Planning for Students with Special Needs

CONFLICT OF INTEREST / COMMERCIAL SUPPORT DISCLOSURE This educational activity is being presented without the provision of commercial support and without bias or conflict of interest from the planners and presenters.

LECTURE OBJECTIVES Understand the federal laws that affect students with chronic health conditions or physical impairments. Develop an individualized health care plan, an emergency care plan, or both for students who have special needs. Understand how the Individuals With Disabilities Education Improvement Act, the Americans With Disabilities Act, and Section 504 of the Rehabilitation Act relate to the various care plans. Understand the implications and special challenges posed by pediatric do not resuscitate (DNR) orders.

YOUR ROLE IN PLANNING SPECIAL CARE Students have diverse medical conditions & needs Asthma Cancer Diabetes Genetic Disorders Immunologic Disorders Life-threatening Allergies Neurologic Disorders Mental Health Disorders Orthopedic Disorders

FEDERAL LEGISLATION AFFECTING CARE OF STUDENTS IN SCHOOOL The Individuals with Disabilities Education Improvement Act of 2004 [IDEA] The Americans with Disabilities Act of 1990 [ADA] The Rehabilitation Act of 1973, Section 504

PLANS THAT ADDRESS FEDERAL MANDATES Individualized Health Care Plans [IHP] Individualized Emergency Care Plans [ECP] 504 Accommodation Plans

IHP: INDIVIDUALIZED HEALTH CARE PLAN Cannot be delegated For any student with a chronic health condition Takes medication at school Requires environmental modifications in order to attend school, including Participation in field trips Participation is school-sponsored activities Safe, swift evacuation during an emergency

PLAN DEVELOPMENT Assessment/History Nursing Diagnosis Outcome Identification Planning Implementation Evaluation

PLAN USE & MAINTENANCE IHPs are only as useful as the information they contain Make an accurate, detailed plan Review regularly Update as changes occur IHP will be especially valuable When another nurse substitutes for you If you move to another position If the student moves to another school

ECP: INDIVIDUALIZED EMERGENCY CARE PLAN Medical condition, medications, allergies, equipment and supplies Signs and symptoms of an exacerbation of the condition Step-by-step action for each presenting problem Appropriate response for escalating situations Chain of command for managing the emergency at school Contact information parent/guardian secondary contact person primary care physicians specialists for consultation Request for transport to a specific ED for specialized care

ECP: DEVELOPMENT & USE Collect Information Confirm the Information Prepare the ECP Instruct the Staff Provide for Access to the ECP Monitor the Student’s Progress Communicate with the Parent/Guardians

COORDINATING WITH EMS PREPLANNING WITH LOCAL EMS Potential emergencies Special equipment DNR Permitted Response to Cardiac Arrest or Respiratory Distress Transport Destination (Hospital or Home) Who Will Pronounce Death

504 PLANS Physical or mental impairment that Record of this impairment Substantially impedes at least one ADL Record of this impairment Diagnosis Impairment as defined in Section 504

504: DEVELOPMENT & USE Include in the plan Reason for concern Basis for determining disability How the disability affects ADLs Services, assistive devices, and accommodations the student will require Date for review and reassessment of the List all specific individuals involved in planning Name & contact information of the case manager Implement the plan in the classroom

DNR ORDERS Written medical order Name of the student Name and signature of the physician Effective date “Do Not Resuscitate” clearly spelled out Signature documenting consent by the legally recognized decision-maker No Abbreviations

DNR PROVISIONS Provides for comfort care Limits resuscitative interventions Works with ECP Specific actions permitted Transport destination Parent or guardian develops transport plan with EMS Incorporate school, state and local guidelines

SUMMARY IHPs Personalized care instructions Encourage goals with measurable outcomes ECPs Specific care in emergencies 504s Ensure appropriate accommodations for students with disabilities who do not qualify for special education services Keep all plans accessible, reviewed, and up-to-date

RESOURCES SNEMS-C Manual Chapter 14, pp 343-356 Key points, p 595 Appendices A and B

QUESTIONS?