THE PLANS

1. THE PLANS IEP’s IHP’s 504’s EAP’s Pat Glass, R.N. Jessamine Co. Schools District School Nurse Health Services Coordinator

2. INDIVIDUALIZED EDUCATION PROGRAM (IEP) • An IEP is developed for every student that is identified as special needs (special education). • The rules surrounding the development and implementation of an IEP was established by IDEA( Individuals withDisabilities Education Act), which is a federal law.

3. IEP’S • An IEP is developed thru the joint collaboration of a multidisciplinary educational team (school psychologist, counselor, spec. ed teachers, regular ed teachers, speech therapist, OT, PT, and school nurse) along with the parents. • Special needs students can have multiple handicaps which impact learning, which include developmental, physical, and medical.

4. OHI • OHI – means “Other Health Impaired” • The student has a health condition that impacts his/her ability to learn in the classroom setting. “ADHD” “MVA” “OCD” “Diabetes”

5. ARC • An ARC (Annual Review Committee) is where the IEP is developed. The ARC group is comprised of the multidisciplinary educational team. • Once an IEP is developed, an ARC is held every 12 months to review and update the IEP. For every student that has a medical condition, it is imperative that the school nurse participate in this meeting. The nurse will interpret, assess, and evaluate all info and services relating to the health condition.

6. The Law • Whatever is stated in the IEP is the law! • In other words, if it is part of the plan for that student, the school system is obligated to follow the IEP to the “letter”! • As the school nurse, it is your responsibility to insure that all nursing services that are set forth by the IEP are being provided.

7. IEP’S • For Medicaid billing, the nursing services that is billed for must be stated in the IEP. • Stephanie Aldridge, from KSBA, will discuss more of this tomorrow.

8. INDIVIDUALIZED HEALTHCARE PLANS(IHP’s) • All IHP’s must be: a. Comprehensive b. Coordinated c. Communicated

9. IHP’s (cont.) • The school nurse uses her professional judgement to determine the need for an IHP. • Once the need has been established, the school nurse must investigate all pertinent medical information regarding the health condition. This requires communication with the parents and all health care providers along with thorough medical documentation.

10. IHP’s (cont.) • Once the nurse has a clear picture of the health care needs of the student, a plan is developed. • Communicate the plan to the parents and the doctor/doctors. Ask for input before you set the final plan into “concrete”. • Once plan approved, coordinate the services.

11. IHP’s (cont.) • Communicate the plan to school staff in written and verbal communications. • Train and review with staff members. • Supervise! Supervise! Supervise! • Supervision is an excellent way to assess and evaluate the effectiveness of the plan.

12. IHP’s, IEP’s, EAP’s, and 504’s • The IHP can be used in multiple situations. • You can use with: IEP EAP (Emergency Action Plan) 504 OR – the IHP can simply stand alone.

13. 504 • 504 is in reference to the Section 504 of the Rehabilitation Act 1973, which is a federal mandate. • Many students with health conditions qualify under the 504 law. • The key phrase in this law is “reasonableaccomodations”.

14. 504’s (cont.) • Each school building has a 504 coordinator (usually the counselor). • When a parent or the school determines the need for a 504 plan for a student, the 504 committee meets. The parent is invited, and the school nurse should always be part of this committee.

15. 504’s (cont.) • The 504 committee develops the 504 plan, taking into consideration “reasonable accomodations” and puts the plan in writing. • The school nurse is the “go to” person in deciphering the medical information that is in front of the committee. • The parent receives a copy of the finalized plan. • The school nurse works with the building personnel in implementing, coordinating, and communicating the plan.

16. MAIN PROBLEMS WITH 504’s • NO FUNDING FOR 504’s!!!!!!!!! • A parent comes in with the 504 already written!!!!! • ALWAYS REMEMBER – WHATEVER YOU AGREE TO IN A 504 – YOU MUSTPROVIDE!

17. EMERGENCY ACTION PLANS(EAP’s) • Many times in the development of a IHP, the school nurse makes the determination that the health condition has the potential to progress into a medical emergency or crisis. When this situation exists, the student needs an EAP.

18. EAP’s (cont.) • Some examples: peanut allergies asthma epilepsy insulin dependent diabetes panic attacks mental illness “melt downs”

19. EAP’s (cont.) • Chapter 9 in “School Nursing: AComprehensive Text” good examples of EAP’s pages 186 – 191 REMEMBER – In order to have an EAP, the school nurse has to start with an IHP (Individualized Health Plan).

20. EAP’s (cont.) • Use same process in the development of the IHP • Must have the 3 main components: Comprehensive Coordinate Communicate

21. Training and Communication • Plan must be written • Communicate written plan to all personnel that are involved. Plan thoroughly. Don’t leave anyone out. • Example: Teacher Classroom asst. Bus Driver and Monitor Coaches (extracurricular activities) ESS or ESY personnel Counselor PE teacher Administration

22. Training and Communication • Training – thorough!!!!!!!!!! Always have “return demonstrations!” REVIEW OFTEN!! (Annually would be the least amount of time for a review). Unfortunately, the ability to supervise during the crisis (if one occurs) is not always available.

23. DOCUMENTATION • Important for evaluation and assessment to review documentation after the crisis occurs to see if EAP needs any changes. • Also, excellent opportunity to review plan with staff (and see if any additions needed for personnel). • BE SUPPORTIVE AND ENCOURAGING WITH STAFF!

24. RESOURCES • School Nursing: A Comprehensive Text • Overview of School Health Services (NASN) • The School Nurse’s Source Book of Individualized Healthcare Plans – Arnold and Silkworth • Clinical Guidelines for School Nurses – School Health Alert • Clinical Manual of Pediatric Nursing – Wong and Whaley’s, Fourth Edition