Frank Kline, Ph.D. and Lisa Rubel

Over the past twenty years, there has been a considerable
amount of discussion regarding collaboration between
schools and various other community entities. These efforts
have risen out of the desire to better serve those in need
and to use the resources of the community efficiently and
effectively. A specific area of this collaboration effort is the
collaboration between school personnel and those in the
medical community. These efforts are most common in the
arena of special education and were largely initiated from
the Public Law 94-142 passed in 1974 to assure fair and appropriate education for all individuals. While the physician’s role is not specifically delineated in this law, collaboration between these two communities could be beneficial to all of the involved parties. In this paper, we will explore prominent models of interprofessional collaboration, as well as, the research on teacher-physician collaboration. Barriers that have impacted these collaborative efforts, and the suggestions made to overcome these barriers will also be discussed. Finally, we will highlight ways in which parents can help establish collaborative relationships between professionals in the medical and educational communities that are in their lives.

Many different terms are used in the literature to describe interactions between different professional communities. The most common terms used include, comprehensive school-linked services, full-service schools, integrated services, school-linked services, and collaboration. These terms are neither independent nor mutually exclusive. There is tremendous confusion in the literature providing operational definitions of these terms.

The terms are all ambiguous, one of the most ambiguous terms being, school-linked. This term is used to describe anything from an after-school daycare bus that picks students up at school to a drug intervention program at a school. It may also refer to a model of collaboration and integration of the services of different social services including the school. Practically, it would be nice if these terms, in themselves, indicated if there was co-location of the services in the school, how much collaboration and communication occurs between the services providers, and the degree of change of policies around the services occurred. Different authors, however, have used these same terms with only slightly different meanings. Most authors do give an operational definition and therefore, the reader must read carefully to decipher their actual definition.

Models of Interprofessional Interaction
Briar-Lawson, and Lawson, (1997) provided working definitions for some of the terms used referring to the communication between the educational and other professional communities. They described four different models of interprofessional interaction:

1. school-linked comprehensive services are described as services that co-locate and link educators with service providers and places them into a model incorporating collaboration, as well as, integrated services,


2. the full service-school model, achieved by having community services located in the school and using the school as a sort of community center,


3. service integration is defined by the efforts of school and the community to coordinate and blend the intervention strategies offered to students and families, having community services co-located in the school and having a degree of communication between the school personnel and the community service personnel, and


4. school-linked services are those in which there is communication between the community services and the school.

School-linked comprehensive services: According to Briar-Lawson and Lawson (1997), the broadest category of interaction between professionals of different communities is school-linked comprehensive services. By including the term, comprehensive, they reduced some of the ambiguity of this term. The school-linked comprehensive service models are characterized by co-location of school and other professional offices. In addition, this model requires a link between school personnel and other services providers, interprofessional collaboration, and service integration. In order to have the complete model of school-linked comprehensive services a “system change” must take place. Systems change involves revision in job descriptions, leadership structures, accountability, resource allocation, policies, and work cultures.

School-linked comprehensive services require an incredible amount of effort and commitment to establish. Hardiman, Curcio, and Fortune (1998) wrote that creating and implementing such services are complex endeavors; the division of labor, lines of responsibility, and policies of collaboration are hard to formulate and summarize.

Harvey (1995) cited the Nashua school district as a district that successfully implemented school-linked comprehensive services. The service focus was care for the needs of students with Emotional Behavior Disorder (EBD). This movement was started by the inclusion policies. In 1985, the district began to focus on creating the necessary supports for students with EBD. By 1991, the school district had initiated interagency meetings involving administrators from the schools, child welfare, the local mental health agencies, and developmental disabilities agencies. They created a vision for this team, and organized a structure for its existence. They also operated at the individual client level. This community had created a continuum of services in the school, recreational and after-school programs, and community groups for these children and their parents. Harvey noted that they successfully implemented school-linked comprehensive services by working through frustration and working hard.

Full-service schools: There are a few full service schools that have made steps towards the school-linked comprehensive service model. Full-service schools are characterized by having community agencies co-located in schools and by having communication between the community agencies and school personnel. Full-service schools do not have the systems change that school-linked comprehensive services do. Adelman (1996) stated that the primary focus of the full-services school model is on the development of a mechanism to enhance service, improve case management, enhance service access, and increase efficiency. Full-service schools strive towards this end by becoming a community center. Existing and new community services are housed in the school; the school is open for the community’s needs and enjoyment from early morning until night and on the weekends.

A New York City school, Intermediate School (I.S.) 218 is a typical full-service school. It opens a 7 a.m. for breakfast. Before school officially starts, classes such as band, dance, ethics and law, and business are attended. Students can also choose to play sports, or go to the store and buy school supplies. Within the school walls is a Family Resource Center offering a broad range of services from an employment office to immigration offices. After the school day ends, the building stays open until 10:00 p.m. The school building is also open on weekends and in the summer. Academic activities, community resources, music, arts and other activities for all ages are available.

Dryfoos (1996) cited some positive results from full-service schools. In schools with clinics, students using the clinic have showed less substance use, better school attendance, and lower drop out rates. Those involved, including, teachers, students, families, and school personnel have a higher level of satisfaction with the school-based services and appreciate their accessibility. As well as increased attendance and graduation rates, the comprehensive full-service schools are also reporting increases in reading and math scores. The math scores at I.S. 218 rose from 37 percent at grade level in 1994 to 44 percent in 1995 and 51 percent in 1996 (Coltoff, 1997).

Dryfoos (1996) named “Governance” as the largest barrier to successful full-service schools. He stated that there must be a sophisticated collaboration among the organizations “whereby school systems and community agencies leave behind their parochial loyalties and pitch in to form a new kind of union” (p.3).

Adelman (1996) mentioned a few drawbacks to the full-service school approach. These may be the limitations of this model compared to a school-linked comprehensive service model. Adelman stated that a considerable amount of school resources are used for functions other than regular instruction and that not all resources are essential or used in cost effective ways. He further asserted that this is often due to ill-conceived policies or lack of coordination. However, he contended that when the focus is on linking community services to school, the resources already in school and the scope of the problem of coordinating the services are often overlooked. He also mentioned that this movement could create tension between the school-based staff and the community-based staff.

Service integration: Another model of interagency communication is the service-integration model. Briar-Lawson and Lawson (1997) provided an operational definition stating that, “service integration refers to efforts to coordinate and blend the intervention and improvement strategies professionals offer to children, youth and their families” (p. 136). Jensen and Kiley (1998) explained that the integrated services highlight the impact of all aspects of individuals’ lives and their school success. There is particular focus given to at-risk students and acknowledgment that all students can benefit from a team approach in providing integrated services.

Jensen and Kiley (1998) explained Lincoln School’s attempt at providing integrated services to early childhood special needs students. The critical dimensions mentioned as characterizing a team approach are collaboration, schools as organized cultures, teachers as leaders, and establishing cultures of leadership. They created an integrated therapy team (ITT) that consisted of the classroom teacher, the speech-language therapist, the physical and occupational therapist, and the student’s parents. These members worked together to maximize the educational benefits to the students they served. They met weekly to develop and prioritize objectives for students, share information, problem solve, develop behavior plans, plan integrated activities, and evaluate students progress. As a means for assessing this program, the ITT compared themselves to seven characteristics of inclusive schools. The characteristics that they used were:

1. a sense of community,


2. leadership,


3. high standards,


4. collaboration and cooperation,


5. changing roles and responsibilities,


6. an array of services, and


7. partnerships with parents.

School-linked services: Hardiman, Curcio, and Fortune (1998) described school-linked services as “the coordinated linking of school and community services to support the needs of school aged children and their families” (p. 37). They surveyed a nationwide stratified random selection of school board members on the issue of school-linked services. The analysis of the data indicated that while board members understood that these services were necessary to meet the needs of the students and families the majority of the respondents stated that their district had no policies governing all school-linked services. Examples of the school-linked services they noted included: (a) to invite a drug and alcohol intervention team from the community to give a presentation to the school; (b) to have an after-school day care pick-up students at the school; and (c) to have job training and juvenile probation at the school.

Summary
The range of models for interprofessional and interagency communication or linking is vast. While both Adelman (1996) and Skrtic and Sailor (1996) stated that the idea of school-linked services originated in the 1970’s the movement has only become a strong force in the last ten years. They explained that the school-linked, service-integration movement is a response to the crisis we are facing with the increase of economic and social problems American society is facing. Service integration at the community level appears to have risen from the notion that unless children’s basic needs are met, they will not be able to learn (Adelman, 1996; Peter, 1995; Skrtic & Sailor, 1997). These services have been incorporated into schools because schools provide ready access to school-aged individuals and most of their families (AAP Task Force, 1994; Skrtic & Sailor, 1996). DeFur (1997) also argued for collaboration between the school personnel and many different members of the community. She asserted that we must acknowledge the interdependence of school failure, the increase of truancy behavior resulting in an increased likelihood of dropping out, and the increasing attraction to drugs and gang membership. In this acknowledgment, we must act in favor of cooperative and collaborative service provision options to maximize the benefits to these students.

Systems change: Systems change is the most substantial aspect of an effective school-linked comprehensive service model. It is the aspect that is missing from most full-service schools and which distinguishes them from the school-linked comprehensive service model. Skrtic and Sailor (1996) focus on this aspect in their description of the school-linked comprehensive service model. They explained that school-linked comprehensive services are created from two interactive policy structures, one at the community level and one at the state level. Services that were previously discrete are integrated through local collaborative arrangements. These collaborative arrangements are usually made with community councils and family resource centers and they are often empowered through a state-level policy team. Through these arrangements, the services can share funds, databases, staff, and facilities. Skrtic and Sailor (1996) emphasized that a key aspect in this uniting is the power of voice and planning that is given to community residents.

Furthermore, they envision this service integration as a policy reform agenda. In order for any system transformation to occur, all of the professionals involved must acquire specialized skills in collaboration, as well as interprofessional sharing and language systems. They cited the Johnson school system in New York as an example of a school moving towards inclusive education, explaining that the processes of service-integration transformation greatly resemble those of the inclusive education reform efforts. They cited two processes that they believed to be critical to a successful reform. One was the formation of teams composed of representative parents, administrators, teaching staff, and other “stakeholders”. The teams were to develop school-wide inclusion plans. Being part of the team provided a “voice” in what was happening. Creating these teams indicated an investment in the teaching staff. The second process crucial to success was the change to a site-based management system.

Skrtic and Sailor (1996) are not the only authors mentioning the importance of systems change for effectiveness of a collaborative model. In an article describing the essential components of systems of care and interagency collaboration, Harvey (1995) also highlighted the need for systems change. She noted that successful programs of school-based services, integrated services, and the previously cited school-linked comprehensive service model in the Nashua schools, have all had systems changes. She also cited two examples in which there was little systems change. These programs did not work effectively.

Hardiman et al. (1998) surveyed a nationwide stratified random selection of school board member on the issue of school-linked services. From the results of this study, he argued that most districts have not had a systems change. Hardiman et al. (1998) stated that nearly half of the respondents indicated their districts did not allow needs assessments to be done by other agencies and that the districts did not assess the effectiveness of the services. He presented this as evidence that the systems were not working together. There are numerous ongoing projects to create a sort of collaborative model, indicating that this model has potential. However, it is multifaceted, and takes a lot of work to establish and maintain a successful program; without some systems change, it may not prove effective and efficient.

Collaboration
Collaboration is often regarded as a necessary prerequisite for any systems change. Collaboration indicates a team approach and a substantial degree of communication, but it also allows each profession and community to be one in itself. Knackendoffel, and Robinson, (1992) define collaboration as an ongoing process whereby professionals with different expertise voluntarily work together to create solutions to problems that are impeding student’s success, as well as, to carefully monitor and refine those solutions. Two or more individuals working for a common goal, mutual benefits, or desired outcomes characterize collaboration.

Knackendoffel and Robinson (1992) highlighted a few beliefs that must be central to a collaborative relationship. Those involved in collaborative relationships must believe that all participants have equal status, all participant have something to learn about working with children, services offered for children improve as educators work together rather than in isolation. Collaboration is enhanced by trust, respect, openness, and clear communication among the participants. Professionals will learn to work in new ways and acquire new skills. This paper will examine what have been the barriers to this type of interaction between the medical and the educational communities.

Laws Suggesting Collaboration in the Education Field
The guidelines established for both the medical and the educational professional practices imply the need and importance of collaborative relationships. The remainder of this paper will discuss aspects of and the research concerning a collaborative relationship between the medical and educational communities.

In 1975, Congress passed Public Law 94-142. A primary purpose of passing this law is to assure that children with disabilities have available to them free and appropriate education that emphasizes special education and related services designed to meet their unique needs. “Special education” is a set of services provided to meet the unique needs of a student in special education (OSPI, 1999). “Related services are those services required by a student to allow them to benefit from their special education program” (p. 16). Included in related services are medical services for diagnostic or evaluation purposes. The court case of Irving Independent School District vs. Tatro affirms that it is the schools responsibility to provide support services allowing meaningful access to education for a child with a disability. The medical services provided, however, must be either diagnostic or evaluatory in nature (Turnbull, 1993). This law promotes the collaboration and joint efforts of teachers and physicians in the education of children.

The formation of an Individualized Education Plan (IEP) for children who receive special education services is the mechanism through which the law promotes collaboration. Turnbull (1993) described the IEP as a method for assessing the child based on nondiscriminatory evaluation for prescribing an appropriate program. The evaluation is an ongoing process and therefore, ongoing communication must occur between each evaluator and the IEP team. Within the regulations for creating an individualized education plan for a special education student, it is stated that any individual can be invited to the meetings at the discretion of the public agency or the parent (Turnbull, 1993). Turnbull explained that physicians classify children as disabled and, therefore, they also have become one of the law’s groups of agents for deciding inclusion methods.

There are many students who do not qualify as students needing special education services but who do have medical needs. The services and attention provided by the school for both of these groups can be greatly enhanced by the school having input from the medical community regarding each student’s condition.

Suggestions for Collaboration in the Medical Field
The chapter 11 bylaws of The American Academy of Pediatrics (AAP) indicate that this organization is also in favor of promoting collaboration in order to best meet the needs of all children. Article four cites the goals and purposes of the AAP. Two objectives allude to this matter: “B. conduct and encourage programs designed to maintain and increase the effectiveness of all those who provide health care to infants, children, adolescents, and young adults;” and, “L. establish and promote liaison and cooperation with other organizations concerned with the well being of infants, children, adolescents, and young adults” (The American Academy of Pediatrics, 1996, p. 674).

The American Academy of Pediatrics has a Task Force on integrating school health services. In an article on integrating school health services the Task Force wrote that, “Every child should have a ‘medical home’ that provided health supervision and medical care that is continuous, comprehensive, family centered, culturally, sensitive, compassionate, coordinated and provided by a pediatrician or other physician well trained in child or adolescent health” (p. 400).

They mentioned that schools are recognized as community focal points and for that reason, there has been a focus on the school site as a place to access families and children and to access and coordinate health services. They mention that an effective system should be collaborative and create a link with the medical home. The Task Force noted that each community should develop its own approach to integrated care depending on its unique needs. However, each system is recommended to have a council consisting of many different people such as students parents, pediatricians, nursing personnel, school administrators, faculty and board members, community members, social services, higher education institutions, and local government to name a few. The council should then evaluate needs, establish communications and define the integrated services. This Task Force also emphasized that all work should be done in a collaborative fashion, no work or services should be duplicated, that neither on account of finances nor any other reasons should the quality of care and spectrum of services be lost or jeopardized. It is also stated that new mechanisms of financing should be developed to ensure monies to all health and human services providers in “a seamless web of services for the child and family” (p. 401). There also needs to be a systematic evaluation of this program. Finally, the Task Force stated that pediatricians practicing in both the “public and private sectors should become actively involved in any community effort to develop an integrated school health services initiative” (p. 402).

Barriers to Teacher-Physician Collaboration
A review of articles on the topic of educator-physician collaboration indicated that there appear to be three main categories of barriers to effective collaboration. These three categories are demographics, attitudes, and the systemic barriers of each individual profession.

The demographic variables of physicians have a significant association with the degree to which physicians communicate with teachers. Cranston, Ulrey, Hansen, Hudler, Marshall, and Wuori (1988) found several demographic characteristics of physicians’ practices, which correlated at a significant level with the degree to which the physician collaborated with a teacher. Physicians practicing in rural settings seem to have significantly more frequent communication with teachers than those in urban or suburban areas. The size of practice that the physician entertains also shows a significant correlation with the degree to which the physician collaborates with teachers. Physicians that classified themselves as having a solo or small group practice have significantly more frequent communication with teachers than those with a large group practice. A significant difference was also found with those physicians who reported treating patients with learning disabilities. As one would expect, those who reported a higher percent of patients with a learning disability also had more frequent useful communication with teachers.

Another category of barriers to teacher-physician collaboration appears to be the attitudes portrayed and perceived by the individuals in both of these professions. In response to an open-ended question 52 percent of the responding physicians indicated that a disadvantage to collaboration was in the area of teacher attitude problems (Cranston et.al, 1988). Beck, Edgar, Kenowitz, Sulzbachr, Lovitt, and Zwiebel, (1978) reported that the primary attitude problem reported by both physicians and teachers, is the complaint that the other has an arrogant attitude. Physicians coupled the arrogant attitude with a complaint of defensive reactions from teachers. Marshall, Wuori, Hudler, and Cranston (1987) wrote three specific issues for physicians to be aware of when working with teachers. Two of the three issues listed indicate that while some educators may welcome physician involvement, some may be defensive and hostile towards the physician. In the study done by Cranston et al. (1988), only four percent of the responding physicians cited the importance of information going from the physician to the school as an advantage to collaboration. Cranston et al. wrote that, “few physicians cite the value of utilizing teachers to help monitor the effects of important medical treatment . . . despite previous evidence regarding the need for this” (p. 138).

The final category of barriers considered is the systemic barriers within each and between the two professions. Physicians and educators are both confined by the systems in which they work and the ethics that guide their practices, as well as their individual styles and beliefs. These systemic barriers include issues of time, finances, and knowledge of each other’s field.

The medical and educational systems determine the amount of time and the times of the day that these professionals are available to talk or meet to collaborate. Thirty two percent of the physicians surveyed by Cranston et al. (1988) indicated that a major disadvantage to collaboration was the time/distance barrier. Both physicians and teachers indicate a frustration with the other profession from the lack of follow-up or long-term interactions, and phone calls that are not returned. Physicians also complain that conferences are scheduled at inconvenient times (Beck et al., 1978). It is interesting to note that these studies were conducted before recent changes in communication such as, email, and fax. These technological changes may ameliorate some of these communication problems.

These systems also impact the finances that can be spent towards collaboration. This element depends on if the physician has a private practice and the particular HMO affiliation(s) the physician has. Teachers, also have no way to be financially reimbursed for the extra time that collaboration requires. Teachers have also expressed concern about the cost of using a physician (Beck et al., 1978).

Because physicians and educators are both professionals, each has their own background and training. These two disciplines do not use the same terminology and have limited knowledge of the capabilities of the other field. Physicians seem unsure of the services school systems are obliged, or capable of providing (Cranston et al., 1988; Marshall et al., 1987). Cranston et al. found that while only 22 percent of the physicians interviewed received training in working with teachers, 81 percent of the physicians wanted more information on how the schools evaluate and identify children’s educational needs. In a questionnaire of 54 teachers, 22 percent cited “don’t understand classroom” and “use different terminology,” as disadvantages in working with physicians, or, “have no idea of what goes on in school” (Beck et al., 1978, p. 81). Marshall et al. (1984) cited similar responses. Teachers also have poor understanding of what physicians can and cannot provide (Marshall et al., 1987; Beck et al., 1978). Another type of barrier to collaboration that was cited as a disadvantage was teacher misinformation on controversial topics, such as, alternative treatments, and inattention behavior (Cranston et al., 1988; Beck et al., 1978). This resulted in a decreased desire to collaborate by physicians (Beck et al., 1978).

Overcoming Barriers
There are significant barriers to effective interagency collaboration, but these barriers can be overcome. Skrtic and Sailor (1997) suggested that professionals involved in system transformation must have specialized skills in collaboration, and interprofessional information sharing and language systems. They stated that agencies should have a consumer database that is shared, as well as confidentiality waiver forms. The services should be family focused and community managed (Skrtic & Sailor, 1997). The most prominent suggestions for overcoming barriers are creating a shared vision among all of the people, creating a clearly defined system with clear roles and administrative support, and to increase the professionals’ knowledge of what the other systems can offer to the child and the family.

Parent Strategies
It is also crucial to understand how parents can help promote collaboration between physicians and teachers. Harvey (1995) noted that family involvement is critical in developing a system of care. Six guiding ideas for parents to remember in order to help facilitate this collaboration as follows: choose your doctor carefully, suggest collaboration, share information from the doctor with teachers, share information from the teacher with the doctor, facilitate scheduling, and take a pro-active role in developing integrated services.

1. Parents want the best care for their children. Carefully picking a doctor who collaborates with school personnel increases the chances of this. Listed below are questions to ask a pediatrician when choosing your child’s doctor:
   a. Please describe any interagency service provision efforts in which you may be involved.
   b. How often do you communicate with school personnel?
   c. Do you have established methods of communicating with the schools of your patients?
   d. Are you familiar with the policies, programs and practices of the special education department in any schools?
   e. What role does teachers’ input play in your work with your patients?
   f. What percent of your patient population is identified as learning disabled?



2. Parents can suggest collaboration to physicians, and to teachers. After making this suggestion, a parent must make sure that release forms for both the school and the doctor’s office allowing them to share information on a need to know basis are on file.



3. Communication about medical issues can be directly initiated by parents. For example, parents can tell school personnel when a child begins medication or switches medications or dosage of medication. A parent can also ask the doctor about possible side effects that might impact the child’s education, and share this information directly with the school.



4. Communication of teacher concerns or observations regarding the child can also be conveyed to the doctor by the parent. If a student has an IEP, the parent can share this information with the doctor. Parents also can share more technical information from the assessments done for the IEP. This will help the doctor understand how the school perceives the child’s abilities. An outline of the child’s school day will also help the doctor see what demands the child faces.



5. A major task for a parent is to respect the schedules and limitations of both the school and the medical communities. Scheduling routine doctor visits outside of school hours has a major positive impact on the child’s school life. By knowing the schedules and communication needs of both of these communities, a parent can help arrange necessary conferences at mutually agreeable times.



6. Parents can also help to initiate this interagency collaboration in their community. There is money available for this sort of dedicated school-linked comprehensive service model. The U.S. Department of Education granted the Nashua school an 18-month federal grant to facilitate the interagency collaboration model that they had implemented (Harvey, 1995). While it takes time and energy, parents can be catalysts to build the necessary relationships for collaboration and help start various models of interagency collaboration.

Summary
While interest in efforts of interprofessional interaction is building, the reality of a confusion in basic terms shows that the movement is still young. The existence of many different integration models may indicate the degree of effort required for building a school-linked comprehensive service model. The essential component of any service integration model, that is collaboration, is complex to achieve. Educational and medical communities are different enough so that there are significant real and perceived barriers to clear communication and effective collaboration. However, parents can serve as key players in overcoming these barriers and in creating easy channels for the communication of important information, allowing their children to receive the best services possible from both the medical and educational communities.

References
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Adelman, H. S., & Taylor, L. (1998). Involving teachers in collaborative efforts to better address the barriers to student learning. Preventing School Failure, 42, 55-60.

Allen, J. M. (1994). School counselors collaborating for student success. ERIC Digest. American Academy of Pediatrics Task Force (1994). Integrated school health services. Pediatrics, 94, 400-402.

American Academy of Pediatrics (1996). Fellowship Directory.

Beck, R. G., Edgar, E., Kenowitz, L., Sulzbacher, S., Lovitt, T. C., & Zwiebel, S. (1978). The physician-educator team. Let’s make it work. The Journal of School Health, 48, 79-83.

Briar-Lawson, K., & Lawson, H. A. (1997). School-linked comprehensive services: Promising beginnings, lessons learned, and future challenges. Social Work in Education, 19, 136-149.

Coltoff, P. (1997). Full-service school broaden definition of education reform. Christian Science Monitor, 89, 19-20.

Cranston, C. S., Ulrey, G., Hansen, R., Hudler, M., Marshall, R., & Wuori, D. (1988). Interprofessional collaboration: Who is doing it? Who isn’t? Developmental and Behavioral Pediatrics, 9, 134-139.

DeFur, S. H. (1997). Collaboration as a preventive tool for youth with disabilities. Preventing School Failure, 41, 173-178.

Dryfoos, J. G. (1996). Full-service schools. Educational Leadership, 53, 18-24.

Hardiman, P. M., Curcio, J. L., & Fortune, J. C. (1998). School-linked services. The American School Board Journal, September, 37-40.

Harvey, V. S. (1995). Interagency collaboration: Providing a system of care for students. Special Services in the Schools, 10, 165-181.

Jensen, R. A., & Kiley, T. J. (1998). Teams or torture? Creating a climate for collaboration. Research/technical report: Bradley University. (ERIC No. ED 41 93 44).

Marshall, R. M., Wuori, D. F. (1985). Medical and educational literature on physician/teacher collaboration. Journal of School Health, 55, 62-65.

Marshall, R.M., Wuori, D. F., & Carlson, J. R. (1984). Improving physician/teacher collaboration. Developmental and Behavioral Pediatrics, 5, 241-245.

Marshall, R.M., Wuori, D. F., Hudler, M., & Cranston, C. S. (1987). Physician/school teacher collaboration. Clinical Pediatrics, 26, 524-527.

Office of Superintendent of Public Instruction (OSPI). (February, 1998). Special education and the law: A legal guide of families and educators. Olympia: OSPI.

Seeger, K., & Aceves, J. Assisting with the school placement and interventions for children with special needs—from disabled to gifted. Primary Care, 22, 51-68.

Skrtic, T. M., & Sailor, W. (1996). School-linked services integration: Crisis and opportunity in the transition to postmodern society. Remedial Education, 17, 271-283.

Ulrey, G., Hudler, M., Marshall, R., Wuori, D., & Cranston, C. (1987). A community model for physician, educator, parent collaboration for management of children with developmental and behavioral disorders. Clinical Pediatrics, 26, 235-239.

Frank Kline, Ph.D. is an Associate Professor and Director of Teacher Education at Seattle Pacific University. Lisa Rubel is a doctoral student at Seattle Pacific University.

This article was reprinted from The Journal of the Learning Disabilities Association of Massachusetts, January 2000, Vol. 1, No. 1. (This publication is now called Journal of Learning Disabilities Worldwide.)

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