Manual For School Health Programs


Chapter 3: Health Plans for Students with Special Health Care Needs

The number of children with chronic health conditions is approximately 25 percent of the student body. School care for these students has become increasingly complex. Individual student health-related plans assist school nurses in providing quality health care in school, account for school safety, protect students' rights and reduce health barriers to learning. It is important to understand the professional, ethical and legal foundations of student health plans and their impact on federally mandated education plans.
Federal statutes that pertain to the treatment of children with disabilities support this trend.

Section 504 of the Rehabilitation Act of 1973, as amended through the Americans with Disabilities Amendment Act (ADAA) in 2008, prohibits recipients of federal funds from discriminating against persons with handicapping conditions or persons who are regarded as handicapped. School districts must make reasonable accommodations to make their programs and services available to such students.

Section 504 provisions are important because the definition of children with handicapping conditions is broader than the definition of such children under the Individuals with Disabilities Education Act (IDEA). Thus, a child may be eligible for certain services under Section 504 but not for special education under IDEA. Section 504 does not require an Individualized Education Plan (IEP) but a written plan for accommodation. It is recommended that the district document that a group of individuals familiar with the student’s needs meet and identify the needed services.

IDEA is the second federal statute that pertains to the issue of school health services. This statute requires public school districts to provide a “free appropriate public education (FAPE)” for eligible children of providing special education and related services. Regulations and court decisions have defined related services, including school health services. Criteria for required services include:

  1. Can be learned in a reasonable amount of time.
  2. Should not require the presence of a physician, medical judgment from extensive medical training, or an undue amount of time to perform.
  3. Must be provided or performed during the school day for the pupil to attend school or benefit from his/her educational program.
  4. Must be ordered by a licensed physician or surgeon.

IDEA’s definition of services includes the variety of procedures described in these guidelines; therefore, school districts have the responsibility to provide them when it is determined necessary for a child with a disability to benefit from the special education program, as documented in the IEP. Read more on the DESE website.

Quality health care is in students' best interest and safety and supports the optimal educational experience. This health care is best provided in school through assessment, planning, and monitoring by a registered nurse in collaboration with the student’s primary physician. Districts enrolling students with complex medical needs must have access to this type of health care management to provide for the student’s special needs safely.

Students with special needs may require a variety of health-related plans. A registered nurse must develop these plans, including care delegated to other staff. The types of plans include:

  • Emergency Action Plan (EAP)
  • 504 Accommodation Plan
  • Individualized Health Care Plan (IHP)

Emergency Action Plan (EAP)

The needs of a student with a condition that may become life-threatening (i.e., severe allergic response, persistent asthma, diabetes, etc.) require a written plan or protocol for the school district personnel who may be called upon to respond. The Emergency Action Plan (EAP) should include:

  • Definition of medical emergency for this student.
  • Specific actions staff should take in the emergency, based on the student’s signs and symptoms.
  • List of individuals to notify when this emergency occurs.
  • Transportation procedures.

As indicated, the school nurse should share these student-specific emergency plans with school personnel, including teaching staff, cafeteria workers, custodians, and bus drivers. Fillable PDF plans can be found for use on the School Health Program website. If the student is transported daily, the school nurse should provide specific training and plans to the driver(s) responsible for their transportation. See Appendix 3D for a sample Transportation Plan.

Will’s Law—statutory
Individualized Emergency Health Care Plan (IEHC)

The term Individualized Emergency Health Care Plan is used in Will’s Law and has statutory requirements. It is defined in legislation as a document developed by the school nurse in consultation with the parent and other appropriate medical professionals. This plan describes the procedures and specific directions a person will take in an emergency. The parent, school nurse and a school administrator sign this form. In the absence of a school nurse, the administrator signs.

The IEHC provides for effective and efficient planning and protects both the student and the school personnel. Components of the IEHC may include:

  • A notice about the student's condition for all school employees interacting with the student.
  • Written orders from the student's physician or advanced practice nurse describing the epilepsy or seizure disorder care.
  • The student’s symptoms of epilepsy or seizure disorder and recommended care.
  • Information about the student’s participation in exercise and sports, including any contraindications to exercise and required accommodations.
  • Accommodations for school trips, after-school activities, class parties, and other school-related activities.
  • Information for school employees about how to recognize and provide care for epilepsy and seizure disorders, epilepsy and seizure disorder first aid training, when to call for assistance, emergency contact information, and parent contact information.
  • Medical and treatment issues that may affect the educational process of the student.
  • The student's ability to manage, and the student's level of understanding of, the student's epilepsy or seizure disorder.
  • How to maintain communication with the student, the student's parent and health care team, the school nurse or the school administrator or the administrator's designee.

Also, as part of Will’s Law, an Individualized Health Care Plan (IHCP) is defined as:

“a document developed by a school nurse, in consultation with a student's parent and other appropriate medical professionals who may be providing epilepsy or seizure disorder care to the student, that is consistent with the recommendations of the student's health care providers, that describes the health services needed by the student at school, and that is signed by the parent and the school nurse or the school administrator or the administrator's designee in the absence of the school nurse.”

It continues to state: ”Each individualized health care plan shall include but not be limited to the following information:

  1. A notice about the student's condition for all school employees who interact with the student;
  2. Written orders from the student's physician or advanced practice nurse describing the epilepsy or seizure disorder care;
  3. The symptoms of the epilepsy or seizure disorder for that particular student and recommended care;
  4. Whether the student may fully participate in exercise and sports, and any contraindications to exercise or accommodations that shall be made for that particular student;
  5. Accommodations for school trips, after-school activities, class parties, and other school-related activities;
  6. Information for such school employees about how to recognize and provide care for epilepsy and seizure disorders, epilepsy and seizure disorder first aid training, when to call for assistance, emergency contact information, and parent contact information;
  7. Medical and treatment issues that may affect the educational process of the student;
  8. The student's ability to manage, and the student's level of understanding of, the student's epilepsy or seizure disorder; and
  9. How to maintain communication with the student, the student's parent and health care team, the school nurse or the school administrator or the administrator's designee in the absence of the school nurse, and the school employees.”

Individualized Healthcare Plan (IHP)

A student with special health care needs benefits from developing an Individualized Healthcare Plan (IHP) to guide nursing interventions based on a nursing diagnoses. This nursing care plan has student-centered goals and objectives and describes the nursing interventions designed to meet the student’s short- and long-term goals. IHPs are useful when the nurse is assisting the student to:

  • Become better educated about their special health care need.
  • Develop more self-care activities.
  • Address health-related absenteeism.
  • Cope more effectively with their condition/disease.

The IHP is for the school nurse’s use and does not require a parent or health care provider’s signature. (See Appendix 3E for a sample format). School nurses often use the IHP as a contract between the student and the nurse to accomplish specific outcomes for the student. Not all students with a special health care need will require an IHP; only those with whom the nurse or UAP provides significant intervention or addresses daily health needs or as part of an IEP or 504 Accommodation Plan.

Section 504 Accommodation Plan

The school nurse is often one of the staff members who identifies the need for a 504 Accommodation Plan to address the health needs of a student on a temporary or permanent (school year) basis. The need may relate to mobility, access to care, classroom adaptations, etc. The nurse may need to advocate for the accommodation. A group of individuals aware of the need for accommodation should develop a plan to ensure the student is getting the best possible access to learning (see Appendix 3F for sample format).

Technical Skills and Services

The RN should provide assessment, planning, and monitoring for all students requiring technical skills and services to meet their health care needs at school. In addition, the RN is responsible for writing and implementing students’ health care plans. Schools may employ an RN or contract with an agency to provide nursing services.

A physician’s written authorization is required for all medical procedures performed at school. School staff should not perform the procedure at school unless clearly necessary and the family cannot reasonably accomplish it outside of school hours. School staff should consult students and parent(s)/guardian(s) on how they perform the procedures at home; however, the school nurse must determine how the procedure will be done at school. An unlicensed, non-medical person cannot perform certain procedures. School personnel, including the nurse, may need additional training for some procedures. If no registered nurse is available, a physician should determine who may safely provide care, and assure the necessary training.

The person delegating the care should periodically monitor and document the quality of the care to ensure the caregiver is correctly following the procedure, completing the required documentation, and reporting concerns appropriately. Special care videos with written procedures are available on Missouri’s Just In Time website. The website is available to Missouri school nurses and is easy to access.

A physician or registered nurse should decide who can provide care based on an assessment of the student’s health status, the complexity of the procedures, and the capability of the proposed caregiver. The caregiver must be provided training and support until they feel competent to provide the care. The person delegating the care must be confident the caregiver has mastered the skills necessary. School staff have the right to refuse to provide special health care procedures, including medication administration, without jeopardizing their position [RSMo 167.621(2).].

Resources

Resources for Special Health Care Needs

Chapter 3 References

Appendix 3B: Sample Letter to Physician Regarding Health Care Plan

(Date)

Dear Dr. _______________________:

The parent/guardian of your patient, [student name/DOB], requested that [school district] provide specialized health care. If district staff must perform this procedure during school hours, we will need a written order on file in the student’s health record.

Attached is a tentative health care plan for this student, including a description of a standardized procedure. Please review these materials, write needed adjustments to the procedure, and provide the requested information to guide us in providing a safe environment for your patient. We will incorporate your comments and adjust the procedure as you direct. School staff will begin providing the care requested when we have the necessary orders and adequately trained personnel in place.

Please feel free to contact _______________________, who is assuming responsibility for the management of the student’s health needs in our school. They can be reached at _______________________.

Sincerely,

Administrator or School Nurse

Appendix 3C: Transportation Plan

Transportation Plan for Students with Special Needs

View Form
Appendix 3D: Individualized Health Care

Confidential Individualized Healthcare Plan

View Form
Appendix 3E: 504 Outline

Section 504 Accommodation Plan

View Form

Table of Contents

On this page