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Students with chronic and complex healthcare needs often require specialized care at school to help ensure their health and safety. An Individual Health Plan may be developed by the school nurse as part of the IEP or a Section 504 Plan to specifically address your child's medical needs in the school setting.
The Complex Care Center at Cincinnati Children's provides resources to help families find the special education supports they need.
When healthcare needs impact the school day, an Individual Health Plan can be written as a related service provided by an IEP or as an accommodation under a Section 504 Plan. The school nurse helps identify students whose health needs affect their daily functioning and their ability to access the school curriculum. This usually includes students who:
The Individual Health Plan is developed by the school nurse. This care plan should be written with the input and approval of the primary care physician and / or your child's other health providers. The plan identifies the medical needs that the child has at school and how those needs will be met. The team should look at the nature and complexity of the health care need, such as suctioning, ventilator support or tube feeding and recommend the level of nursing or assistive personnel required to ensure the health and safety of the child.
The team should consider supports needed during the entire school day, including the classroom, physical education, the school bus, behavior needs, field trips, and extracurricular activities.
Your school is obligated to provide the necessary school health services without cost to you. However, the school can ask you to pay for part or all of the health services through a financial assistance program such as your Medicaid, private insurance or other sources of funding, but only if this will not reduce your benefits or create additional cost to you. It is up to you to decide whether you will use these outside resources.
The Individual Health Plan will often require frequent updating as changes in the child's medical condition and needs occur. You can request an IEP or 504 Plan meeting at any time to address your concerns.
The Individual Health Plan should detail the nursing services that will be required in the school environment. There are a variety of options for nursing care, ranging from using an on-site school nurse for intermittent needs to assigning a dedicated one-to-one nurse for the entire school day. Some school districts may use Licensed Practical Nurses or aides who are supervised by a Registered Nurse.
When planning for nursing in the school environment it is important to consider:
Sometimes a family can use the same nurse before, during and after school. In this situation, before and after school nursing care is often paid for under a financial assistance program such as a home care benefit, a public waiver program or by private insurance. However, many school districts are beginning to hire their own nursing staff as a cost cutting strategy. As a result, families often face the challenge of providing nursing in the home to cover before and after school hours. This can be challenging because nurses are sometimes unwilling to work these short and fragmented shifts. Therefore, some families have selected home instruction on their child's IEP to avoid this dilemma.
The Individual Health Plan should include instructions on how to address the child's specific medical needs during an emergency, such as fire drills, power failures and school lockdowns. Access to building exits, the need for additional staff support and emergency response time by school nursing and /or local ambulance service should be considered.
Your physician is key in helping you obtain the school health services and supports your child needs. Ask your child's doctor to contact your school to communicate the health services and staffing support necessary for your child to:
The Medicaid School Program can reimburse participating schools for related services provided to Medicaid-eligible students. Services must be identified in the IEP and can include nursing, occupational therapy, physical therapy, speech therapy, specialized medical transportation and medical equipment and supplies for use only in school.
It is possible for a family's current Ohio Home Care waiver provider to go to school with the child if the team determines that the IEP is not adequate to ensure the child's health and welfare.
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