out the attached table.

An efficient, effective health program for all children of a community will result only when :

1. The public departments of health and of education as well as specialized personnel within each department agree to the principle of coordination of health programs for school children, including the health program of the community and the health aspects of school programs.

2. Each agency and profession respects the contribution of the others.

ment of regulations governing the administra tion of any funds that may be made availabe On the State and Local Level:

1. Committees comparable to the coordinat ing committee on the Federal level should be established at the State and local levels b tween departments of public education ab health. These committees may include representatives from professional educational in stitutions and other agencies and professiona groups concerned with the health of the schoo, child.

2. In the departments responsible for health instruction, physical education, and health services there should be qualified professiona personnel such as physicians, nurses, ar educators all of whom have been trained in school health.

3. A comprehensive program to meet the health needs of school children in any State should provide for:

(a) Development or extension of programs in teacher-education institutions to prepare administrators and teachers so that they ca: participate effectively in the school health program.

(b) Appropriate pre-service and in-service i education for school health administrators,

Governmental responsibilities for the school health program

Program essentials

I. Safe, sanitary, healthful environment including: 1. Grounds available for school and community 2. Buildings available for school and community 3. Janitorial service-adequate and functioning 4. Time allotment for instruction, examination, recreation, and athletics..

5. Periodic inspection, repair, and remodeling II. School health personnel:

1. Teachers trained in school and public health education-certification and salaries.

2. Specialists-physicians, dentists, nurses, teachers, and nutritionists.

3. Counseling and guidance.

4. Supervision.

III. Health service program:

1. Pupil inspection and screening..

2. Periodic medical and dental examination of personnel and pupils.

3. Establish and maintain cumulative health and fitness records..

4. Correction of medical and dental defects.

5. Communicable disease control-X-ray, immunization, isolation, and quarantine_

the follow-up. In one community the PTA has interested itself in securing 100 percent corrections. In one school system there is a January follow-up to learn what corrections have been made since the fall inspection. In another school system a special check is made at the time of the annual dental inspection to discover what corrections have been made since the last previous inspection. Nine of the thirty-two schools mention that a report is sent to the school by the dentist making the correction; in one school this report comes from the parents.

Special education concerning the care of the teeth is mentioned by most of these selected schools. Some of this is classroom instruction usually as a part of health education. Frequently it includes also motion pictures, film slides, charts, models, plays, puppet shows, and assembly programs. Generally the instruction is for pupils in the schools; however, several of the schools feel that the instruction about dental health of growing boys and girls ought to reach the parents no less than the pupils; these schools develop their instruction on dental matters accordingly. Several of the programs have been in operation for 20 or more years and the community has become "dental conscious." In addition to the schools and the public health authorities, the PTA, the woman's club, the junior league, the nursing association, the local dental society, and the local dairy council are community agencies mentioned in one or more reports as having a part in developing or maintaining the dental program.

Correction of Dental Defects

With few exceptions reliance for corrections is placed upon dentists in private practice. In order to make the plan effective many of the school systems mention that pupils may be excused from school to meet dental appointments. In some communities dentists have agreed to reserve certain times, especially after-school hours and Saturdays, for appointments of school pupils.

Rather generally some sort of provision is made for dental treatment of pupils whose parents are unable to pay for the needed dental work. Of the 32 communities, 23 report that they make such a provision. School dental clinics of

one kind or another supply dental service to indigent pupils in 12 communities of the 23. In 2 the public health department provides the service, and in 2 a welfare agency supplies it. Other agencies mentioned as operating the dental service for indigent pupils are the social service center, the variety club, the health unit dental club, and the university clinic. Usually the agency operating the service pays the cost of it; however, 2 of the clubs offering the clinics draw the funds from the community chest, and 2 of the school dental clinics are supported with funds supplied by the PTA. Three of the school clinics make nominal charges of 25 cents to $1 per sitting.

A County Program in Mississippi

Washington County, Miss., has a county-wide program for grades 1 to 12 made effective by thorough cooperation of the county health department, the schools, and the dentists of the county. Four schools in Greenville, the county seat, and four rooms in county schools achieved 100 percent corrections. A total of 781 pupils had their teeth cleaned and 438 home visits were made. These results were achieved through the following program:

1. Dental examination is made of all pupils who do not present dental certificates; a check on brushing technique is made of those who do have dental certificates..

2. Charted notices of defects are sent home to parents.

3. Home visits are made on cases where mouths are in very poor condition or where home care is completely lacking.

4. Teeth are cleaned for those whose gums are inflamed, bleeding, or sore.

5. Principals permit pupils to have dental appointments during study hall or gymnasium periods in the communities having resident dentists.

6. In communities having no resident dentist, notices are sent home to parents asking if they want the corrections made at school or if they prefer to have them made by the family dentist; the cost of treatment at school is indicated. Later a second notice is sent home advising parents of the date when a dentist from a neighboring town will be at the school.

7. A high-school pupil unable to pay for dental corrections may make ar

rangements with the principal to have his dental work paid for by funds supplied jointly by some local agency (usually the PTA) and the State board of health. Dentists also arrange to do work at reduced rates for families able to pay something but not in position to pay regular rates.

An Industrial Community In Southern Minnesota

Austin, Minn., follows the basic plan recommended by the dental health director in the State department of health. Under this plan each child in the school system from the kindergarten through the twelfth grade is given a card each year which he takes to the family dentist for an examination. The dentist indicates on the card what needs to be done, if anything, and signs the card. which is then returned by the student to the school. The cards are distributed throughout the school year but in only one school at a time. They come in three colors as do the teachers' record sheets-yellow for kindergarten, pink for grades, and blue for high-school students. The cards of each color carry an appropriate letter to the parents explaining the importance of dental health; and there is a statement to be signed by the dentist when the work is completed. Generally the dentist will give the examination free, but the student pays for his own dental care. Those who cannot afford to pay are given free care through a special fund.

With present shortage of dentists, it is impossible for those who remain in practice to take care of school children entirely in the late afternoons and on Saturdays. For that reason, children are sometimes excused from school to have dental work done. The dentists have cooperated very well in preventing the abuse of this privilege, and excuses from schools are signed by the dentist when the pupil leaves his office.

Educational projects are carried on for both parents and pupils just before the cards are distributed. Units on dental health, including tooth brushing, are presented in all of the kindergarten and elementary classes. In the junior and senior high schools the subject is presented through home rooms or through the teachers of subjects taken by all students. Special aids used include "Facts About Teeth and Their Care,"

"Your Child's Teeth," and "Teeth, Health, and Appearance." Last year for the first time extra educational material was sent to the parents along with the cards. Two schools used "How to Save Teeth and Money," and two schools sent a mimeographed letter.

The means of stimulating interest among high-school students have been varied. At different times, in addition to the teaching of formal dental health units, there have been assembly programs arranged by the local dental society, a speaker from the State board of health, films, and posters. Pupils from the public-speaking classes have appeared before student groups and a student council representative spoke over the public address system. There were also releases in the school and local papers.

A Mobile Dental Trailer In Louisiana

The Caddo-Shreveport (Louisiana) Health Unit and the Caddo Parish School Board jointly supply a mobile dental trailer fully equipped and staffed with dentist and assistant to make regular trips to the schools, public and private, throughout the parish. A plan is followed of rapid examination of all pupils. The findings are recorded and a notice sent to the parents. All those able to pay for the necessary dental service are referred to their family dentist for corrections. Those unable to pay are given treatment in the mobile unit.

A Follow-up Program In Kansas

In Kansas City, Kans., the president of the local dental society arranges the inspection schedule for dentists in the schools. This plan for examination works so well that the schools can give their undivided attention to the all-important problem of getting the student and his parents to realize the importance of dental corrections. Following are some of the methods used in arousing more interest in dental hygiene and thereby bringing about a greater number of corrections:

Dental Program Widened

The American Dental Association early in 1943 established what has become known as the Physical Fitness Dental Program Committee. This committee during the past 22 years has been active in promoting the cause of better teeth among high-school pupils, especially among those who soon would be in the armed services or would enter upon wartime employment. The membership of the committee, four from the Dental Association membership and two from the education field,

has been as follows:

Leon R. Kramer, director, Division of Dental Hygiene, Kansas State Board of Health, Topeka, Kans., chairman.

Norman H. Denner, practicing dentist, Cleveland, Ohio. Vern Irwin, director, Division of Dental Health, Minnesota Department of Health, Minneapolis, Minn.

Carl A. Jessen, senior specialist in secondary education, U. S. Office of Education, Washington, D. C.

With the close of the war the Physical Fitness Dental Program Committee is widening its horizons to include all pupils in the schools and those of preschool age as well. The committee has also expanded its membership by the addition of two persons representative of parent groups and of the very young child:

Mrs. James C. Parker, Grand Rapids, Mich., National Congress Parents and Teachers.

Frank C. Neff, Kansas City, Mo.,

American Academy of Pediatrics. In the article on Dental Programs in Local Schools, Mr. Jessen reports results of a study made by the Office of Education for the Physical Fitness Dental Program Committee. The spe

J. A. Salzmann, practicing dentist, cific programs described have been seNew York, N. Y.

lected because they illustrate various

Harold C. Hunt, superintendent of significant practices and conditions schools, Kansas City, Mo. with a minimum of duplication.

5. Slogans posted from time to time and a cumulative record is kept in the on the school bulletin board. school showing the dental condition of

6. Display of posters made in the the student from year to year. At the school art department.

7. Films shown in the health classes. 8. Articles in the school newspaper. 9. Announcements in PTA meetings of results of dental program.

10. Excuse of students for dental appointments upon presentation of form card filled out by the family dentist. A Well-established Program in Ohio

The Cincinnati public schools have had a dental service for elementary school pupils in operation continuously since 1911; dental service for highschool students was begun in 1941.

The service includes, in the first

2. Oral essays in the speech and English classes.

3. Latest books and literature available in the library.

gienist once each year. The examination is conducted carefully for the smallest defects, but it is purely a search for defective teeth; diagnosis and corrections are left to the family dentist. Den

brought to the attention of parents

time of examination, comparison is made with the previous year's findings; thus a record is made of any work which has been done since the former examination.

Follow-up of health examinations, which include dental examinations, is carried on through the physical education department. Each physical education teacher has a record of the defects of every student in his classes and works for their correction in close cooperation with the nurses employed by the board of health. Reports are made to the nurses of all defects that have been corrected as well as of those that have not been corrected.

The first free dental clinic was established in Cincinnati in 1911. Last year over 33,000 operations were performed for nearly 4,000 patients. Eligibility for clinical treatment is determined by weekly income of the family in relationship to the number in the family.

A Large City on the Atlantic Seaboard

In Baltimore, Md., the health service for high schools is operated under the educational authorities, while elementary school health service is the responsibility of the city health department. The high-school service provides an examination each year of each student in grades 7 to 12 by a school physician. Dental defects are reported to students and parents, and the regular follow-up to secure corrections is begun. The features, time-schedule, and sequence of the follow-up vary somewhat from school to school but fundamentally consist of:

1. Notification form sent to parents regarding defect. This is signed and returned within 3 to 5 days indicating contemplated action.

2. Conference of student with nurse 2 to 4 weeks after return of notification form.

3. If correction has not been started, a special letter is sent to parents, followed by a nurse-student conference.

4. During this time the teachers of physical education who are informed of all defects:

a. Urge students to have defects corrected.

b. May reduce marks in physical education because of uncorrected defects.

c. May refuse to allow students with uncorrected defects to play on teams. This is invariably done when a misplaced or decayed tooth may cause self injury in contact games.

5. Uncorrected cases are referred for special action to counselors, vice-principals, or principals.

6. Arrangements are made for some cases to go to dental clinics of the University of Maryland where the charges are nominal.

A Well-coordinated New England Program

In Holyoke, Mass., the dental program was developed through aggressive and well-coordinated cooperation of educational authorities, health officials, members of the dental society, the council of social agencies, and the woman's club. Preliminary work was done in meetings with teachers and pupils and through evening meetings with parents. Films were shown, radio broadcasts were arranged, posters were displayed, school assemblies were held, projects were launched in science,

home economics, art, and speech classes. For a month prior to the issuance of dental cards to pupils, there was a daily 15-minute discussion on teeth, using materials supplied by the State department of health, the State department of education, and advertising departments of food and dental companies. Holyoke was made dental

conscious.

The result was that when the cards were distributed, dental offices were swamped with requests for appointments. Within a 3-month period over 80 percent of the school pupils had been to their family dentists. In later years, the cards have been given out to one school at a time in order to distribute the dental work for pupils more evenly throughout the year.

By the end of the school year, the remaining 20 percent of the pupils had been examined. This resulted from the assignment by the president of the dental society of dentists to the various schools for the examination of these pupils. Also, by the end of the year 80 percent of the pupils had had defects corrected or had made appointments to have them corrected. This was brought about by careful follow-up under the direction of the physical education department. Interviews with individual pupils played an important part in this follow-up.

In recent years the cards have been given out by section teachers who are also responsible for checking on the return of cards. A primary objective of the Holyoke program is to establish the habit of regular visits to the dentist-a habit that will likely persist through life.

The chairman of the Holyoke dental program submits the following view points growing out of his experience:

"1. There must be a good program in the elementary and junior high schools in order to have a good program in the senior high school.

"2. The superintendent of schools must furnish the spark to ignite the whole program.

"3. The principal of the high school must lend full-hearted support.

"4. Some delegated person of the faculty who is health-minded should be appointed to see that the program is capably administered.

"5. Section teachers must be impressed with the fact that in addition to their own subject which they teach. health is still the first cardinal objective of secondary schools.

"6. The local dental society must assume its responsibility and must be converted to the idea that there is al educational aspect of dentistry as well as a remedial one.

"7. Cooperation is the secret of success: Pupils, parents, teachers, principals, superintendent of schools, and dentists must each assume their respec tive obligations in the functioning of the dental program."

Feeding Nursery School
Children

Teachers and parents are becoming increasingly aware of the importance of providing the foods necessary to meet the nutritional needs of children, especially during preschool and early school age.

Among recent publications which should be helpful to persons responsible for child feeding programs is a bulle tin issued by the Division of Instruc tion, Alabama State Department of Education entitled Feeding Children in the Nursery School. It is to be used as a guide by teachers or parents in planning menus served in the nursery schools or at home.

The pamphlet contains helpful sug gestions on meeting the nutritional needs of the child, encouraging goo food habits, buying, storing, and preparing foods for young children, guides for menu planning, charts on size o portions, time table on vegetable cook ery as well as other useful information A large section of the bulletin contains recipes for quantity cookery which hav been tested in the nursery schools i Alabama.

Members of the staff of the School of Home Economics, University of Ala bama, and the Supervisors of Hom Economics and Extended School Services of the Alabama State Departmen of Instruction participated in the preparation of this bulletin.

Copies of the bulletin (No. 3) may b obtained by writing State Department of Education, Montgomery, Ala. Sin ple copies are 35 cents; in lots of 10, they may be purchased for 30 cents each.