Child-Initiated Care: The Use of School Nursing Services by Children in an “Adult-Free” System

An experimental child-initiated care system was developed in an elementary school that permitted children, ages 5 to 12, to act independently of adults in seeking care from a nurse practitioner. Over 300 children were observed for two years. The patterns of use of services displayed by them were similar to those of adults. Seventeen percent did not make a visit to the nurse during the two-year period, and approximately 15% of the children accounted for over 50% of all of the visits. Rates of utilization were associated with those variables known to affect adult pattern of use: sex (female), social class(more affluent), ordinal position (only children or youngest children), and health orientations. The pattern of use was not associated with the presence of known medical problems. Analysis of data on the utilization of pediatric services by these children indicated a significant association between the patterns of being taken to pediatricians and use of services in school. The mother's pattern of use of care was also significantly associated with her pattern of use of pediatric care for her children. The children's health-related beliefs and expectations were examined before this child-initiated care system was initiated and at the end of the first and second years of operation. Significant treatment effects were observed in the predicted direction in several elements of the health-belief model, i.e.,perceived vulnerability and severity. In addition, children who had used the system placed greater emphasis on their own responsibilities for maintaining their health. Despite these changes in beliefs, utilization behaviors were not altered.