individualized healthcare plan

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Individualized Individualized Healthcare Healthcare Plan Plan Family to Family Family to Family Health Information Center Health Information Center PTI Nebraska PTI Nebraska 888-490-9233 888-490-9233 Or 402-403-3908 (new Or 402-403-3908 (new number) number)

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Individualized Healthcare Plan. Family to Family Health Information Center PTI Nebraska 888-490-9233 Or 402-403-3908 (new number). Parent Training and Information Nebraska. PTI Nebraska is a statewide resource for families of children with disabilities and special health care needs. - PowerPoint PPT Presentation

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Page 1: Individualized Healthcare Plan

IndividualizedIndividualizedHealthcareHealthcare

PlanPlanFamily to FamilyFamily to Family

Health Information CenterHealth Information CenterPTI NebraskaPTI Nebraska888-490-9233888-490-9233

Or 402-403-3908 (new Or 402-403-3908 (new number)number)

Page 2: Individualized Healthcare Plan

Parent Training and Parent Training and Information NebraskaInformation Nebraska

PTI Nebraska is a statewide resource PTI Nebraska is a statewide resource for families of children with for families of children with disabilities and special health care disabilities and special health care needs.needs.

• PTI Nebraska's staff are parent/professionals PTI Nebraska's staff are parent/professionals • PTI Nebraska conducts relevant workshops across PTI Nebraska conducts relevant workshops across

the state. the state. • PTI Nebraska has printed and electronic resources PTI Nebraska has printed and electronic resources

available at no cost. available at no cost. • PTI Nebraska encourages and supports parents in PTI Nebraska encourages and supports parents in

leadership roles locally and statewide.leadership roles locally and statewide.

Page 3: Individualized Healthcare Plan

Parent Training and Parent Training and Information NebraskaInformation Nebraska

• You are encouraged to You are encouraged to contact us or visit the office contact us or visit the office if:if:

• You would like information about You would like information about your child's disability your child's disability

• You have a question about your You have a question about your child's special education program child's special education program

• You would like to schedule a You would like to schedule a workshop in your community workshop in your community

• You would like to talk to another You would like to talk to another parent parent

www.pti-nebraska.orgwww.pti-nebraska.org

Page 4: Individualized Healthcare Plan

Family to FamilyFamily to FamilyHealth Information CenterHealth Information Center

PTI Nebraska is home to the Family to Family PTI Nebraska is home to the Family to Family Health Information Center Health Information Center

Funded by:Funded by:

• U.S. Dept of Health and Human ServicesU.S. Dept of Health and Human Services

• Health Resources and Services Health Resources and Services AdministrationAdministration

• Maternal and Child Health BureauMaternal and Child Health Bureau

• Division of Services for Children with Special Division of Services for Children with Special Health NeedsHealth Needs

Page 5: Individualized Healthcare Plan

Family to FamilyFamily to FamilyHealth Information CenterHealth Information Center

We provide information about:We provide information about:

•Health evaluations for children with Health evaluations for children with special health care needsspecial health care needs

•Medical care optionsMedical care options

•Medical care funding optionsMedical care funding options

•Appeals for denial of servicesAppeals for denial of services

•Connections with other familiesConnections with other families

•Health Care and the schoolHealth Care and the school

•Call Nina Baker – 402.403.3908 or Call Nina Baker – 402.403.3908 or

Toll Free 1-888-490-9233Toll Free 1-888-490-9233

Page 6: Individualized Healthcare Plan

What we will learnWhat we will learn

• What is skilled medical careWhat is skilled medical care

• What is included in an Individualized What is included in an Individualized Healthcare plan (IHP)Healthcare plan (IHP)

• Who is responsible for the Who is responsible for the development of the IHPdevelopment of the IHP

• What is the parent’s role in the IHPWhat is the parent’s role in the IHP

Page 7: Individualized Healthcare Plan

What is Skilled Medical What is Skilled Medical Care?Care?

– Urinary catheterizationUrinary catheterization– Gastrostomy tube feedingsGastrostomy tube feedings– Tracheostomy caresTracheostomy cares– Medication by route other than oral, Medication by route other than oral,

topical, inhalation, and instillationtopical, inhalation, and instillation– Care for students with diabetesCare for students with diabetes– Invasive procedures of any typeInvasive procedures of any type– Procedures used on an as needed basis Procedures used on an as needed basis

including when it is or isn’t neededincluding when it is or isn’t needed

Page 8: Individualized Healthcare Plan

Individualized Healthcare PlanIndividualized Healthcare Plan(IHP)(IHP)

•Is a written plan of careIs a written plan of care– For a student whose For a student whose

special health care needsspecial health care needs• Require attention and Require attention and

services during the school services during the school dayday

• May require emergency or May require emergency or crisis interventioncrisis intervention

• Impact the student Impact the student performance or presence at performance or presence at schoolschool

Page 9: Individualized Healthcare Plan

Individualized Healthcare PlanIndividualized Healthcare PlanPurpose:Purpose:

• Communicate health/medical safety Communicate health/medical safety needsneeds– In school, including field trips and In school, including field trips and

extracurricular activitiesextracurricular activities

• Specify emergency interventionsSpecify emergency interventions

• Consider the range of interventions to Consider the range of interventions to support student success, (school nurse)support student success, (school nurse)

• Articulate the expected actions of school Articulate the expected actions of school personnel and expected outcomes personnel and expected outcomes

Page 10: Individualized Healthcare Plan

Materials ProvidedMaterials Provided• The Individualized Healthcare Plan (IHP)The Individualized Healthcare Plan (IHP)

A Tool for SchoolsA Tool for Schools

• Decisions about nursing care at schoolDecisions about nursing care at school

• Making Decisions about Assigning Skilled Medical Making Decisions about Assigning Skilled Medical Procedures/Nursing Interventions at School: Procedures/Nursing Interventions at School: Guidance for School AdministratorsGuidance for School Administrators

Additional materialsAdditional materials

• Evacuation ConsiderationsEvacuation Considerations

• School Nurse QualificationsSchool Nurse Qualifications– Kathy Karsting, RN, MPH, DHHS School Health ProgramKathy Karsting, RN, MPH, DHHS School Health Program

Page 11: Individualized Healthcare Plan

Development of the IHPDevelopment of the IHP

• The Registered Nurse is responsible – The Registered Nurse is responsible – for the student requiring specialized for the student requiring specialized care at schoolcare at school

• Only the Registered Nurse is Only the Registered Nurse is qualified and credentialed in qualified and credentialed in Nebraska to delegate decisionsNebraska to delegate decisions

If there is no school nurse…If there is no school nurse…

Page 12: Individualized Healthcare Plan

If there is no school nurse…If there is no school nurse…

• Delegation decisions require a Registered Delegation decisions require a Registered NurseNurse

• Neither parent, administrator, nor physician is Neither parent, administrator, nor physician is qualified to delegate and provide training and qualified to delegate and provide training and supervision of unlicensed personsupervision of unlicensed person

• Registered Nurse (RN) may be a volunteerRegistered Nurse (RN) may be a volunteer• Local health dept may employ a nurse to Local health dept may employ a nurse to

consult to the local schoolconsult to the local school• Dept of Health and Human Services, School Dept of Health and Human Services, School

Health program employs an RN FOR Health program employs an RN FOR CONSULTATIONCONSULTATION

Page 13: Individualized Healthcare Plan

Development of the IHP?Development of the IHP?

• Parent expectations and contributions to Parent expectations and contributions to the IHP are criticalthe IHP are critical– To assure student safety and wellbeingTo assure student safety and wellbeing– Build essential relationship of trust between Build essential relationship of trust between

school and familyschool and family• The IEP or 504 team contributions must The IEP or 504 team contributions must

also be considered to assure the IHP will be also be considered to assure the IHP will be effectively implemented This includes that:effectively implemented This includes that:– School personnel is informed and preparedSchool personnel is informed and prepared– Medical procedures are integrated into the Medical procedures are integrated into the

student’s school daystudent’s school day

Page 14: Individualized Healthcare Plan

Development of the IHP?Development of the IHP?

• All medical All medical procedures and procedures and interventions must interventions must be legally be legally authorized by authorized by prescriberprescriber

• There is no There is no requirement for requirement for physician review or physician review or authorize of the IHPauthorize of the IHP

Page 15: Individualized Healthcare Plan

Components of the IHPComponents of the IHP

The IHP is student specific and includes:The IHP is student specific and includes:• Diagnosis or conditionDiagnosis or condition• Current Statement of assessmentCurrent Statement of assessment

– AgeAge– Stage of developmentStage of development– Cognitive abilityCognitive ability– Communication abilityCommunication ability– MobilityMobility– Evacuation needs – (ex. fire drills)Evacuation needs – (ex. fire drills)

Page 16: Individualized Healthcare Plan

Components of the IHPComponents of the IHP

Step by step description of Step by step description of procedures/intervention should procedures/intervention should include:include:

• Routine and predictable needsRoutine and predictable needs– Specific School personnelSpecific School personnel– Incorporate accepted standards of Incorporate accepted standards of

nursing and medical carenursing and medical care– Expected OutcomesExpected Outcomes

Page 17: Individualized Healthcare Plan

Components of the IHPComponents of the IHP

• Emergency Emergency care/procedures/interventionscare/procedures/interventions– Prevention and early interventionPrevention and early intervention– Expected outcomesExpected outcomes

•Recognition of expected response Recognition of expected response

•Observable signs that emergency Observable signs that emergency interventions are neededinterventions are needed

•““What to do next” is writtenWhat to do next” is written

•School personnel identifiedSchool personnel identified

•Specific skills/interventions describedSpecific skills/interventions described

Page 18: Individualized Healthcare Plan

Promotion of Self-Care Promotion of Self-Care & TRANSITION SKILLS& TRANSITION SKILLS• Student age and developmentally Student age and developmentally

appropriate needs for learning self-careappropriate needs for learning self-care• Communication to an adultCommunication to an adult• Self management of complex conditionSelf management of complex condition

Promote psychosocial development:Promote psychosocial development:• Student needs, age, cognitive Student needs, age, cognitive

developmentdevelopment• Draw from family communication, Draw from family communication,

prioritiespriorities

Page 19: Individualized Healthcare Plan

Documents Related to the IHPDocuments Related to the IHP• Parent/guardian written consentParent/guardian written consent

– The parent is the guardian for legal The parent is the guardian for legal purposespurposes

• Medical authorizationsMedical authorizations– Must be in writing and renewed when Must be in writing and renewed when

student condition changes or at the student condition changes or at the beginning of each school yearbeginning of each school year

– Prescriptive authority belongs only to Prescriptive authority belongs only to physicians, physician assistants & physicians, physician assistants & advance practice registered nursesadvance practice registered nurses

Page 20: Individualized Healthcare Plan

Documents Related to the IHPDocuments Related to the IHP• Medical authorizations – (continued)Medical authorizations – (continued)

– A statement of medical authorization A statement of medical authorization from the prescriber is needed if medical from the prescriber is needed if medical decisions are to be made “per parent”decisions are to be made “per parent”

• Procedural guidelines and relevant Procedural guidelines and relevant policies – consistent with standards policies – consistent with standards of practice and Nebraska statutes.of practice and Nebraska statutes.

Page 21: Individualized Healthcare Plan

Open Communication between Open Communication between parent, school nurse parent, school nurse

and medical provider facilitates and medical provider facilitates both quality and continuity of both quality and continuity of the provision of the student’s the provision of the student’s

essential health careessential health care

Page 22: Individualized Healthcare Plan

Documents Related to the IHPDocuments Related to the IHP• Consent for release of informationConsent for release of information

– Facilitates open communicationFacilitates open communication– Not required for implementation of IHPNot required for implementation of IHP– Families have responsibility to provide Families have responsibility to provide

information and access to information information and access to information about their childabout their child

– An IHP can be developed without parent An IHP can be developed without parent input, but this is not idealinput, but this is not ideal

Page 23: Individualized Healthcare Plan

IHP Relationship to IEPIHP Relationship to IEP

• The IHP should be named and referenced The IHP should be named and referenced in the IEP, but should stand apart from the in the IEP, but should stand apart from the IEPIEP– IHP must be available to parent and school IHP must be available to parent and school

nurse to revise as needednurse to revise as needed– IHP available to IEP team to address related IHP available to IEP team to address related

services on IEPservices on IEP– Address areas of “overlap” on the documentsAddress areas of “overlap” on the documents– Plans need to collaborate and coordinate to Plans need to collaborate and coordinate to

build trust and confidencebuild trust and confidence

Page 24: Individualized Healthcare Plan

IHP Relationship with 504 IHP Relationship with 504 Plan?Plan?• The IHP may be the basis of need for a 504 The IHP may be the basis of need for a 504

PlanPlan• IHP establishes medical necessity and IHP establishes medical necessity and

appropriateness of accommodationsappropriateness of accommodations• Educational accommodations beyond the Educational accommodations beyond the

scope of the IHP need to be addressed in a scope of the IHP need to be addressed in a 504 plan such as:504 plan such as:– Accommodations to leave to test blood sugar and Accommodations to leave to test blood sugar and

return, like timed testing in all school assessmentsreturn, like timed testing in all school assessments– Accommodations during classroom activities due to Accommodations during classroom activities due to

medical needmedical need– Addressing excessive absence due to medical needAddressing excessive absence due to medical need

Page 25: Individualized Healthcare Plan

How 504 Plans work for How 504 Plans work for students with Hidden students with Hidden DisabilitiesDisabilities• Special consideration to Special consideration to

accommodate needsaccommodate needs

• Modify test arrangements – SAT/ACTModify test arrangements – SAT/ACT

• Provide for note taking or writing Provide for note taking or writing accommodationsaccommodations

• Chronic medical needs – parking Chronic medical needs – parking space, time between class,space, time between class,

Page 26: Individualized Healthcare Plan

How 504 Plans work for How 504 Plans work for students with Hidden students with Hidden DisabilitiesDisabilities• Diabetes – class scheduling for Diabetes – class scheduling for

needs, time for care, needs, time for care,

• Time for counseling, therapyTime for counseling, therapy

• Seizures – Accommodate individual Seizures – Accommodate individual needsneeds

• Adapted physical education programAdapted physical education program

Page 27: Individualized Healthcare Plan

Questions?Questions?

Page 28: Individualized Healthcare Plan

Role of the Role of the School NurseSchool Nurse

Contact Carol Tucker, RNContact Carol Tucker, RN

School and Child Health School and Child Health ProgramProgram

DHHS Division of Public DHHS Division of Public Health, School Health Health, School Health

ProgramProgram

[email protected]@dhhs.ne.gov

Page 29: Individualized Healthcare Plan

Nurse Practice ActNurse Practice Act

• Defines the practice of nursingDefines the practice of nursing– Nebraska Administrative Code (NAC) 99 Nebraska Administrative Code (NAC) 99

states only RNs may delegate intervention states only RNs may delegate intervention to be performed by non-nursesto be performed by non-nurses

– Individual tasks labeled as nursing done Individual tasks labeled as nursing done by non-nurses is unlawful – nursing by non-nurses is unlawful – nursing without a licensewithout a license

– School employees who perform medical School employees who perform medical care for children with medical needs are care for children with medical needs are under Nurse Practice Actunder Nurse Practice Act

Page 30: Individualized Healthcare Plan

Nurse Practice ActNurse Practice Act

• Complex interventions require nursing Complex interventions require nursing judgment to alter standards of care in judgment to alter standards of care in accordance with need of a student may accordance with need of a student may not be delegated to non-nursesnot be delegated to non-nurses

• Non-complex interventions can safely be Non-complex interventions can safely be performed. They do not require performed. They do not require alteration of standard of care when alteration of standard of care when results and student responses are results and student responses are predictablepredictable

Page 31: Individualized Healthcare Plan

School Nurse is EssentialSchool Nurse is Essential

• School nurse develops the IHPSchool nurse develops the IHP– Including identification of responsibilities of Including identification of responsibilities of

(medically) (medically) unlicensedunlicensed school personnel school personnel– If there is no nurse??? See slide #12If there is no nurse??? See slide #12

• For Students who are:For Students who are:– not medically stablenot medically stable– New to school/environmentNew to school/environment– Require complex interventionsRequire complex interventions– Require staffing in schoolRequire staffing in school

Page 32: Individualized Healthcare Plan

School Nurse is EssentialSchool Nurse is Essential

• Families may request use of a Families may request use of a trusted teacher or para professionaltrusted teacher or para professional– May or may not be feasibleMay or may not be feasible– School is responsible for decision of School is responsible for decision of

assignmentassignment– Decisions should be lawful for safety Decisions should be lawful for safety

and medical wellbeing of studentand medical wellbeing of student

Page 33: Individualized Healthcare Plan

NAC Title 172 Chapter 99NAC Title 172 Chapter 99

Keep in mindKeep in mind

• Nurse Practice Act does Nurse Practice Act does not apply to:not apply to:– Self careSelf care– Family home care or Family home care or – When care is not at a level When care is not at a level

requiring nursing judgment requiring nursing judgment or skillor skill

Page 34: Individualized Healthcare Plan

Individuals with DisabilitiesIndividuals with DisabilitiesEducation Act (IDEA)Education Act (IDEA)

• School health services is a related School health services is a related serviceservice

• IEP team determines need for related IEP team determines need for related services for a child to benefit from services for a child to benefit from special education program, those special education program, those services must be providedservices must be provided

• School health services are provided School health services are provided by a qualified school nurse or other by a qualified school nurse or other qualified personqualified person

Page 35: Individualized Healthcare Plan

Questions?Questions?

Page 36: Individualized Healthcare Plan

Interventions at School:Interventions at School:Guidance for School Guidance for School AdministratorsAdministrators

Page 37: Individualized Healthcare Plan

To School AdministratorsTo School AdministratorsAn IHP:An IHP:• Is not required by all students with Is not required by all students with

medical diagnoses or conditionsmedical diagnoses or conditions• Is for interventions medically necessary Is for interventions medically necessary

during the school dayduring the school day– In order to maintain health, safety, ability to In order to maintain health, safety, ability to

perform at schoolperform at school– With written authorization from doctorWith written authorization from doctor– With parent consent obtain additional With parent consent obtain additional

medical history – (to establish medical medical history – (to establish medical necessity)necessity)

– Includes Skilled Medical Procedures (slide 7)Includes Skilled Medical Procedures (slide 7)

Page 38: Individualized Healthcare Plan

Talk with your School Talk with your School AdministratorAdministratorSo plans can be made for your So plans can be made for your childchild• Staff assignment and training Staff assignment and training

considerations are made by administrationconsiderations are made by administration– Assignment may be outside the usual dutiesAssignment may be outside the usual duties– Specialized training requiredSpecialized training required– Staff should feel comfortable with additional Staff should feel comfortable with additional

assignment to provide medical careassignment to provide medical care– Gender and strength consideration applyGender and strength consideration apply– Adequate planning for substitute or other Adequate planning for substitute or other

unplanned changesunplanned changes

Page 39: Individualized Healthcare Plan

Talk with your School Talk with your School AdministratorAdministratorSo plans can be made for your So plans can be made for your childchild• ConsiderationsConsiderations

– Parents rely on principal to assign staffParents rely on principal to assign staff– Parents need ongoing and frequent Parents need ongoing and frequent

communication with assigned staffcommunication with assigned staff– Parents judge adequacy of care and Parents judge adequacy of care and

communicate concerns to the principalcommunicate concerns to the principal– Parents build trust and satisfaction that Parents build trust and satisfaction that

expectations are met over timeexpectations are met over time

Page 40: Individualized Healthcare Plan

Talk with your School Talk with your School AdministratorAdministratorSo plans can be made for your So plans can be made for your childchild• Legal and Ethical considerationsLegal and Ethical considerations

– Adequacy of delivery of skilled medical Adequacy of delivery of skilled medical care can mean life or deathcare can mean life or death

– Child in special education - protected by Child in special education - protected by IDEA (Individuals with Disabilities IDEA (Individuals with Disabilities Education Act)Education Act)•Related Services and child’s safety at schoolRelated Services and child’s safety at school

– Child not in special education – may Child not in special education – may qualify for accommodations under qualify for accommodations under Section 504, Civil Rights ActSection 504, Civil Rights Act

Page 41: Individualized Healthcare Plan

Parent does this at home, why Parent does this at home, why can’t a teacher do it at school?can’t a teacher do it at school?• Delivery of skilled medical Delivery of skilled medical

procedures is a regulated act in procedures is a regulated act in Nebraska (Nurse Practice Act) Nebraska (Nurse Practice Act)

• At school the school assumes At school the school assumes responsibility within state regulationsresponsibility within state regulations

• IDEA provides for related services IDEA provides for related services that require a licensed nursethat require a licensed nurse

Page 42: Individualized Healthcare Plan

Administrative Decision Administrative Decision Process to assign School StaffProcess to assign School Staff• Parent request/consentParent request/consent• Written medical Written medical

authorizationauthorization• Additional medical Additional medical

information if neededinformation if needed• Identification of nursing Identification of nursing

interventionsinterventions• Delegation - Delegation -

Transference from RN Transference from RN to unlicensed person to unlicensed person non-complex nursing non-complex nursing interventionsinterventions

• What may be What may be delegated?delegated?

• Which person may Which person may provide intervention?provide intervention?

• Only licensed Only licensed Registered Nurses may Registered Nurses may delegate nursing delegate nursing interventions to othersinterventions to others

• Only non-complex Only non-complex interventions may be interventions may be performed by non-performed by non-licensed personnellicensed personnel

• Only RN may provide Only RN may provide complex interventionscomplex interventions

Page 43: Individualized Healthcare Plan

Questions?Questions?

Page 44: Individualized Healthcare Plan

EvaluationEvaluation

• Tell us what was Tell us what was valuablevaluable

• Tell us what needs Tell us what needs to be addedto be added

• Tell us what we Tell us what we can do to provide can do to provide better information better information to families in to families in NebraskaNebraska

Page 45: Individualized Healthcare Plan

For Health Care InformationFor Health Care Information

•Contact:Contact:– Nina BakerNina Baker

•402-403-3908402-403-3908

•1-888-490-92331-888-490-9233