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

Health and the IEP
Liz Hecht
Waisman Resource Center
Southern Regional CYSHCN Center
1-800-532-3321
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 needs
Provide information as appropriate
Participate in plan development with
school and medical team
Provide medication and supplies
Share contact information
Support child/youth to acquire needed
skills
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The School Nurse’s Role
 Identify students
 Arrange meetings to discuss accommodations
 Develop health care plan and emergency care
plan
 Delegate responsibility
 Provide training
 Provide supervision
 Gathering data from medical providers
and agencies
 Case management
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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 WORK
Expanded appointment times
Time commitment
After hours communication
Reimbursement 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
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Tools For Schools: Care Plans for
Children With Special Health Needs
Identify Health Issues
Identify/educate those on the team
– SE teacher, SE 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
– SE 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 transfers
Feeding
Gastrostomy tube use
Personal cares, toileting
Seizure management
Airway management
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Communication Aides
 Forms— school medication, allergies
 Daily care plans
 Behavioral Intervention Plan (BIP) from formal
Functional Behavioral Assessments
 Strategies for ongoing communication—
daily shared notebook, emails, phone
 Consider 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 allergies
Example:
–
–
–
–
–
–
–
–
–
–
–
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
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Flonase Nasal Spray 2 squirts each nostril QD for allergies
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/caregivers
Pediatrician
– 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
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