Embedding Health Outcomes in the IEP Process

1. Embedding Health Outcomes in the IEP Process Elizabeth Hecht Southern CYSHCN Center Rachel Gallagher, RN, APNP Wisconsin DPI School Nurse Consultant

2. Embedding Health Outcomes in the IEP Process Elizabeth Hecht Southern Regional CYSHCN Center Rachel Gallagher, RN, APNP Wisconsin DPI School Nurse Consultant

3. Health is Critical to School Success Success in the classroom, in the community, and on the job requires that young people are healthy. Young people with life-long health issues need to learn early how to maintain and sustain health and wellness -- and to participate in their health care decisions.

4. Health Assessment Tools Health history of student Educational and Medical records Health appraisal Observations Health plans

5. Health Plans Emergency Health Plans Individual Health Plans

6. Education Evaluations 504 Accommodation Plans Individual Education Plans Two federal laws provide guidance to school districts for provision of nursing services for children. Section 504 of the Rehabilitation Act of 1973 is an anti-discrimination law that requires school districts to ensure that handicapped students as defined in 34 CFR §104.3(j) have an equal opportunity to participate in academic, nonacademic, and extra-curricular activities which are available to other students enrolled in the school district. To ensure the equal opportunity for participation of handicapped students, school districts must develop a written plan to meet the student’s health needs as it relates to the handicapping conditions. This plan is also known as a 504 plan, may include school nurse or school health services.   The Individuals with Disabilities Act (IDEA) is a federal law that requires a school district to provide students with a disability a free appropriate public education [34 C.F.R. § 300.101] by implementing an individual educational program (IEP) designed to meet each child's unique academic, physical, and social emotional needs. The individualized education programs must include health and nursing services if they are necessary for the student to receive a free, appropriate public education [34C.F.R. § 300.34(13)].   If the 504 plan or IEP includes school health services or school nursing services, the school district must arrange for an appropriately licensed health care professional to offer the service or have that person delegate the performance of the procedure to a trained unlicensed person. Federal law defines the difference between school nursing and school health services in the related services section of the individual education plans. School nurse services are provided by a qualified school nurse. School health services are services that may be provided by either a qualified school nurse or other qualified person [34 CFS § 300.34(13)] Two federal laws provide guidance to school districts for provision of nursing services for children. Section 504 of the Rehabilitation Act of 1973 is an anti-discrimination law that requires school districts to ensure that handicapped students as defined in 34 CFR §104.3(j) have an equal opportunity to participate in academic, nonacademic, and extra-curricular activities which are available to other students enrolled in the school district. To ensure the equal opportunity for participation of handicapped students, school districts must develop a written plan to meet the student’s health needs as it relates to the handicapping conditions. This plan is also known as a 504 plan, may include school nurse or school health services.   The Individuals with Disabilities Act (IDEA) is a federal law that requires a school district to provide students with a disability a free appropriate public education [34 C.F.R. § 300.101] by implementing an individual educational program (IEP) designed to meet each child's unique academic, physical, and social emotional needs. The individualized education programs must include health and nursing services if they are necessary for the student to receive a free, appropriate public education [34C.F.R. § 300.34(13)].   If the 504 plan or IEP includes school health services or school nursing services, the school district must arrange for an appropriately licensed health care professional to offer the service or have that person delegate the performance of the procedure to a trained unlicensed person. Federal law defines the difference between school nursing and school health services in the related services section of the individual education plans. School nurse services are provided by a qualified school nurse. School health services are services that may be provided by either a qualified school nurse or other qualified person [34 CFS § 300.34(13)]

7. Health also can be a part of the IEP process and documented in: The Present Level of Academic Achievement and Functional Performance (PLAAFP) The IEP Goals The Supports and Services The list of accommodations and modifications

8. Health Information in the Present Level The present level must provide information in each area of need, including a clear descriptive statement of how the child is performing in specific areas. The PLAAFP also should include the student’s strengths, interests and needs.

9. Present Level of Performance (cont) Any health issue or limitation can be incorporated into the PLAAFP if it describes how the child’s disability affects the child’s participation in school and recreational activities. (20 U.S.C. Section 1414 (d) (1) (A) of IDEA

10. Present Level (cont.) In addition, other needs for supports, adaptations, accommodations, equipment, etc. related to the student’s health concerns can be recorded in the PLAAFP.

11. Related Services Assistive Technology Audiology Counseling Occupational Therapy Physical Therapy

12. Additional Related Services Speech and Language School Health and Nursing School social work Services Psychological Services Recreation Transportation

13. Role of the School Nurse Develop emergency and individual care plans Provide training to students and care givers in the school Provide health education Provide for case management and advocacy Liaison between student, school, family, medical provider and community agencies

14. What are transition services? According to IDEA, transition services means “a coordinated set of activities for a student with a disability that is designed within an outcome-oriented process that promotes movement from school to post-school activities.”

15. When do we do transition planning? Individual with Disability Act IDEA 2004 Federal regulation requires transition planning to be included in the IEP in the year the student turns 16. In Wisconsin, when a student reaches the age of 14, the IEP Team must formally begin planning for the student’s transition to adult life beyond high school. Transition planning ends in the IEP, when a student graduates from high school or reaches the age of 21 and is no longer in public school.

16. Transition and PLAAFP Starting at age 14, IEPs can be more closely linked to post-school outcomes. Post-school outcomes can and should include as much self-care and independent management of health conditions as possible.

17. Criteria for IEP Goals Student-centered Measurable Reasonable

18. Transition Post-School Outcomes Employment and job training Post-secondary education Independent/home living Community life Leisure and recreation

19. Transition-Example #1 PLAAFP-“Leah knows where the pharmacy is, but does not know how to call in prescription refills.” She has difficulty reading, but is very good at following instructions if accessible to her. IEP Goal-“Leah will learn the phone number and rehearse a script to be able to call in her own prescription refills 3 out of 5 times.

20. Transition-Example #1 con’t Accommodation-Leah will use a picture board that helps her sequence the steps to order her prescription. Who Helps- The SLP will work with Leah to develop the picture board. The school nurse will consult with the SLP as needed.

21. Transition-Example #2 PLAAFP-“This year, Latrice missed 2 months of school because of pressure sores. She continues to be at high risk for future occurrences. She needs to learn ways to move in her wheelchair to reduce risk of pressure sores so she doesn’t miss school.” IEP Goal-“Latrice will learn a routine of chair exercises during gym class that she uses 3x/day to reduce the chance of pressure sores.”

22. Transition-Example #2 con’t Accommodation- Use of an alarm watch to use in remembering medical schedules. Who Helps-OT will identify the best watch to use which the school will purchase for her use. The PT will help develop exercises for Latrice.

23. Transition-Example #3 PLAAFP-“Jermaine has CF and needs regular lung treatments during the day to stay healthy. He also has a learning disability which makes it difficult for him to follow complex information. He is interested in obtaining a job, but does not know what accommodations to expect.

24. Transition-Example #3 IEP Goal- Jermaine will contact local resources to find out about his rights in a work setting and will develop a script to request the accommodations he needs Who helps-Special educator will help Jermaine identify resources and create a script to use with employers. School nurse will help Jermaine develop a list of accommodations he needs.

25. Transition-Example #4 “Monica has a bi-polar disorder. She recognizes that her illness impacts her ability to manage medication and is willing to accept support from her family. She wants to learn how her parents can remain involved in helping her make health care decisions after she turns 18.”

26. Transition-Example #4 con’t IEP Goal-Monica will be knowledgeable about the process to obtain Power of Attorney for Health Care to enable her and her family to manage her illness. Who Helps-School social worker with support from the school nurse and special educator will assist Monica to get the legal information and documents she needs.

27. Transition-Example #5 Josie is interested in going into a career in food preparation. She is planning on attending a culinary school. Her team is concerned about her peanut allergy. She has a basic awareness of her allergy, but not a lot of information about how to avoid an allergic reaction. She carries an Epi-Pen, but has never used one. IEP Goal?

28. Let’s practice! 1. In your small group think of a student who has a health condition that may need accommodations as they prepare for transition. 2. Describe the PLAAFP. 3. Identify one IEP goal. 4. Describe steps to meet this goal. 5. Who might help implement this?

29. Resources ISSUE BRIEF. School Nursing Services Role in Health Care. School Nursing Management Of Students With Chronic Health Conditions http://www.nasn.org/Portals/0/briefs/2006briefchronichealth.pdf Transition to Adult Health Care: A Training in Two Parts. http://www.waisman.wisc.edu/wrc/pub.html Healthy & Ready to Work. http://www.hrtw.org/ Transition Health Care Checklist. http://www.waisman.wisc.edu/wrc/pub.html Guardianship of Adults: A Decision-Making Guide for Family Members, Friends and Advocates. http://dhs.wisconsin.gov/aging/guardianship/guardianship.pdf PACER Center. http://www.pacer.org/publications/ncsetbriefs.asp Wisconsin Regional Centers Children and Youth with Special Health Care Needs 800-642-7837

30. Contact Information Rachel Gallagher, RN, APNP School Nurse Consultant Wisconsin Department of Public Instruction 125 South Webster St. Madison, WI 53707 Phone: (608) 266-8857 rachel.gallagher@dpi.wi.us Elizabeth Hecht Waisman Resource Center Southern Regional CYSHCN Center 608-263-7148 hecht@waisman.wisc.edu