School Nurse = Care Coordination
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1 School Nurse = Care Coordination Linda J. Gibbons, MSN, RN, IL PEL/NCSN Lewis University, College of Nursing & Health Professions Catherine F. Yonkaitis, DNP, RN, IL PEL/NCSN University of Illinois at Chicago, College of Nursing
2 Session Objectives: Identify ways to increase collaboration between the medical home and school health personnel Describe information needed from medical provider for developing 504 plans and IEP s Review information that school nurse can provide related to daily experiences Discuss how to maintain communication among family, healthcare provider, and school nurse 2
3 Disclosures We each declare that neither one of us, or our immediate families, have a financial interest or other relationship with any manufacturer/s of a commercial product/s or service/s which may be discussed at the conference.
4 Collaboration between home, school, and healthcare providers is crucial to support student health (AAP council on school health, 2016) 4
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8 When do students benefit from care coordination? ANYTIME! ALWAYS! CONTINUOUSLY! 8
9 Care Coordination is necessary when a student needs: Episodic care Functional accommodations (504 plans) Learning accommodations (Special Education) 9
10 Coordination of care is successful when information and concerns are shared between home, school and healthcare providers. 10
11 Communication is KEY! Consent form for sharing information (HIPAA/FERPA compliant) Ongoing/ consistent Phone Electronic messaging 11
12 HIPAA compliant form contains: Basic demographic information Information to be disclosed Parent guardian signature 12
13 Who benefits from Care Coordination? Students with: Chronic conditions Complex healthcare needs Behavioral health concerns Post accident/injury Post trauma exposure? 13
14 Sharing: home/healthcare provider to School Medications Changes to dose and frequency Order for the medication Treatments (including written order) Tube feeding, Suctioning, Ventilator orders, IV s OT/PT orders DNAR Disease management through health teaching Carb count, insulin administration Inhaler use Allergen avoidance 14
15 Sharing: school to home/healthcare provider Medication: Side Effects Evaluation of effectiveness Frequency of use of PRN meds Treatments: Discuss changes in student condition Results of hearing and vision screenings Need for immunizations and physicals Share logs documenting care over time Disease management through health teaching Discuss progress and success of health teaching Coordinate plans between school & home for consistency 15
16 Non-traditional nursing support of learning: Consulting with teachers, administrators, and school support personnel Homebound status Adjusting class schedules Maintaining supplies (medications, catheters, glucometer strips) Transportation concerns Collaborating with other school health team members (one to one) 16
17 Special Education and 504 plans Some students with health concerns need care beyond a individualized health care plan (IHP). Parents and healthcare providers can request that a school district conduct an evaluation for 504 or special education support oa medical condition does not guarantee a 504 plan or an IEP. In Illinois School Code, healthcare providers can and should contribute to the student evaluation for services; the school nurse insures that the student s health concerns are addressed in the educational programming. 17
18 504 plans for students with health concerns Consultation between the school nurses, parents, and healthcare providers should take place prior to the 504 meeting. Health care providers are responsible for sharing the medical management plan for the student. This can be in the form of orders or standardized plans such as: Asthma Action plan Allergy Action plan Diabetes Medical management plan The 504 meeting is convened and the team, including the nurse and parents, meets to discuss the student s needs. If a 504 is warranted the nurse ensures that the health related accommodations are put in place and monitors the student's progress. 18
19 What is a 504 plan? A written plan, developed by the school team, including the parent to provide accommodations to allow the student to participate in learning The term comes from Section 504 of the Rehabilitation Act of
20 What is an Individualized Education Program (IEP): Federally mandated under IDEA 2004 Must qualify under one of 14 disabilities Evaluation of health is conducted when it is suspected of impacting learning. Special education services are provided to help students access their education. Students with health issues may also need health services to access learning 20
21 Comparing IEP and 504 plans: (Quintero, 2009) 21
22 Comparing IEP and 504 plans: (Quintero, 2009) 22
23 Comparing IEP and 504 plans: The 504 or IEP team including parent and nurse identifies the health related accommodations to be included in the educational plan. o Details related to this plan are included in an IHP and EAP Health-related accommodations for IEP s & 504 plans can be similar type of plan is dependent on if the students ability to learn is impacted AND meets a disability category. Students cannot have both a 504 plan and an IEP. An IEP supercedes the 504 plan 23
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27 Episodic Care: Unlikely that an IEP would be instituted for what is expected to be a short term disability. Return to School *: Post- injury (orthopedic,concussion etc) Post-Hospitalization (Medical/ Surgical or Behavioral) Post-incarceration *Provide copies of discharge summaries to school 27
28 Concussions CDC and The Illinois High School Association have various online resources Concussion treatment plans can last days or weeks! Concussion Oversight Committee/Team (must include a nurse if one is employed by district) Return to Learn Return to Play From CDC Heads Up page: 28
29 Possible accommodations for students with episodic conditions: Homebound status Class schedule adjustment (location or different time) Provide rest periods/ safe space /activity breaks Limitation or Return to Physical Eduation (AAP form) 29
30 Resource from Illinois Chapter American Academy of Pediatrics Return to school/ return to physical education form (2012) Permission to return to school Activities at school Modified activity & restrictions Healthcare provider information 30
31 Resource from Illinois Chapter American Academy of Pediatrics Classification of sports by contact Classification of sports by strenuousness 31
32 Collaboration between home, school and healthcare provider is the key! We have a shared goal: that every student to be successful! 32
33 Linda Gibbons MSN, RN, IL PEL/NCSN Lewis University College of Nursing & Health Professions Cathy Yonkaitis, DNP, RN, IL PEL/NCSN University of Illinois at Chicago 33
34 References CDC (2017). HEADS UP: Concussion at play. Center for Disease Control and Prevention. Retrieved from: Epilepsy foundation (2016). Seizure Action Plan, Retrieved from: Action-Plan.pdf HIPAA Compliant Authorization for Release of Health information. Retrieved from: CT State Department of Education, Nadine Schwab, & CT Chapter, American Academy of Pediatrics; adapted format from Ohio. Retrieved from: Illinois FOOD ALLERGY EMERGENCY ACTION PLAN AND TREATMENT AUTHORIZATION. ICAAP (2012). School return to play form Retrieved from: Kutner, M., Greenberg, E., Jin, Y., and Paulsen, C. (2006). The Health Literacy of America s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES ). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved from: 34
35 References (continued) NASN. (2016). Framework for 21 st century school nursing pracatice: National Association of School Nurses, NASN School Nurse (31) doi: Quintero, A. (2009). 504 plans: What parents should know. Muscular Dystrophy Association. Retrieved from U.S. Department of Education (2004).Individuals with Disabilities Education Improvement Act (IDEA) Retrieved from: U.S. Department of Education (2017). Protecting Students with Disabilities Frequently asked questions about Section 504 and the education of children with disabilities. Retrieved from 35
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