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PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS

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Your Pediatrician's Role. IEP planning and input on Behavior Intervention Plan (BIP) ... Consider having your pediatrician/FP complete 'signs and symptoms checklist' ... – PowerPoint PPT presentation

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Title: PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS


1
PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS
  • Ann T. Behrmann MD Group Health Cooperative
  • Janice Cooney, PA-C UW Family Practice
  •  
  • Liz Hecht Waisman Center  

2
What is a Medical Home
  • What is a Medical Home?A medical home addresses
    how a primary health care professional works in
    partnership with the family/patient to assure
    that all of the medical and non-medical needs of
    the patient are met. A medical home is defined as
    primary care that is accessible, continuous,
    comprehensive, family centered, coordinated,
    compassionate, and culturally effective. 1
  • A medical home includes
  • A partnership between the family and the
    child's/youth's primary health care professional
  • Relationships based on mutual trust and respect
  • Connections to supports and services to meet the
    non-medical and medical needs of the child/youth
    and their family
  • Respect for a family's cultural and religious
    beliefs
  • After hours and weekend access to medical
    consultation
  • Families who feel supported in caring for their
    child
  • Primary health care professionals coordinating
    care with a team of other care providers

3
Familys Role
  • Notify school of childs needs
  • Provide information as appropriate
  • Participate in plan development with school and
    medical team
  • Provide medication and supplies
  • Share contact information
  • Support child/youth to acquire needed skills

4
Your Schools Role
  • The Individuals with Disabilities Education Act
    (IDEA) grants to eligible children with
    disabilities the legal right to receive a free
    appropriate public education in the least
    restrictive setting. For an increasing number of
    children with disabilities, access to education
    is only achieved through the provision of
    necessary health services (e.g., administration
    of intravenous medications, catheterization,
    tracheostomy care, gastrostomy tube feedings).

5
Your Schools Role
  • The 1999 United States Supreme Court ruling in
    Cedar Rapids Community School District v. Garret
    F. (hereinafter known as "Garret F.") held that
    the Individuals with Disabilities Education Act
    (IDEA) requires school districts to provide
    nursing services when such supportive services
    are necessary in order for students to access and
    benefit from their educational program.

6
Your Schools Role
  • "School nurse services" is a new related service
    and has replaced "school health services".
  • (26) Related Services. The term 'related
    services' means transportation, and such
    developmental, corrective, and other supportive
    services school nurse services designed to
    enable a child with a disability to receive a
    free appropriate public education as described in
    the individual education program of the child,
    ...as may be required to assist a child with a
    disability to benefit from special education,
    Reference from IDEA 2004 - 20 U.S.C. Section
    1401 (26) (A)

7
Your School Nurses Role
  • Identify students
  • Arrange meetings to discuss accommodations
  • Develop health care plan and emergency care plan
  • Delegate responsibility
  • Provide training
  • Provide supervision
  • Provide health education
  • Case management

8
Your Pediatricians Role
  • IEP planning and input on Behavior Intervention
    Plan (BIP)
  • Medication administration information/forms
  • Advocacy with family for services
  • Communication re medication and its effect on
    academic progress or behavior with school
    nurse/teachers/psychologist phone and email
  • Development of an Emergency Care Plan
  • Creation of a Signs and Symptoms Checklist
  • In service for specific caresmay be done jointly
    with familys help and input

9
Your Pediatricians Role
  • MAKING IT WORK
  • Expanded appointment times
  • Time commitment
  • After hours communication
  • Reimbursement for care coordination

10
AAP Resources
  • Helpful guidelines from the American Academy of
    Pediatrics, Committee on Children With
    Disabilities, including The Pediatrician's Role
    in the Development and Implementation of an
    Individual Education Plan (IEP) and/or an
    Individual Family Service Plan (IFSP) (RE9823)
    Pediatrics. 1999104(1)124-127
  • http//www.medicalhomeinfo.org/publications/educa
    tion.html

11
Child/Youth and Pediatrician Partnership
  • Peds doc/family sharing information with kid
  • facts about illness/disabilities and
    medication and allowing child to be the expert on
    herself and her medications
  • Responsibility to always take meds when driving,
    working, swimming or participating in dangerous
    recreation or sports
  • Never taking scheduled medications (prescription
    pain meds or stimulants for ADD/ADHD) to school
    or giving or selling them to friends

12
Child/Youth and Pediatrician Partnership
  • With the individual
  • it takes time
  • it takes practice
  • it involves a little risk on your part
  • model your speech and behavior from parents or
    others who do it well
  • it takes extra time
  • get to know the child at their typical setting

13
Child/Youth and Pediatrician Partnership
  • EMPOWER AND TEACH EACH INDIVIDUAL
  • Involve the individual in discussions regarding
    their health care
  • Age appropriate level
  • Engage them in decision making when possible

14
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15
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16
While a disability may create challenges, the
need for information or assistance, it does not
define a persons entire existence. Hanft, 1989.
17
Language
  • Language is an extremely powerful tool.
  • Language reflects concepts.
  • Language reflects our ideas and judgements of
    others.
  • Model appropriate language for others.

18
Language
  • People first language refers to individuals
    first, and their disease or disability when
    necessary.
  • Demonstrates respect for the person and
    recognizes their abilities.

19
Choose your words carefully
  • Medical records and care plans are shared across
    environments. Remember that numerous people may
    see your written documentation.Your language
    reflects your views and helps paint a picture for
    the reader.
  • People may be offended at language you use in
    your medical writing.

20
Tools for Communication
  • 1) Develop partnerships to possibly include these

    participants
  • child, family, school nurse, teachers, school
    administration (principal, special ed
    coordinator), school psychologist or social
    worker, special education assistants, fellow
    students
  • 2) Schedule a summer or spring pre-school year
    planning meeting

21
Communication Aides
  • Forms school medication, allergies
  • Daily care plans
  • Behavioral Intervention Plan (BIP) from formal
    Functional Behavioral Assessments
  • Strategies for ongoing communication
  • daily shared notebook, emails, phone
  • Consider having your pediatrician/FP complete
    signs and symptoms checklist

22
Care Plans for Children With Special Health Needs
23
Care Across Various Settings
  • Home
  • School
  • Day Care settings
  • Community
  • Work
  • There may be multiple people of various
    disciplines/skill level involved. Develop
    communication strategies across all settings.

24
Identify Health Issues
  • Identify/educate those on the team
  • SE teacher, SE aide, school nurse, teacher,
    others
  • Day care providers, support /aides at day care
  • Home - parents, personal care workers
  • Provide information. Information builds
    confidence!
  • articles regarding condition
  • handouts regarding tubes, lines, etc.
  • Develop a plan
  • Identify those that are medical providers and
    their availability
  • Emergency training such as CPR, airway
    management.
  • Medications
  • Seizure management

25
Developing A Plan - School
  • Identify individuals to help
  • Nurse
  • Teacher
  • SE assistant
  • Write a plan of care - consider potential
    problems and outline solutions
  • Provide information
  • get articles describing typical health problems
    and characteristics of the childs problems
  • medication lists
  • emergency contacts
  • allergies - include food / meds/ environmental/
    latex
  • Train necessary individuals at various settings

26
School - Identify Need
  • Justify need via IEP
  • documents need for nursing care
  • builds nurse into the team

27
School - Identify Need
  • Identify training needs for school personnel.
    Train support staff and teachers prior to, and
    during the school year.Utilize the IEP.Use tools
    such as training videos.
  • Examples Safe handling and transfers Feeding Ga
    strostomy tube use Personal cares,
    toileting Seizure management Airway management

28
Communication
  • With parents/caregivers
  • cell phones
  • pagers
  • contact numbers where available
  • make a form with contact numbers clearly outlined

29
Communication
  • May be multiple people involved over various
    settings.
  • Central, organized format is helpful.

30
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31
Health Information
  • Keep information in an organized 3-ring file.
  • Include the following
  • Medical diagnosis
  • Names and phone numbers of medical providers
  • Medication lists
  • Allergies

32
Medication List
  • Carry a list of medications and allergies
  • Example
  • R.C. DOB 5/16/93
  • Medical Diagnosis Cerebral Palsy, Asthma, Low
    Vision, Reflux
  • Allergies Amoxicillin and Clindamycin
  • Baclofen 20 mg TID for spacticity
  • Valium 2 mg AM and 4 mg PM for spacticity
  • Dantrolene 25 mg AM and 75 mg PM for spacticity
  • Prilosec 20 mg BID for reflux
  • Metoclopramide 5 mg QID for reflux
  • Flovent MDI 2 puffs BID for asthma
  • Albuterol MDI 2 puffs TID-QID for asthma
  • Flonase Nasal Spray 2 squirts each nostril QD for
    allergies
  • Multivitamin with iron QD

33
Other strategies
  • Medic Alert Bracelets
  • Child Alert Program
  • register child through Child Alert Program-
    educates and alerts EMS to potential problems of
    individuals so EMS can react proactively in an
    emergency situations

34
Signs and Symptoms of Problems
  • Listen to the parents or primary providers of
    care
  • School personnel may detect changes as well
  • Theyre just different
  • Something is wrong

35
Signs and Symptoms of Problems
  • Remember kids with special health care needs also
    develop typical childhood illnesses. Look for
    those. Consider where they spend time - home, day
    care, school.

36
Signs and Symptoms
  • Do a good once over, including vital signs.
  • Assess level of response, is it typical?
  • Include skin and remember that some people have
    decreased sensation.
  • Sleep
  • poor sleep or increased sleep
  • Muscle tone
  • Increased / decreased muscle tone
  • Head banging

37
Signs and Symptoms
  • Aggressive behavior
  • towards self or others
  • Change in bowel or bladder habits
  • Emotional changes
  • anger/withdrawal
  • crying
  • Whining, crying, vocalizations
  • changes over time which may cause subtle changes
  • Seizure patterns -
  • increase in seizures or change in pattern may
    reflect infection
  • Look for signs of abuse
  • Medication changes
  • Think about poisoning
  • can make adverse reactions and behavior

38
Signs and Symptoms some examples
  • Hypoglycemia (low blood sugar or Insulin)
    reaction in diabetic studentconfusion and
    irritability, uncooperative diabetic may signal
    low blood glucose, so better to give sugar (OJ,
    concentrated glucose) than time out!
  • Pain manifestations in nonverbal childincreased
    agitation, elevated heart rate, sweating
  • Response to a seizure in child with epilepsy
    when to call 911/use of Diastat rectally

39
Emergency Care
  • Develop emergency and medical plans pro-actively.
  • Develop relationships with parents and
    individuals.
  • Involve parents and primary care providers.
  • Look for subtle changes.
  • Develop teaching tools and training sessions.
  • Compile information in central format.

40
Emergency Care Plan
  • Know your emergency plan.
  • Review plans periodically.
  • Know who can help you in an emergency.
  • School nurse
  • 911
  • Identify individuals trained in schools, may
    include students.

41
Emergency Contacts
  • Parents/caregivers
  • Pediatrician
  • plan for after-hours care
  • Hospital used in emergency
  • Services provided via local ambulance
  • transportation only
  • advanced training
  • ability to handle childs special issues

42
  • Remember the individual involved.
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