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Instruction of Students with Severe
Disabilities
Ninth Edition
Chapter 9
Understanding and Meeting the
Health Care Needs of Students
with Severe Disabilities
Copyright © 2020, 2016, 2011 Pearson Education, Inc. All Rights Reserved
Learning Outcomes (1 of 3)
9.1 Students with Special Health Care Needs Defined
Identify the types of heath care conditions likely to be present in
students with complex heath care needs that require specialized
knowledge to assure their inclusion in school settings.
9.2 General Knowledge of Health Care Procedures
Describe methods to help school personnel develop the essential
general knowledge to assure safe care of students with complex
health care needs in school settings.
9.3 Understanding Specialized Health Care Procedures
Describe specialized roles and responsibilities of school personnel as related to
the provision of health care to students with complex health care needs.
Describe methods to help school personnel develop the essential specialized
skills to assure safe care of students with complex health care needs in school
settings.
9.4 Care Coordination Through Communication
Describe critical members of teams necessary to assure health, safety, and
inclusion of students with complex health care needs in school settings.
Describe the communication processes necessary to assure health, safety, and
inclusion of students with complex health care needs in school settings.
9.5 Inclusion in the General Education Setting
Describe procedures to ensure that students with special health care needs are
included successfully and accepted by peers.
Describe methods for teaching students with special health care needs so that
they can participate in performing routine health care procedures; and describe
methods to embed other instructional goals into health care procedures.
9.6 Other Considerations Related to the Education of Students with Special
Health Care Needs
Identify other issues and practices essential for the safe care and effective
education of students with complex health care needs.
Students with Special Health Needs-Defined
“those who have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and who also
require health and related services of a type or amount beyond that
required by children generally”
(McPherson et al.,1998, p 138). age
Students with Special Health Needs:
Incidence
• No definitive count
• Reported to be increasing
Child and Adolescent Health Measurement Initiative of the

Maternal and Child Health Bureau (2012)
2001 12.8%
2005/2006 13.9%
2009/2010 15.1%
2012 19.8%
Preferred Terminology
• Student with Special Health Care Needs
– Preferred Term
• Medically Fragile
– Off putting term; scary; perhaps will break
– Inaccurate – students demonstrate resilience
Hygienic Care Practices
• Universal and Standard Precautions
– Use standard precautions when handling blood, bodily fluids,
secretions, excretions, and mucous membrane regardless of
the infection status of the individual being cared for.
• Hygienic Practices in Schools
▪ Handwashing
▪ Disinfecting the Environment
▪ Waste Disposal
▪ Allergy Control
Basic Care and Emergency Preparedness
• Basic First Aid
– Basic knowledge of procedures
– Availability of necessary supplies
• Seizure Management
– Knowledge of types
– Knowledge of student’s needs
– Knowledge of appropriate responses to seizures, those
routine and not
Basic Care and Emergency Preparedness:
Seizures
• Provide care to the student having the seizure
• Assess the student’s condition, measurement of the seizure
duration, and monitoring the student’s respiration
• Determine whether to activate plans for calling emergency
personnel
• Supervise other students
• Communicate with parents
Medication Administration (1 of 2)
• Obtain list of all currently used medication prior to a student
coming to school
• Become familiar with medications and their effects
• Follow state and district policies for safe administration of
medications
• Ideally, medication is administered by a full time school nurse
Medication Administration (2 of 2)
• Prescription medication, that must be administered at school,
should only be accepted when it is in its original container
• Store medication securely
Emergency Responses
• Be prepared for emergencies
– Clearly articulated plans – procedures to be followed
– Plans covering all locations and routes of access
– Readily accessible individualized emergency information –
clarifying routine care, minor illnesses, emergency care
– Roles and responsibilities
– Campuswide communication systems
– Practice drills with EMS
Types of Training
• CPR training
– Important for all school personnel including those working
with students with special health care needs
• Anaphylaxis Emergency Response Training
– Use of epinephrine autoinjector including safe and
accessible storage
– Emergency medical services following its use
Understanding Specialized Care Procedures
• Training Levels
– General – to understand the procedures and their need
– Child-specific training-teaching the student how to provide, to the
greatest extent possible, his or her own care, or direct it
– Child specific – Competency training for school personnel
▪ How to implement procedure
▪ How to implement for specific student
• Training Quality
– By those trained to train
– Ongoing monitoring
– Fidelity of implementation of procedures
– Change as the needs of the student changes
Responsible Personnel
• Who can be trained based on nurse practice acts
• Who will be trained
• Who will provide the training
Specialized Health Care Procedures
– CI C
– Shunt Monitoring
– Nebulizer Treatment
– Tube Feeding
– Tracheostomy Care
– Mechanical Ventilation
Coordination of Care
• Communication is key!
– Individualized Health Care Plans
▪ Part of the IEP, developed as part of the IEP process
▪ Should also address transportation
– Careful Record Keeping
▪ Know health status of students when under the care of
school personnel
▪ Seizure Event Recording
▪ Medication Administration and Reactions
Individualized Health Care Plans (1 of 2)
– a description of the student’s health history
– a description of the specific health care needs of the child
– a description of the child’s current health status
– a description of the medications used at home and school,
possible side effects of the medications taken, and a clear
specification of which school personnel will be responsible
for administering the medicine while the students is at school
(Adapted from Porter et al., 2014)
Individualized Health Care Plans (2 of 2)
– a description of any special dietary and nutritional needs of the
student
– specialized transportation needs (types of supports and
equipment needed, including on bus supervisions)
– a listing of specialized equipment needed for administration of
special health care procedures, if needed
– descriptions of what constitutes an emergency and specific
procedures for responding to them
– child-specific emergency plans
(Adapted from Porter et al., 2014)

Inclusion in the General Education Setting
• Acceptance by peers
– Function of acceptance by school personnel
• Specialized educational content
– Access to the general education curriculum
– Learning to administer or direct own care
• Maximizing educational opportunities
– Combining care with instruction
Other Considerations (1 of 2)
• Medical Discrimination
– Baby Doe – denied corrective surgery for defective
esophagus due to presence of Down syndrome
– Baby Jane Doe – denied spina bifida surgery due to presence
of microencephaly
– Phillip Becker - denied corrective heart surgery due to
presence of Down syndrome
– Ashley X - prescribed growth attenuating hormones to make
care easier, but considered obtrusive and medically
unnecessary
Other Considerations (2 of 2)
• Do Not Resuscitate
– Typically begins with a request from parents
– School nurse then leads the process of determining state and
local policies and clarifying those policies with school
administration, by communicating with the hospital care team,
and conducting team meetings with the family to discuss the
plan.
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Instruction of Students with Severe

(McPherson et al.,1998, p 138). age

Child and Adolescent Health Measurement Initiative of the

(Adapted from Porter et al., 2014)

(Adapted from Porter et al., 2014)

This work is protected by United States copyright laws and is

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