Definition: Other Health Impairment Other health impairment (OHI) means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that: is due to a chronic or acute health problem e.g., as acquired immune deficiency syndrome, asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, Tourette syndrome, or tuberculosis; and adversely affects a child’s educational performance. 34 CFR 300.8 (c) (9) 707 KAR 1:280 Section 1 (42) KRS 157.200 (1) (b) The federal and state laws define OHI as a “Health Impairment” that: Limits strength Limits vitality Limits alertness Due to chronic health problem Adversely affects a child’s education

Definition: A Chronic or Acute Health Problem includes a non-exhaustive list that covers health problems such as acquired immune deficiency disease, asthma, attention deficit disorder, attention deficit hyperactivity disorder, diabetes, epilepsy, heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, Tourette syndrome and tuberculosis. 34 C.F.R. 300.8 (a) (9) 707 KAR 1:280 Section 1 (42) A chronic or acute health problem includes a list of health problems that are diagnosed by a licensed physician or a qualified mental health provider.

OHI means having limited: STRENGTH VITALITY When making an eligibility determination, the ARC must document the affect the ADHD has on the student in terms of: Strength Vitality Alertness ALERTNESS

Definition: Limited Strength includes the endurance of fine and gross motor skills and activities including trunk control, slouching, and the maintenance of posture. It may also include how the student’s emotional stamina and how the student deals with stress or pain. When determining strength, the ARC considers the endurance of the student in both physical and emotional stamina.

Definition: Limited Vitality includes physical and mental endurance (duration, intensity, and frequency over time) in an activity as measured by work completion; time on task; and the number of times the student took a break.   When determining vitality, the ARC considers the physical and mental endurance of the student.

Definition: Limited Alertness  including a heightened alertness to environmental stimuli, in the focus on tasks, activities, and responses, as measured by whether the student has a short attention span (i.e., pays attention to nothing) or is highly distractible (i.e., pays attention to everything). When determining alertness, the ARC considers the attention and focus of the student in activities and responses.

OHI * Chronic condition - develops slowly and has long-lasting symptoms * Acute condition - develops quickly and symptoms are intense but last for a relatively short period of time

Sickle Cell Disease Most common inherited blood disease in USA. 80,000 Americans have this disease 1 in 500 African Americans 1/1000 – 1,400 Hispanic Americans have disease. Lifespan has increased from 20 to 50 years May suffer from depression or anxiety

Symptoms primary symptoms anemia; periodic pains Pain triggers (4) Extreme heat of cold Poor diet Not enough liquids Lack of sleep Performs well in school Long sickle cells cause blood clots and pain

Epilepsy a condition characterized by seizures cause by unregulated electric discharges in the brain students can have two types of seizures generalized or partial for seizures type, characteristics first aid, possibility of injury see figure 11-1 what triggers seizures? Extreme stress, fatigue, infections, disease, bright lights, certain sounds, and odors. some students have academic challenges and can be misidentified as having AD/HD.

Asthma less air passes out of lungs students have inhaled triggers cause it such as: exercise, dust, chalk, stress, mold, and pollens Most prevalent chronic illness of children Symptoms maybe mild or life threatening Asthma symptoms can adversely affect school performance

Leading cause of school absenteeism Increasing among African Americans and women Students have trouble exhaling not inhaling On average teacher have two students with asthma in each classroom. Managing episodes in an essential first – aid skill for teachers

Cancer ruthlessly indiscriminate, attaching children and adults. 9,100 children under age or 15 were diagnosed with cancer (2002) cancer in the primary cause of death by disease in children of this age group child has a 72 to 92 % likelihood of five-year survival, depending on the site of the cancer. the cure rate is 60% (for childhood cancer)

treatments chemotherapy children respond well because several type specially affect growing cells surgery radiation therapy combination side effect (chemotherapy) nausea loss of hair lower white cell count, increasing possibilities of infections more than half of students with cancer have leukemia or brain tumors, Leukemia survivors may develop difficulty with writing and concentration

Diabetes genetics or following a viral infections juvenile Type I diagnosed between age 10 and 16 students do not think of themselves as disabled. May try to hide it, but teachers need to know in case of emergency. Hyperglycemia – too much sugar symptoms : hunger, fatigue, blurred vision excessive thirst & Urination treatment – insulin

Hypoglycemia not enough sugar symptoms : dizzy, sweaty, shaky, nervous, headaches, blurred vision, Also change in behavior: outgoing withdrawn treatment (sugar) fruit juice, milk, soda could go into convulsion – no liquid call for medical assistance. lower IQ possible (especially with boys)

HIV Human Immunodeficiency Virus attacks immune system. Gradually infects and eventually destroys T4 and other immune cells that protects the body from disease.   HIV is found in certain body fluids, can be spread through blood, semen, vaginal fluid, breast milk, and fluids containing blood. HIV is passed from person to person thought sexual contact and blood to blood, sharing needles or injections equipment

3 distinct phases of HIV   students is asymptomatic and feels healthy minor symptoms such as fever, fatigue, increase as immune system weakens AIDS acquired immunodeficiency disease occurs when students has 1 or more infections and a T4 count below 200 symptoms include : seizures, memory lapses, impaired vision, blindness, weight loss and in a child, loss of cognitive abilities

HIV cannot be contracted through saliva feces, nasal secretions, sweat, tears, urine, or vomit, unless blood is present Among teens sexual contact largest cause Females more likely than males African American highest risk of HIV transmission (17x more likely) 64% adolescent aids were African American (2002) Hispanic American are second highest

Types of ADHD Primarily Inattentive Primarily Hyperactive-Impulsive Combined Type The DSM IV lists two basic types of ADHD: primarily inattentive type and primarily hyperactive-impulsive type. The DSM IV also notes that a person can have a combined type of AHD with characteristics from both types. The DSM IV also specifies that the child must display the characteristics before the age of 7. There are times when a child doesn’t receive the diagnosis that early but there should be evidence that the characteristics were present in early childhood. This is not a disorder one develops as a teen, for example.

Look For: Primarily Inattentive: Makes careless mistakes Has trouble sustaining attention Seems not to listen Has difficulty following directions Disorganized Losses things Forgetful Primarily Hyperactive-Impulsive: Fidgets or squirms frequently Often runs, climbs and is restless Has difficulty working or playing quietly Always seems on the go Talks excessively Blurts out answers before question is finished Difficulty waiting turn Interrupts others Children who have ADHD typically have either a limited attention span or high distractibility. A child with a limited attention span pays attention to nothing; a student who is highly distractible pays attention to everything. BELINDA: I changed the definitions above, but not sure I correctly captured it. I use the analogy above because teachers understand it, but we may need to slides: one with the hyperactivity and inattention, and one with attention vs. distractibility

Eligibility Guidelines for Other Health Impaired In the next section we will explore the current regulations and guidelines necessary to determine a student eligible for specially designed instruction under the category of OHI Show on document camera. KAR 1:300 §3(2)(3)

Eligibility (cont.) Adverse Affect: the progress of the child is impeded by the disability to the extent that the educational performance is significantly and consistently below the level of similar age peers. Adverse Affect: the progress of the child is impeded by the disability to the extent that the educational performance is significantly and consistently below the level of similar age peers. 34 CFR 300.8 707 KAR 1:280 Section 1 (2) KAR 1:280 §1(2)

Eligibility (cont.) Exclusionary Clause: The student is not eligible for services if the ARC determines: A lack of instruction in reading A lack of instruction in math The student is limited English proficient The student child does not meet eligibility criteria As with every other disability, the ARC must rule out the exclusionary factors: A lack of instruction in reading A lack of instruction in math The student is limited English proficient The student child does not meet eligibility criteria(the guidelines previously discussed) KAR 1:280 §1(2)

Eligibility (cont.) The eligibility form gives the ARC guidance for understanding the disability. It also gives guidance for planning the evaluation. If the ARC plans well for the evaluation during the Referral meeting the likelihood of having insufficient data at the Eligibility meeting decreases. (Last item on eligibility form) KAR 1:300 §3(2)(3)

Evaluation Planning Form In planning for an assessment to determine if a child or youth has a mild mental disability, the ARC must review the definition and requirements to ensure all areas of requirement are assessed. KAR 1:300 §3(2)(3)

Develop the Evaluation Plan Based on referral information & eligibility requirements, determine additional information needed Determine needed areas of evaluation; Determine types of personnel to complete evaluation components; Target specific areas for observation; Determine the need for Assistive Technology Evaluation; and Determine the need for modifications to evaluation procedure(s). Develop the Evaluation Plan. Based on referral information & eligibility requirements, determine additional information needed; Determine needed areas of evaluation; What information does the ARC currently have Target specific areas for observation; Determine types of personnel to complete evaluation each component Determine the need for Assistive Technology Evaluation; and Determine the need for modifications to evaluation procedure(s).

Develop the Evaluation Plan Small Group Activity Determining Needed Evaluation Plan Components Handout: Eligibility form for chosen Disability Area Handout: Evaluation Planning Form Brainstorm Activity for Determining Required Evaluation Components Trainers will: Put each component of the eligibility criteria on separate posters or give the participant the criteria so they can write it on the poster. Assign one criteria to 2-3 participants. Adjust, as needed, to the number of participants in the session. With fewer participants assign more than one criteria/poster. Instruction to Participants The purpose of this activity is to practice the thinking process for determining the components of the evaluation plan. The activity will be completed in 2 large steps. A. Participants, in each assigned small group, will: Read the assigned criteria Brainstorm and write the specific evaluation or supportive data that will provide information for the criteria Target specific areas for observation, if appropriate for the eligibility criteria Determine setting(s) for observations, if appropriate for the eligibility criteria After this part of the assignment is completed give the participants the next steps. B. After brainstorming the evaluation needed for the criteria, participants will: Determine types of personnel qualified to complete the evaluation component(s); Target specific areas for observation In what setting will the data be collected? Does it need to be collected in more than one setting? Determine the need for Assistive Technology Evaluation; and Determine the need for modifications to evaluation procedure(s). Participants will report their results to the large group. Using all the charts, ask the group if the plan will gather: Enough information to determine if the child has a disability, including Adverse Effect? Enough information to determine the child’s learning needs? Do the charts show information to write and IEP, if appropriate, or to further plan programming if not eligible. What OTHER information is gathered?

Evaluation Planning Form Health, Vision, Hearing, and Motor Abilities: the ARC identifies any of these issues that were not ruled out in the screening process. Academic Performance: the ARC requests Educational Assessment (Reading, Math, and/or Written Language) Medical Statement KAR 1:300 §3(2)(3)

Evaluation Planning Form (cont.) General Intelligence: is measured by Cognitive/Intellectual Assessment to assess the aptitude and mental processing of the child. The average score is 100 on most IQ tests. Children and youth scoring below 70 are thought to have a mild mental disability. Social and Emotional Status: is measured by Adaptive Behavior/Self-Help scales; behavior observations; behavior rating scales; functional behavioral assessment. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of his or her age. Certain skills are important to adaptive behavior, such as: daily living skills, such as getting dressed, going to the bathroom, and feeding one's self; communication skills, such as understanding what is said and being able to answer; social skills with peers, family members, adults, and others. Communication Status: is measured by tests that assess the child’s or youth’s receptive and expressive language skills; articulation skills; voice, fluency, and oral mechanism. If the child or youth failed the communication screening, the ARC further investigates this area through assessment. Vocational Evaluation/Transition Needs: is assessed by interest inventories, vocational aptitude tests, learning style inventories and observation, depending on the age of the child or youth. Often the vocational assessments are given when the youth reaches age 14; however, the ARC must identify other needs of the child or youth outside of the general curriculum. This often includes the identification of daily living and self help skill development. NOTE TO STAFF-All need to address and emphasize this. A student may not be referred until around this age. KAR 1:300 §3(2)(3)

Evaluation Planning Form (cont.) Other Assessments: The ARC identifies additional assessments as needed. In Kentucky, we use the Social and Developmental History interview of the parent to look at social and cultural issues, and to help the ARC identify additional assessment that may be needed. Very important for Disproportionality. Beef this up. Social and cultural issues are in one of the regulations. KAR 1:300 §3(2)(3)