Monthly Archives: September 2015

Options for meeting the needs of students with special health conditions in public schools

classroom-42275_1280On average, about 20% of the students in our public schools have some sort of chronic health condition. Some of these students have Individualized Education Programs (IEPs) because they require specially designed instruction, but many of them do not. Because students have a wide variety of special needs, sometimes a combination of multiple issues, there are also several different options for meeting their educational and health-related needs. The following list will reflect the range of possibilities going from the most common and least restrictive, to the less common and more extreme. A professional school nurse and the child’s personal healthcare providers will play important roles in each of these situations.

  • There are many students who do not require any action on the part of school staff other than to monitor and document the administration of medications that are taken at school. In order for this to happen, parents must provide the school with written documentation of medical need from a physician, physician assistant or nurse practitioner (hereafter referred to as “doctors”).  They must also give their written permission for school staff to administer the medication.
  • Emergency Care Plans are developed for students who have a health condition that can potentially lead to a medical crisis. In the case of some students who are at risk of a life-threatening allergic reaction, there should be an on-going effort to reduce the child’s exposure to the allergen involved, but also a plan that includes actions that staff should take immediately if there is a serious reaction to accidental exposure. The plan may include things like administering Benadryl, giving an Epi-pen injection, calling 911 and/or notifying the child’s parents. Some students have a seizure disorder that requires the immediate administration of specific medication in order to prevent major escalation of symptoms and possible long-term complications.
  • Individual Health Plans (IHPs) describe how a student’s special health care needs will be met while they are at school. The plans are written by the school nurse, other school staff and the child’s parents, using information provided by the child’s doctor(s). The IHP will identify the child’s health condition(s), describe how the child is impacted by it, clearly state the actions that should be taken by school staff to manage or treat the condition, and how to respond if the child shows specific signs of distress or unusual developments occur. IHPs are also written for students who self-monitor their health condition and self-administer medication.
  • Section 504 Accommodation Plan. Some students have health conditions that require some adjustment in the way things are normally done in order for that student to have an equal opportunity to access, participate in, or benefit from the public education program. For example, a child with asthma may be allowed to take breaks during intense physical activity like PE class, or a child who has difficulty regulating body temperature may need a climate-controlled school bus. Some children may need shortened school days because of low stamina, and others may need flexibility with the school system’s attendance policy due to frequent health-related absences. Each school system creates its own Section 504 Policy within federal guidelines. A child must be determined to be eligible under Section 504 before an accommodation plan will be developed to address that child’s specific needs.
  • Individualized Education Programs (IEPs) are developed for children who have been found eligible for special education services because of disabilities that may or may not be related to a health condition.  The IEP describes the services, supports and instructional goals required for the student to receive a free appropriate public education. The plan can include accommodations similar to those of a Section 504 Plan, but it may also include health or nursing services that are part of the student’s IHP. The IEP may include annual goals for the student to learn how to better participate in his own health care. The school nurse can also provide technical assistance and training to other school staff who will be working with the student.That service should be documented on the IEP. Sometimes, especially when the student’s health condition is totally unrelated to the disability that the special education focuses on, the IEP will simply mention implementation of the IHP to make sure that school staff are prompted to read the IHP and understand any responsibilities that they may have.
  • Medical Homebound Instruction is sometimes required when a student is unable to attend school for medical reasons. Very specific documentation from a doctor is required, and there is usually an expectation that the student will have to be out of school for an extended period of time. If medical homebound services are approved by the school district, arrangements are made for a teacher to provide instruction in the child’s home or another setting outside of school. Because homebound services are considered to be extremely restrictive, the child’s situation is reviewed on a regular basis to see if the child is still unable to attend school.

Medical needs and special health conditions should never stand in the way of a child getting a free appropriate public education. What it takes will vary from one child to the next, but there is an option that is right for each child who wants to learn. When parents, schools and medical providers all work together anything is possible!

Tools to help others know your child better

One of the most basic advocacy tips for parents is to make contact with your child’s teachers at the beginning of the school year, or anytime new teachers or service providers become involved. One purpose for this initial contact is to introduce yourself, exchange information about how each of you prefers to be contacted, and to establish a good working relationship long before there are problems to tackle. Another important purpose for this first contact is to share some vital information about your child, such as the fact that the child has a disability and an Individualized Education Program (IEP) or Section 504 Accommodation Plan. Sometimes classroom teachers are not made aware of these things right away.

Beyond the nuts and bolts of diagnoses, accommodations, modifications, special education services and such, it is important to make sure that the people who will be working with your child have a sense of who that child is as an individual, unique human being. Some parents simply write a letter, others have created brochures and PowerPoint presentations. ECAC has developed a couple of tools that make it easy for parents to share important information about their child with others.

ECAC Painting the Big Picture 1 Painting the Big Picture This is a worksheet that offers a way to quickly share information about things such as your child’s likes, dislikes, strengths, successes, challenges, as well as your dreams and visions for your child’s future. In each section there is also a place to share tips and successful strategies (what works) that help your child overcome difficulties and build relationships with others. There is even a place to capture Other Helpful Information that doesn’t fit anywhere else. This could include information about special healthcare needs, dietary restrictions, fears, unusual responses and things that can be done to calm your child when he/she becomes upset. Having a written document to refer back to will give teachers and others a big head start as they get to know your child!

ECAC_StudentSnapshot2014 1 ECAC’s Student Snapshot serves the same basic purpose as Painting the Big Picture, but it mainly focuses on the most important information that will make the biggest difference for your child. Areas of concern could include things like emotions, communication, sensory issues, medical conditions, academic needs, etc.  In addition to teachers and other school staff, ECAC’s Student Snapshot can be shared with childcare providers, summer camp staff, Sunday School teachers, Scout leaders, etc. It provides a description of something that the adult may notice, an explanation of what that probably means, along a suggestion or two. Statements could go something like this:

When you see that I’m not raising my hand to answer questions, I’m probably not confident that my answer would be correct and I don’t want to embarrass myself. You can help by only calling on me when I do raise my hand.

If I ask to use the bathroom in the middle of an activity, it means that I cannot wait until the next break. You can help by letting me go immediately so that I do not have an accident.

If I’ve been having problems with asthma lately and I seem unusually hyperactive, it may be a reaction to the medicine that helps me breathe better. Please try to be patient and find ways to keep me occupied so that I don’t drive you crazy.

Teachers can also share these tools with parents so that they can get to know their students more quickly. It would also send a clear message to parents that you care about their child. Regardless of who reaches out first, sharing important information will help the people in a child’s life work together as a team. This will give the child a much better chance to have a successful experience.