1. What School Nurses Need to Know Karen Erwin, RN, MSN Education School Nurse Consultant July, 2014

2.  Approximately 25% all students have a chronic health condition (CHC)  Chronic health conditions include long-term physical and mental disorders  Federal Law requires student with a CHC be educated in the “least restrictive environment”

3.  Identifying barriers to learning  Requires communication, planning and evaluation  Develop a plan which may include: 1. Individual Health Plan (IHP) 2. Emergency Action Plan (EAP) 3. Individual Education Plan (IEP) 4. 504 Accommodation Plan

4.  Written medical management plan (nursing care plan) that ensures the health and educational needs of student  Aligned and compliments medical provider’s management plans and follows standards of professional nursing care  Must be comprehensive, communicated and coordinated

5.  Identifies healthcare needs of student  Describes actual and potential goals and outcomes  Lists interventions (medications, clinical procedures, etc.) and evaluation criteria  Updated as necessary and beginning of school year

6.  Based on student’s IHP  Written for school personnel to follow when responding to a health crisis  Describes signs/symptoms of pending health emergency or crisis

7.  Gives step by step clear steps for treatment of health emergency or crisis  Comprehensive, Coordinate, Communicate  Updated as needed and beginning of school year  Best practice: include names of school personnel who have been trained and delegated to intervene

8.  IDEA- a federal law that ensures a free and appropriate education services for students with disabilities who fall within one of the specific disability categories as defined by the law.  Eligible students ages 3-21 whose disability adversely affects the child's educational performance and/or ability to benefit from general education.

9.  Developed to ensure student whose disability impacts their learning receives specialized instruction and related services to facilitate student’s learning. Measurable goals for learning may require related services such as health services to support and assist student with disability.  Student must have one or more conditions that adversely affect educational performance

10.  IEP developed through joint collaboration of multidisciplinary education team (school psychologist, counselor, Sp Ed teachers, regular ed teachers, PT,OT, ST and SN) along with parents  IEP includes the current level of academic performance, measurable educational goals, related services and specialized instruction necessary for student.  School health services is a “related service” that may be necessary to provide to assist student to meet educational goals. Related health services are listed in the IEP summary

11.  May have multiple conditions which impact learning, including developmental, physical and medical  14 categories of eligibility: autism; deafness; developmental delay; emotional disturbance; orthopedic impairment; speech or language impairment, etc.  Most frequent category that requires skilled nursing services: other health impairment

12.  Student has a chronic health condition that adversely impacts his/her educational performance  May include: ADHD, OCD, Diabetes, etc.  School nurse participation imperative in IEP development for student with a chronic medical condition (SN interprets, assesses and evaluates all info and services related to chronic health condition)

13.  IEP reviewed and updated every 12 months  Whatever is stated in the IEP is “required” (If a service is part of the plan for the student the school district is obligated to follow the IEP “to the letter”)

14.  Nursing or other health services (PT/OT/ST) may be billed to Medicaid if these services are included in the IEP  For more information on billing for school based services: http://education.ky.gov/specialed/Pages/School-Based- Medicaid-Services.aspx Becky.Stoddard@education.ky.gov

15.  Reference to Section 504 of the Rehabilitation Act 1973, which is a federal law  A civil rights act that protects rights of students with disabilities  Student cannot be denied benefits or excluded from any school program that receives federal funding  Definition of disability broader than IDEA because it extends beyond learning to other more health related functions “major life activities”

16.  Have a physical or mental impairment that substantially limits one or more major life activities  Have a record of such an impairment, or  Are regarded as having such an impairment (e.g. whose disability does not meet the IDEA requirements but who needs to have help to access school programs)

17.  Functions such as ability to: 1. provide self-care 2. performing manual tasks 3. walking 4. seeing 5. hearing 6. speaking 7. breathing 8. learning 9. working

18.  Many students with chronic health conditions who are served under Individual Health Plan (IHP) may also be eligible for Section 504 plans  Key phrase in this federal law is “reasonable accommodations”  School nurses may be more likely to be involved with 504 plans than IEP’s

19.  Each school building has a 504 coordinator (usually the counselor)  When a parent or school determines the student’s need for a 504 plan, 504 Committee meets.  Parent and school nurse should participate

20.  504 committee considers the chronic health condition, the impact on student learning, what reasonable accommodations are needed and puts the plan in writing  Parent receives copy of finalized 504 plan  School nurse works with school personnel in implementing, coordinating and communicating the plan

21.  Remember, 504 plans written to eliminate barriers to accessing public school programs and school sponsored activities  IHP’s address the management of the chronic health condition in support of eliminating barriers to the educational process  IHP cannot replace a 504 Plan

22.  Accommodations may include: frequent bathroom breaks, scheduled medication or blood glucose monitoring  Unlike IEP’s, there is no funding for 504 Plans  Always remember, whatever you agree to do in a 504 plan, you must provide

23.  In summary, remember, 504 plans written to eliminate barriers to learning through access to public school programs and school sponsored activities  IHP’s address the management of the chronic health condition in support of eliminating barriers to the educational process  IHP cannot replace a 504 Plan

24.  Karen Erwin, KY Education School Nurse Consultant Karen.Erwin@education.ky.gov  Sandi Clark, KDPH School Health Nurse Consultant SandiK.Clark@ky.gov