HEALING HANDS: As long as special healthcare needs do not involve procedures that only a doctor can provide, the student has the right to a free, appropriate public education.
BY LAUREN AGORATUS, M.A.
Students with special healthcare needs may need extra medical support to attend school. Special healthcare needs could impact attendance, academic performance, or even require emergency intervention. Children with special healthcare needs can have an Individualized Healthcare Plan (IHP) as an addendum to their IEP (Individualized Education Program) or 504 plan.
Who Creates the IHP?
The National Association of School Nurses has a policy statement indicating that it is the responsibility of the school nurse to develop an IHP for every student "whose healthcare needs affect or have the potential to affect safe and optimal school attendance and academic performance."1 Parents must contribute to the IHP, in much the same way as they help develop the IEP. Parents must give written consent to implement the IHP. Specific services, up to nursing, must be documented by a healthcare provider. Some parents even create their own IHP, which is reviewed by the nurse and child study team. As with an IEP, when there are changes to the student's health, medications, or procedures, the IHP needs to be revised.
What is Included in the IHP?
The IHP should include the diagnosis and both routine and emergency care. It should also include self-advocacy for the child based on their ability to enhance transition. Some students are able to self-administer medications, including using inhalers. Essential components could be:
• diagnosis/background/implications for school • emergency procedures •medication administration • allergies • special diet • special toileting hygiene • activity restrictions (e.g., at risk for dehydration/photosensivity) • climate control (heat and A/C including transportation) • sports accommodations (fall risk, contact sports, special equipment such as kidney guard for transplant patient) • Other (e.g. infection control for those with suppressed immune system)
Please see Resources for a detailed explanation of IHPs and sample plans, including specialized plans for asthma, diabetes, and seizures.
A special note on nursing
All students have the right to a free, appropriate public education (FAPE). Even a child who may require nursing can attend school. Two Supreme Court cases decided this matter. Garret F. vs. Cedar Rapids IA and Tatro vs. Irving spelled out details on nursing at school. The Tatro case clarified that a student who required clean, intermittent catheterization could attend school. The Garret case clarified that a student on a ventilator had the right to attend school with a nurse. For more details on these cases, please see Resources below. It is important to note that schools may ask for consent to access insurance but must provide related services even if parents don't consent to insurance access. Families may contact their Parent Training and Information Center (PTI) for more information. Parents may also wish to contact Voices/Family-to-Family their Family Health Information Center in their state if they have difficulty getting nursing for their child.
When a child is too sick to attend school
Some children may be temporarily immune-suppressed, hospitalized, or have a long-term illness. There are options, if the child is well enough, to continue their education. If the child will be home recuperating, the district should provide home instruction, including related services such as speech, occupational, and physical therapies. If the student is hospitalized long term, the hospital can contact the school district to provide hospital instruction and therapies. Note that the child's condition may warrant a change in therapies.
For example, a child who had to stay in bed for months, or was on a ventilator for a time, will lose muscle tone and may require physical therapy for gross motor skills. Here again if families have questions, they may wish to contact their PTI.
All children have the right to attend school, even those with special healthcare needs requiring nursing or other medical procedures. As long as it is not a procedure that only a doctor can provide, the child has the right to FAPE. By creating IHPs in addition to IEPs and 504 plans, families and schools can help students maintain their health at school and benefit academically.•
ABOUT THE AUTHOR: Lauren Agoratus, M.A. is the parent of a child with multiple disabilities who serves as the Coordinator for Family Voices-NJ and as the central/southern coordinator in her state's Family-to-Family Health Information Center, both housed at SPAN, found at spanadvocacy.org
THE NURSE'S OFFICE : RESOURCES FOR INDIVIDUALIZED HEALTHCARE PLANS
IndIvIdualIzed healthcare Plans: the role oF the school nurse National Association of School Nurses nasn.org/advocacy/professional-practice-documents/position-statements/ps-ihps
nursIng at school Tatro vs. Irving: wrightslaw.com/law/caselaw/ussupct.tatro.htm Garret F. vs. Cedar Rapids: wrightslaw.com/law/caselaw/case_Cedar_Rapids_SupCt_990303.htm
Individualized healthcare Plan: PowerPoint NE Family-to-Family Health Information Center (PDF pages 1-6 of slides) fv-ncfpp.org/files/6813/3489/0607/NE-IHP509final.pdf
Parent training and Information centers parentcenterhub.org/find-your-center
Individualized healthcare Plans For the school nurse By diagnosis (with student goals) School Health schoolhealth.com/media/pdf/IHP_GUIDE.pdf
Family voices/Family-to-Family health Information centers familyvoices.org
Pacer center: Individual health care Plans and emergency Information Forms
pacer.org/health/samplehealthplans.asp
Individual health care Plan templates: General IHP: pacer.org/health/pdfs/ind_health_plan.pdf Diabetes IHP: pacer.org/health/pdfs/DiabetesIHCP.pdf 34 September 2018 • EP Magazine | ep-magazine.com Asthma IHP: health.state.mn.us/asthma/documents/09.childaap.pdf Seizure IHP: pacer.org/health/pdfs/SeizureIHCP.pdf