Families whose children and youth who have special health care needs and educational issues have a lot of stuff to balance. While learning about IEPs, 504 plans, and how to get the system to respond to what is needed, medical issues seem to be regulated to the clinic or pediatric office.

Think about a holistic approach! No you do not have to become a health expert, just be aware of some basic key points in your discussion with families and in writing IEPs or 504 Plans. After you ask about learning styles and needed accommodations also ask - is there any health issues that may affect progress in learning, school attendance, stamina to keep up with other students?

Key Points

Learning takes place in the classroom. You gotta be there to learn!

Often when students have a health need that requires extra attention they miss class time. Sometimes this is due from illness, clinic appointments, surgeries, or down-time due to equipment failure or maintenance. It is important to stress that some of these issues can be handled on non-school days or after school hours. Being aware of the school schedule, not only days off and early dismissal times but also days, times to avoid having your student out of school (important testing times, state wide competencies, end of the quarter, mid-grading period) or when school sporting/social events are scheduled. Work around these when possible.

Doctor Appointments - Consider advising families to make well doctor appointments after school hours. Have "block-out dates" written down when calling for an appointment, state up-front dates and times to avoid. Many times the scheduler is used to being the one in control (it is easier and takes less time on the phone), develop a rapport saying what you need (a certain appointment time) and why (you want you child not to miss learning time.) There may need to be some flexibility, but if you make these well-visits in advance they are easier to accommodate your requests. Absenteeism and tardiness will be greatly reduced.

If the specialty clinic, or say dentist, only offers daytime not afternoon appointments encourage the family to discuss the importance of the situation with the person in charge to see if there is some flexibility for an appointment later in the day. If this not an option attempt to schedule appointment on early dismissal days, school vacations, or during the summer. It's common sense, but sometimes we need a reminder that we DO have control over our time and how is it spent.

Try to keep regular maintenance current on wheelchairs, van ramps, batteries, and other medical devices in good condition to avoid missing school due to mechanical failures.

Personal Needs - Another issue that takes kids out the classroom is time spent going to the bathroom - especially if one needs assistance. Encourage families to ask their health care providers for ways to help regulate bathroom times, to increase bladder control, to implement a bowel management program for before or after school.

Ten minutes here, 20 minutes there, add up at the end of the day. To see if this is an issue that interferes with learning time, consider charting time out of the classroom for a 2 week trial period, then evaluate if there is a problem. If you chart the time that is spent out of the classroom on non-learning activities you would be amazed how many minutes are lost each day. Try to isolate why this issue is time consuming: socialization with aides, socialization with peers, physical effort and support take time, etc. Is there an intervention that can be implemented? These types of issues can become a problem later in life and when in an employment setting.

Eating on the run, well that's what it feels like in many school cafeterias. There are only so many minutes in a school schedule and getting down and back from the cafeteria takes time, time away from a relaxing lunch experience. As students get older those that need assistance to eat often feel uncomfortable when having an aide at a table with friends. Their typical conversation - talking about others - gets stifled. While we don' t like to think about emergency situations in a cafeteria we need to ask about choking possibilities. One way to allow students to be without an adult at the table and to reduce choking plus be able to "eat" in the designated compressed time is to consider having a "power drink" instead of the traditional lunch food. These liquid drinks are "in" right now and some combinations pack a powerful energy boost -great for afternoon learning. Encourage families to check with the medical providers or nutritionist for recommended products.

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Health & Wellness is critical. Stay well - stay in school.

If you are not well you can not think well, you will not be in school learning, you can not participate in life's activities.

Students with known medical issues sometimes need accommodations in the school setting. Being able to "fit in" and not be seen as different is important to students. Thinking ahead about issues that may interfere with learning and socializing needs to be considered.

Stamina - Has the student's schedule, class changes been thought out to assure that the time and distance in-between classrooms will not be fatiguing? Is homework geared toward mastery learning vs bulk exercises that maybe to labor intensive for the student to complete? Example: Instead of doing a page of math problems, the student who be assigned to complete 10 out of 50 with an accuracy rate of at least 80% The point here has the student learned the lesson and can demonstrate the skill? Not doing the entire page that took hours to complete. Are these types of skills being taught to the student so they can better assess situations and make smarter choices?

Medication - Does the student and their teachers know what medication they are on and the side effects? Do they know who to report unusual behavior that may be a drug side effect or a health status problem? Has an effort been made to schedule medication times not during school?

Health Status - What does wellness look like when someone has a chronic health condition? And what is hormones, depression or health problem? It is important that the staff who will be around the student be advised what "usual" behavior for that student is and to report when something seems a little off. A student who suddenly starts falling asleep in the classroom may be having a problem with oxygen intake. Friends of students can also be part of the circle of support. Friends of a student who has diabetes often carry sugar candy to assist their friend, and in some cases have permission to obtain a beverage that may help in avoiding a serious episode. We do not need to be in a crisis mode when a student has a chronic health issue, but rather be observant, be informed, and do what you can to avoid a serious problem.

Hygiene - Wash your hands. Really this does work and so many times students do not have the opportunity to even wash their hands before they eat. Simple encouragement of this easy to implement good health habit can keep a classroom healthy. Some students with medical issues often will have a flu shot in effort to avoid getting in. School staff who have students with these issues may also want to be more proactive in staying well. Catch the health not the flu! There may also be times when the student needs to stay home to get well and not infect others.

Body beautiful looks good, smells good. It is important that hair, teeth, and body are clean. This may require some skills from the occupational therapist and physical therapist.

Stay in the Know - Encourage families to provide simple information sheets for school personal to better understand health issues and the impact on learning without violating a student's privacy. Staff should be prepared to handle or know what to do for simple non-life threatening health issues. Families may be helpful in identifying medical personnel who can provide staff with additional information or even a instructional in-service.

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Terminal illness does not mean tomorrow!

Students, even with life threatening issues, need and deserve to be a kid first, who has friends and is a member of the community who gets to have fun.

Raising Expectations - None of know how long we will be on this earth. Some students who have life threatening issues may have shorter time, but it does not need to be a time of mourning nor does it need to be a Disney World everyday either. Students will appreciate being treated like any other student. The more typical the treatment the more comfortable all will be. Knowing that there will be times that may be intense emotionally and healthwise should be seen as part of the package. Life is for living. It is important that rules and consequences apply to ALL students. Some may even try the system to assure they are not being treated differently. Some due to that enjoyable hormonal time, may choose some odd choices, they too need to be accountable for their actions.

If you have something to look forward to you enjoy life more. And there is a relationship between positive mental health and well-being. The goal is to keep moving forward, to support and prepare a student to be successful in their life's goals. With the advancement of technology independence and career options are more open now than ever before.

Friendships are Life Savers - It is critical that students have friends - all students need to feel connected. Encourage inclusive activities whenever possible. Provide students with learning experiences that foster positive relationships. Improving socialization skills, age appropriate behavior, communication for the classroom and for peers dialogue (some to be heard and some not to be overheard) is essential. If medical issues or equipment appear to be a barrier identify ways to neutralize the problem. Wheelchairs now come is some fun colors and can be more kid like with sticker, bike spoke decorations, fun back packs.

Being There When You Can Not Be There - For some students there will be unavoidable times they will not be in the classroom, but that does not mean that empty desk and chair really have to be "vacant.' Simple techniques such as NCR notebook that allows another student to take notes to give to the absent student later, or a daily email from different classmates each day keeps the connections going. During "homebound" instruction times, phone calls, emails or speaker phone during classroom times also are helpful. When things change and may become more serious honesty without jeopardizing the student's privacy is important. Students with serious health issues sometimes have many ups and downs and manage to rally back.

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Teach health skills along with educational skills, and when possible merge them!

Skills for improved health and wellness can be incorporated into math lessons, science projects, language art writing skills and assertiveness training.

Ideas to include in IEPs

Science - Science Fairs can be a teaching moment for students to research and learn about their health issue or disability. Others may want to focus on effects of medication, how to stay well, analyzing time efficient strategies for changing classrooms or other topics that blend issues the student is experiencing and knowledge to be gained through research.

Language Arts - Ah the written word has an everlasting power punch and what better way to learn how to make it work for you is to put in to practical experiences. If you know a student will be going to a medical appointment teaching the student how to phrase and record their questions - of course with correct punctuation and grammar - will assist them in "getting heard " and their issues addressed. Some students elect to fax or email these questions to their doctors ahead of time which allows the physician time to research and prepare accurate responses to the questions.

Attending a clinic is often the "wait and we'll eventually get to you" routine. This could be a time where a student creates a story from what they see, or records in a tape recorder ideas for a story later. Using spelling words in an amusing paragraph will help move the "mind" towards humor rather than be irritated at waiting.

Math - Immediately what comes to mind is medication and reordering prescriptions. If the dosage is x amount each day how many pills do you need for a month? If x amount are left in the bottle and x amount are needed each day, how many days are left before you need to reorder?

Comparisons on length of time a wheelchair battery lasts from one manufacture vs another could be studied, how many steps or wheelchair turns does it take to get from the bus stop to the classroom, how far is a wheelchair turn and how far does one wheel in one day? Combining with real life issues can make math REAL and learning more fun!

History - There are many famous people who happened to have a disability. How do this positively affect them? Did it make an effect on society? Legislation changes and civil rights from access to federally funded buildings to web pages has led to sweeping changes in the last decade. The ADA can be learned by doing an assessment on the school's building, parking lot and classroom space. Recommendations for corrections can be created and then submitted to proper school personnel.

Communication - Practicing verbal skills will assist the student articulate their issues quicker, which is a skill needed in the medical setting. How to negotiate what you need vs. what you want is also important in improving the quality of life. Skills that could be taught: How to monitor prescription refills, how to call in a reorder, how to describe quickly health issues to others, how to identify an impending health problem and where to find help quickly, how to call and get the appointment time you want, how to evaluate body language (yours and theirs), and when to negotiate or compromise.

Technology - This can be as simple as key board skills that take into consideration of assistive technology, to email peer support, to learning how to research medical issues on the web are the mechanical issues to consider. Also how can technology make things easier for a student to be more involved in the educational setting can range from no-cost/low cost ideas to complex tech stuff that has all the bells and whistles.

Build up pens/pencils, soft led or felt tip writing instruments, NCR notebook paper that able-bodied students can write notes and share the second copy with the student who finds writing difficult. Rubber signature stamp for those who can not fast or have lost fine motor ability.

Electric door openers, voice activated software for the computer, voice activated note-taking that is compatible with a computer, watch timer that vibrates to remind a student when to do body shifts to avoid pressure sores, walkie-talkies as a backup for communication in remote areas away from adult supervision, learning how to use a traditional or adapted phone, or cell phone with the added features that allows students to be connected with their peers.

Physical Education/Organized Sports - Adapted PE is a start if it is offered in an inclusive setting. Not everyone is a master at PE but it sure is a terrific social integrator. In addition to PE time increasing one physical strength and motor skills, why not consider being part of a sports team whether as a player or a support staffer (score keeper, equipment manager, timer, etc.) Health issues to consider - stamina, weather, environment/pollution, environment/play area safe for those who have motor issues (uneven ground, glass, sharp items) to hydration (water bottle or even Gator Aide).

Assent/Consent - Nothing important happens without a signature. Children and youth need experience in learning how to be informed decision makers prior to giving permission. Encourage situations where treatments, education plans are shared with the student to get their "buy-in" and have them sign off as "assent." Teach them about consent and being an informed decision maker. Encourage one page medical summary that the student carries along with photocopy of their health insurance card. (see resources on the following pages.)

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