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507.80 Students with Special Health Needs

Definition of Services: Students with special health needs are those who require medical treatments, procedures, use of a health device, or require professional health management in the school setting. These students may have chronic health conditions such as diabetes, asthma, attention deficit disorder, cerebral palsy, or more short-term needs, such as extensive illness or accident.

Provision of Services: Federal rules and regulations require the provision of health services for students who have health needs that interfere with learning. Although a student has special health needs, educational accommodations may or may not be required. It is up to the discretion of the Level II-III extended problem-solving team as to whether or not additional educational resources or accommodations are necessary and how to best support ongoing problem-solving. The school nurse is integral in the planning and execution of special health services in the school setting and is included as part of this team.

If the student’s needs are immediate and/or extensive, a special health information meeting will be scheduled before the student attends school to provide the team with accurate information and to facilitate a safe transition in to the school environment. Keep in mind that a student cannot be denied immediate school entrance unless it can be proven that such enrollment would compromise the student’s safety. At the informational meeting, the team should discuss the student’s medical history, the possible need for emergency planning, the health services required in the school setting, additional personnel or staff training necessary to provide the required health services, and the level of intervention required. It is also crucial to establish an ongoing communication network among the school, the parent/guardian, and the health care providers to ensure safe delivery of health services. Parental/guardian consent should be obtained by the school nurse or principal to allow sharing of medical information between the school and the health care providers and to protect confidentiality.

School Nurse Responsibilities: The school nurse will work with the educational team and the parent/guardian at all levels of the problem-solving process to identify the student’s unique health needs and determine how to best meet those needs within the school setting. At times, health procedures may be prescribed that require a nursing license to administer. Some tasks may be prescribed that can safely be delegated, under the right circumstances, by a registered nurse to unlicensed personnel. Any time a nursing task is delegated, the school nurse must be able to provide supervision. Under the guidelines of the Iowa Board of Nursing, it is the professional decision of the nurse as to whether or not a nursing task may be safely performed in the school setting and under what circumstances it may be delegated.

Individualized Health Plan: Students whose health status requires professional nursing observation or intervention, administration of procedures, or the use of a health device need an individualized health plan (IHP). An IHP outlines the safe delivery of health services by the District to the student. The IHP must be written by either a registered nurse or a physician. To meet the Iowa Board of Nursing practice guidelines, registered nurses must document their assessment, nursing diagnosis, outcome or goal statements, intervention strategies, and evidence of ongoing plan completion/evaluation. The IHP is the way in which school nurses meet these requirements. IHP’s are written for students who have health needs that may directly affect them in the educational setting or when the nurse is routinely performing professional tasks for a student that require a nursing license. Any IHP form may be used as long as the basic components previously mentioned are included.

When applicable, emergency planning will be done as part of the IHP for both individual medical needs and for safe evacuation of the student in case of disaster. For medically fragile students, the IHP may also include some or all of the following: a transportation plan; a field trip plan; and a staff training plan. All plans will be evaluated as needed but at least at the beginning and the end of each school year. The original IHP will be kept in the health office, and a copy will be placed with any team documents, such as an IEP or 504 Plan.

Interaction Between the IHP and Section 504: It is up to the discretion of the Level III problem-solving team , in collaboration with the school nurse, to examine all student health concerns and decide what accommodations are needed. If there are any educational accommodations needed, such as reduced work load, shortened school day, or building modifications, a standard 504 Plan will also be written in addition to an IHP.

Interaction Between the IHP and the IEP: The IHP is mandatory and considered part of the IEP for students whose health needs interfere with learning. Examples of possible health concerns requiring an IHP are asthma, diabetes, Tourette Syndrome, ADD/ADHD with medication prescribed, seizure disorder, and severe cerebral palsy. The school nurse is primarily responsible for ensuring the plan is written to meet the necessary criteria of an IHP, but the entire IEP team will have input. Nursing time spent working with a student on IEP goals should also be listed on the grid portion of the Program Description From. Interventions on the IHP can be revised by the registered nurse without reconvening the problem-solving team, unless the interventions include other professional disciplines’ practice.

Students whose primary reason for receiving special education services is health related should also have a health goal on the IEP. Health goals are written more broadly than IHP goals and should focus the entire team on improving or maintaining the student’s health status. Possible areas to focus on for health goals are mastery of self help skills, independence, tolerance of procedures or activity, and school attendance. Health goals will not be revised without the input of the entire team.

February 1, 1999

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