Health and the IEP

 

Liz Hecht Waisman Resource CenterSouthern Regional CYSHCN Center1-800-532-3321 

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The School’s Role

The Individuals with Disabilities Education Act (IDEA) grants to eligible children with disabilities the legal right to receive a free appropriate public education in the least restrictive setting. For an increasing number of children with disabilities, access to education is only achieved through the provision of necessary health services (e.g., administration of intravenous medications, catheterization, tracheostomy care, gastrostomy tube feedings).

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The School’s Role

The 1999 United States Supreme Court ruling in Cedar Rapids Community School District v. Garret F. (hereinafter known as "Garret F.") held that the Individuals with Disabilities Education Act (IDEA) requires school districts to provide nursing services when such supportive services are necessary in order for students to access and benefit from their educational program.

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The School’s Role

"School nurse services" is a new related service and has replaced "school health services".

(26) Related Services. The term 'related services' means transportation, and such developmental, corrective, and other supportive services …school nurse services designed to enable a child with a disability to receive a free appropriate public education as described in the individual education program of the child, ...as may be required to assist a child with a disability to benefit from special education, …Reference from IDEA 2004 - 20 U.S.C. Section 1401 (26) (A)

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The Family’s Role

Notify school of child’s needsProvide information as appropriateParticipate in plan development with

school and medical teamProvide medication and suppliesShare contact informationSupport child/youth to acquire needed

skills

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The School Nurse’s Role

Identify students Arrange meetings to discuss

accommodationsDevelop health care plan and emergency

care planDelegate responsibilityProvide trainingProvide supervision

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The Pediatrician’s Role

IEP planning and input on Health Plan or Behavior Intervention Plan (BIP)

Medication administration information/forms Advocacy with family for services Communication re medication and its effect on academic

progress or behavior with school nurse/teachers/psychologist – phone and email

Development of an Emergency Care Plan Creation of a Signs and Symptoms Checklist In service for specific cares—may be done jointly with

family’s help and input

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The Pediatrician’s Role

MAKING IT WORKExpanded appointment timesTime commitmentAfter hours communicationReimbursement for care coordination

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AAP Resources

Helpful guidelines from the American Academy of Pediatrics, Committee on Children With Disabilities, including: The Pediatrician's Role in the Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP) (RE9823) Pediatrics. 1999;104(1):124-127

http://www.medicalhomeinfo.org/publications/education.html

Tools For Schools: Care Plans for Children With Special Health Needs

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Identify Health Issues

Identify/educate those on the team

– EEN teacher, EEN aide, school nurse, teacher, others

– Day care providers, support / aides at day care

– Home - parents, personal care workers Provide information. Information builds confidence!

– articles regarding condition

– handouts regarding tubes, lines, etc. Develop a plan Identify those that are medical providers and their availability

• Emergency training such as CPR, airway management.

• Medications

• Seizure management

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Developing A Plan - School

Identify individuals to help– Nurse– Teacher– EEN assistant

Write a plan of care - consider potential problems and outline solutions

Provide information– get an article describing typical health problems and

characteristics of the child’s problems– medication lists– emergency contacts– allergies - include food / meds/ environmental/ latex

Train necessary individuals at various settings

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School - Identify Need

Justify need via IEP – documents need for nursing care– builds nurse into the team

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School - Identify Need

Identify training needs for school personnel. Train support staff and teachers prior to, and during the school year.Utilize the IEP.Use tools such as training videos.

Examples: Safe handling and transfersFeedingGastrostomy tube usePersonal cares, toiletingSeizure managementAirway management

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Communication Aides

Forms— school medication, allergiesDaily care plansBehavioral Intervention Plan (BIP) from formal

Functional Behavioral Assessments Strategies for ongoing communication—

daily shared notebook, emails, phoneConsider having your pediatrician/FP complete

“signs and symptoms checklist”May be multiple people involved over various

settings, develop a central organized contact list

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Health Information

Keep information in an organized 3-ring file.

Include the following:– Medical diagnosis– Names and phone numbers of medical

providers– Medication Lists– Allergies

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Medication List

Carry a list of medications and allergiesExample:

– DOB: 5/16/93– Medical Diagnosis: Cerebral Palsy, Asthma, Low Vision, Reflux– Allergies: Amoxicillin and Clindamycin– Baclofen 20 mg TID for spacticity– Valium 2 mg AM and 4 mg PM for spacticity– Dantrolene 25 mg AM and 75 mg PM for spacticity– Prilosec 20 mg BID for reflux– Metoclopramide 5 mg QID for reflux– Flovent MDI 2 puffs BID for asthma– Albuterol MDI 2 puffs TID-QID for asthma– Flonase Nasal Spray 2 squirts each nostril QD for allergies– Multivitamin with iron QD

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Signs and Symptoms of Problems

Listen to the parents or primary providers of care. School personnel may detect changes as well. “They’re just different”. “Something is wrong”.Remember kids with special health care needs

also develop typical childhood illnesses. Look for those.

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Signs and Symptoms some examples

Hypoglycemia (low blood sugar or Insulin) reaction in diabetic student—confusion and irritability, uncooperative diabetic may signal low blood glucose, so better to give sugar (OJ, concentrated glucose) than time out!

Pain manifestations in nonverbal child—increased agitation, elevated heart rate, sweating

Response to a seizure in child with epilepsy— when to call 911, use of Diastat rectally

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Emergency Care Plan

Know your emergency plan.Review plans periodically.Know who can help you in an emergency.

– School nurse– 911

Identify individuals trained in schools, may include students.

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Emergency Contacts

Parents/caregiversPediatrician

– plan for after-hours care

Hospital used in emergency– Services provided via local ambulance

• transportation only

• advanced training

• ability to handle child’s special issues