Health and the IEP

1. Health and the IEP Liz Hecht Waisman Resource Center Southern Regional CYSHCN Center 1-800-532-3321

2. 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).

3. 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.

4. 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)

5. 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

6. 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 providersand agencies • Case management

7. 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

8. The Pediatrician’s Role • MAKING IT WORK • Expanded appointment times • Time commitment • After hours communication • Reimbursement for care coordination

9. 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

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

11. 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

12. 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

13. School - Identify Need • Justify need via IEP • documents need for nursing care • builds nurse into the team

14. 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

15. 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

16. 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

17. 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 • Flonase Nasal Spray 2 squirts each nostril QD for allergies • Multivitamin with iron QD

18. 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.

19. 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

20. 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.

21. 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