The duties and responsibilities of education authorities and schools in Scotland with regard to pupils who are absent for health reasons are unclear in comparison to other UK countries. This study examined in-school and out-of-school learning contexts for Scottish pupils, ages 5 through 18 years, with medical conditions of sufficient severity and duration that normal school attendance or progress might be disrupted. Data sources included surveys of Scottish education authorities, interviews with key staff, 4 detailed mainstream school studies, and 18 detailed child profiles. Findings indicated that factors influencing in-school learning included systems and levels of support for learning, schools' knowledge about and attitudes toward the medical conditions, and specific aspects of the medical condition that might incapacitate a child. Factors influencing out-of-school learning included education authorities' and schools' interpretation of their responsibilities, availability and quality of outreach services, families' and caregivers' ability and willingness to support children's education, children's motivation and capacity to learn outside school, and specific aspects of the medical condition that might incapacitate a child. Factors making positive educational outcomes more likely included good overall school ethos, nurtured partnerships between the school and others, professional development for education staff, and effective management of out-of-school education. Based on findings, it was concluded that proposed legislative changes and national guidance on the education of children with health needs will ensure that their educational needs reach a higher profile. (Includes a list of relevant organizations. Contains 12 references.) (KB)