Related Services
SCHOOL NURSE UNDER IDEA, SECTION 504
Under IDEA (Individuals with Disabilities Education Act) and Section 504 (Section 504 of the Rehabilitation Act), children with disabilities are entitled to receive a free appropriate public education, or FAPE, in the least restrictive environment, or LRE.
RELATED SERVICES, SCHOOL NURSE (TIJANA)
A child with a disability who requires school health services or school nurse services in order to attend school and receive FAPE, must be provided those services by their school at no cost to their parents.
IDEA requires schools to provide special education and related services to students with a qualifying disability
Related services are transportation and developmental, corrective, or other supportive services that are required to help a child with a disability benefit from special education. Related services under IDEA include school nurse and school health services, which are health services designed to enable a child with a disability to receive FAPE.
School nurse services must be provided by a qualified school nurse.
School health services may be provided by a qualified school nurse or other qualified person.
Under IDEA, school districts are not required to provide medical services except for diagnostic or evaluation purposes. However, schools are responsible for providing services that are necessary to maintain the health and safety of children at school, including services for breathing, nutrition, and other bodily functions (e.g., suctioning a tracheotomy, urinary catheterization) if these services are not the type of services that must be provided by a licensed physician.
Section 504 “related aids and services” are similar to related services under IDEA. Section 504 requires schools to provide qualifying children with disabilities health-related services, including services provided by a nurse during the school the day, if necessary, to allow the child to receive FAPE.
A school’s obligation to provide nursing services includes full-time, one-on-one nursing services if that is what is necessary to provide a child with FAPE. In addition to the classroom, these services must also be provided during transportation to and from school if needed.
When a child’s IEP or 504 plan requires a school nurse to provide services, the child’s school must provide for coverage during nurse absences.
If a child has to stay home because there is no nurse to perform nursing services as outlined in the IEP or 504 plan, the child has been denied FAPE.
If the nursing services are being provided as part of the child’s IEP or 504 services, then the school has the authority to choose which agency or individual provides the services.
A parent may raise concerns about a staff member’s qualifications or the quality of the nursing services their child is receiving; however, they generally do not have the right to obtain their preferred nurse.
If a school contracts with several third party nursing agencies and allows parents a choice between the agencies, the school still remains ultimately responsible for the provision of FAPE
If a child has a medical or health need, a school nurse should ideally be involved in the IEP or 504 plan process from the beginning.
A school nurse can help ensure that all areas of need are evaluated, including health or nursing needs, explain medical evaluation data, determine the adverse impact the condition has on the child’s education, and determine the individualized health needs of the child.
SCHOOL NURSE RESPONSIBILITIES
The school nurse is the appropriate person to provide care coordination for health-related disabilities in the school setting.While the IEP team as a whole tackles the academic, developmental, social, and emotional needs of the student, the responsibility of addressing the healthcare needs of the student falls squarely on the school nurse.
When health services are determined to be necessary for students to access their educational programs, it is the school nurse’s role to provide a direct or related service in an IEP. In those cases, the school nurse is responsible for supplying specific information describing which type of health services should be provided and how often the service(s) need to be provided
Assisting in identifying students who may need special educational or health-related services/accommodations
Counseling
Assessing the identified student’s functional and physical health status in collaboration with the student, parent(s)/guardian(s), teachers and other school staff, and healthcare providers
Why is there a school counsellor and what is their role?
According to both the Individuals with Disabilities Education Act and Section 504, student with disabilities must be able to able to avail of the best support possible in order to help them succeed in and out of the classroom. As such, a counsellor is there to provide the support to help students as much as possible.
Developing IHPs and EAPs based on nursing assessments
Recommending health-related accommodations or services that may be required for the student to access the educational program
Assisting students, parent(s)/guardians, and teachers to identify and remove health-related barriers to learning
Providing in-service training for teachers and staff regarding the individual health needs of the student
Training and supervising unlicensed assistive personnel to provide specialized healthcare services in the school setting according to state delegation guidelines
Participating in transition planning, including promotion of successful post-school employment and/or education, and transition of medical care
Evaluating the effectiveness of the health-related components of the IEP and/or 504 plan with the student, parent(s), and other team members and revising the plan(s) as needed
The school nurse plays an integral role in planning, implementation, and evaluation of IEPs and Section 504 Plans. For a student with disabilities, it is the school nurse’s role to identify needed health accommodations, outline a plan of care, provide nursing services, and evaluate the health-related components of the IEP and/or 504 Plan. An IHP is written to meet professional school nurse standards
The student’s IHP and/or EAP may guide the student’s Section 504 Plan health-related accommodations. As IHPs and EAPs are fluid documents, IHPs and EAPs should not be included in an IEP but might be referenced to provide rationale for the needed service
CONCLUSION
The school nurse is the recognized healthcare expert in the school setting. School nurses have the unique knowledge and experience essential to evaluate the health of students in order to identify health-related barriers to learning and the accommodations necessary to provide access to education. School nurses work collaboratively with other team members to identify, evaluate, and develop plans for students in need of services. School nurses should be involved in and present at all meetings where an IEP and/or Section 504 plan related to a student’s health condition is being discussed and developed. School nurses are integral to ensuring the civil rights of all students so that they can achieve optimal success and well-being at school
SCHOOL NURSE SERVICES AND THE IEP
School nurses should be invited to participate in meetings to determine special education eligibility for students who have significant medical/health needs. They can help the team understand written medical reports and the possible educational impacts of the student’s health condition.
The school nurse may also conduct his/her own assessment of the student’s needs and the results would be included in the Summary of Evaluation Results (DEC 3). As appropriate, the school nurse can help the team consider and/or describe medical needs and concerns as they develop various sections of the Individualized Education Program (IEP):
Student profile
Consideration of transitions
Consideration of special factors
The student’s present level of academic and functional performance
Annual goals
Benchmarks/short-term objectives
and in other areas
If school nursing services are required for the student to benefit from the specially-designed instruction, designation as a Related Service is appropriate. In that role, the school nurse would help the IEP Team write academic or functional goals for the student that require school nurse services, such as developing self-care or health management skills
As a Supplementary Aid/Service, the school nurse can be called upon to provide training to school staff to ensure that the student can safely access all components of their educational program, including non-academic activities such as lunch, recess and field trips
The school nurse may be responsible for addressing health-related goals themselves, or integrating school nursing services to address other student goals. The school nurse would monitor and report on the student’s progress on the relevant IEP goals as specified on the student’s IEP.
They can help plan for potential health issues such as seizures, asthma attacks, allergic reactions, etc. so that school staff know who will do what, when and where, identifying both response and prevention activities when possible.
It is extremely important for significant medical and health needs be clearly and thoroughly documented on an IHP, IEP or 504 Plan and also communicated to those who will be working closely with the student
Updated information from the student’s medical provider(s) is periodically needed to keep the records and plans current and appropriate. Parents, teachers, administrators and school nurses should work as a team to ensure that children with special medical or health needs can remain safe and ready to learn.
The IDEA lists the categories of students it deems as being special needs. Any student who falls into these categories are deemed to also be able to avail of a counselor. The categories of students are as follows: autism, deaf-blind, developmental delay, emotional disturbance, hearing impairments, intellectual disability, multiple disabilities, orthopedic impairments, other health impairments, specific impairments, speech or language impairments, traumatic brain injury, visual impairments.
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The school counselor is obliged to give direct and indirect services to students who both in the Least Restrictive Environment and in an inclusive setting. They are responsible for providing school counseling lessons, these could be one on one or in a group. They should also be in communication with both the staff and the students family in order to help them understand the accommodations the student may need.
What is counseling and what does it mean?
Counseling is a service that is provided by a qualified social worker, psychologist, counselor, or other qualified personnel.
What do these services do?
Counseling services are intended to help all children in areas of academic achievement, developing self knowledge, making effective decisions and helping them improve their responsibility and maturity.
Although any students in these categories may receive counseling, their disability must have an adverse impact on their learning that requires them to need counseling.
In addition to this, the counselor is also required to help older students who may need help with preparing for their future career and education. They may be also required to advocate for their student to receive other supports and services that they feel the student may need.
The overall breakdown of what counselor does may be described as someone who offer positivie direction and positive adjustment to the student who needs it.
What type of behavior does a student who needs counseling exhibit?
A student who needs counseling may present themselves in a variety of ways.
Although there are a variety of things a counselor may be required to do, the top 5 things according to Studer and Quigney (2003) are as follows: 1. Provide individual counseling
- Meeting with admin and supervisors to provide information about supporting special needs students.
- Utilizing conflict and resolution skills to help reduce conflicts involving certain students.
- Scheduling classes, programs and services that may be of benefit to the students.
- Offer career and education counseling.
Physical Therapy
What is school-based physical therapy?
A school based physiotherapist is someone who is there to support the child to access their educational environment.
The physical therapy differs from standard physical therapy. IT is not taking place in an outpatient area of hospital. The focus of the therapy is also different. In a standard physical therapy session, the aim is to improve their physical impairments or clinical deficits.
Who qualifies to have physical therapy?
School based physical therapy is not meant to replace therapeutic physical therapy. It is there only to provide the student with the best way to access their education.
Physical therapy may only be offered in specific situations. A child who would NOT qualify for physical therapy for example would be a child with mild motor delay skills. Although they have problems and may not be able to skip or jump, they are still able to contribute in gym class. Furthermore, they can get to and from their classroom with any issue and work in the classroom with out a problem. Due to this, they would NOT qualify.
A student who would qualify is someone who is struggling to navigate the school. A child who is in danger of causing harm to themselves by falling over, bumping into something while they move. The student may also need help to get in and out of their seat in the classroom or to reach certain materials.
A student who has low muscle tone or muscle weakness would also qualify. This would result in the student being unable to be seated in the chair or have difficulty maintaining an upright posture.
According to federal law, every child is entitled to have the best means possible to help them succeed in the classroom. The benefit of physical therapy is that it allows them to participate fully in the school.
What is the process of a student getting a physical therapist?
If the student is struggling in the classroom or school, they can be recommended for physical therapy. They can recommended by a number of the stake holders.
The people who can recommend are a teacher, caregiver, teacher or member of staff. If the Childs pediatrician recommends physical therapy, then that may also accepted.
Once a child has been deemed to be potentially in need of physical therapy then they will go through a screening process. The screening process could include a variety of members o f the school healthcare professionals. The social worker, school psychologist and physical therapist. The physical therapy will be part of their IEP. They will have goals set and will have frequent check ins to see how the child is progressing.
What happens in a typical physical therapy session?
Physical therapy can be either push in or pull out sessions.
During a pull out session, the student is removed from the classroom and goes to separate room or facility in order to do their therapy.
Depending on the issues the student has, the exercises will vary. Generally, the therapy will work on helping the students to improve their strength, range of motion and balance.
Students who have difficulty walk may have gait training, this would be to help them navigate the school safely and help them be less of a danger to themselves.
Push in therapy could involve games or centre activities that work on fine motor skills.
The physical therapist can also offer advice to the parents. They can give the student exercises to do at home to help them progress. The parent can also talk to the therapist and the IEP coordinator to make sure the child is on track.
For young students, it could be play based physical therapy. Examples of this would be having stundets building a structure with big Lego blocks. This would work their fine motor skills. Also it would strengthen their core as they squat and stand to pick up and move blocks.
For older students, this is more difficult to do. If the student is working on issues related to balance, strength and coordination, then pull out is the best option. Also, as the child gets older, they may prefer to work on these deficiencies in a more private area.
Physical therapy can differ somewhat to other related services. Given that the student may need to work on strength and balance, this could be quite difficult and distracting for others to do in the classroom. If for example the student is working on walking up and down stairs, or possibly even skipping, then it really needs t happen outside the classroom.
Pet Therapy
Our newest addition at school that was offered by the school nurse and benefits all of the students including students with special needs
What is PET THERAPY
Pet therapy is a guided interaction between a person and a trained animal. It also involves the animal’s handler. The purpose of pet therapy is to help someone recover from or cope with a health problem or mental disorder.
Pet therapy is also referred to as animal-assisted therapy (AAT). AAT is sometimes confused with animal-assisted activities (AAA). AAT is a formal, structured set of sessions that helps people reach specific goals in their treatment. AAA involves more casual meetings in which an animal and its handler interact with one or more people for comfort or recreation.
Benefits from Pet Therapy
Pet therapy builds on the pre-existing human-animal bond. Interacting with a friendly pet can help many physical and mental issues. It can help reduce blood pressure and improve overall cardiovascular health. It can also release endorphins that produce a calming effect. This can help alleviate pain, reduce stress, and improve your overall psychological state.
The goals of a pet therapy program can include:
Pet therapy can be used in many different ways. Defined objectives are an important part of therapy, and your progress will be recorded and tracked at structured sessions.
improving motor skills and joint movement
improving assisted or independent movement
increasing self-esteem
increasing verbal communication
developing social skills
increasing willingness to join in activities
improving interactions with others
motivating willingness to exercise
Other benefits of pet therapy include:
making you happier, lessening depression, and improving your outlook on life
decreasing loneliness and isolation by giving you a companion
reducing boredom
reducing anxiety because of its calming effects
helping children learn empathic and nurturing skills
improving the relationship between you and your healthcare provider
WHO should consider Pet Therapy
Pet Therapy can be useful for
people undergoing chemotherapy
residents in long-term care facilities
people hospitalized with chronic heart failure
veterans with post-traumatic stress disorder
children having physical or dental procedures
stroke victims and people undergoing physical therapy to regain motor skills
people with mental health disorders
Before an animal and its handler can participate in pet therapy, the team has to fulfill certain requirements. This process typically includes:
a physical examination of the animal to confirm that it’s immunized and free of diseases
an obedience training course to ensure proper animal control
an instructional course to teach the trainer about interaction with other people
an evaluation of the animal’s temperament and behavior with the handler
a certification from the sponsoring organization
How is Pet Therapy administered
What are examples of a counseling session?
There can different types of conuseling sessions. These will vary depending on the need of the student. The main goal can be academic, social/behavior or career.
Guidance Curriculum
Guidance curriculum would have lessons that follow the standards the are being taught in the classroom. The goals would be to help the student with their knowledge acquisition and application of the knowledge that they are learning in the classroom. Thee would in small/large group and be the least intensive for of counseling.
Responsive services
Individual planning/system support
These services are for students who need to have urgent matters addressed. This would be to teach student skills to help them overcome their learning difficulties. This would be in a one to one setting. The counselor would help the student develop confidence and motivation. In this type of situation, the student may need help I controlling their feelings and understanding the feelings of others.
This would involve the student working less on the standards that are followed in the classroom.
The Counselor needs to follow the standards of the American School Counselor National Standards for Students.
Student who are not being social, stuggling to finish homework, frequently late to class, having difficulty form friendships may be recommended to have counseling. These student may require one to one counseling to help them achieve a better state of mind.
Any of the above mentioned students can avail of counseling. In the case of autistic students, the counselor could work on helping them focus in class and try to control emotions.
Students with emotional disturbances could also have counseling sessions related to controlling emotions and understanding the feelings of others.
Counseling seesions should generally not be longer than 20-30 minutes. There needs to be clear guidelines from the start.
The counseling session should always have a clear goal that the student is told about before the session starts. It should also take place in an environment that is free of distractions. There should be a variety if manipulative and sensory toys/equipment available to the student depending on their needs.
Student who are in elementary school and are low on confidence, possibly due to their disability may also be referred for counseling. They may need help with learning strategies or self-management. This could be done in a small group or the student could be given strategies to help them succeed in the classroom.