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Planning for Students with Special Needs
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CONFLICT OF INTEREST / COMMERCIAL SUPPORT DISCLOSURE
This educational activity is being presented without the provision of commercial support and without bias or conflict of interest from the planners and presenters.
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LECTURE OBJECTIVES Understand the federal laws that affect students with chronic health conditions or physical impairments. Develop an individualized health care plan, an emergency care plan, or both for students who have special needs. Understand how the Individuals With Disabilities Education Improvement Act, the Americans With Disabilities Act, and Section 504 of the Rehabilitation Act relate to the various care plans. Understand the implications and special challenges posed by pediatric do not resuscitate (DNR) orders.
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YOUR ROLE IN PLANNING SPECIAL CARE
Students have diverse medical conditions & needs Asthma Cancer Diabetes Genetic Disorders Immunologic Disorders Life-threatening Allergies Neurologic Disorders Mental Health Disorders Orthopedic Disorders
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FEDERAL LEGISLATION AFFECTING CARE OF STUDENTS IN SCHOOOL
The Individuals with Disabilities Education Improvement Act of 2004 [IDEA] The Americans with Disabilities Act of 1990 [ADA] The Rehabilitation Act of 1973, Section 504
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PLANS THAT ADDRESS FEDERAL MANDATES
Individualized Health Care Plans [IHP] Individualized Emergency Care Plans [ECP] 504 Accommodation Plans
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IHP: INDIVIDUALIZED HEALTH CARE PLAN
Cannot be delegated For any student with a chronic health condition Takes medication at school Requires environmental modifications in order to attend school, including Participation in field trips Participation is school-sponsored activities Safe, swift evacuation during an emergency
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PLAN DEVELOPMENT Assessment/History Nursing Diagnosis
Outcome Identification Planning Implementation Evaluation
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PLAN USE & MAINTENANCE IHPs are only as useful as the information they contain Make an accurate, detailed plan Review regularly Update as changes occur IHP will be especially valuable When another nurse substitutes for you If you move to another position If the student moves to another school
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ECP: INDIVIDUALIZED EMERGENCY CARE PLAN
Medical condition, medications, allergies, equipment and supplies Signs and symptoms of an exacerbation of the condition Step-by-step action for each presenting problem Appropriate response for escalating situations Chain of command for managing the emergency at school Contact information parent/guardian secondary contact person primary care physicians specialists for consultation Request for transport to a specific ED for specialized care
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ECP: DEVELOPMENT & USE Collect Information Confirm the Information
Prepare the ECP Instruct the Staff Provide for Access to the ECP Monitor the Student’s Progress Communicate with the Parent/Guardians
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COORDINATING WITH EMS PREPLANNING WITH LOCAL EMS Potential emergencies
Special equipment DNR Permitted Response to Cardiac Arrest or Respiratory Distress Transport Destination (Hospital or Home) Who Will Pronounce Death
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504 PLANS Physical or mental impairment that Record of this impairment
Substantially impedes at least one ADL Record of this impairment Diagnosis Impairment as defined in Section 504
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504: DEVELOPMENT & USE Include in the plan
Reason for concern Basis for determining disability How the disability affects ADLs Services, assistive devices, and accommodations the student will require Date for review and reassessment of the List all specific individuals involved in planning Name & contact information of the case manager Implement the plan in the classroom
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DNR ORDERS Written medical order Name of the student
Name and signature of the physician Effective date “Do Not Resuscitate” clearly spelled out Signature documenting consent by the legally recognized decision-maker No Abbreviations
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DNR PROVISIONS Provides for comfort care
Limits resuscitative interventions Works with ECP Specific actions permitted Transport destination Parent or guardian develops transport plan with EMS Incorporate school, state and local guidelines
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SUMMARY IHPs Personalized care instructions
Encourage goals with measurable outcomes ECPs Specific care in emergencies 504s Ensure appropriate accommodations for students with disabilities who do not qualify for special education services Keep all plans accessible, reviewed, and up-to-date
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RESOURCES SNEMS-C Manual Chapter 14, pp 343-356 Key points, p 595
Appendices A and B
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QUESTIONS?
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