Individual Health Plans (IHP’s) for Students with Chronic Health Conditions Individual Health Plans (IHP’s) for students with chronic health conditions. I imagine most of you don’t like the title- much less the topic. A more exciting title for many of you might be: McLane Children’s 2016 School Nurse Conference Charlotte Smith, MSN, RN- Belton ISD

IHP’S: How to Get Rid of a School Nurse in 24 Hours IHP, EAP, IEP, 504, NANDA, NIC, NOC IHP’S: How to Get Rid of a School Nurse in 24 Hours IHP’s-How to get rid of a school nurse in 24 hours. All you have to do is start talking in acronyms…IHP, EAP, IEP, 504- or worse yet…NANDA, NIC, & NOC. 5 years ago I was probably saying- yeah right…and when am I going to find time to do that? For me, understanding and accepting the need for IHP’s has been an ongoing process. Honestly, I am giving this presentation today because I wasn’t at the first planning meeting to plan this conference and they drafted me to speak on this topic. I agreed because I knew it had been a goal of mine for a while to do better, and preparing for the presentation would be good for me. Our district still has a long way to go to reach the school nursing standards related to health plans, but each year we will get a little better. Today I want to share with you our journey into IHP’s. You are welcome to this power point, which has my entire script in the notes section, but the most valuable piece will be the resources listed at the end. Take time to read them. I think they will inspire you to give it a try. Even more valuable than that are the people in this room. Many here have been doing this for a while. Take the time to share ideas. I don’t think we could have started on our own without other school nurses sharing care plan templates and experiences at conferences similar to this one.

What is an IHP? Individualized healthcare plans (IHP’s) document the nursing process for students who have health-related issues. (Herrmann, 2005) Though there will be some slides to help define IHP’s my goal today is to share our experiences using electronic templates for care plans. (Show IHP book)There are books and articles written by school nurses to help us develop IHP’s that meet the health needs of students and clearly document nursing practice using the nursing process of assessment, diagnosis, goals & outcomes identification, interventions, and evaluation. My first year of school nursing in a small south Texas town I don’t think I ever heard the word care plan- we didn’t even have emergency care plans for asthma. Many times we didn’t even know who our chronic kids were. Somehow those sped kids just enrolled and we never knew about them till 2 months later. I was one of those innocent lambs who started school nursing without any one to orient or mentor me. Thank goodness for school nurse conferences and school nurse resource books. Our second year we started using some paper templates to do emergency care plans for the hot 4: diabetes, life-threatening allergies, asthma, & seizures. Later on I tried the care plan disks, but we were printing out these 20 page care plans that were impossible to implement. After moving to Belton 4 years ago, we started using using paper emergency action plans that also served as our authorization form for emergency medications. Two years ago in Belton we finally starting to do EAP’s electronically, and this year we have we’ve added more IHP templates. ASSESSMENT INTERVENTIONS ASSESSMENT DIAGNOSIS EVALUATION GOALS/OUTCOMES

ELECTRONIC HEALTH RECORD IHP is not…. EAP IEP 504 MD Orders HEALTH LIST TO TEACHER EMAIL TO TEACHER ELECTRONIC HEALTH RECORD An IHP is not the same as an emergency action plan (EAP), an individual education plan (IEP), or a Section 504 plan. Later in this presentation, we will briefly discuss how these plans are related to IHP’s. We cannot assume our job is done when we receive DR. orders or when we document a health condition in the student's electronic health record or email the teacher that one of her students has an asthma inhaler. Nor should we be providing lists of student health conditions to teachers and no plan to follow. Though training documentation for teaching someone how to administer Diastat is important, it does not take the place of an IHP.

Why an IHP? IHP’s Improve: Documentation Communication & Continuity Implementation Evaluation Why do we need to have IHP’s? I’ve been one of those school nurses who say…We do our best to document everything we do – using office visit notes, annual student health forms, & entering health conditions electronically. An IHP is the best way to document in one place all that we will do. It communicates the student’s plan of care using standardized language. It ensures consistency and continuity of care. Honestly, when I used the IHP resources out there, they list interventions that I might forget to do. It includes an evaluation step to help us determine if our nursing interventions are effective.

Who needs an IHP? Disability…(Gibbons, Lehr, Selekman, 2013) Chronic health conditions (Zimmerman, 2013). Special healthcare needs (AAP, 2003). Healthcare needs affect or have the potential to affect safe and optimal school attendance and optimal performance.” (NASN, 2015). The National Association of School Nurses state that “the development of individualized health care plans (IHP) is a nursing responsibility and is based on standards of care that are regulated by State Nurse Practice Acts.” Believe it or not, the American Academy of Pediatrics mention IHP’S in their policy statement about the role of the school nurse. School nursing experts identify a need for an IHP in different ways. They state: Every child with a disability…(Gibons, Lehr, Selekman, 2013) All students with chronic health conditions (Zimmerman, 2013). All students with special healthcare needs (AAP, 2003). Though we know all our students are special…where do we draw the lines on IHP’s? The NASN states IHP’s are needed for students whose healthcare needs affect or have the potential to affect safe and optimal school attendance and optimal performance. “ (NASN, 2015). They also write that if a student’s health condition has the possibility of posing a risk for school failure, an IHP is needed. (NASN, 2012). My reality over the last couple of years as we have started to implement care plans is few school staff, parents and maybe even some primary care providers could not tell you what an IHP is. They think you are talking about an IEP (the student’s educational plan). Recently I was in a meeting with our administration about our electronic student data base- and we will discussing who has access to certain areas. As we reviewed the health record section some asked me what the tab IHP stood for. It was a great opportunity to educate them on what school nurses do. The down side to this is now when our school legal counsel calls and lets me know we are investigating a parent complaint that might involve a student with a health condition, she will ask me- Does the student have an IHP? I always hope I can tell her yes.

Where is the IHP? My reality over the last couple of years as we have started to implement care plans is few school staff, parents and maybe even some primary care providers could not tell you what an IHP is. They think you are talking about an IEP (the student’s educational plan). Recently I was in a meeting with our administration about our electronic student data base- and we will discussing who has access to certain areas. As we reviewed the health record section some asked me what the tab IHP stood for. It was a great opportunity to educate them on what school nurses do. The down side to this is now when our school legal counsel calls and lets me know we are investigating a parent complaint that might involve a student with a health condition, she will ask me- Does the student have an IHP? I always hope I can tell her yes.

IHP Identification Student health forms- paper/online Our main tool in beginning to identify students who need IHP’s are our student health forms. How many do paper?- online?) Though we do not want this form to be too long, we can ask some important questions to help us prioritize who needs a plan first. We use on-line health forms adopted from forms created by school nurse trainers who presented at our Skyward electronic health program annual training event. There are drop-down boxes that parents could select to let us know about emergency meds. This example asks about life-threatening allergies- we ask if they require an EPIPEN and accommodations and whether or not the students will carry or not. Our program then allows us to take all the answers for one set of questions for all the students and put in an Excel spread sheet to help us filter the students we need to know about first. That is, we can bring all the yes answers for a campus up to the top. At a glance I am able to see around 10 students where parents report they have life-threatening food allergies- but only 2 state they require epipens. Though we know we will have to call and ask a few more questions, this at least helps us to know whom we will call first.

IHP Identification Parent information SPED/ARD invitations Teacher/staff information Student information Observations –frequent flyers, etc. From experience we know that sometimes parents may fail to fill out student health forms completely, so sometimes we rely on parent phones calls, emails, and visits to give us a heads up. Be sure to make information like parent authorization forms and school nurse contact info available on our school website to encourage parent communication. Its important that you make best buds with your special ed diagnostician at your campus so that they let you know when new students are coming. They may think the student doesn’t need nursing services but its always nice to be able to find out for yourself. Another important way we identify students that need plans or from teachers and other staff. We probably have all seen new students who have never received medical care or received services for chronic health problems- train your teachers to refer health concerns to you. And finally, we need to consider those frequent flyers that come in- what is the underlying issue?

IHP Priorities & EAP’s Medically fragile-complex care-SPED /daily care-catherizations, g-feeds, trachs, etc. Diabetics-all Type 1 Life-threatening allergies-with and without Epipen- Seizures-with and without Diastat, VNS Asthma-with inhalers @ school or recent episode Cardiac conditions-on meds/activity restrictions Bleeding Disorders, etc. Does every student with a diagnosis need an IHP? No. Will we be able to do an IHP on everyone that should have one- probably not. We have to prioritize which plans to do first. We will always give priority to safety, and we want to be sure that students are safe from day one of school. The students we most worry about are the medically fragile who require complex care or daily procedures or medications like those with diabetes, life-threatening allergies, seizures, and the list goes on. For these students we must have an emergency action plan (EAP) that is written in lay terms. The school nursing experts tell us that Emergency Action Plans (EAP’s) are created as part of the student’s IHP. So in a perfect world…every student that needs an EAP should have an IHP. (Don’t throw anything at me-yet) Honestly, up until this past school year, most of our plans were Emergency Action Plans (EAP’s).

EAP Authorizations Condition specific questions If you see this: Do this Med & other instruction spaces Signatures Med administration boxes for field trips We created EAPs using a separate parent & physician authorization form for certain conditions, like diabetes, life-threatening allergies, seizures, asthma, cardiac conditions, and bleeding disorders. These authorization forms incorporate condition specific questions as well as a basic emergency plan for that condition that we ask the parent to review. There are areas for parents & physicians to write emergency medication instructions as well as any other specific instructions to help us individualize the emergency plan. Some include a few medication administration boxes at the bottom that staff can use for field trips. This clause can be used to remind staff of the need for confidentiality when they are given an EAP: “The parent/guardian is aware of the emergency action plan and has agreed it may be shared with school staff in the best interst of the student. This information will be handled confidentially. (Selekman, Bolchenek, & Lukens, 2013).

EAP Templates This year we created our EAP’s electronically using our electronic student health program. We still have have the authorization forms filled out, but the EAP’s are created electronically. The template allows us to include relevant history/assessment info, steps to take in an emergency, and at the bottom we include spaces for emergency contact info which includes parent name and phone number as well as nurse name and contact number. We also have spaces for caregiver names and dates trained. The template automatically places the student’s name, DOB, grade, campus name, and picture on the form. We also have templates that are generic emergency plans where we type in all the instructions. Our care plans are easier to read and easier to access. We make copies of our plans and place them in a pencil bag with the emergency meds.

IHP Tools IHP Templates Resource Books- samples to help you create using word processing or their CD Electronic Health Records-Some programs allow for template creation that include student data, pics, parent info, nurse name, etc. Don’t try to start writing IH{‘s without resources. This past year we were able to start creating IHP’s electronically because other nurses did a lot of work on creating care plan templates for the Skyward program. I still had to learn how to create basic plans in order to edit and revise them for our district and dstudents, but their hard work helped jumpstart the process. I will be glad to share these templates, but the documents cannot be read or edited unless you upload them into the Skyward program. For those of you who don’t have Skyward but want to see what they look like, I have printed and scanned them and have them available for a short time on our Belton ISD Health Services Department webpage- under the tab IHP RESOURCES. There are several school nursing resource books that have several comprehensive IHP’S samples for lots of different health conditions. They provide lists of possible assessment questions, nursing diagnosis, outcomes/goals, nursing interventions, and evaluation questions. (Silkworth 2005, Selekman, 2013, Hootman, 2004). With the right tools and resources we can begin to develop IHP’s that help us document our nursing care for students who need our help to manage their chronic health conditions.

Skyward IHP Templates I would like to try to show you how quickly we start an IHP using our electronic health program.

IHP = Nursing Process Assessment Diagnosis Outcomes Identification/Goals Interventions Evaluation The nursing process, the standards of practice for school nursing, guide IHP’s. If we follow this process it provides comprehensive documentation of all you do for the student with special health needs. IHPs remind me to follow-up on how the student is doing. Whether you decide to use paper or electronic templates, each IHP should have these components.

Assessment Health history Current health status/management Self-care skills/needs Psychosocial status Health issues related to learning First we start with an assessment. Assessments help our IHPs to be individualized or provide data for our nursing diagnosis. Though it would be hard to develop IHP’s without written care plan templates that have condition specific questions for our parents to answer, be sure to take the time to call and or meet with them as well to help you determine how much the students and parents know about the disease and how well it is managed. The 5 main areas of assessment are health history, current health status/management, self-care skills/needs, psychosocial status, and health issues related to learning. (Herrman, 2005). The tools and books I mentioned earlier provide lots of appropriate questions for all these areas.

Assessment Health Hx: Age @ diagnosis Current: What current meds or treatments are being used and are they helping? Self-care skills/needs: Is the student able to anticipate signs& symptoms? Psychosocial status: Hoave migraines caused disruption of school activities? Health issues related to learning: What accomodations can we do at school to help? For example- here are just a few questions that a nurse could ask of a student with severe migraines. History question: How old was the student when they were diagnosed with migraines? Current management question: What current medications or treatments are being used and do you think they are helping? Self-care question: Is the student able to anticipate signs & symptoms? Psychosocial questions: Have migraines caused disruption of school activities? Academic question: What accommodations can we do at school to help?

Assessment Methods Parent letters/packets Authorizations-with condition specific questions Releases to communicate with PCP It is suggested that you have packets ready to help you with your assessments for your most common health conditions, especially those that could result in a health crisis. (Zimmerman, 2013). Upload these documents on your web-site, too. That way parents can access them before they come to meet with you. These packets can include parent & physician authorization forms with condition specific questions, as well as a letter informing the parent of the need to meet with the nurse to help with forming their plan or care. For complex health conditions we use a form called an assessment intake form to help us remember the questions to ask about all the body systems. The electronic templates we will be using this next school year have an assessment section where the assessment can be summarized on the plan. No matter whether you use electronic forms or paper forms, make sure you document an assessment for your IHP.

Assessment Methods Interviews Review of Records-SPED Schedule/ teacher assignmens Observations- physical assessment Try to obtain as much information as you can by phone before you meet with the parent and receive the appropriate paperwork. If the student is in special education, ask to review their SPED paperwork. Many times SPED has obtained Dr. notes and diagnosis. To facilitate PCP communication, we use a form called parent & physician authorization for school health services. We either send it blank and have the PCP fill it out, or sometimes we type in the orders as the parents have described and leave blanks for the PCP to fill out. This helps in obtaining a formal diagnosis. Other assessment data can be obtained by interviewing school staff. Also remember to include a copy of the student’s school schedule and their teachers/coaches before you proceed with the planning. That will help you determine when to do certain interventions to minimize time out of class and will help you to identify any staff that you might need to train. Don’t forget to interview the student. It also might help to observe them while in class to help you with gathering data for your plan. (Hermman, 2005).

North American Nursing Diagnosis (NANDA) Examples: Risk for injury related to deficiency in clotting factor Activity intolerance related to decrease cardiac output Risk for infection related to chronic condition The North American Nursing Diagnosis Association (NANDA) developed standardized nursing language called nursing diagnosis to uniformly and precisely identify health issues for which nurses are responsible. They describe the status of the student’s health problem.(Zimmerman, 2014). Many IHP templates that are written for specific health conditions will list several common diagnosis associated with that health condition. Some of these templates can be overwhelming. One IHP template I have seen for students with brain tumors provides 40 different nursing diagnosis. The only way I can survive is to keep a list of the most commonly used diagnosis for the most common health conditions we see and when needed, have a resource book available to help us when we are having to create a IHP for a student with multiple or unusual health conditions. We should choose a diagnosis that will focus first on the health issues that affect safety and are potentially life threatening and the next priority would be the student’s ability to learn and succeed in the educational setting. Some IHP templates have a blank place for you to type in the nursing diagnosis(s)for that student, while others may list several for you to choose from. Examples of some nursing diagnosis are listed on screen.

Goals/Outcomes Nursing Outcomes Classification (NOC) Student will be able to perform activities of daily living within his/her physical limits without excessive fatigue Student will have no signs & symptoms of infection Student recognizes onset of asthma IHP’s should include goals, or hoped-for outcomes that will measure behavior that is evident after a student receives certain nursing interventions. Some IHP templates separate goals and outcomes They place the goals first, then the interventions, then the expected student outcomes. Another one listed the goals, then the interventions, and then the evaluation. The electronic templates we will be using combine them in one section and use the listed outcomes to help with evaluation. Our templates will list several possible outcomes that would be appropriate for that health conditions, and the school nurse can either select the ones that apply and add others if needed. Examples of outcomes are listed on screen:

Interventions-NIC Nursing Interventions Classification Develop emergency action plan (EAP) for administration of prescribed seizure emergency medication Provide training on the application of the VNS magnet to assigned caregivers The planning phase of the nursing process is where we select the interventions that validate our nursing diagnosis. The National Interventions Classification (NIC) provides a standardized language for what nurses do and lists specific activities that nurses can select in implementing the intervention. (Hermann,2005 )(Hootman, 2004). Choose nursing interventions that will achieve the desired outcomes. Some interventions may be delegated to other staff. Example activities that would support the intervention of medication administration and safety are listed on the screen.

Evaluation Evaluate at least annually Modify plan when significant changes occur -making additions or deletions Evaluation process includes reviewing the desired outcomes. Each IHP should include a review date. It is suggested that no more than one year lapse between review times. (Schwab & Gelfman, 2001). Our electronic IHP template includes a rating scale to indicate the student’s current status for each outcome. There is also a blank box where an evaluation summary or progress note can be placed. Our goal will be at least an annual evaluation at the end of the year. Iif we don’t place this on our end of year to-do lists, I imagine it will be easy to forget. IHP’s usually do not need to be rewritten- just modified when significant changes occur. (Hermann, 2005). If you revise your IHP electronically, you want to save the old way and make it inactive so you can still see it if needed, and save the revised one as the current IHP.

Emergency Action Plan’s (EAP’s) Written in “lay” language Directions for specific potential medical emergency Share with all appropriate staff Lists caregivers & equipment/meds needed/location Include specifics for transportation or field trips Both IHP’s and EAP’s help manage health issues and are initiated by nurses. Rarely does a state statue require these plans, but professional nursing standards set the expectation. IHPs’ are written using standardized nursing language, while the EAP should be written so that staff with limited medical knowledge can understand it. The IHP should be developed first and the ECP may be a specific intervention of an IHP that deals with specific potential medical emergency. The IHP is written to guide nursing interventions- and may or may not be shared with other staff. The EAP must be shared with all appropriate staff and usually involved specific training. Their names should be listed as caregivers on the EAP. Be sure to include specific instructions if needed for transportation staff or when student is on a field trip. The EAP lists equipment and medications needed.

Individualized Education Program (IEP’s) Students eligible to receive special academic and related services Federal and state laws mandate them Requires parent participation/due process An IHP can be incorporated into or added to the IEP Not all students with IEP’s need IHP’s Individual Education Programs (IEP’s) are developed by special education staff and other district team members to deal with learning and/or educational issues and federal and state laws and rules mandate their use. They require parent participation and have a process that makes sure student and parent rights are not violated. Nurses should be invited to be a part of the team if a student’s health condition could put them at risk for not being successful at school. An IHP can be incorporated into or added to the IEP and required nursing services should be spelled out in the student’s IEP if there will be billing for services. Not every special education student needs an IHP. If a special ed student has a chronic health condition that requires daily or regular nursing care they will need an IHP. Students whose healthcare needs are to be met through an IEP may require an IHP. For example, an ADHD students with an IEP that states they will receive medication at school should have an IHP. (Brandstaetter, Leifgren & Silkworth, 2005).

Section 504 Plans Federal and state laws mandate accommodations in instruction or environment due to documented medical condition/disability Can attach the IHP, EAP to the 504 plan or use them to help write that section that includes the nursing services/accommodations provided Schools should have a process for referral Designated district administration is responsible for writing Section 504 plans when a student requires accommodations in instruction or environment to attain academic goals due to a documented medical condition. The disability is determined by whether or not the student has a physical or mental impairment which substantially limits one or more major life activities (walking, seeing, hearing, speaking, breathing, learning working, caring for oneself, performing manual tasks.” The office of civil rights is responsible for overseeing the enforcement of section 504 plans in the school setting and they have found that school districts are out of compliance if they take the position that the student’s condition is adequately managed by an IHP and find that the student is ineligible under section 504.Someimtes it takes the authority of Section 504 to obtain all the necessary accommodations needed at school. Section 504 helps to ensure accountability and communication concerning the accommodations needed. The 504 plan helps to protect their educational rights.(Zimmerman, 2013). The school district should develop procedures for identification and review of students with IHP’s for eligibility under 504.The school nurse plays a vital role in identifying and evaluating students who may be eligible for services under 504. (Gibbons, Lehr, & Selekman, (2013).

Legal: Sharing the Plan Share the plan- not a list Paper or electronic? Email or in person? Nurses should use professional judgment in deciding what is to be shared with teachers and staff for the learning and safety needs of the child- it is not enough to provide the name and diagnosis if they need to know what to do in an emergency. Professional standards demand that he nurse, with the parents and others on the team, collaborate to develop a plan detailing staff responses to specific symptoms. If the student’s condition is not serious enough to interfere with safety or learning, there is no need to share this information with teachers and staff. We should train staff to respond to all foreseeable serious health conditions. (Bergren, 2004). Our electronic health record allows teachers to see the IHPs and EAPS of their students- but not all students. We still print copies to give to teachers and remind them to place it in a confidential place. Subs need to know which students have EAP’s. Most of our nurses meet with the teachers in person to go over the EAP’s, but there have been times when our secondary nurses at a campus of 2600 students email teachers at the beginning of the year and attach the EAP because they will not have time to meet 7 teachers for each plan.

Legal Considerations: Training Nurses vs unlicensed assistive personnel District vs private-duty nurses In person vs in writing Nurses should consider which nursing tasks in the IHP can be delegated and include interventions for the training in the written plan. Nurses should collaborate with campus administrators, special ed directors, athletic trainers, and even transportation directors to identify staff that will need to be trained as caregivers so that students are safe in classrooms, in cafeterias, at swim meets, on field trips and on buses. If the nurse determines the tasks cannot be delegated, then other district nurses should be trained to cover if the nurse is unavailable. The school district has sole discretion in selecting personnel to provide its special education services and they do not have to use parent’s preferred aide or nurse (Engdale, (2013) Training should provide periodic review and opportunity of demonstration of skills so that they will be ready when needed. Most of the time we ask our bus drivers and monitors to meet individually with the school nurse at the campus and go over any EAP’s instead of just providing copies of the plans to the department.

Legal Considerations: Documentation Health condition & office visit notes can include: Assessment: physical data/current treatment/relevant history Diagnosis: the “problem” Interventions: education, staff training, EAP Response to interventions- evaluation Developing and documenting an IHP -whether it be 2 pages or 20 pages or whether it be in an electronic format or on paper is not enough. We have to implement it. If we looked at all the interventions that were required for managing our most common chronic conditions, we do lots of them, but sometimes we don’t document what we do or we document interventions like medication administration but we never evaluate how the student’s are responding to our interventions. At this point, if you don’t think you can develop an IHP as described in the textbooks, use your current documentation system to document the key components of the plan. When you enter health condition notes at the beginning of the year like for a student with asthma- take the time to write a short assessment that includes any relevant history and the current treatment the student is using. Mention the students ability to manage their chronic disease and list any interventions, like creating an EAP or training staff, in your notes. Use your office visit notes to document health teaching, parent communication, or PCP consultation about medications. If the student’s condition changes during the year, add notes to your health condition section to keep it current.

IHP If you write the Plan … …The Pee Will Stop! IHP Success Story As I was researching articles for this presentation I came across an article in 2009 that was titled: Can Individualized Health Care Plans help increase continence in children with dysfunctional elimination syndrome. That is, can an IHP help stop the pee? It made me think of the movie: Field of Dreams that had the quote: If you Build it- He will Come. But in this case- the conclusion was: If you write the plan- The PEE will stop! Whether you believe it or not, a nurse practitioner conducted a study on 13 students she was treating with dysfunctional elimination syndrome (DES)- students were having a lot of accidents at school and home. The NP collaborated with school nurses and the student’s parents to write IHP’s that were then shared with the teachers. The plans asked the teachers to do 2 things: provide free access to the bathroom when needed and allow a timed voiding schedule every 2 hours- the parents kept a log of dry days and wet days. Measurements were made before IHP development and 6 weeks afterwards. The study reported 92% of the children had increased dryness and parents reported 100% teacher support- that is they allowed the students to go to the bathroom when needed. I don’t know if you have time to do IHPs for your kids with frequent bathroom accidents, but I do know that If I take the time to write a plan and share the plan…we’ll all be more likely to do the plan. …The Pee Will Stop!

IHP Resources Skyward IHP templates retrieved from http://www.bisd.net/Domain/44 Tab: IHP Resources References American Academy of Pediatrics. (2003). The role of the school nurse in providing school health services. The Journal of School Nursing, 19(3), 127-129. I’ve placed this power point that has a list of references as well as some sample forms and care plan templates on our Our Belton ISD website. Thank you.

IHP Resources Bergren, Martha. (2004). Privacy Questions from Practicing School Nurses. The Journal of School Nursing, 20(5), pp. 296-301. Boisclair-Fahey. (2009). Can individualized health care plans help increase continence in children with dysfunctional elimination syndrome? The Journal of School Nursing, 25(5), 333-341. Brandstaetter, P., Leifgren, M, & Silkworth, C. (2005) Special Education: Other Health Impairment (OHI). In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp.59-68. Sunrise River Press: North Branch, MN. Engdale, Jennifer. (2013). Health Services for Students in Special Education. Presented at the Region 12 Education Service Center on April 11, 2013. Gelfman, M. & Schwab, N. (2000). School Health Services After Cedar Rapids Independent School District v. Garret F. The Journal of School Nursing, 16(4), 54-59. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources Gelfman, M. & Schwab, N. (2001). School health records and documentation. In Schwab, N. & Gelfman, Mary. (Eds.) Legal issues in school health services, p. 313. Sunrise River Press: North Branch, MN. Gibons, L., Lehr, K., & Selekman, J. (2013). Federal Laws Protecting Children and Youth with Disabilities in the Schools. In Selekman, J. (Ed.) School nursing: A comprehensive text, p. 257- 281. F. A. Davis Company, Philadelphia, PA. Herrman, D. (2005) Individualized healthcare plans. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp.2-4. Sunrise River Press: North Branch, MN. Herrman, D. (2005) The unique qualities and the similarities of ihps and other educational, health, and home care agency plans. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp. 7-10. Sunrise River Press: North Branch, MN. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources Herrman, D. (2005) Delegation of school nursing activities. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp. 12-13. Sunrise River Press: North Branch, MN. Hootman, J. (2004). Quality Nursing Interventions in the School Setting: Procedures, Models and Guideline, Forward, pp. VI-2-3. National Association of School Nurses, Inc.: Scarborough, ME. Hootman, J., Schwab, N., Gelfman, M., Gregory, E. & Phlman, K. (2001). School nursing practice: Clinical performance issues. In Schwab, N. & Gelfman, Mary. (Eds.) Legal issues in school health services, pp.173, 190-192. Sunrise River Press: North Branch, MN. Lenz, B. (2005) Chronic health conditions: indicators of need. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp. 109-111. Sunrise River Press: North Branch, MN. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources National Association of School Nurses (2012). Chronic health conditions managed by school nurses. Retrieved April 7, 2016 from https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/ NASNPositionStatementsFullView/tabid/462/ArticleId/17/Chronic- Health-Conditions-Managed-by-School-Nurses-Revised-January- 2012 National Association of School Nurses (2015). Individualized healthcare plans: The role of the school nurse. Retrieved April 7, 2016 from https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/ NASNPositionStatementsFullView/tabid/462/ArticleId/32/Individual ized-Healthcare-Plans-The-Role-of-the-School-Nurse-Revised- January-2015 I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources National Association of School Nurses (2014). Nursing delegation to unlicensed assistive personnel in the school setting. Retrieved April 7, 2016 from https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/ NASNPositionStatementsFullView/tabid/462/ArticleId/21/Delegatio n-Nursing-Delegation-to-Unlicensed-Assistive-Personnel-in-the- School-Setting-Revised-June-2014 National Association of School Nurses (2011). The role of the school nurse. Retrieved April 7, 2016 from http://pediatrics.aappublications.org/content/121/5/1052.full.pdf National Association of School Nurses & the American Nurses Association (2011). School nursing: Scope and standards of practice, pp. 22, 32-49. American Nurses Association: Silver Spring, MD. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources Poulton, S. & Denehy, J. (2005) Integrating nanda, nic, and noc into individualized healthcare plans. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp.25-33. Sunrise River Press: North Branch, MN. Schwab, N. & Gelfman, Mary. (Eds.)(2001) Legal issues in school health services, p.615. Sunrise River Press: North Branch, MN. Sedgwick, J. (2005) Using individualized healthcare plans with 504 plans and accommodations. In Silkworth, C., Arnold, M., Harrigan, J. & Zaiger, D. (Eds.) Individualized healthcare plans for the school nurse, pp. 69-71. Sunrise River Press: North Branch, MN. Selekman, J., Bochenek, J., & Lukens, M. (2013). Children with Chronic Health Conditions. Selekman, J. (Ed.) School nursing: A comprehensive text, pp. 700-783. F.A. Davis Company: Philadelphia, PA. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.

IHP Resources Skyward IHP Forms.(2015). Presented at the Texas Skyward State School Conference October 2015. Texas Board of Nursing. (2007) Texas Administrative Code: Rule 217.11: Standards of Nursing Practice retrieved June 3, 2017 from http://www.bon.texas.gov/rr_current/217-11.asp Texas Board of Nursing. (2014). Delegation Resource Packet. Retrieved April 8, 2016 from https://www.bon.texas.gov/practice_delegation_resource_packet. asp Zimmerman, Barbara. (2013). Student health and education plans. In Selekman, J. (Ed.) School nursing: A comprehensive text, pp. 284-314. F.A. Davis Company: Philadelphia, PA. I’ve placed some of those Skyward templates on our Belton ISD website for you to view and here are lots of fun references for your summer reading pleasure.