1. NEW STANDARDS TO CONSIDER Expanded definition of major life activities Substantial limitation -- without mitigating measures Substantial limitation – during exacerbation

2. IMPLEMENTING STANDARDS Develop form with standards imbedded Use consistent team members Provide staff training on each professional’s role; repeat annually Prepare before a Section 504 meeting; gather medical and educational data to inform decisions

3. 504 FORM Provides a meeting agenda Defines the standards to be applied Guides discussion regarding eligibility Sets format of 504 plan(s) Provides option for eligibility without a plan

4. Major Life Activities Reading, concentrating thinking, communicating Operation of a major bodily function, e.g., functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions eating walking seeing hearing speaking breathing caring for oneself performing manual tasks working learning other

5. Determining eligibility: degree to which impairment limits a major life activity 5 Extremely 4 Substantially 3 Moderately 2 Mildly 1 Negligibly From Perry A. Zirkel The Special Educator, 1997, 13 (3), 6-9

6. Criteria for Assessing Substantial Limitation Severity of impact on the major life function Daily impact versus once in a long time Duration of the physical or mental impairment over time (days or weeks versus months, years, undetermined)

7. Case study 1 – Food Allergy Kindergarten student with history of positive Rast testing for peanuts, tree nuts, milk, eggs and sesame. Parent requesting child to have Epi-Pen in back pack and a Section 504 plan. No known history of asthma or anaphylaxis; Rast test strongly positive, history of hives to touch.

8. Case study 1 – Food Allergy At 504 eligibility meeting, new history presented by parent: Recent anaphylactic reaction On daily medication for seasonal allergies On daily steroid inhalant medication Currently being evaluated for asthma

9. Case study 2 – Diabetes Fifth grade student with diabetes using a pump for insulin delivery. She has stable health status and is doing well with self-care management skills. In 3 rd and 4 th grades she had an IHCP, IEP and ITP. Now parent is requesting 504 identification and new accommodations related to learning, including extended time on tests, frequent bathroom breaks for tests, rescheduling of any tests if high or low, BG level at time of test documented on the exam.

10. Case 3 – Field Trip Parents of four special education students with multiple disabilities and significant medical issues that require immediate nursing intervention for management, ask to have their children included in a sixth grade Nature’s Classroom overnight camp

11. Medical Considerations Distance to camp facility (hour and half) Response of ambulance to van (en route) Response time of ambulance to camp facility Response time of nurse at camp Seasonal allergies Temperature – no air conditioning 24-hour medications; emergency medications Medical clearance from physician New staff members Dietary needs Other

12. Environmental Considerations Amount of walking around facility Limited places to rest Uneven terrain Field group activities take place in the woods Activities continue in all weather conditions (rain/shine) Length of day (7:00AM – 9:00PM) Bathroom locations Endurance Activity tolerance Other

13. Nighttime Considerations Sleep safety (rails, other) Behaviors Nighttime supervision needs Personal care (showering, brushing teeth, dressing) Other

14. STANDARDS TO CONSIDER Expanded definition of major life activities Substantial limitation without mitigating measures

15. IMPLEMENTING STANDARDS Develop form with standards imbedded Use consistent team members Provide staff training on each professional’s role; repeat annually Prepare before a Section 504 meeting; gather medical and educational data to inform decisions