Transcript No Slide Title

Special Health Care
Paraprofessional Module
Arkansas Department of Education
Special Education Unit
Paraprofessional Competencies
Children with Special Health Care Needs
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Understanding the legal basis for providing safe and
health-related services to students.
Knowledge about prevention measures, medication
administration, and treatment procedures to meet
the special health care needs of students.
Ability to use infection control and universal
precautions, basic first aid and proper lifting,
carrying and transferring techniques.
Paraprofessional Competencies
Children with Special Health Care
Needs (Continued)
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Knowledge about the use and maintenance of
assistive technology and adaptive equipment.
Ability to collect, report and document data
related to the health care of students.
Ability to make educational environment
barrier-free and accessible.
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Paraprofessional Competencies
Children with Special Health Care
Needs (Continued)
Knowledge about the development and
implementation of emergency and disaster
plans specific for students with special health
care needs.
Knowledge about the safe transportation of
students with special health care needs.
Paraprofessional Competencies
Children with Special Health Care
Needs (Continued)
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Ability to advocate for oneself in an
appropriate manner which ensures the safety
of the paraprofessional and student.
Knowledge about the confidentiality of student
information.
Arkansas Department of Education’s
Director’s Communication Memorandum
Memo Number: ACC-00-027 Date 12/09/99
Subject: IHPs for Students with Special
HealthCare Needs
Regulatory Authority:
Act 1565 of 1999
SPECIAL HEALTH CARE
TERMS
A.
B.
C.
D.
E.
Students with Special Health Care Needs
Chronically Ill
Medically Fragile
Technology Dependent
Other Health Impairments
SPECIAL HEALTH CARE
TERMS
(Continued)
1.Term referring to a student with a condition
that is long-term and results in decreased
strength, vitality and alertness. Conditions
may include: asthma, diabetes, rheumatoid
arthritis, cancer, or epilepsy.
B. Chronically Ill
SPECIAL HEALTH CARE
TERMS
(Continued)
2. Term referring to a student who
requires a medically or mechanical
device to compensate for the loss of a
vital body function, including
mechanical ventilation, tracheotomies,
oxygen, and respirator.
D. Technology Dependent
SPECIAL HEALTH CARE
TERMS
(Continued)
3.Student’s condition is such that the
absence of immediate, health-related,
specialty skilled care threatens his/her
life or health.
C. Medically Fragile
SPECIAL HEALTH CARE
TERMS
(Continued)
4.
Term used in the educational setting to
identify a student who requires special
education and related services because
of a health condition resulting in limited
strength, vitality or alertness due to chronic or
acute health problems that adversely affect a
child’s educational performance.
E. Other Health Impairment
SPECIAL HEALTH CARE
TERMS
(Continued)

Some examples of OHI are heart condition,
tuberculosis, rheumatic fever, nephritis,
asthma, sickle-cell anemia , hemophilia,
epilepsy, lead poisoning, leukemia and
diabetes.
SPECIAL HEALTH CARE
TERMS
(Continued)
5.Students requiring an individualized
health care intervention to enable them
to participate in the educational
process.
A. Students with Special Health Care Needs
DOES THE STUDENT...
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Have a medical diagnosis of a chronic health
problem?
Receive medical treatments during or outside
the school day?
Experience frequent absences due to illness?
Experience frequent hospitalizations?
DOES THE
STUDENT…(Continued)
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Receive ongoing medication for health
problems?
Require environmental adjustments to
classroom?
Require adjustments of the classroom
schedule due to a health condition?
Require major safety considerations?
Components of a Health Care Plan
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Required Components
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Brief Medical History
Physician’s Order for Procedures
Standards for Implementation
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Care Goals
Authorized person(s) responsible for the care
actions/procedures
Equipment to be used
Person responsible for maintenance of equipment
Supervisor of the care actions/procedures
implementation
Components of a Health Care Plan
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Required Components(Continued)
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Prescription for medication and procedures for
administration
Physician’s ordered diet
Transportation plan/procedures
Classroom/School modifications (including
adaptive physical education)
Equipment and supplies provided by parent
Equipment and supplies provided by school
Emergency procedures
Components of a Health Care Plan
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Required Components(Continued)
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Safety measures
Contingency plans: emergency, transportation and
training
Substitute/backup staff
Authorization/signatures (all parties, including
parent/guardian)
Effective dates
Components of a Health Care Plan
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Optional Components
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Student and family strengths
Academic achievement profile
Specialized training or education for staff
Student participation procedures
Other related information
Sample
Health Care Plan
Case Study
Health Care Plan
for
Jane Doe
Special Health Care Team:
Student Needs
Questionnaire
Student Needs Questionnaire
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1. Does the student have a health
condition which will require
inservice training?
Student Needs Questionnaire
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2. Does the student have a health
condition which will require
changes or modifications outside
the classroom (lunchroom,
playground, gym, bus)?
Student Needs Questionnaire
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3. Does the student have a health
condition which will require
changes in or modifications of the
classroom environment?
Student Needs Questionnaire
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4. Does the student have a health
condition which will require safety
precautions on the bus,
playground, gym, etc.?
Student Needs Questionnaire
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5. Does the student have a health
condition which would result in
pain?
Student Needs Questionnaire
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6. Does the student have a health
condition which would require a
special diet?
Student Needs Questionnaire
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7. Does the student have a health
condition which will require
medication?
Student Needs Questionnaire
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8. Does the student have a health
condition which will require
rehabilitative treatment?
Student Needs Questionnaire
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9. Does the student have a health
condition which will require regular
contact with a doctor?
Student Needs Questionnaire
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10. Does the student have a health
condition which will require training
someone else (fellow student,
classroom teacher,
paraprofessional)?
Student Needs Questionnaire
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11. Will the student require an
adapted health education
program?
Student Needs Questionnaire
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12. Will the student require
special equipment for learning
because of a health problem?
Student Needs Questionnaire
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13. Will the student require
assistance of a personal nature
(toileting, feeding, positioning)?
Student Needs Questionnaire
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14. Does the student have to take
medication?
Student Needs Questionnaire
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15. Does the student require
health maintenance care
(immunizations, exercise, dental
care)?
Student Needs Questionnaire
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16. Does the student require
health related procedures?
Student Needs Questionnaire
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17. Are there any other needs?
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What are they?
UNIVERSAL
PRECAUTIONS
Universal Precautions
Section 1
Barrier Precautions
Section 2
Cleaning and
Decontaminating Spills or
Other Body Fluids
Section 3
Recommended Contents of
Body Spills Kit
When Should We Wash Our Hands?
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Before and After Contact with Student
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Before and After Contact with Equipment
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After Using Gloves
YANKEE DOODLE
Oh, Yankee Doodle went to town, a-riding on a
pony;
He stuck a feather in his cap and called it
macaroni.
Yankee Doodle keep it up;
Yankee Doodle Dandy,
Mind the music and the step and with the girls
be handy.
Guidelines for the
Handling of Body Fluids
in the School Environment
Disposable Gloves Procedures
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Maintain supply of latex and/or disposable
gloves of various sizes in accessible locations.
Do not reuse gloves. Use fresh gloves for each
student and task.
Slip each hand into a clean glove, pulling it over
the finger for a good fit. Pull glove over wrist as
far as it will go.
Disposable Gloves Procedures
(Continued)
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Remove the first glove by turning it inside out
as it is pulled over the hand. Grasp the glove in
the remaining glove hand.
During removal of second glove, avoid touching
the outer surface. Slip fingers of the ungloved
hand under the glove and pull it inside out,
effectively sealing the first glove inside.
Disposable Gloves Procedures
(Continued)
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Dispose of the used gloves in a lined waste
container.
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Wash your hands thoroughly, following the
hand-washing procedure.
Basic Guidelines in Preventing
Exposure & Transmission of
Infectious Disease
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Avoid direct contact with body fluids.
Encourage student to do own care.
Wear gloves.
Have first aid & other supplies available.
Playground staff to carry first aid supplies.
Basic Guidelines in Preventing
Exposure & Transmission of
Infectious Disease (Continued)
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Do not eat or touch your mouth or eyes while
giving first aid.
Remind students to avoid contact with the
blood and body fluid of other people.
Wash hands after helping student with a
tissue.
Clean up and dispose of waste and
contaminated products.
“Crash Course in First Responder”
 First Aid Kit
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General Rules of Thumb
In An Emergency...
Pressure Points
Fainting, Seizures, Diabetes
Diabetic Emergencies
“Crash Course in First Responder”
(Continued)
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Shock
Head and Spinal Injuries
Bites
Dental/Eye Injuries
Choking
Heat Related Emergencies
EMERGENCY PLAN
HANDOUT H-7
LIFTING
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Clear the transfer surface.
Stabilize transfer surface.
Wear non-skid shoes.
Explain to the student what is being done.
Keep feet a shoulder width apart.
Unfasten all straps and safety belts.
Bend mostly at hips and knees while
maintaining back alignment.
LIFTING (Continued)
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Lift student close to his/her center of gravity, by
waist or crossed arms.
Hold object/student close to your body.
Have student help as much as possible.
Complete the lift before turning.
Use safety devices, including gait belt, whenever
possible.
If student is greater than a fourth of your body
weight, use two people to transfer rather than lift.
Transfer from Sitting - One Person
Lock the wheelchair and
Lift
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remove the arm-rest on
the side from which you
are lifting. If the footrests
are close to the ground,
you may need to remove
them to allow for your foot
placement.
Transfer from Sitting - One
Person Lift Place one arm under
the child’s knees and
(Continued) the other arm behind
the child’s back.
Transfer from Sitting - One
Person Lift
 Lift, keeping the
(Continued) child’s body as
close to you as
possible
Transfer from Sitting - One Person
Lift
 Complete the lift before
(Continued) turning
Wheelchair to Floor - Two
Person Lift Preparation
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Lock the wheelchair
brakes.
Wheelchair to Floor - Two
Person Lift Preparation
(Continued)
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Remove the
footrests.
Wheelchair to Floor - Two
Person Lift Preparation
(Continued)
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Unfasten the seat belt
and any other supports.
Wheelchair to Floor - Two
Person Lift Preparation
(Continued)
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The taller person stands
behind the child, reaches
under the child’s arms, and
holds the child’s fore- arms
which are crossed over the
chest.
The other person places
both arms under the child’s
thighs.
Wheelchair to Floor - Two
Person Lift
The wheelchair is prepared
Lifting
and two people are in position
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to lift the child.
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They lift the child upward as
they stand erect.
Wheelchair to Floor - Two
Person Lift
Lifting (Continued)
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The person who is holding the
child’s legs moves one hand
down to the child’s child’s calf.
Wheelchair to Floor - Two
Person Lift
Lifting (Continued)
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Both persons step sideways to
clear the wheelchair, then
lower slowly until the child is
safely resting on the floor.
Floor to Wheelchair - Two Person
Lift
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The child is in a sitting position on the floor.
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The wheelchair is placed parallel to the child.
The brakes are locked and the footrests are
removed. The seat belt is unfastened and is
hanging at the sides of the chair, not on the
seat.
Floor to Wheelchair - Two
Person Lift
(Continued)
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The taller person
squats behind the child,
reaches under the
child’s arms, and holds
the child’s forearms
which are crossed over
the chest.
Floor to Wheelchair - Two
Person Lift  The other person
(Continued) squats beside the child
and supports the child’s
legs, placing one hand
under the thighs and
the other hand under
the lower legs.
Lifting the child slowly, they stand
erect.
The person who is supporting the
child’s legs moves both hands to the
child’s thighs.
Floor to Wheelchair - Two Person
Lift
They carry the child to the
(Continued) wheelchair, position the child
over the seat, and lower
slowly until the child is resting
on the seat. They position the
child properly in the chair and
replace the seat belt and
wheelchair adaptations.
Lifting and Carrying “Do’s and
Don’ts  DO have a transfer
(Continued) surface that is clear of
objects

DO have a stable
transfer surface.
Lifting and Carrying “Do’s and
Don’ts”  DO NOT have objects
(Continued) on the transfer surface.
Lifting and Carrying “Do’s and
Don’ts”  DO NOT have an
(Continued) unstable transfer
surface.
Lifting and Carrying “Do’s and
Don’ts”
lock the wheel- chair
(Continued) DO
brakes whenever moving
the child in or out of the
wheelchair.
Lifting and Carrying “Do’s and
Don’ts”
(Continued)
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DO tell the child what you are going to do.
DO wear non-skid, low-heeled footwear (both
helper and child).
DO keep feet apart for a wide base of support.
DO remember to unfasten all seat belts and
harnesses.
Lifting and Carrying “Do’s and
Don’ts”
(Continued)
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DO bend at the hips
and knees.
Lifting and Carrying “Do’s and
Don’ts”
NOT bend forward at
(Continued) DO
the hips while standing
with the knees straight.
Lifting and Carrying “Do’s and
Don’ts”
keep your back
(Continued) DO
straight.
Lifting and Carrying “Do’s and
Don’ts”
NOT relax your back
(Continued) DO
and let it round.
Lifting and Carrying “Do’s and
Don’ts”
lift by holding the child
(Continued) DO
at the waist or by holding
the child’s crossed arms.
Lifting and Carrying “Do’s and
Don’ts”
NOT lift with the
(Continued) DO
child’s arms.
Lifting and Carrying “Do’s and
Don’ts”
(Continued) DO hold the child as close
to you as possible.
Lifting and Carrying “Do’s and
Don’ts”
NOT hold the child
(Continued) DO
away from you.
Lifting and Carrying “Do’s and
Don’ts”
complete the lift
(Continued) DO
before turning.
Lifting and Carrying “Do’s and
Don’ts”
(Continued)
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DO NOT twist your body
while lifting.
Transferring Principles
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Transfer rather than lift if the student can
assist.
Stabilize transfer surfaces.
Clear transfer area of obstacles.
Lock and stabilize wheeled items.
If student is more than 1/4 of your body
weight, use two people or an assistive
device.
Transferring Principles
(Continued)
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Unfasten all straps and safety belts.
Arrange the transfer so that surfaces are close
as possible.
Keep feet wide apart, back straight, bend at
hips and knees, with student as close to your
body as possible.
Use gait belt for those students who can
stand.
Assisted Standing Transfer
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Position the wheelchair
facing the transfer
surface, allowing room
for two people to stand.
Lock the wheelchair
brakes. Swing aside
the footrests.
Assisted Standing Transfer
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Prepare the child and
assist the child to
stand.
Assisted Standing Transfer
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Leading with your
outside foot, take small
steps for a half turn.
Turn slowly so that feet
do not become
entangled.
Assisted Standing Transfer
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Tell the child to lean
forward and lower
slowly to the transfer
surface.
Purposes of Positioning
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Improve muscle tone
Increase weight bearing
Maintain symmetry and movement (range of
motion)
Increase strength
Increase and maintain bone density
Purposes of Positioning
(Continued)
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Increase participation in meaningful activities,
such as activities of daily living
Increase communication
Increase circulatory & respiratory function
Components of
Positioning
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Symmetry - Both sides of the body are
positioned identically and the head is
centered in the middle of the body.
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Body Alignment - Positioning the body to
maintain normal posture with the back
straight and feet directly under the knees and
pointed straight ahead.
Personal Health Care Needs
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Naso-gastric Feeding
(health aide only)
Personal Health Care Needs
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Gastrostomy Feeding
(health aide only)
Personal Health Care Needs
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Ambu bag (in
emergencies only)
Personal Health Care Needs
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Colostomy Care
Personal Health Care Needs
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Postural drainage
Personal Health Care Needs
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Postural drainage
Personal Health Care Needs
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Percussion
Personal Health Care Needs
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Percussion
Personal Health Care Needs
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Percussion
Personal Health Care Needs
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Tracheotomy
Suctioning
Factors in Feeding Disorders
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Altered muscle tone
Impaired ability to swallow
Tongue thrust
Poor voluntary head control
Weak or absent ability to cough
Impaired gag reflex
Congestion
Factors in Feeding
Disorders
(Continued)
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Secretions
Low level of alertness or cognition
Poor growth rate
Poor general health
Cultural considerations
Feeding
“EVERY LITTLE BITE COUNTS”
&
“SWALLOWING SAFELY,
SWALLOWING NUTRITIOUSLY”
Toileting, Diapering
& Feminine Hygiene
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Principles
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Determine what and how the student needs to
communicate the need to void.
Assist with transfer as necessary or as instructed.
Support, as necessary, for sitting or lying.
Always maintain student privacy by closing the door or
using a screen.
Wear gloves, bag and seal diaper or any body fluid
and dispose in proper container.
Wash your hands as well as the student’s hands.
Procedures for Diapering
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Assemble supplies beforehand.
Use disposable diapers.
Put on disposable gloves.
Place the student on a washable table or mat that is
used for only that purpose.
Do not leave the student unattended.
Removed soiled diaper, folding inward and wrapping
it in its own plastic liner.
Procedures for Diapering
(Continued)
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Put soiled diaper in a small plastic bag and place in
a lined, covered waste container.
Cleanse skin with a disposable wipe and cleaning
solution or moist towlette.
Move from front to back to prevent urinary-tract
infections, paying attention to skin creases.
Redress the student.
Remove gloves using the recommended disposal
procedures.
What to do When an
Asthma Episode Occurs
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Watch for Symptoms:
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wheezing
coughing
difficulty breathing/breathlessness
bluish color on lips and nail beds
decrease in peak flow (meter)
Judge the severity of episode
What to do When an
Asthma Episode Occurs
(Continued)
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Find out if student was exposed to any asthma
triggers
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cold & other viral infections
irritants
exercise or over-exertion
air pollution
strong emotion
Help student sit up with shoulders relaxed
Speak calmly and provide reassurance
What to do When an
Asthma Episode Occurs
(Continued)
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Encourage student to drink fluids (helps to thin
mucous)
Help student take the prescribed amount of
prescribed medication
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medications should be given or directed by qualified health
professional
If medication does not work, notify the student’s
parents and health care providers
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Only in rare cases do students with asthma need
emergency medical care
What to do When an
Asthma Episode Occurs
(Continued)
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Document the asthma episode
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Note in daily log and student health care record
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Follow-up. Let student’s parents know about any
medical intervention.
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Check the supply of prescribed medication and
notify parents if more is needed.
Suctioning Instructions
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General Considerations
Equipment
Set Up and Pressure Adjustment
Suction
Saline Irrigation
Cleaning
Safety Precautions
Suction Machine
Orientation Checklist
What a paraprofessional should be taught:
 how to set up and operate an aspirator
 how to adjust the amount of vacuum
 how to apply intermittent suction with a suction catheter
 how to suction using clean/sterile technique
 how to clean and disinfect suction catheter, collection
bottle and equipment
 how to change inlet filter
Suction Machine
Orientation Checklist
(Continued)
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explain safety precautions
explain importance of cleanliness with equipment
if battery operated, explain importance of keeping
a charge
how to order supplies
SPECIALIZED HEALTH CARE
PROCEDURES RECORD
OVERHEAD/HANDOUT H32
Situation 1
Nine year old Sally suffers from asthma. Jill, the
paraprofessional, is asked to administer Sally’s
inhalation medication. Jill never received training in
this skill area. What should Jill’s first response be?
A.Do the best she can even though she has not been
trained in this skill area.
B.Tell the nurse that she does not feel comfortable with
this because she has not been trained.
C.Tell the nurse that she has been trained in this skill
area, but does not feel comfortable
administering
medication.
D.Tell the nurse that she has been trained in this skill
area and feels comfortable administering this
medication.
Situation 2
Johnny suffers from cerebral palsy and is nonambulatory. You are in the lunchroom with his fourth
grade teacher when he indicates on his
communication board that his diaper needs to be
changed. What procedures would you follow?
A. Ignore his cues.
B. Take him into the hallway and change him.
C. Tell the nurse that Johnny needs to be
changed.
D. Take Johnny to the designated changing
area and follow diapering procedures.
ACCESSIBILITY
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Transportation
Barrier-free parking lots, walks, curbs
School building
Classroom entrances
Sanitary facilities
Cafeterias, auditoriums, libraries, etc.
ACCESSIBILITY (Continued)
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Controls and fixtures
Emergency systems
Educational programs
Peers
ACCESSIBILITY
QUESTIONS
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In what ways is this training facility accessible to
people in wheelchairs?
In what ways is this training facility accessible to
people who are visually impaired?
What could do in this facility to make it more
accessible?
How are hotels made accessible to individuals with
disabilities?
ACCESSIBILITY
QUESTIONS
(Continued)

How are airplanes and airports made accessible to
individuals with disabilities?

What could you do in your classroom and school to
make it accessible (barrier-free) to one of your
students with physical disabilities in a wheelchair?
TRANSPORTATION
Transportation
Questions to
Consider
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Can the student be safely transported without undue risk to the
student or others?
Does the student have medical, health, physical and/or behavioral
concerns which would expose the student to unreasonable risk?
Can assistive or adaptive equipment used to accommodate the
student during transportation process be safely secured and
transported and are there adequate instructions for use?
Are the individuals making transportation decisions
knowledgeable enough about transportation?
Transportation
Questions to Consider
(Continued)
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Is there consideration about the length of the ride or time spent on
the bus?
What assistive or adaptive equipment needs to be transported (e.g.,
mobile seating devices, ventilator)?
Can the student use the regular transportation?
If the student cannot use regular transportation, can
accommodations be made?
Is an attendant required?
Transportation
Questions to Consider
(Continued)
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Is there a responsible adult available for pick-up and delivery of
the student?
Is there alternative transportation available (e.g., parent, relative,
public, or private)?
Medication
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Only medication that is in the original prescription
bottle, with no alterations, is allowed on school
grounds
Requirements for storage
Expected reactions
Secured storage
District designee must be appointed for dispensing
medication
ADVOCATING
Linda Kay, a paraprofessional in the Washington County School
District, stops off at the grocery store on her way home from work
to pick up some items for dinner. Mrs. Massey, the mother of one
of her students, spots her and asks, “What happened to Jessie
Loye today? I heard he had a seizure and 911 had to be called.
Is that true?”



How should Linda respond?
What, if anything, should the paraprofessional say in school the
next day?
What are the procedures for confidentiality?
Communication Strategies






Be Receptive
Listen to the Ideas of Others
Share Ideas
Ask for Clarification of Information & Instructions
Ask for Assistance
Respect Individual Differences in Backgrounds,
Values & Experiences
Communication
Strategies
(Continued)

Develop a Shared Vocabulary

Develop a System of Non-Verbal Cues

Create a Climate of Trust, Cooperation & Loyalty

Take on Responsibility
“ARKANSAS SAFE KIDS
ARE NO ACCIDENT!”
Health Children Handbook & Video
Office of Childhood Injury Prevention
Division of Child & Adolescent Health
Arkansas Department of Health
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
1. Federal legislation and court cases serve as a basis for providing
services to children with special health care needs.
True
2. The duties and responsibilities of the para-professional are
included on a student’s health care plan.
True
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
3. It is necessary for paraprofessionals to be trained by qualified
personnel on the health care proce- dures to be used with specific
students.
True
4. Health care procedures administered to students are documented
by nurses only.
False
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
5. Paraprofessionals are not involved in the planning and
the transporting of students with special health care
needs.
False
6. Paraprofessionals are obligated to protect students’
rights to privacy and confidentiality.
True
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
7. Paraprofessionals may be required to maintain and use assistive
technology and equipment.
True
8. An assigned duty of a paraprofessional may be the collecting,
reporting and documenting of data related to a student’s health
care plan.
True
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
9.
The paraprofessional should be a member of
the
planning team that develops a student’s
health care
plan.
True
10.
Prevention of the spread of infectious diseases
begins
with some basic practices, including
proper hand
washing, universal precautions
such as the use of latex
gloves and proper
disposal of waste
.
True
Paraprofessional Training
Children with Special
Health
Care Needs Post Test
11.
12.
All school buildings and educational programs
do not have to be accessible to students with
special health care needs.
False
When a paraprofessional is directed to perform
a new task without previous training, he/she
should do the procedure.
False
SPECIAL HEALTH CARE
TRAINING MODULE
Arkansas Department of Education, Susie Branon, CSPD Coordinator