Title: PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS
1PARTNERSHIPS 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
3Familys 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
4Your 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).
5Your 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.
6Your 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)
7Your 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
8Your 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
9Your Pediatricians Role
- MAKING IT WORK
- Expanded appointment times
- Time commitment
- After hours communication
- Reimbursement for care coordination
10AAP 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
11Child/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
12Child/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
13Child/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
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16While a disability may create challenges, the
need for information or assistance, it does not
define a persons entire existence. Hanft, 1989.
17Language
- Language is an extremely powerful tool.
- Language reflects concepts.
- Language reflects our ideas and judgements of
others. - Model appropriate language for others.
18Language
- People first language refers to individuals
first, and their disease or disability when
necessary. - Demonstrates respect for the person and
recognizes their abilities.
19Choose 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.
20Tools 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
21Communication 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
22Care Plans for Children With Special Health Needs
23Care 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.
24Identify 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
25Developing 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
26School - Identify Need
- Justify need via IEP
- documents need for nursing care
- builds nurse into the team
27School - 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
28Communication
- With parents/caregivers
- cell phones
- pagers
- contact numbers where available
- make a form with contact numbers clearly outlined
29Communication
- May be multiple people involved over various
settings. - Central, organized format is helpful.
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31Health Information
- Keep information in an organized 3-ring file.
- Include the following
- Medical diagnosis
- Names and phone numbers of medical providers
- Medication lists
- Allergies
32Medication 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
33Other 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
34Signs 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
35Signs 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.
36Signs 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
37Signs 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
39Emergency 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.
40Emergency 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.
41Emergency 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.