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504s

LISA M RUIZ, MD CHILD PSYCHIATRY FELLOW, PGY-4 JANUARY 27, 2014

What About School & Chronic Illnesses?


Do you keep the patient home?

Do you force the patient to continue as is?


Does the patient qualify for school accommodations? What does that even mean?

How to get started?

Case 1 Outpatient Clinic


15y/o WF moderate depression & migraines Progressively worsening past 2 months Recent work-up negative, no PMH, no meds High functioning but declining performance Missing school, falling behind, grades dropping Supportive parents Psychosocial stressors

No previous treatment
Psychiatry/psychology new appt 6 months out

Case 2 - Inpatient
9y/o HF lupus mood lability w/ anxiety

Ready for discharge tomorrow


Parents worried about school

Case 3 Outpatient Clinic


6y/o WM mild tics and ADHD combined type

Doing well on Methylphenidate


Neighbor mentioned 504 plan

Definitions
Accommodation: A change to the way a student receives

regular curriculum content usually delivered by a regular classroom teacher expectations concerning content the student will master usually delivered by a regular classroom teacher performance expectations, and method of instruction usually delivered by staff with special training protocol to address specific behaviors that interfere with the learning environment usually developed by a specialized team

Modification: A change in teaching strategies or in

Specialized instruction: A change to the content,

Behavioral planning: Developing and applying a

ID EA
( Sp ecial Ed u catio n )

504

STUD ENT NEED


Pre-Assessm en t Activities

( Regu lar Ed u catio n )

Co n sid eratio n o f ID EA

Co n sid eratio n o f 504

Evalu atio n

N o Referral

D ata review an d evalu atio n , if n ecessary

D isab ility ad versely affects ed u catio n al p erfo rm an ce? YES

NO N o t Eligib le
NO O

N o t Eligib le

D isab ility su b stan tially lim its o n e o r m o re m ajo r life activities YES

ID EA Eligib le

Ed u catio n reaso n ab ly d esign ed to co n fer b en efit

Healthcare plan MTSS


YES

504 Q u alified

Is th e ed u catio n al p ro gram co m p arab le to th at p ro vid ed to n o n d isab led stu d en ts? NO Acco m m o d atio n s

Sp ecially D esign ed In stru ctio n

Ph ysical

In stru ctio n al Related Aid es & Services

Related Services

Free Appro priate Public Educatio n


In d ivid u al Ed u catio n Pro gram ( IEP)

Sp ecialized Ed u catio n

ID EA Reviewed An n u ally 504 Reviewed Perio d ically

Stu d en t Acco m m o d atio n s an d / o r Services

504
What is it?

Section 504 is part of the Rehabilitation Act of 1973 that applies to individuals with disabilities & education

Eligibility?

Those students who have a physical or mental impairment which limits 1 or more major life activities that impacts education:

Caring for one self Speaking Breathing Communicating Learning Seeing Bending Eating Hearing Sleeping Reading Concentrating Non-volitional bodily functions Performing manual tasks

Thinking Walking Working Standing Lifting

504 Accommodations
Examples: HIV, Tourettes syndrome, ADHD, heart malfunctions, anxiety, depression, urinary conditions, blood disorders, chronic fatigue syndrome, school phobia, respiratory conditions, epilepsy, cancer, birth defects, TB, intermittent symptoms Accommodations: Environmental: adjust class schedule, change student seating Organizational: peer tutoring, set time expectations for hmwk Behavioral: contracts, awards, progress reports Presentation: small groups, peer tutors Methodology: alter pace, audiovisual instructions Curriculum: supplementary materials, practice test

Case Application
How to get started? Obtain release of information Make correspondence to principal See Samples (hand-outs) Parent letter Examples of Accommodations Red Flags

Case 1 Outpatient Clinic


15y/o WF moderate depression & migraines

Recent work-up negative, no PMH, no meds


High functioning but declining performance Missing school, falling behind, grades dropping

Supportive parents
Psychosocial stressors No previous treatment

Psychiatry/psychology new appt 6 mo out

Case 2 - Inpatient
9y/o HF w/ lupus mood lability & anxiety

Ready for discharge tomorrow


Parents worried about school and flare-ups

Case 3 Outpatient Clinic


6y/o WM mild tics and ADHD combined

Doing well on Methylphenidate


Neighbor mentioned 504 plan

Take Home Points


Release of information

Patient advocator School should be looking for these kids


Doctors cant order 504 Rather is a suggestion for review or possible helpful recommendations

Write These Down!


http://www2.massgeneral.org/schoolpsychiatry/inte

rventions_begin.asp
http://www.ncld.org/parents-child-disabilities http://departments.weber.edu/teachall/504/handbo

ok.html
http://www.utahparentcenter.org/resources/school-

services/

Summary
Issue Respon Funding Admin Eligibility 504 Gen educ No addl Sect 504 Coord Maj life activ affecting educ 3-18y/o IEP __ Special education State/federal Sp. Ed. Director 14 qualifying categories 3-21y/o

Covers

References
www.schools.utah.gov/sars/DOCS/disability/emer504.asp www.utahparentcenter.org/what-is-a-section-504-plan-does-my

student-qualify-for-one/ kidshealth.org/parent/growth/learning/iep.html# www.ncld.org/students-disabilities/iep-504-plan/what-is-iep www2.ed.gov/about/offices/list/ocr/504faq.html www.rochester.k12.mi.us/pages/6275/medical-action-plans en.wikipedia.org/wiki/Individualized_Education_Program departments.weber.edu/teachall/504/handbook.html http://www.updc.org/umtss/ Nichcy.org www.milupus.org autismcouncilofutah.org/wp-content/uploads/2010/.../504 Handbook.pdf AACAP. Practice parameter for psychiatric consultation for schools. J Am Acad Child Adolesc Psychiatry. 2005;44(10):1068-1084.