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The Texas guide to school health Programs

Module 7: Treatments and Care Plans

Module 7

TREATMENTS AND CARE PLANS

Special Education: Children With Special Health Care Needs

Children with Disabilities

Children Requiring Special Health Care Procedures
Children with Chronic Illnesses

Published by: Published August 2001

Texas Department of State Health Services Revised January 2011

Child Health and Safety Branch

School Health Program

1100 West 49th Street

Austin, Texas 78756-3199

External links to other sites appearing in The Texas Guide to School Health Programs are intended to be informational and do not represent an endorsement by the Texas Department of State Health Services (DSHS). These sites may also not be accessible to people with disabilities. External email links are provided to you as a courtesy. Please be advised that you are not emailing the DSHS and DSHS policies do not apply should you choose to correspond. For information about any of the programs listed, contact the sponsoring organization directly. For comments or questions about the guide, contact the DSHS School Health Program of the Child Health and Safety Branch, attention School Nurse Consultant at . Copyright free. Permission granted to copy, disseminate or otherwise use information from the Texas Guide to School Health Programs with appropriate acknowledgement.

Module 7: Treatments and Care Plans

Table of Contents:

Special Education: Children with Special Health Care Needs…………………………………...3

Individuals with Disabilities Education Act……………………………………………………………………..…….3

Section 504……………………………………………………………………………………………………………...4

Americans with Disabilities Act……………………………………………………………………………………..…6

Related Services………………………………………………………………………………………………………..6

Scope of Related Services…………………………………………………………………………………………….6

Individualized Education Program……………………………………………………………………………………7

Timeline for Major Legislation Related to Children with Special Health Care Needs in

School Based Settings…………………………………………………………………………………………………7

The Role of the School in the Individualized Health Care Plan Process…………………………………………8

The Role of the School Nurse in the Individualized Health Care Plan Process………………………………..10

Children with Disabilities…………………………………………………………………..…………..12

Eligibility………………………………………………………………………………………………………………..12

Types of Disabilities…………………………………………………………………………………………………..13

The School’s Role………………………………………………………………………………………...…………..16

The Educational Environment: Inclusion………………………………………………………………………..…18

Children Requiring Special Health Care Procedures……………………………………………..19

Procedures Performed in School Settings…………………………………………………………………………20

Steps for Procedures Performed in Schools………………………………………………………………………21

Learning Disabilities………………………………………………………………………………………………….22

Role of the School and the Nurse in the Assessment of learning Disabilities…………………………………26

Learning Disability and the Law…………………………………………………………………………………….32

Increased Services, Equal Opportunity……………………………………………………………………………33

Public Agency Support………………………………………………………………………………………………33

Children with Chronic Illnesses………………………………………………………………………34

Allergies………………………………………………………………………………………...... 34

Asthma…………………………………………………………………………………………………………………37

Diabetes……………………………………………………………………………………………………………….42

Seizure Disorders…………………………………………………………………………………………………….45

References………………………………………………………………………………………………..52

Special Education:

Children With Special Health Care Needs

Children with special health care needs attend Texas public schools successfully due to the collaborative efforts of local and state-wide health care teams. Special health care requirements are frequently the result of acute and chronic illness processes requiring special procedures to meet the individual child’s needs. These special health care needs include: assistance with activities of daily living, individual and emergency health care plans, and coordinated interventions from school personnel, health care providers, and the student’s family. Enactment of federal, state and local legislation along with improvements in medical technology and acceptance of psychosocial and environmental differences have all combined in recent years to permit a greater number of children with special health care needs to attend public school systems.

This section will address a variety of general issues involved when caring for children with special health care needs in school based settings. Resources for additional information are discussed throughout the module.

Individuals with Disabilities Education Act

The Individuals with Disabilities Education Act (IDEA) is a United States federal law that governs how states and public agencies provide early intervention, special education, and related services to children with disabilities. [1] To receive special education under IDEA, a child must have one or more disabilities listed by the law and the child must require special education and related services because of the disability. IDEA defines the term “child with a disability” as a child


With mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, specific learning disabilities, deaf-blindness, or multiple disabilities, and who, by reason thereof, needs special education and related services. [2]

The IDEA and its predecessor, the Education for All Handicapped Children Act, originated from federal case law holding the deprivation of free public education to disabled children constitutes a deprivation of due process. It has grown in scope and form since EHA was enacted in 1975. IDEA has been reauthorized and amended a number of times, most recently in December of 2004. IDEA 2004 clarifies Congress’ intended major outcome for each child with a disability: students must be provided a Free Appropriate Public Education (FAPE) that prepares them for further education, employment and independent living (reference).Under IDEA 2004, special education and related services should be designed to meet the unique learning needs of eligible children with disabilities, preschool through age 21. Students with disabilities should be prepared for further education, employment and independent living.


Children with disabilities who qualify for special education are also automatically protected by Section 504 of the Rehabilitation Act of 1973 and under the American with Disabilities Act (ADA). However, all modifications that can be provided under Section 504 or the ADA can be provided under the IDEA if included in the student’s Individualized Education Program (IEP). Additionally, students with disabilities who do not qualify for special education services under the IDEA may qualify for accommodations or modifications under Section 504 and under the ADA. Their rights are protected by due process procedure requirements (reference). A plethora of information can be obtained from the Building the Legacy training curriculum, www.nichcy.org/Laws/IDEA/Pages/BuildingTheLegacy.aspx produced by the National Dissemination Center for Children with Disabilities to assist in understanding and implementation of the IDEA 2004 and its Part B regulations. 3

Section 504

Some children with disabilities may not meet the strict criteria of IDEA, but may still qualify for services at school. (See Exhibit 2 for a comparison of IDEA and Section 504) Section 504 of the Rehabilitation Act of 1973 (see module Appendix) is a civil rights provision, which prohibits discrimination on the basis of handicap by recipients of federal funds. The law states that

… no otherwise qualified individual with handicaps in the United States … shall solely by reason of her or his disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.4

Schools that receive federal funding must comply with this Act by providing whatever services are necessary to allow disabled students to participate fully in the educational services offered.

Section 504 identifies an individual with a disability as any person who:

Has a physical or mental impairment which substantially limits participation in one or more major life activities such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working and has a record of such an impairment or is regarded as having such an impairment. 5

A “physical or mental impairment” is defined as any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hematic and lymphatic; skin; and endocrine or any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. 6

Cancer, diabetes, seizure disorders, asthma or chronic allergies are just a few examples of physiological disorders that can place affected students at risk for severe health problems and/or emergencies. Blood sugar fluctuations, asthma or allergy attacks, and seizures are events that impact “major life activities” as described above. Reasonable accommodations can, and should be, planned and documented in a “504” plan by the designated “504” case manager in each school district. The written “504” plan provides for clearly understood and accepted interventions that support the child and school personnel. Under Section 504, this plan must exist in writing and reflect that a group of persons knowledgeable about the student convened and specified planned services,

although it does not have to be a formal individualized health care plan (IHP). Personnel involved in the education of the student with a chronic illness or disability should be educated about the student’s needs.7 (See Exhibits 3 and 4).

Americans with Disabilities Act

The Americans with Disabilities Act of 1990 (ADA) specifies that public entities and public accommodations must ensure that individuals with disabilities have full access to and equal enjoyment of all facilities, programs, goods, and services. In short, the ADA extends the rights of Section 504 to public accommodations such as restaurants, museums, etc. An important inclusion in this extension is private schools. Specifically, Title III of the ADA “prohibits discrimination on the basis of disability in public accommodations, such as schools operated by private entities . . .” 8 (See Appendix)

Related services

The definition of related services in the IDEA includes, but is not limited to: transportation, and such developmental, corrective, and other supportive services—including speech language pathology and audiology, psychological services, physical and occupational therapy, recreation (including therapeutic recreation and social work services), and medical and counseling services (including rehabilitation counseling), except that such medical services shall be for diagnostic and evaluation purposes only—that may be required to assist a child with a disability to benefit from special education. The term also includes school health services, social work services in the schools, and parent counseling and training.

For a student to receive “related services” under IDEA, the student must first be evaluated by a physician. This evaluation/assessment should then be reviewed by the school nurse and any additional relevant information from the school health record should be included in the written report. The school nurse should then make recommendations to the appropriate individual or IEP team about the services or program modifications the student will need.

The Scope of Related Services
The United States Supreme Court has articulated criteria to be used to determine if services needed by a student are “related services.” These criteria include only those

necessary to aid a handicapped child to benefit from special education, and those provided only if they can be performed by a nurse or other qualified person, not if they must be performed by a physician.[3] Subsequent decisions by lesser courts have further refined these criteria. These court decisions concluded that the intensive nature of the services some students need are beyond the scope of the “related services” all schools are required to provide. Each court held that there must be reasonable limitations on the nursing and supportive services required under IDEA, and that the determination is not based simply on whether the service is provided by a nurse or a physician.9

Individualized Education Program

The IDEA requires that public schools create an Individualized Education Program (IEP) for each student who is eligible under both the federal and state eligibility standards. The IEP is the foundation for a student achieving an individualized educational experience. The IEP specifies the services to be provided, how often the services will be provided, the student’s present level of performance, specific accommodations and modifications that will be provided and how the student’s disabilities may affect their academic performance.10

An IEP must be designed to meet the unique needs of the student in the appropriate and least restrictive environment for the child to learn. When a child qualifies for services, the IEP is developed in conjunction with the school district’s Admission, Review and Dismissal (ARD) Committee. The IEP must be a collaborative effort between the child’s teachers, designated school personnel and the child’s family. The child’s parents/guardians must be involved in the development of their child’s IEP. Based on the full education evaluation results, an IEP that will provide a free, appropriate public education for the individual child. An IEP that complies with IDEA requirements simultaneously fulfills the requirements of Section 504 of the Rehabilitation Act. Information that should be contained in the IEP is described in detail in 19 Texas Administrative Code § 89.1055, which is included in Appendix A of this manual.11


Timeline for Major Legislation Related to Children with Special Health Care Needs in School Based Settings
1975 – The Education for all Handicapped Children Act (EACHCA) became law; renamed the Individuals with Disabilities Education Act (IDEA) in 1990.

1997 - Significant amendments to IDEA occurred including: (1) The definition of disabled children expanded to include developmentally delayed children between three and nine years of age, (2) Created a process requiring parents to attempt to resolve disputes with schools and Local Educational Agencies (LEAs) through mediation, (3) Authorized additional grants for technology, disabled infants and toddlers, parent training, and professional development (Pub.L. No. 105-117, 111 Stat.37).

2004 – IDEA was amended and renamed as the Individuals with Disabilities Education Improvement Act of 2004 (IDEAIA). Provisions aligned IDEA with the No Child Left Behind Act of 2001; authorized fifteen states to implement 3-year IEP’s on a trial basis when parents continually agree with the plan in place. Drawing on the report of the President’s Commission on Excellence in Special Education, the law revised the requirements for evaluating children with learning disabilities and provided concrete provisions for discipline of special education students. (Pub.L.No.108-446, 118 Stat. 2647).

2009- With the passing of the American Recovery and Reinvestment Act of 2009 (ARRA) on January 28, 2009, IDEA was granted $12.2 billion in order to provide adequate funding to schools for the implemental of this act.12

The Role of the School in the Individualized Health Care Plan (IHP) Process

Introduction

Every school day, there are more than four and a half million children attending elementary and secondary schools in Texas. The Department of Health and Human Services, Centers for Disease Control, Developmental Disabilities Branch states that approximately 17 percent of children under the age of 18 years in the United States have a developmental disability.13 Each child with a disability requires special education services or supportive care. It is imperative that School Administrators and the School Health Teams in Texas know the prevalence of disabled children and those requiring special care needs so the required special education services or supportive care can be readily available to minimize disabilities and students can achieve the best educational outcome.