Patti Hackett, MEd

1
Whats HEALTH Got to Do with Learning?
EVERYTHING!
Patti Hackett, MEd Co-Director, HRTW National
Resource Center Bangor, ME Future of Pediatrics
Orlando, FL June 30, 2007
2
Disclosure

• Neither I nor any member of my immediate family
  has a financial relationship or interest with any
  proprietary entity producing health care goods or
  services related to the content of this CME
  activity.
• My content will not include discussion/reference
  of any commercial products or services.
• I do not intend to discuss an unapproved/investig
  ative use of commercial products/devices.

3
Objectives

• Review the issues/causes as identified in select
  research
• Understand the connection
• Impact of health on learning
• Identify role for Physicians to support student
  success

4
www.hrtw.org
5
Living Well with a Disability
6
Transition to Adulthood
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Roots of Failure

• Anxiety / Depression
• Problems in the family
• Learning disabilities
• Social poverty, frequent moves, truancy
• Health chronic illness, teenage pregnancy
• Other causes inability to speak English, etc

8
What Causes Success and Failure in School and
Friendship?

• Developmental Differentiation of
• Children's Beliefs across Middle Childhood
• 420 children, ages 7-12 years,
• reported the perceived effectiveness of five
  causes
• Effort
• Attributes
• Powerful others
• Luck
• Unknown factors
• SOURCE Ellen A. Skinner and Max Planck Institute
  for
• Human Development and Education, Berlin, F.R.G.
• International Journal of Behavioral Development,
  Vol. 13,
• No. 2, 157-176 (1990)DOI10.1177/01650254900130020
  2

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Developmental Differentiation of Children's
Beliefs across Middle Childhood

• ACADEMIC - Effort was perceived as a more
  effective
• FRIENDSHIP - Attributes, powerful others, and
  luck were viewed as more important
• NOTE Effort and powerful others, increased with
  age.
• In contrast, the perceived effectiveness of
  attribute causes
• became more similar across domains as children
  became
• older.
• SOURCE Ellen A. Skinner and Max Planck Institute
  for
• Human Development and Education, Berlin, F.R.G.
• International Journal of Behavioral Development,
  Vol. 13,
• No. 2, 157-176 (1990)DOI10.1177/01650254900130020
  2

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Are We Ignoring Foster Youth With Disabilities?

• Foster youth
• who need special education are less likely to
  receive services than
• not in foster care often face social isolation
• disability and/or special education needs are
  often unknown or overlooked
• with disabilities lack educational advocates
•  
• Professionals receive inadequate information
• about the unique needs of foster youth with
  disabilities
• SOURCE Dr. Sarah Geenen at the OHSU OIDD
• Center on Self-Determination [phone] ex.
  111
• geenens_at_ohsu.edu / www.selfdeterminationohsu.org

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Safe and Sound Campaign / Baltimore City

• Children
• live in nurturing families
• enter school ready to succeed
• ..and young adults are educated
• ..and their families are healthy, with youth
  avoiding high-risk behaviors
• live in safe/supportive communities
• Their families are self-reliant
• SOURCE Suzanne Bronheim, PhD
• Social Exclusion in the United States Policy
  Implications for Community Solutions Georgetown
  University Child Development Center,
• Center for Child Health and Mental Health Policy,
  June 1999

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• Maternal Reports of Raising Children With Chronic
• Illnesses The Prevalence of Positive Thinking
• R. Chernoff, MD,D. List, MA, MPH, CHES, K.DeVet,
  PhD, and
• H. Ireys, PhD, Ambulatory Pediatrics Vol. 1, No.
  2, pp. 104107
• Results
• 80 of the mothers felt better about themselves
  by
• learning to manage child's chronic
  condition
• 70 felt that their families were stronger
  because of
• their child's condition and
• 80 felt that their family had benefited in some
  way
• from having a child with a chronic
  illness.
• 98 of the mothers endorsed at least 1 positive
  item
• 58 endorsed all 3.
•  

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Maternal Reports of Raising Children With
ChronicIllnesses The Prevalence of Positive
Thinking

• Conclusions
• Asking mothers about the positive impact on a
• family of a child's chronic illness captures an
• important part of the experience of caregiving.
• Physicians' recognition and encouragement of
• this positive outlook may help families continue
• to face the challenges of raising a child with a
• chronic illness.

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Objectives

• Review the issues/causes as identified in select
  research
• Understand the connection
• Impact of health on learning
• Identify role for Physicians to support student
  success

15
Health Impacts All Aspects of Life

• Success in the classroom, within the
  community, and on the job requires that young
  people are healthy.
• To stay healthy, young people need an
  understanding of their health and to participate
  in their health care decisions.

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Health Learning

• "You cannot educate a child who is
• not healthy, and you cannot keep a
• Child healthy who is not educated.
• Joceyln Elders
• Former Surgeon General
•  

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Screen for Life Areas

• How does health affect
• Employment
• Leisure, Recreation
• Community transportation, housing
• Higher Education or Training

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Screen for All Health Needs

• Hygiene
• Nutrition (Stamina)
• Exercise
• Sexuality Issues
• Mental Health
• Routine (Immunizations, Blood-work, Vision, etc.)
• Elimination Bowel/Bladder

19
Objectives

• Review the issues/causes as identified in select
  research
• Understand the connection
• Impact of health on learning
• Identify role for Physicians to support student
  success

20
Transition .Medical Home

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The Ultimate Outcome Transition to Adulthood!
Health Learning There is a Connection

• Doctors know, Families Know, students know, but
  did we tell the teachers?
• Teachers
• - fear of having to do health services
• - failure to consider accommodations based
• on impact of health, disability or side
  affects
• of medications
• - lack of support from administration

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Disabled?? Special Health Care Needs?

• HEALTH SERVICES CYSHCN
• - Children Youth with Special Health Care
  Needs
• - Genetic
• - Chronic Health Issues
• - Acquired
• EDUCATION SERVICE
• - Youth with Disability
• - Youth with Health Impairment
• ADA 504
• - Disability and/or Health Impairment

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What Teachers Want Medical Providers to Know

• We need basic understanding of disability/health
  impact
• We need to know danger signs for health decline
  (whats development? health? slacking?)
• We speak different language re services for CY
• Help us help your patient We need to share
  notes, reciprocal support

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What Teachers Want Medical Providers to Know

• School Speak
• Health ? IEP/PLOP, 504, Transition Plan
• School mandates
• Non-intrusive medical plans for the school
  setting
• Privacy - Balancing FERPA HIPAA

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What Teachers Want Medical Providers to Know

• School Speak
• - Getting Health in the IEP, 504, Transition
  Plan
• -  Non-intrusive medical plans for the school
  setting
• -  Privacy Balancing FERPA HIPAA

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Mandates IDEA

• THE LAW Any health issue or limitation can be
• incorporated into the PLOP/PEP if it describes
  how the
• childs disability affects the childs
  participation in school
• and recreational activities.
• (20 U.S.C. Section 1414 (d)(1) (A) of IDEA)
•  
• Health supports documented in ..
• The Present Level of Performance
• The IEP Goals
• The Supports and Services
• The list of accommodations and modifications

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Present Level of PerformanceShould also include
HEALTH

• John cannot verbally tell caregivers how to
  transfer him, making him reliant on his ed. Asst.
  throughout the day.
• This year, Latrice missed 40 school days
  because of pressure sores. She needs to learn
  ways to move in her wheelchair to reduce risk of
  pressure sores so she doesnt miss school.

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Health in the IEP

• Starting at age 14, IEPs can be more closely
  linked to post-school outcomes.
• Post-school outcomes can and should include as
  much self-care and independent management of
  health conditions as possible

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Health in the IEP

• Starting at age 14, IEPs can be more closely
  linked to post-school outcomes.
• Post-school outcomes can and should include as
  much self-care and independent management of
  health conditions as possible

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Section 504 of the Rehab Act of 1973

• Section 504 is a civil rights law that prohibits
  discrimination against individuals with
  disabilities. Section 504 ensures that the child
  with a disability has equal access to an
  education. The child may receive accommodations
  and modifications.
• Unlike the Individuals with Disabilities
  Education Act (IDEA), Section 504 does not
  require the school to provide an individualized
  educational program (IEP) that is designed to
  meet the child's unique needs and provides the
  child with educational benefit.

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504 Plan Health

• Student not in special education
• Student requires accommodations and modifications
  to participate in education.
• May be developed as a result of a request by the
  school, a request by the parents/guardians, or in
  response to a problem with the students care at
  school.
• Downside Under Section 504, fewer procedural
  safeguards are
• available to children with disabilities and their
  parents than under
• IDEA. States/local school districts receive NO
  financial support.

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504 Plan Health

• 504 Plan
• Student not in special education
• Requires accommodations and modifications to
  participate in education.
• May be developed as a result of a request by the
  school, a request by the parents/guardians, or in
  response to a problem with the students care at
  school.
• Testing conditions (extended time, quiet spot,
  etc)
• Attendance (absenteeism, late arrivals)
• Adapted coursework volume, PE,

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Family Educational Rights and Privacy Act (FERPA)
1974

• PL 94-142 ? IDEA ? IDEIA
• Protects privacy of educational records
• Gives parents rights to their childs school
  records until youth turns 18.
• Right to correct misleading information

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Health Insurance Portability Privacy and
Accountability Act of 1996 (HIPAA)

• Insurance Coverage /exclude pre-existing
• Protect personally identifiable health
  information signature _at_ age 18
• Reduce costs by standardizing CPT
• ICD-9 codes

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HIPAA FERPA

• Signature consent at age 18
• Education mandated to start conversation re
  education records/sign-offs
• Health when does this conversation start?
• Student/patient needs to practice skill before
  age 18 ASSENT to CONSENT
• - circles of support (stand by, part-time,
  fulltime)

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Informed Decision Makers

• FERPA Family Education Rights Privacy Act
• HIPAA Health Insurance Portability and
• Accountability Act
• 1. Privacy ? Records
• 2. Consent ? Signature (signature stamp)
• - Assent to Consent
• - Varying levels of support
• - Stand-by (health
  surrogate)
• - Guardianship (limited to
  full)

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Transition Family Youth
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Societal Context for Youth without Diagnoses in
Transition

• Parents are more involved - dependency
• Helicopter Parents
• Twixters 18-29
• - live with their parents / not independent
• - cultural shift in Western households - when
  
• members of the nuclear family become adults,
  
• are expected to become independent
• How they describe themselves (ages 18-29)
• 61 an adult
• 29 entering adulthood
• 10 not there yet
• (Time Poll, 2004)

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Skills for Families, Children and Youth

• Advocacy without agitation
• Negotiation based on law and compromises
• If the answer is NO, more information maybe
  needed
• Gather strength Find an ally

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Take Home Messages

• Support for Success
• (screening- eyes, ears, fine motor,
  intellect and emotional IQ)
• 2. Partner with the Educator
• (tools for families, direct contact)
• 3. Communication Information
• (Skills for families and children/youth
• post info in waiting rooms teaching
  moments)
• 4. Health and Wellness Baseline

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• What would you do,
• if you thought you could not fail?

42
www.hrtw.org
43
Patti Hackett, MEd Co-Director, HRTW
Center Bangor, ME pattihackett_at_hrtw.org
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Lets Talk.Questions ??
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Resources - FAMILY RESILIENCY

•  
• SOURCE National Center on Accessibility
• "Becoming a Resilient Family Child Disability
  and the
• Family System"
• Monograph addresses not only how having a child
  with a
• Disability can impact the family system, but also
  how
• families can use their circumstances to become a
  more
• resilient and Healthy family.
• http//www.ncaonline.org/monographs/17family.shtml
  

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IDEA 504

• Discrimination Section 504 and ADA
• http//www.wrightslaw.com/info/sec504.index.htm
• Sample Section 504 Plan Medical Management Plan
• for a student with diabetes
• http//diabetes.org/advocacy-and
• legalresources/discrimination/school/504plan.jsp
• IDEA 2004
• http//www.wrightslaw.com/idea/index.htm
• IEP's vs. 504 Plans
• http//www.slc.sevier.org/iepv504.htm

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IDEA 504

• Overview of Section 504
• http//www.504idea.org/504overview.html
• SECTION 504 AND IDEA Limited vs.
• Substantial Protections For Children With
• AD/HD and Other Disabilities
• http//www.parenttoparentofga.org/roadmap/advocacy
  /educationlaws504ideachadd.htm

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HIPAA FERPA

• UNIVERSITY OF MIAMI- ETHICS PROGRAM
• Privacy / Data Protection Project
• http//privacy.med.miami.edu/glossary/xd_educatio
  n_records.htm
• Legal and easily understood overview of FERPA
  and HIPAA. Great resource for teachers and young
  adults- to better understand compliancy and what
  it means when you sign over permission.

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The Impact of FERPA and HIPAA on Privacy
Protections for Health Information at School
Questions from Readers

• http//www.healthinschools.org/ejournal/2003/priva
  cy.htm
• Summary on HIPAA and FERPA from the
  Department of Education The Family Policy
  Compliance Office has not published any guidance
  on the applicability of FERPA to HIPAA. However,
  the Office worked closely with HHS on this issue
  during the rulemaking process. Because FERPA
  affords students adequate privacy protections,
  the Government agreed that records that are
  protected by FERPA should not be subject to
  HIPAA.
• The HIPAA Final Privacy Rule of December 28,
  2000 explains that records that are subject to
  FERPA are not subject to HIPAA. Additionally,
  medical records that are excepted from FERPA's
  definition of "education records" under section
  99.3 "education records" provision are also
  exempted from coverage by HIPAA. (See page 82483
  of the December 28, 2000, Federal Register
  document on the HIPAA final rule.)

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How to Solve Problems and Protect Parent-School
Relationships

• by Pam Wright Pete Wright
• http//www.wrightslaw.com/info/advo.probs.protect.
  htm
• Offers advice about how to resolve problems with
• the school by restructuring relationships,
  learning
• effective advocacy skills, using strategies in
• letters, and learning to negotiate and persuade.
• Learn why Pam says, "You need to view your
• relationship with the school as a marriage
• without the possibility of divorce."

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Learn to Ask Questions, Get Services

• http//www.wrightslaw.com/info/advo.parent.askqs.h
  tm
• How does the school perceive you?
• Good article about how to ask questions
• and get better services.

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Tests and Measurements  for the Parent, Teacher,
Advocate Attorney

• by Peter W. D. Wright, Esq. and Pamela Darr
  Wright, M.A., M.S.W.
• www.wrightslaw.com/advoc/articles/tests_measureme
  nts.html

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Preventing School Failure

• http//www.heldref.org/psf.php
•  
• Forum to examine critically emerging and
• evidence based best practices that are both
  data-driven and practical, for children and
  youths served in traditional and nontraditional
  education settings.
• new research and innovative practices,
• debate controversial subjects
• international peer-reviewed publication

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Bibliography -01

• School FailureWayne Yankus, MD, FAAP, McInerny,
  Thomas, MD Children Who Have Difficulty in
  School A Primary Pediatricians Approach.
  Pediatrics in Review. Vol. 16 No. 9 September
  1995.
• Dworkin, Paul, MD, FAAP. School Failure.
  Pediatrics in Review. Vol 10. No. 10 April 1989.
• Byrd, Robert S., MD School Failure Assessment,
  Intervention, and Prevention in Primary Pediatric
  Care. Pediatrics in Review. Vol. 26. No.l 7 July
  2005.

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Bibliography - 02

• Reiff, Michael, MD, Adolescent School Failure
  Failure to Thrive in Adolescence. Pediatrics in
  Review. Vol 19. No. 6 June 1998.
• Casey, Patrick, MD and Evans, Larry, PsyD School
  Readiness An Overview for Pediatricians.
  Pediatrics in Review. Vol 14. No. 1. January 1993
• Committee on Children with Disabilities American
  Academy of Pediatrics The Pediatricians Role in
  Development and Implementation of and Individual
  Education Plan (IEP) and /or and Individual
  Family Service Plan (IFSP). Pediatrics. Vol 104.
  No. 1. July 1999.

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Bibliography - 03

• Oberklaid, Frank, MBBS, Melvin, MD Precursors of
  School Failure, Pediatrics in Review. Vol. 2. No.
  1. July 1980.
• Blancett, Wanda. Mumford, Vincent, Beachum,
  Floyd Urban School Failure and
  Disproportionality in a Post-Brown Era. Remedial
  and Special Education Vol 26. No. 2 March/April
  2005. pg. 70-81.