PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS

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PARTNERSHIPS WITH HEALTHCARE PROVIDERS AND SCHOOLS

• Ann T. Behrmann MD Group Health Cooperative
• Janice Cooney, PA-C UW Family Practice
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• Liz Hecht Waisman Center  

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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

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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

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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).

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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.

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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)

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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

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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

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Your Pediatricians Role

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

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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

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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

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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

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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

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While a disability may create challenges, the
need for information or assistance, it does not
define a persons entire existence. Hanft, 1989.
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Language

• Language is an extremely powerful tool.
• Language reflects concepts.
• Language reflects our ideas and judgements of
  others.
• Model appropriate language for others.

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Language

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

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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.

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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

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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

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Care Plans for Children With Special Health Needs
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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.

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Identify Health Issues

• Identify/educate those on the team
• EEN teacher, EEN 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

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Developing A Plan - School

• Identify individuals to help
• Nurse
• Teacher
• EEN 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

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School - Identify Need

• Justify need via IEP
• documents need for nursing care
• builds nurse into the team

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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

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Communication

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

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Communication

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

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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

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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

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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

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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

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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.

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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

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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

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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

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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.

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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.

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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

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• Remember the individual involved.