1. Filling the Nurse’s Tool Box in Constructing a Well Built IEP
Care Planning
Communication
System /Protocol
Goals and Objectives
Care Evaluation
Nursing Evaluations
IHP and ECP
Present Levels of Performance
Filling the Nurse’s Tool Box in Constructing a Well Built IEP
Reimbursement
PED Licensed School Nurses

2. Presentation BY….. Susan Acosta, B.S. RN
State of New Mexico, Human Services Department
Medical Assistance Division, Quality Bureau

3. Disclosures Disclosures
All planning committee members and presenter(s) author(s), and content reviewer(s) participating in this educational activity do not have any financial relationships they or an immediate family member may have with any commercial interest in any amount occurring within the past 12 months that create a conflict of interest.

4. Presentation Focus
This presentation is to assist the participant in delivering services that meet New Mexico Medicaid School Based Service Program
The specific focus is for Nursing Service
Best practices to integrate or link nursing services into special education service to enhance communication and notification of student need for Related Health and Nursing Service
Nursing Evaluation as a best practice to determine need for Related Health and Nursing Service
Best practice on how to place Related Health and Nursing services on the written IEP to meet New Mexico Medicaid School Based Service Program
Care planning, care coordination, and care evaluation as a claimable service under New Mexico Medicaid School Based Service Program

5. Learning Objectives
The steps in creating an Individualized Educational Plan from student referral to placement on written IEP
What are Related Services and Support Services
How Related Services are used in the IEP process
Distinction between Related Health and Nursing Service and why distinction is important

6. Learning Objectives
Best practice on how to document nursing service justification in a written IEP for MSBS program purpose
How to use the Independent Care Plan in the IEP process and how to make it claimable under the MSBS program
Making Care Evaluation claimable for Medicaid School Based Program requirements

7. Where to begin
Think of the Individual Educational Program (IEP) as if you were constructing a house. The project manager (special education case manager) will get the request to begin the construction of the IEP for a special education student through information given by the Early Intervention Program, SAT team, diagnostician, school registrar office of a transfer student with existing special education services. At this point the process is deployed and the special education team goes into action. At this point is when the related services are to be deployed to if the student’s needs may a related service or support service to help the student to achieve success in special education or to receive a free and appropriate public education (FAPE).

8. Special Education and Health Issues
IDEA describe students with health issues
and the health service they require within two
categories:
• Other Health Impaired – 504 services and plans
• Special Education – IEP special education services and related services

9. Working Together IDEA-97 emphasizes a collaborative approach.
The IEP requirements under IDEA emphasize the importance of working cooperatively as a team.
Under IDEA-97, the IEP process is a focal point for reaching improved outcomes for students with disabilities. The process, critically important to children with disabilities, must be carefully managed to ensure that the unique needs of the student are addressed and to ensure full compliance with statutory and regulatory requirements.

10. Construction of the IEP
Think of the Individual Educational Program (IEP) as if you were constructing a house for the special education student
The request to begin the construction of the IEP may come by way of a request or referral from a Child Find Program, Early Intervention Program, SAT team evaluation, diagnostician, school registrar office of a transfer student with existing special education services, teacher or parent referral.
The IEP process starts at this point and an evaluation is done by an eligibility team or case manager to determine if the student meets special education requirements for eligibility and related service need(s).

11. Case Management model Multidisciplinary Team Model
IEP Models
Case Management model Multidisciplinary Team Model

12. Multidisciplinary Team Model
The team has integrated activities to manage. Each activity is of equal importance and interdependent on the quality of the other.
Multidisciplinary Team Model
Eligibility determination
Evaluation of disabilities needs and impact
Determine the need for related and support services and refer for evaluations
Guide to the Individualized Education Program
Office of Special Education and Rehabilitative Services U.S. Department of Education July 2000
Each public school child who receives special education and related services must have an Individualized Education Program (IEP). Each IEP must be designed for one student and must be a truly individualized document. The IEP creates an opportunity for teachers, parents, school administrators, related services personnel, and students (when appropriate) to work together to improve educational results for children with disabilities. The IEP is the cornerstone of a quality education for each child with a disability.

13. Case Management Model
In order to ensure the integrated delivery of services, some school systems use a case management approach
a team leader coordinates and oversees services on behalf of the student. In some schools, this person might be the child's special education teacher. In other schools, supervisory school district personnel may assume this responsibility.

14. What is IEP?
It is an Individualized Educational Program for the a special education student
The IEP is a collaborative process and product
The product of the IEP is the written document which reflects that the student is receiving a Free Appropriate Public Education (FAPE) consistent with all federal and state requirements.
The written 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
The IEP is the foundation for a student achieving an individualized educational experience.
It captures the special education student’s and the family’s vision for how to educate to the extent appropriate with individuals who do not require special education (Least restrictive environment).
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.

15. Considerations and Suggestions
IDEA 2004 requires all related services to be considered (evaluated) and specifically defines health related services
Since related health services can be provided by qualified individuals other than a nurse, it is recommended for MSBS billing purposes that the NM PED licensed school nurse be the professional who evaluates, delegates, trains, monitors and provides the ongoing assessment for all health related services provided to a student in special education.
School health services and school nurse services means health services that are designed to enable a child with a disability to receive FAPE as described in the child's IEP. School nurse services are services provided by either a qualified school nurse or other qualified person.

16. Recommend Nurse Evaluation
A key component of this multidisciplinary evaluation for a child with a
health related condition is a health assessment that may be conducted by
the school nurse. Based on this assessment, the school nurse identifies
those health issues that are relevant to the child's educational progress.
If a child with health related disabilities is determined eligible for
special education and related services an individualized
health care plan (IHCP) with specific health and medical related objectives, interventions and evaluation criteria should be initiated by the school nurse as part of
the child's individual education program (IEP) or the individual family
services plan (IFSP) team process, and incorporated into the IEP or IFSP.

17. What Are Related Services
Related services are the supports needed for a child to benefit from special education.
Transportation and such developmental, corrective and other supportive services are required to assist a child with a disability to benefit from special education
Includes speech-language pathology
Audiology services
Interpreting services
Psychological services
Physical and occupational therapy
Counseling Services
Rehabilitation Counseling
Orientation and Mobility Services
Recreation - including therapeutic recreation
Early identification and assessment of disabilities in children
Medical services for diagnostic or evaluation purposes
Social work services in schools and parent counseling and training
Health and Nursing services

18. Construction Process STEP ONE Identification STEP TWO
Special Education Evaluation
STEP THREE
Individual Education Plan Meeting

19. Related Service Evaluation
IEP PROCESS
Step Four
Related Service Evaluation
Step Five
IEP Meeting
Step Six
IEP Written

20. Related Health vs. Related Nursing Service
A related health service can be provided by either a qualified licensed provider or non licensed provider, such as a resource aid. Examples would be providing assistance with ADLs, providing delegated care indicated in the Independent Care Plan.
A Nursing service requires a qualified licensed skilled nurse to provide the service. Examples of this service would be medication administration, skilled nursing procedures, assessment, care planning and care evaluating.
School health services have long been a part of IDEA’s related services definition. The definition of related school health services changed under IDEA in 2004, which delineates the difference between related school health services and school nurse services and explicitly added nursing services to the list of related services in special education What was previously called “school health services” has been expanded to distinguish between services that are provided by a qualified nurse and those that may be provided by other qualified individuals (paraprofessional or teacher). Why is it important to understand how related health service is defined in IDEA 2004? The implications for related health services are primarily two fold.

21. Notification and Awareness…..
Who needs nursing services that receive special education ???
Which special education students are Medicaid
Participants or eligible?

22. Best Practices to link nursing services to special education
School nurses are not always aware that a special education student has a health related or medical condition which could impact the student’s ability to meet the goals and objectives in his or her special education.
The best practice is for each district or campus to have a formal process or system to ensure that all student’s related service needs are being met and communicated in a timely and effective method.
Special educations case managers, do not know the student has a health related or medical condition which could influence the outcome of the student’s ability to achieve goals established in special education.
Therefore, it is vital

23. Create formal communication systems which consistently link the school nurse to the special education student
Best practices for linkage:
Each month obtain a roster of special education students and review for health related needs or medical conditions that may impact the student education –
Ensure that the school nurse is on the notification list distributed by the school’s registrar for incoming students –
Be a standing member of the SAT team: The school nurse will not attend every meeting but will be linked in to be notified of students who have been determined to qualify for special education-
Develop a campus protocol- only the school nurse is to complete page 13 of IEP to be completed by nurse.
Establish a procedure that all special education students with a medical or health related condition must have a evaluation to determine the need for health related and nursing services
The last process can be automated if the district’s electronic system is programmed to only allow the nurse to complete and sign off on page 13 before the case manager could proceed in developing the draft IEP. We currently have a large school district using this concept sucessfully.

24. How to Determine if the student has a need for Related Health or Nursing Service?
Providing a health assessment is part to the Standards of Professional School Nursing Practice (National Association of School Nurses, 2000).
New Mexico Licensed School Nurses, NM Public Education licensed NM Registered Nurses (PED-RN) can only perform the Assessment/Evaluation and not NM Licensed Professional Nurses (LPN). LPNs can only participate in the assessment per NM Nurse Practice Act
This evaluation may reimbursed through the MSBS program if the student’s evaluation determines the need for Related Health and Nursing Services

25. Conduct a Related Health and Nursing Evaluation

26. Identifying Related Service
Role of School Nurse
As evaluation proceeds, the team or case manager will be responsible demonstrating an understanding of the impact of the health condition and the needs for care during the school day.
Schools nurse acts as health professional consultant
School nurse can determine Related Health and Nursing Service needed
School nurse develops the individualized health
care plan that becomes the blue print to care for health related needs
School nurse provides direct care and indirect care
School nurse makes the decision to delegate care
School nurse determines competency of unlicensed personnel to provide delegated care.

27. Skilled Nursing Evaluation
Assesses the student’s health or medical conditions which may impact the student’s ability to learn or achieve special education goals and objectives
Assesses of need for direct nursing service and health related service necessary to enable a student with a disability to receive FAPE
Assesses the educationally relevant medical or health related conditions that are likely to adversely impact the student’s educational performance
If related health and or nursing services are needed
To assess the type of care, amount of care, and which environment to deliver health and nursing care in a safe and effective manor to promote optimal student outcomes.

28. Nursing Evaluation Continued
The assessment or evaluation information is to be used in the development of the student’s individualized health care plan (IHCP).
The care planning for the IHCP and ECP is a collaborative process that includes the student’s parent or guardian, the student (when appropriate), the student’s physician, other school staff, community health providers, and medical specialists, if applicable.

29. Components of Nursing Evaluation
Students health history
Physical Assessment
School and medical record review
Consultation with health care providers, teachers, parents
Student observation
Determine if health condition impacts student’s ability to learn
Assessment of needed accommodations & other related services.
New Mexico Licensed School Nurses, NM Public Education licensed NM Registered Nurses (PED-RN) can only perform the Assessment/Evaluation and not NM Licensed Professional Nurses (LPN). LPNs can only participate in the assessment per NM Board of Nurses.

30. Assessment of Health/Physical Status is recommended when:
Medications or health care procedures are necessary at school for the student to be able to receive FAPE
A student has a physical or mental Health Condition (past or present) that may be impacting learning
A student has a sensory deficit (i.e. fluctuating hearing loss) which requires ongoing monitoring and/or case management by the School Nurse
A student has a complex health/medical history requiring Individual and/or Emergency Health Care Plan
The Licensed School Nurse is involved in care coordination and/or case management for a student who has physical and/or mental health conditions

31. Assessment and Evaluation Tools
Log into the internet
Click on nmschoolhealthmanual.org
Enter Special Education
You will find most of your information needed under this section, including DNR, 3 assessment forms: Student Health Assessment
Initial Student Health History
Special Education Nurse Screening Summary Form

32. What Happens After the Nursing Evaluation?
Case Manager Construct the written IEP
School Nurse Develops the Independent Health Care Plans

33. The written IEP is developed by the case manager and Independent Care Plan is developed and written by the School Nurse
All related services must provide evaluation results and recommendations
Nursing service is unique –traditionally special education staff write in information regarding services
It is imperative the school nurse collaborates and provides results of the nursing evaluation and provides service justification, scope, and service time

34. IEP Form
The Federal special education law tells us what information must be included in the IEP
The Federal special education law does not specify we use particular form
Each state may decide what form to use – The Public Education Department has a recommended IEP form for use
Each school district in New Mexico may use own form or written IEP design – Most likely when districts use Electronic Student Records or documentation systems
Most important is that each written IEP form used must be clear and useful to parents, educators, related service providers, and administrators.

35. Next Step in Constructing Building the Written IEP
Next Steps in Constructing IEP
Next Step in Constructing
Building the Written IEP
The IEP is written by the Case Manager/team leader with evaluation information entered by each related service provider, except nursing.
The school nurse is to participate in the development of the IEP by providing the case manager (written) information as to why related health and nursing services are needed for the student. This reason or justification is to be incorporated in to the Present Level of Performance area of the written IEP.
The type of related health and nursing service are needed, the amount of service, and frequency of service to include on the service page of the written IEP.
The related health services can be placed in multiple area of the written IEP. Such as, medical supplemental page, or accommodation section

36. Medicaid Reimbursement Program for the Schools
For a school to bill Medicaid for covered IEP services the following
requirements must be met:
The student receiving the service must be enrolled in the Medicaid program.
2. The student must qualify for services under the IDEA.
3. The student must have an IEP or FSP.
4. The services must be specified in the IEP or FSP.
5. The services must be furnished by a practitioner who meets Medicaid qualified
provider criteria and who is qualified to provide the service under
applicable NM State licensure requirements.
6. The school must obtain a signed parental consent to bill Medicaid for covered IEP services provided to the student.*
The school corporation must first bill other liable insurers (if any) before
billing Medicaid for the services. Note: if billing a student’s third party carrier
would constitute a FAPE violation (cost the parent/student a copayment,
exhaust a benefit cap, etc.), the school may not bill either public or private
insurer for the IEP service

37. Components of the Written IEP for Related Health and Nursing Service for MSBS Program
Present Level of Performance
Medical Considerations
Service Page
Service Justification
Service need for Related Health and Nursing Service
Service Time and Place

38. Schedule of Service Requirements for Medicaid School Based Service Program
Nursing services rendered must be listed in the written IEP in the following areas:
Justification listed in the Present Level of Performance section
Medical Considerations page
Schedule of Service page either in the direct service grid or supplemental area of the service page
SN Services must be considered medically necessary under MSBS regulations
SN services are provided by practitioners who meet MSBS qualifications and who are acting within the scope of their license.

39. What is a Present Level of Performance?
For the MSBS program serves as the written justification for services to be claimed and billed under the MSBS program
The PLP according to Special Education in Plain Language, “The IEP must provide information on the child's present level of performance, addressing each area of need. The present level of performance is a clear, descriptive statement of how the child is performing. Any health issues, limitations, or needs can be incorporated into PLP if it describes how the student’s disability affects the student’s involvement and progress in the general curriculum and also how the disability affects the child’s participation in school and recreational activities. (20 U.S.C. Section 1414 (d) (1) (A) of IDEA).
Other needs for supports, adaptations, accommodations, equipment and other issues related to the student’s health concerns also can be recorded in the present level of performance.
Any health issue or limitation can be incorporated into the present level 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

40. Examples of Present Level of Performance Statements for Nursing Service
Jane missed 10 days of school last year due to pressure sores. So that Jane does not miss school, Health related and nursing services are needed to for assessment of care needs and plans, health related classroom interventions to prevent skin breakdown, needed direct nursing services for skin breakdown if needed. Student unable to move self due to physical and cognitive inability
Danny requires nursing services for medication management and administration since her medications are taken mid day and Sarah is not developmentally able to self administer. Danny also has “as needed” medication for her asthma. She is beginning to recognize her symptoms that indicate the need for her to use her inhaler, but needs more instruction and practice therefore related nursing services are needed.
Example statements for justification provided in a handout.

41. Identified Area of Need: Health Maintained
PRESENT LEVELS OF FUNCTIONAL PERFORMANCE
Please document the student’s present levels of functional performance for identified areas of need (eg. social/emotional, behavior, life skills, energy level, sustained attention, memory function, impulse, processing speed, and motor skills).
Identified Area of Need: Health Maintained
Student/Parent Input :
Student has difficulty remembering to take oral medication each morning for ADHD. Student has missed 4 out of 5 doses of ADHD medication in the past 3 weeks, which has affected his cognitive ability and ability to maintain attention to participate in instructional interventions and the meeting of educational goals. The missing of oral medication for his ADHD also affects his ability to control impulses, which create behavioral issues. The student has had 7 behavior/disciplinary referrals in 3 weeks in which affects instructional time. Parent is not able to provide daily supervision for medication or able to administer daily oral medication.
Intermittent skilled nursing for development of IHP related to ADHD, and daily skilled nursing for medication administration for ADHD. Student’s cognitive ability and participation in special education interventions dependent on daily compliance of prescribed ADHD medication, Student and family not able to be consistent in prescribe daily administration regime.
Student reports he does not remember, and does not remember to set alarm to use as an aid.
Mother reports she is a single mother and due to her work schedule is unable to be present to supervise or to administer medication administration.
Symbol indicates information that goes into the Student Teacher Accountability Recording System (STARS).
IEP Page 7 of 31 IEP for ___________________________________________________ Date: _________________________

42. Medical Consideration Page
School Nurse to collaborate with the case manager or provide written information to the case manager for scribing purposes
Medical Consideration Page is where the student’s medical needs are communicated and where specific related health and nursing service can be documented
Important to check whether student has IHCP and or ECP
This is an area we find areas of opportunity for improvement from our site reviews (audits)

43. MEDICAL/SIGNIFICANT HEALTH INFORMATION
MEDICATION: Twice a day oral medication for ADHD. Intermittent Skilled nurse to assessments for medication effectiveness and medical management needs
SIGNIFICANT HEALTH INFORMATION: Student has diagnosis of severe ADHD, and struggles with medication compliance.
Student can self monitor blood glucose, but does not have hand dexterity to conduct finger prick, and use glucose monitoring device. Intermittent SN assessment to evaluate the delegation of interventions in IHCP/ECP, training of Interventions in IHCP and ECP, and provided re-assessment of effectiveness of IHCP and ECP. .Direct Skilled nursing care to respond and deliver nursing interventions for diabetic emergency care per ECP
Does the student require an individualized health plan or school health services as a related service? YES NO:
If YES, attach the health plan to the IEP and/or indicate on the Schedule of Services.
Does the student require an emergency evacuation plan? X YES
If YES, attach the emergency evacuation plan, including the person(s) responsible to the IEP.
Physical Education: Regular with accommodations Adapted
MOBILITY
Does the student require assistance to move in and around the school?
YES NO:
If YES, describe the assistance to be provided:
TRANSPORTATION
Does the student require transportation as a related service?
If YES, what accommodations and supports are required in order for the student to be transported with typically developing peers in the Least Restrictive Environment (LRE)?
- Symbol indicates information that goes into the Student Teacher Accountability Recording System (STARS).
IEP Page 20 of 31 IEP for ___________________________________________________ Date: ____________________

44. Schedule of Service
While it is likely that most covered services appear in the related services grid, the federal regulations simply require that the covered services be ordered in the child’s IEP.
Ultimately the service must be included in the IEP, but the required location of the service is not designated in the federal regulation.

45. Schedule of Service
The amount of a special education or related service to be provided to a child may be stated in the IEP as a range (e.g., speech therapy to be provided three times a week for minutes per session) only if the IEP team determines that stating the amount of the services as a range is necessary to meet the unique needs of the child.
For example, it would be appropriate for the IEP to specify, based upon the IEP team's determination of the student's unique needs, that particular services are needed only under specific circumstances, such as the occurrence of a seizure or of a particular behavior. A range may not be used because of personnel shortages or uncertainty regarding the availability of staff. [Appendix A, Response to Question 35, 64 Federal Register, page (March 12, 1999).]

46. How to document SN and Health Related Services
Schedule of Service
How to document SN and Health Related Services
Document Skilled Nursing Services directly in the service grid area if services are usual and predictable
Usual and predicable are those services that you provide routinely and can estimate time
examples: Medication administration, procedures, assessessment if routine
Document Skilled Nursing Service in Supplemental or Support Area if not routine and predictable
Non routine would be PRN services, or intermittent that cannot be predicted routinely
examples: Intermittent assessment for evaluation of care in IHCP or ECP. Intermittent SN service to implement Emergency Care Plan for seizure, or low blood glucose
Always use language to document related SN services, “as per medical order/ medical plan or IHCP/ECP” to prevent the need for frequent IEP amendment. If changes in the medical order or plan required extensive changes in the IHCP or ECP it is recommended the SN discuss with the case manager, for an IEP amendment may be required.
Related health services are to be placed on the supplemental area of the Service Page of the IEP. Examples of supplemental services and accommodations would be: examples:
Skilled nurse to assess ability of resource aide to provide care RN delegated interventions outlined within the IHP/ECP.
SN to teach delegated interventions to resource aide outlined in IHP for health related services provided in the classroom. Resource aide to provide daily interventions outlined in the IHP in classroom- not a reimbursable direct service but should be on the IEP.

47. How to document SN and Health Related Services
Schedule of Service
How to document SN and Health Related Services
The amount of a special education or related service to be provided to a child may be stated in the IEP as a range (e.g., speech therapy to be provided three times a week for minutes per session) only if the IEP team determines that stating the amount of the services as a range is necessary to meet the unique needs of the child.
For example, it would be appropriate for the IEP to specify, based upon the IEP team's determination of the student's unique needs, that particular services are needed only under specific circumstances, such as the occurrence of a seizure or of a particular behavior. A range may not be used because of personnel shortages or uncertainty regarding the availability of staff. [Appendix A, Response to Question 35, 64 Federal Register, page (March 12, 1999).]

48. SCHEDULE OF SERVICES
If this IEP spans between two school years, please complete this page twice, separating the services to be delivered in each school year.
Special Education & Related Services
Minutes per Day/
Week/
Month/
Semester/Year
Start
Date
Ending Date
Service Provider (s)
Location
Time in Regular
Setting
Time in Special Education Setting
Speech-Language Therapy
1 hr/wk
8/1/2013
8/1/2014
SLP
30 min/wk
Occupational Therapy OT
Direct Skilled Nursing Service
15 min/day or per medical orders
8/14/2014 SN
School Health Office
1 hr/day
08/01/2013
08/01/2014
Time Totals
Supplementary Aids and
Services
Start Date
Ending Date
Related Skilled Nursing
Intermittent SN for Evaluation and Assessments
Educational Classrooms
Related Health Services
1.5 hrs/week for assistance with blood glucose monitoring in classroom.
Resource Aide
Classrooms
Cafeteria
Playground
Intermittent to implement Diabetic ECP
08/13/2014

50. Care Planning for Related Health and Nursing services
The school nurse (RN) is responsible for planning, coordinating and developing the IHP. As the Case Manager develops the written IEP the School Nurse develops the Care Plans.
The IHP is a document or the blueprint of care that is needed for the student to be safe in a school setting and care that is needed to keep the student in school to receive FAPE or to achieve special education goals and objectives.
The IHCP provides direction to staff that implement all or a portion of the plan.
The care plans are to correlate with information found in the Present Level of Performance section of the written IEP.
Every student with an IEP who requires direct nursing care, or health related intervention in the classroom, or care supervision must have a written Health Care Plan and if applicable an Emergency Care Plan (ECP)

51. Care Planning for Related Health and Nursing services Continued
The IHP is a document or the blueprint of care that is needed for the student to be safe in a school setting and care that is needed to keep the student in school to receive FAPE or to achieve special education goals and objectives. The IHCP provides direction to staff that implement all or a portion of the plan.
The Individual Health Plan should detail the nursing services that will be required in the school environment. There are a variety of options for nursing care, ranging from using an on-site school nurse for intermittent needs to assigning a dedicated one-to-one nurse for the entire school day.
Student’s goals for health and nursing related services are to be documented in the IHCP and ECP and do not need to be written in the actual written IEP
IHP is to be signed by the school nurse (RN) who wrote the plan, the student’s parents or guardian, and the student’s primary health care provider
The IHP and ECP is to be retained in the student health record, and a statement placed in the written IEP as to where to access or locate the IHP and ECP.

52. Development of the IHCP/ECP
The Health Assessment
Development of the IHCP/ECP
Health Assessment:
The collection, documentation and analysis of information or data about a student's health situation leading to the development and initiation of an individualized health care plan to determine the student's state of health, patterns of functioning and need for health services, counseling
and education.
The health assessment is on going and as-needed basis evaluating the student's current health status, reviewing medical diagnoses, treatments, or orders and requesting a change in a physician’s order if necessary, reviewing nursing diagnoses and collaborative health problems, assessing routine and emergency health care needs, confirming health procedures, equipment and supplies.

53. Independent Health Care Plan Components
Independent Health Care Plans
Independent Health Care Plan Components
IHPs are individualized to each student’s medical, nursing, and educational needs.
The IHP is to identify health services the child will need during the school day and contain interventions to meet those needs.
The IHP is to contain interventions which support the student’s participation in school activities both inside and outside of the classroom and is to be written with consideration of minimal disruption of the student’s school day.
The IHP should also contain an Emergency Care Plan (ECP) for each student to include care instructions on how to address the child's specific medical or care needs during an fire drills, power failures, and school lockdowns.  Access to building exits, the need for additional staff support and emergency response time by school nursing and /or local ambulance service should be considered

54. Individualized Health Care Plan considerations
Written for a broad audience: the multidisciplinary team and must correlate with what is written in
the IEP and is to detail the health related and nursing services that will be required in the school environment
When planning for nursing in the school environment it is important to consider:
Type of skilled medical needs
Level and frequency of skilled medical needs
Proximity of the nurse to the child 
Type of nursing skill and / or licensure required to provide the care
How providing the required care impacts student participation in a typical school schedule Hours of care required during the school day
Qualified/ designated personnel
Location of the IHP and ECP
Is updated whenever necessary
Uses language appropriate for the broad audience
Can be ”sectioned” as needed- e.g. emergency info to take on
field trips
There are a variety of options for nursing care, ranging from using an on-site school nurse for intermittent needs to assigning a dedicated one-to-one nurse for the entire school day. Some school districts may use Licensed Practical Nurses or aides who are supervised by a Registered Nurse.

55. Evaluation
IHCP/ECP
The school nurse is to evaluate care provided by licensed or unlicensed staff contained in the care plan on a routine basis or as dictated by the student’s needs or staff needs.
The school nurse is to revised the care plan if the student’s health related, nursing, or medical needs change, but at least yearly.
The maintenance of an ongoing, collaborative plan of care can be facilitated by the school nurse attending and being an active participant in all student evaluation and planning meetings.
The evaluation of the effectiveness of the IHCP and ECP is reimbursable service within the MSBS program (Medicaid School Based Services program).

56. References http://idea.ed.gov ED. Gov, U.S. Department of Education
New Mexico Public Education Department
Office of School Health

57. The End
Questions and Answer session