Royal Children's Hospital and Murdoch Childrens Research Institute, and The University of Melbourne, Parkville, Victoria, Australia.
De Bascule, Vrije University Medical Centre, Murdoch Childrens Research Institute, Duivendracht, The Netherlands.
Acad Pediatr. 2017 Aug;17(6):687-693. doi: 10.1016/j.acap.2017.02.012. Epub 2017 Mar 7.
A fifth of children enter school with special health care needs (SHCN), many of whom have difficulties that are milder or not yet formally diagnosed (emerging SHCN). This study aimed to investigate how differing perceptions of children's emerging SHCN across the family and school contexts relates to service utilization.
Sample: The nationally representative birth cohort of the Longitudinal Study of Australian Children, which includes parent reports on the abbreviated Children with Special Health Care Needs Screener. For a subsample of 2459 children teachers also completed the Australian Early Development Census, a measure of early childhood development at school entry that includes SHCN.
Logistic regression analyses were conducted adjusting for severity of condition, gender, language background, and disadvantage.
Overall 24.1% of children were identified by their parent and/or teacher as experiencing emerging SHCN. Compared with those with consistent reports, children with parent-only identified needs had lower odds of accessing school services (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.10-0.81). Similarly, children with parent-only (OR, 0.39; 95% CI, 0.20-0.75) and teacher-only (OR, 0.25; 95% CI, 0.14-0.46) identified needs had significantly lower odds of accessing services in the community.
When parent and teacher perceptions of children's emerging SHCN were inconsistent, service use was lower at school and in the community. Further efforts are needed by health and education providers to ensure that common understandings about a child's needs at school are established early in children's educational careers.
五分之一的儿童在进入学校时具有特殊的医疗保健需求（SHCN），其中许多儿童的困难程度较轻或尚未得到正式诊断（新兴 SHCN）。本研究旨在调查家庭和学校环境中对儿童新兴 SHCN 的不同看法如何与服务利用相关。
样本：澳大利亚儿童纵向研究的全国代表性出生队列，其中包括家长对简短的特殊医疗保健需求筛查器的报告。对于 2459 名儿童的子样本，教师还完成了澳大利亚早期发展普查，这是一项在学校入学时衡量幼儿发展的措施，其中包括 SHCN。
采用逻辑回归分析进行调整，以调整病情严重程度、性别、语言背景和劣势。
总体而言，24.1%的儿童被其父母和/或教师确定为患有新兴 SHCN。与报告一致的儿童相比，仅父母报告有需求的儿童获得学校服务的可能性较低（优势比 [OR]，0.29；95%置信区间 [CI]，0.10-0.81）。同样，仅父母（OR，0.39；95% CI，0.20-0.75）和仅教师（OR，0.25；95% CI，0.14-0.46）确定需求的儿童获得社区服务的可能性显著降低。
当父母和教师对儿童新兴 SHCN 的看法不一致时，学校和社区的服务使用率会降低。卫生和教育提供者需要进一步努力，确保在儿童教育生涯早期就对学校中儿童的需求达成共同的理解。
