SECTION H--STUDENT ASSISTANCE AND STUDENT SUPPORT SERVICES | CCSD HealthOffice Support

SECTION H--STUDENT ASSISTANCE AND STUDENT SUPPORT SERVICES

 

SECTION H CONTENTS

 

SECTION H – STUDENT ASSISTANCE AND STUDENT SUPPORT SERVICES

 

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Student Support Services: Role of The School Nurse

 

 

     Student Assistance Intervention

 

 

     Student Intervention Program (SIP) or Team (SIT)

 

 

     The School Nurse Role to Assist the Student Intervention Team (SIT)

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Section 504 Overview

 

 

     Role of the School Nurse to Assist 504 Teams

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Response to Instruction (Big RTI) and Response to Intervention (Little RTI)

 

 

     The Role of the School Nurse in Assisting RTI Teams

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Special Education

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Referrals to the Multidisciplinary Team (MDT)

 

 

     The Multidisciplinary Team Meeting

 

 

     Required Participants at MDT Evaluation/Eligibility Meetings

 

 

     Initial Evaluation

 

 

     Speech Only Students

 

 

     Transfer Students

 

 

     Re-evaluation

 

 

     School Nurse’s Role in Re-evaluations

 

 

     Annual Updates

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Physical Assessment Reminders

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Neurological Screening

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Cranial Nerves

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Denver Developmental Screening Test

 

 

     Physical Assessment and Education: Putting It All Together

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Written MDT Reports

 

 

     Tips When Giving Verbal report at MDT/ET Meetings

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Documentation

 

 

     Assessments

 

 

     Electronic Health Record

 

 

     Nurse Progress Note

 

 

     Status Record

 

 

     MDT Report

 

 

     Referrals

 

 

     Medical Records

 

 

     EasyTrac

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Summary of Components of Special Education Assessment

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Disability/Special Education Notebook

 

 

     Individual Education Plan (IEPs)

 

 

     Confidential Folders

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Confidential Folder Index-Appropriate Placement of Forms

 

 

     DocDNA

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Additional Programs and Related Services

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Occupational Therapy/Physical Therapy Services

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Speech Services

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Audiology

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Adapted Physical Education (APE)

 

 

     Referral Process for APE

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Assistive Technology

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Low Incidence Disabilities Team

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Hearing Impaired Program

 

 

     Role of School Nurse with Hearing Impaired Students

 

 

          Initial Evaluation

 

 

          Three Year Re-evaluation

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Visually Impaired Program

 

 

     Role of School Nurse with Visually Impaired Students

 

 

          Initial Evaluation

 

 

          Three Year Re-evaluation

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Extended School Year (ESY)

 

 

     Responsibility of the School Nurse in ESY Preparation

 

 

 


STUDENT SUPPORT SERVICES: ROLE OF THE SCHOOL NURSE

 

STUDENT ASSISTANCE INTERVENTION

 

Introduction: Students struggling to keep pace with their age appropriate peers, either academically or functionally are initially assisted by the classroom teacher. The classroom teacher may provide informal accommodations such as extra time or shortened assignments, conference with parents, or alternative teaching strategies in an attempt to assist the student. If the student fails to respond to the interventions provided by the teacher, the teacher may request help from the school based student intervention team known as SIP or SIT. The teacher at this time, may initiate a school nurse referral, CCF-630, if there is a specific health concern and/or to verify adequate vision and hearing.

 

STUDENT INTERVENTION PROGRAM (SIP) OR TEAM (SIT)

 

When a student is having learning problems in the general education curriculum, the teacher may request assistance from the Student Intervention Program by initiating a referral. Usually this team is made up of a chairman and teachers from various grade levels/specialists and administrator(s) who assist the teacher to consider alternative or additional strategies to assist the student in the classroom. This is a general education program. The team meets on a regular basis at the school site. The SIP members are expected to work with the student on an on-going basis and to document considerations and interventions prior to submitting a referral to the Multidisciplinary Team (MDT). When a special education disability is NOT suspected, a minimum of 9-18 weeks of individualized interventions are recommended prior to considering a referral for additional evaluation. When a special education disability is suspected, preferably prior interventions have occurred, and a minimum of 6-9 weeks of individualized interventions will be conducted concurrent with the evaluation process.

 

The SIP team must document their findings on the Evidence Scale for MDT Referral, Student Intervention Program (SIP) form, CCF-572.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ Psychology→ SIP Manual

 

THE SCHOOL NURSE ROLE TO ASSIST STUDENT INTERVENTION TEAMS (SIT)

Upon request, the school nurse will:

  • Screen vision and hearing to determine if both are adequate for learning in the general education classroom.
  • Review any relevant known health/medical needs that may be impacting the student’s learning in the general education classroom.
  • Participate in a SIP meeting if requested to discuss relevant health/medical needs.
  • Document in the student’s electronic health record: screenings, electronic health card review, and school nurse participation in the SIP meeting.

 

The SIP team has several options to assist the student in his/her learning. This includes but is not limited to:

  • Assist the teacher to identify/document individualized interventions to specific problems of learning
  • Monitor the student’s progress over time
  • Refer for formal Response to Instruction documentation
  • Refer for further testing for special education
  • Discontinue SIP intervention due to positive outcomes

 

SECTION 504 OVERVIEW

 

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against persons with a handicap. The school district has responsibilities to identify, evaluate, and provide access to appropriate educational services if a child is determined to be eligible. The school nurse may be part of the team determining eligibility for services and is a vital team member for children with a health disability/impairment. The team will formulate a plan detailing accommodations for students eligible for services under Section 504. This is a general education program. Guidelines for the procedures to be followed in the identification and management of these students have been developed by the Clark County School District and are outlined in the Educational Services Procedures Handbook for Students (Pub-504).

 

This handbook can be found on InterAct→ Ed Link→ Section 504.

 

While teachers may make informal accommodations, these accommodations may not follow a student who moves from one teacher to another or from one school to another. A student who is considered to have a handicapping condition that affects a major life function may have “reasonable accommodations” developed under a 504 plan.

 

There are three basic questions that must be answered to determine 504 eligibility:

  1. Does the student have a physical or mental impairment?
  2. Is a major life activity affected by the physical or mental impairment?
  3. Does the impact of the disability on the major life activity amount to a substantial limitation?

 

The student must have a physical or mental impairment. A physical impairment may include any physiological disorder, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs; respiratory, including speech organs; cardiovascular; reproductive, digestive, genitourinary; circulatory and lymphatic; skin; or endocrine system. Mental impairment includes any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.

 

After the impairment has been identified by the team, there must be a discussion regarding how this impairment substantially limits a major life activity. (The impairment does not have to be diagnosed by a licensed health care provider, but if the parent/legal guardian has any outside reports, the team must consider them). Major life activities include, but are not limited to, caring for one ’s self, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working. As of January 1, 2009, eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, and communicating are all new additions to the list of major life activities.

 

The terminology “substantially limits” is not defined in the law but has been generally interpreted by the Courts and the Office of Civil Rights to mean an impairment which negatively affects the student’s ability to learn to a marked degree.

 

While there is no federal funding attached to a 504 plan, the plan is legally binding and must be followed from one teacher to the next or from one school to the next unless the plan is modified via a 504 meeting. The law requires that 504 plans must be reviewed at least annually but may be reviewed or modified more frequently at the initiation of any member of the 504 team. While “reasonable accommodations” are not defined by law, it is the intention of the law that these accommodations are implemented in the general education setting and provide a student equal access to the curriculum. A parent/guardian, teacher, counselor, administrator, school nurse or school psychologist may initiate a referral.

 

 

ROLE OF THE SCHOOL NURSE TO ASSIST 504 TEAMS

 

  • The school nurse participates in the evaluation of students whose health conditions require accommodations in the school setting.
  • Confers with parent/guardian regarding medical history, current diagnoses, health needs while at school
  • Obtains medical records, licensed health care provider orders, and/or completed medical forms as indicated by history.
  • Interprets health information for the 504 team and its impact in the educational setting – either academically or functionally.
  • Suggests reasonable accommodations to meet health needs in the school setting.
  • Maintains a current log of students with health related 504 plans, in the Special Education Notebook under the 504 section.
  • Obtain a copy of 504 plans from the site 504 Liaison in which there has been school nurse involvement.
  • Document 504 activities on the student’s electronic health record.

 

See InterAct→ Ed Link→ 504 for further information. 504 forms may be accessed on CCSD graphics website @ http://graphics.ccsd.net

 

For more information regarding comparison between Section 504 and IDEA go to:

http://www.ncld.org/at-school/your-childs-rights/iep-aamp-504-plan/section-504-and-IDEA-comparison-chart

 

RESPONSE TO INSTRUCTION (Big RTI) AND

RESPONSE TO INTERVENTION (Little RTI)

 

CCSD is using a Response to Instruction (RTI) model to assist students struggling in school. RTI is the educational practice of providing high quality instruction and intervention that is matched to student needs and uses learning rate over time and level of performance to make important instructional decisions. This practice will focus on providing more effective instruction by encouraging early intervention services to students experiencing academic and/or behavioral difficulties.

 

This educational strategy, which is multi-tiered, will among other things:

  • Focus on research-based instruction practices
  • Provide a student with extended learning opportunities
  • Identify struggling, under-performing students and proven targeted interventions

 

Tier 1 of RTI is intended to provide quality instruction to all general education students and involves 100% of students.

 

Tier 2 is intended to provide quality intervention to at-risk struggling students, usually 20-30% of students.

 

Tier 3 is intended to provide intensive, focused intervention looking at the curriculum (content), how that content is taught (process) and the documented growth of the student (product). It generally involves 5-10% of students.

 

During Tiers 1 & 2, simultaneous involvement of the SIP/SIT or 504 team members may occur. However, as soon as a team suspects a special education disability, regardless of the Tier level, the team may simultaneously initiate Response to Intervention (Little RTI) and evaluate for special education eligibility by referring to the MDT.

 

When a student is determined to meet Tier 3, and the student is being considered for eligibility as a student with Specific Learning Disabilities, an alternative approach may be used…this means that:

  • The team is not required to use the IQ/Achievement discrepancy model to determine eligibility for students suspected of having a learning disability.
  • The team may use scientific, research based interventions to determine learning disability documented at repeated intervals through formal assessment of the student during the instruction.
  • Eligibility is not the lack of instruction in reading or math, or limited English proficiency.
  • The student’s underachievement is not primarily the result of:

                        ·         A visual, hearing, or motor disability

                        ·         Mental retardation

                        ·         Emotional disturbance

                        ·         Cultural factors

                        ·         Environmental or economic disadvantage

 

THE ROLE OF THE SCHOOL NURSE IN ASSISTING RTI TEAMS

 

The school nurse’s role is to:

  • assess the student’s health status, including vision, hearing and motor functioning
  • Interpret health information for the team to assist in the determination of educational impact
  • Document on the student’s electronic health record: screenings and SN participation in meetings

 

The school nurse may request assistance of the FASA in completing vision and hearing screening for students who are in the RTI process. All abnormal results will be referred to the school nurse for re-screening and referral if needed. This is the only part of the RTI process that can be delegated to the FASA.

 

For a more detailed description of CCSD RTI, go to InterAct→ SSSD Departments→ School Psychology→ RTI Resources.

 

Click HERE for a diagram of the CCSD RTI.

 

SPECIAL EDUCATION

 

Special education is the provision of services to students with an identified handicapping condition who require specialized instruction and possible accommodations, modifications and related services in order to benefit from their education.

 

It is the legal responsibility of the school district to identify students with a suspected handicapping condition and evaluate the need for special education. For students in grades K-12, this is done through the RTI process. For children ages 3-5, the district has established the Child Find program to help identify these students. See Section C for further description.

 

REFERRALS TO THE MULTIDISCIPLINARY TEAM (MDT)

 

The MDT is composed of individuals knowledgeable regarding a specific student’s educational needs or conditions that may adversely impact educational progress. The team must include teacher, local educational administration (LEA), parent/guardian, and may include appropriate related services staff, the student and other school staff. The MDT meeting has basically two functions: to discuss a student’s referral for special education testing and to determine eligibility. The school nurse should attend referral meetings and those eligibility meetings as defined below.

 

Referrals to the MDT may come from:

  • SIP/SIT for student who is suspected of having a handicapping condition
  • SIP/SIT for students who fail to respond to RTI and have reached Tier 3
  • Teacher
  • Parent
  • 504 Team
  • Transfer from out-of-state or from in-state but out of county
  • Following a significant hospitalization (physical or psychiatric) which results in a significant change in a student’s ability to learn or function in the school setting.
  • School Psychologist
  • School Nurse

Attendance at Multidisciplinary Team meetings is a priority, and every effort should be made to schedule school coverage to facilitate attendance. School nurse attendance at MDT’s is required for students with the following eligibilities:

  • Health Impaired
  • Orthopedic Impaired
  • Traumatic Brain Injury

School nurse attendance at MDT’s is recommended for student with the following eligibilities:

  • Visually Impaired
  • Hearing Impaired
  • Dual Sensory Impairment
  • Developmentally Delayed
  • Any other eligibility where there are significant health concerns, specialized procedures may be needed, or school health services may be required

 

Click HERE to view a diagram of the Multidisciplinary Team Meeting

 

The school is required to send a Parental Prior Notice of District Proposal and Parental Prior Notice of Proposed Meeting Arrangements (CCF-653 and CCF-654) to the parent/legal guardian along with the Special Education Rights of Parents and Children booklet when the team is considering the option to test for special education. The required MDT members include the Local Education Administration (LEA) representative, the parent/legal guardian, general education teacher, special education teacher and other qualified specialist as appropriate (school psychologist, school nurse, and speech therapist, or others with specialized knowledge) needed to interpret or explain the suspected area of disability.

 

Click HERE to view the document on Required Participants at MDT Evaluation/Eligibility Meetings.

 

The team reviews prior adaptations and interventions, determines the need for testing to refine the referral question, and completes a Student Support Services Referral (CCF-583).

 

If the team decides that special education testing is not indicated, they can continue with current interventions, revise interventions, refer to the 504 team or do nothing and document on the appropriate forms. If the parent has requested special education testing, and the district refuses the request, a Parental Notice of District Refusal, CCF-567 must be completed and sent to the parent.

 

If the team decides to pursue a special education evaluation, the Student Support Services Referral Form, CCF-583, is completed and Parent Consent for Evaluation, CCF-555, must be signed by the parent/legal guardian. It is usually easier if the person who obtains the permission to test, CCF-555, also gives the parent/guardian the Health/Developmental History, CCF-626, and if indicated, the Behavioral/Social History, CCF-627, to complete and return to the school nurse.

 

Click HERE for a diagram for determining Special Education Testing.

 

The MDT determines who is needed to complete the evaluation. The school psychologist conducts academic, behavioral, and emotional assessments as indicated by the referral question. The teacher provides current grades, functioning in the classroom, completed checklists and knowledge of previously attempted interventions and the outcomes. The school nurse conducts a physical assessment, reviews the Health/Developmental History, CCF-626, and Behavioral/Social History, CCF-627, obtains and reviews pertinent medical records, and as needed, conducts a classroom observation and home visit. Other team members may be requested to provide assessment information as well, depending on the referral question (Speech Language Pathologist, Adaptive Physical Education Teacher, Physical Therapist, Occupational Therapist, etc.).

 

 

 

 

 

 

Click HERE for a diagram of requirements of Psychologist, Teacher and Nurse.

 

Accurate record keeping of students referred for special education evaluation, re-evaluation, and annual updates is required. This may be done by printing a caseload from Encore/SEMS or by utilizing the special education roster obtained from the special education facilitator.

 

Nevada Administrative Code (NAC) Website: http://www.leg.state.nv.us/NAC/NAC-388.html

The NAC contains the specific state statutes and regulations to implement IDEA (Individuals with Disability Education Act).

 

INITIAL EVALUATION

 

A Special Student Services Referral Form, CCF-583, Parental Consent for Evaluation from Special Student Services CCF-555 are to be completed for all initial evaluations. A Health /Developmental History, CCF-626, will be obtained on all initial referral students. If indicated, a Behavioral/Social History, CCF-627, will also be obtained at this point. The school nurse will contact the parent/guardian by phone to discuss the health history, if itwas not returned and/or to clarify information provided in the histories. The school nurse must review and synthesize data contained in the history forms and sign/date on the last page of each history obtained.

 

A complete physical assessment, HMS 213 will be completed on all students referred for initial special education testing using the initial template. A neurological assessment and/or Denver Developmental screening may also be completed as part of the physical assessment HMS-213 if the school nurse determines it is necessary. The Temporary Health Assessment Worksheet (HS) may be utilized to gather data for completion of the HMS 213.

 

The original copy of the initial physical assessment is given to the school psychologist along with a Nurse Progress Note, CCF-649, indicating completion of the initial assessment, referrals and follow-up concerns. A copy of the physical assessment is to be maintained in the Special Education notebook for nurse reference during eligibility meetings.

 

The original records along with any medical records received will be sent by the Special Education Instructional Facilitator (SEIF) or Teacher of Record (TOR) to confidential records to compile the student’s confidential record upon completion of the Special Education referral.

 

The team has 45 school days to complete an initial evaluation.

 

SPEECH ONLY STUDENTS

 

Students referred for initial testing for speech and language services and who have no significant health concerns will require a physical assessment, HMS-213 but the nurse may use the speech only template. A Health/Developmental History, CCF-626, is required.

 

If, however, the nurse suspects or knows there are significant medical/neurological concerns, then the Physical Assessment, HMS 213, initial template, should be completed and if indicated, a Behavioral/Social History, CCF-627, will be completed and reviewed.

 

The original copy of the initial speech physical assessment and a Nurse Progress Note, CCF-649, indicating completion of the initial assessment, referrals, and follow-up concerns should be given to the speech language pathologist, and a copy maintained in the Special Education Notebook.

 

The team has 45 school days to complete an initial evaluation.

 

TRANSFER STUDENTS

 

A Student Support Services Referral Form, CCF-583 is automatically generated from SEMS for transfer student evaluations. Records of students admitted for special education services on a transfer basis will be reviewed by the school nurse on an individual basis to determine the extent of health assessment required. At a minimum, all transfer students will have a vision and hearing screening, review of the electronic health record, a review of the Health/Developmental History, CCF-626, and if indicated a Behavioral/Social History, CCF-627, as well as a review of current medications. Students with significant health concerns and/or specialized procedures must have a completed Physical Assessment HMS-213, using the appropriate HMS template as determined by the school nurse.

 

In-state transfer students with a current eligibility for special education services are reviewed and a re-evaluation conducted only when warranted. Existing evaluation data is reviewed and new assessments are done only when needed.

 

If the in-state transfer student has no evaluation needs and a current IEP, the school proceeds with routine implementation of the IEP.

 

The school nurse will:

  • conduct a vision and hearing screening
  • review:

                    ·         the electronic health record

                    ·         the Health/Developmental History, CCF-626

                    ·         if indicated, a Behavioral/Social History, CCF-627

                    ·         current medications.

  • document using the physical assessment transfer template and print a HMS 213 for placement in the student’s confidential folder.
  • initiate a Nurse Progress Note, CCF-649 indicating completion of the initial assessment, referrals, and follow-up concerns.

A Parent Consent for Evaluation, CCF-555, is NOT required for the nurse to conduct a review, medication update and screenings.

 

In-state transfer students with a current IEP but who have either significant health concerns, procedures, and/or require new assessments are considered a temporary placement. The team has 45 school days to complete this evaluation.

The school nurse will:

  • review:

                ·         the electronic health record

                ·         the Health/Developmental History, CCF-626

                ·         if indicated, a Behavioral/Social History, CCF-627

                ·         current medications.

  • request appropriate medical records using the Authorization for Release of Confidential Information, CCF-503, to obtain documentation of a health condition.
  • conduct a physical assessment, HMS-213
  • document using the appropriate physical assessment transfer template and print a HMS 213 for placement in the student’s confidential folder.
  • initiate a Nurse Progress Note, CCF-649 indicating completion of the initial assessment, referrals, and follow-up concerns.

 

A Parent Consent for Evaluation, CCF-555, IS required for the nurse to conduct this assessment and either the Special Education Instructional Facilitator (SEIF) or Teacher of Record, (TOR) should send a Parental Prior Notice of District Proposal, CCF-653.

 

Out-of-state transfer students with a current eligibility and current IEP require an initial evaluation in CCSD to determine if the student meets Nevada guidelines for eligibility. The team has 45 school days to complete an out-of-state evaluation of a student with a current out-of-state IEP.

The school nurse should follow the guidelines for an initial evaluation as noted previously.

 

Either In-State or Out-of-State transfer students with a current eligibility but no current IEP require an initial evaluation in CCSD to determine if the student meets Nevada guidelines for eligibility. The student is given an interim placement. The school nurse should follow the guidelines for an initial evaluation as noted previously. However, the team has 30 Calendar days to complete an out-of-state interim placement evaluation of a student without a current out-of-state IEP.

The school nurse will:

  • review:

                     ·         the electronic health record

                     ·         the Health/Developmental History, CCF-626

                     ·         if indicated, a Behavioral/Social History, CCF-627

                     ·         current medications.

  • request appropriate medical records using the Authorization for Release of Confidential Information, CCF-503, to obtain documentation of a health condition.
  • conduct a physical assessment, HMS-213
  • document using the appropriate physical assessment transfer template and print a HMS 213 for placement in the student’s confidential folder.
  • initiate a Nurse Progress Note, CCF-649 indicating completion of the initial assessment, referrals, and follow-up concerns.

 

 

A Parent Consent for Evaluation, CCF-555, IS required for the nurse to conduct this assessment and either the Special Education Instructional Facilitator (SEIF) or Teacher of Record (TOR) should send a Parental Prior Notice of District Proposal, CCF-653.

 

Click HERE for diagram of Special Education Flowchart.

 

RE-EVALUATION

 

The purpose of a re-evaluation is to provide individualized assessment of the ongoing educational needs of a student. The re-evaluation process helps determine whether a student continues to have an identified disability and whether the student continues to need special education services. As a general rule, a student receiving special education services must be re-evaluated before any determination can be made that the student is no longer eligible for special education services. A formal re-evaluation should be done for students who are 3, 4, or 5, if another disability classification is suspected. Formal re-evaluation is not required if the student is aging out (i.e., reaching 22 years of age), the student is graduating with a standard diploma (Option I), or the parents and the district agree that a formal re-evaluation is not warranted.

 

The MDT/ET team is required to review and determine re-evaluation needs every three years or sooner if needed or requested. The team reviews prior evaluations, evaluations and information provided by the parent, current classroom-based, local, or state assessments and classroom-based observations as well as observations by teachers and as appropriate, related services providers. Based on this review and input from the student’s parents, members of the MDT/IEP team must identify what, if any, additional assessment data is needed to determine:

  • if the student continues to have an identified category of disability and the educational needs of the student
  • if the student continues to need special education and related services
  • the present levels of academic achievement and related developmental needs of the student; and
  • whether any additions or modifications to the special education and related services are needed to enable the student to meet the student’s IEP goals and to participate, as appropriate, in the general education curriculum.

 

The team then has three options: re-evaluation with new assessment needs, re-evaluation with no new assessment needs and if the student has had at least two prior re-evaluations to confirm a specific eligibility classification, the third option for the team is that no re-evaluation is needed (waiver). The MDT completes Statement of Need for Re-Evaluation, CCF-531.

 

Click HERE for diagram of Re-evaluations.

 

SCHOOL NURSE’S ROLE IN RE-EVALUATIONS

A. New Assessment Needs

  1. Parental Prior Notice CCF-653, Statement of Need for Re-evaluation, CCF-531, and Parental Consent for Evaluation CCF-555 are required (SETF or TOR to obtain)
  2. Review confidential folder (CCSD Folder Review Checklist, HS-49) and student’s electronic health record
  3. Students without Health Concerns and Speech Only Students

               a)   screen vision and hearing

               b)       review medications and prior referrals

               c)    review the current health status

               d)        complete physical assessment HMS 213, re-evaluation template.

  1. Students with Significant Health Concerns (regardless of eligibility), who require specialized procedure(s) or have an eligibility of Health Impaired, Orthopedic Impaired, or Traumatic Brain Injury require

              a)          Parental Consent for Evaluation CCF-555 (check with SETF or TOR that this has been obtained)

              b)          Screen vision and hearing

              c)           Physical assessment  HMS 213 re-evaluation or initial template as determined by school nurse

              d)          Update health history as needed

              e)     Request updated medical records as needed

  1. Complete MDT report and Eligibility Statement

B.     No New Assessment Need*

  1. Parental Prior Notice CCF-653, Statement of Need for Re-evaluation, CCF-531are required (SEIF or TOR obtains)
  2. Review confidential folder (CCSD Folder Review Checklist (HS-49) and student’s electronic health record
  3. Screen vision and hearing
  4. If re-evaluation is required but no new assessments are needed, complete MDT report and Eligibility statement
  5. If re-evaluation is not required and no new assessments are needed, team completes a waiver, CCF-607

 

*No new assessment needs includes health assessments. If the nurse determines that a new or updated physical assessment is needed, beyond medication updates, vision and hearing screenings (which do not require a consent to complete) then the team cannot sign “no further assessment needed” or a waiver. A Parental Consent for Evaluation, CCF-555, MUST be obtained for the nurse to conduct a physical assessment.

 

ANNUAL UPDATES

 

An annual physical assessment update HMS 213, confidential folder review and electronic health record reviewis required for special education students with:

  • significant health concerns
  • specialized procedures
  • the following special education eligibilities:

                  ·         Health Impaired

                  ·         Orthopedic Impaired

                  ·         Traumatic Brain Injury

 

PHYSICAL ASSESSMENT REMINDERS

 

1. Health/Developmental History CCF-626: Review completed forms. Areas that require further exploration can be noted directly on the form as a working document. For instance, if the parent/legal guardian notes head injury, further history and details must be obtained. Document in MDT report educationally relevant history. (i.e. no significant pregnancy or prenatal history, pregnancy complicated by exposure to alcohol, delayed development in the areas of walking, talking and feeding etc.).

 

2. Social/Behavioral History CCF 627: Required for all clinics and if suspected language, behavior, emotional or attention concerns. Areas that require further exploration can be noted directly on the form as a working document. For instance, if the parent/legal guardian indicates student has suicidal thoughts, further history and details must be obtained. Document in the MDT report educationally relevant history. (i.e., no family history of emotional disorders, early childhood characterized by difficulty getting along with peers, responding to parental discipline, current concerns include difficulty with sleep onset, sustained attention, aggressive behavior with peers and adults, visual hallucinations etc.).

 

3. Health – Note all three areas (known problems, medications, limits on activities) even if no significant findings (i.e., summary of previous health history, significant illness/diagnoses, accidents, hospitalizations, surgeries, allergies, current health problems, medications -include dose, frequency). If student has a history of previous routine medications include name, dose, effect, and why they were discontinued. Also note any activity limitations and functional abilities or limitations.

 

4. Cerebral Function: Orientation to person, place, time, alertness, eye contact, train of thought, reasoning, judgment, hallucinations, response to testing, facial expression, body gestures/movements, attention span (coming to attention, sustained attention), ability to follow directions (single/multiple step); voice quality, voice tone, rhythm, fluency of speech, articulation, expressive and receptive language abilities; safety concerns, behavioral concerns (aggression, impulsivity, violent, self-abusive behaviors, etc.).

 

5. Appearance: Note facial shape; midline abnormalities; eyes & ears shape, symmetry, size, placement; hair, hair whorls, hair lines; mouth symmetry, lip size, philtrum, body size, shape, proportion, symmetry and alignment of body; appear stated age; skin markings or tags, coloring; general hygiene

 

6. Growth Parameters: Measure without shoes. Head circumference is recorded in centimeters (cm). This is a good time to note the shape of the head. Percentiles are to be included for height, weight, and head circumference. Initiate a growth chart and head circumference chart. Measurements above the 98% or below the 2nd% are medically significant and should be taken twice to verify the measurement. BMI measurements below the 5% and above the 95% are significant.

 

Click HERE for a guide for measuring growth.

 

 


7. Vital Signs: Take apical pulse– assess for murmurs. Blood pressure cuff should be 2/3rd the length of the upper arm and the end of the cuff should fall within the range marked on the inside of the cuff.

 

8. Eyes: Note any misalignment or unusual findings, acuities near/far. Refer to vision screening and assessment protocols, Section G. If unable to obtain a formal vision assessment, document functional vision (e.g., ability to follow objects, reach for items, teacher observations). “Unable to test” (UTT) by itself is an inadequate assessment.

 

9. Ears: Note position, shape, tabs, pain, tympanogram results, if applicable. Refer to hearing screening and assessment protocols, Section G. Otoscopic exam: note landmarks, inflammation, discharge, wax impaction, foreign objects, scarring, or PE tubes. Refer for medical evaluation as indicated. If unable to obtain a formal hearing assessment, document functional hearing (e.g. response to environmental sounds, turn to sounds or voice). “Unable to test” (UTT) by itself is an inadequate assessment. Refer for audiological testing to obtain a baseline and for follow-up as indicated.

 

10. Nasal/Oral: Appearance, size of nose, nasal base, discharge, ability to breathe through the nose; lip appearance, fullness, ability to close fully: tongue appearance and movement, or drooling. Dental: presence of caries, gum disease, dental hygiene, hard/soft palate appearance.

 

Click HERE for diagrams on oral assessments.

 

11. Fine Motor: Hand dominance. Handwriting: legibility, spacing, heavy pressure on writing instrument, stabilization of paper, multiple erasures etc.

 

Independence in functional fine motor self-care tasks (e.g. buttoning, zippers, feeding, toileting, dressing, brushing teeth).

 

Click HERE for pictures of pencil grasps.

 

12. Gross Motor: Leg dominance. Balance: Record in seconds; attempt to balance up to 20 seconds; note extra body movement to maintain balance. Independence in functional gross motor skills: ability to safely walk around campus, sit, get in/out of chair, on/off bus, up/down steps, running, skipping, hopping. Refer to developmental chart for normals, under SN site→ SN Resources→ Assessment.

 

Consider a more extensive neurological screening or Denver if the student has health conditions or global delays. A Denver Developmental II Screening may be used if the child is under 6 years of age and the examiner is unable to complete a neurological screening. Place the Denver form if used in the confidential folder along with the HMS 213.The Denver is normed up to age 6, but it can be used as a descriptor for older students with global delays or those students who cannot complete a neurological screening.

 

13. Spine/Back – Note any curvature, asymmetry. See spinal screening/assessment protocols in Section G.

 

 

NEUROLOGICAL SCREENING

 

Click HERE for the Neurological Screening (The Role of the School Nurse) Powerpoint

 

Click HERE for a diagram of the Brain for Neurological Screening.

 

BRAIN FUNCTION AND MAP: http://www.neuroskills.com/brain.shtml

 

Hard vs. Soft Neurological Signs:
"Hard signs" are obvious indications of nerve damage and/or brain damage observed in a neurological examination. Examples are pathological reflexes, abnormal EEGs, abnormal audiograms, unilateral movement disturbances and loss of function of one or more of the twelve cranial nerves. These signs are objective and reproducible.

 

"Soft signs" are very slight abnormalities of behavior that are observed and recorded in the course of a neurological examination. Outside of the neurological exam, soft signs may be revealed in psychological test performance, in overt behavior or in expressions of emotion. Examples include speech disturbances, awkward gait, hyperactivity, poor balance, lack of coordination, low muscle tone, posturing, and tremors.

 

Cerebral Function: Appearance, orientation to person, place, time, level of consciousness (LOC), behavior, ability to complete age appropriate tasks, speech, language, judgment, reasoning, memory, attention skills, affect, mood, social skills.

 

Cerebellar: Posture, coordination, balance.

 

Hand Dominance/Handwriting: Attach a sample of the student’s handwriting. Note if right handed, left handed or if hand dominance is not yet determined. Note if student can print or do cursive writing. Note if pencil grasp is efficient or not efficient. Consider asking for a person drawing, writing a sentence, numbers 1 – 10 or the alphabet. Assess the student’s ability to button, tie shoes, zip clothing, independently feed, open/close containers, picks up small objects using a pincer grasp.

 

Finger Opposition (Finger to Thumb): Appropriate to administer to students 6 years and older.

Normal: 5-8 years: easy transition, child may put same finger on the thumb several times at the turn 8-10 years: easy transition; smooth placing of fingers; barely discernible associated movements.

Abnormal: asymmetries or associated movements, tremors.

 

Eyes Open/closed touch finger to nose, alternate hands;

 

Eyes open is appropriate to test students 4 years and older.

Normal: 7-8 years old: may miss finger once or twice or have slight wavering of the moving hand.

Abnormal: asymmetries, tremors.

 

Eyes closed: appropriate to test students 5 years and older.

Normal: 8 years and older: correct placement of finger and smooth movements.

Abnormal: asymmetries, tremors.

 

Figure of Eight: Determine the smooth coordinate effort of the student in drawing a figure of 8 in the air with each foot. Students must be able to demonstrate the ability to draw a figure 8 prior to testing.

 

Heel to Shin Test: Determines the student’s ability to perform coordinated movement by alternately placing the heel of each foot immediately below the knee of the opposite foot and moving the foot down (smoothly) along the shin. Failure occurs if the student is unable to place the heel on the shin or must assist the heel on the shin with the hands while performing the test.

 

Muscle Size, Tone, and Strength: Note the symmetry and alignment of muscle mass by comparing one side of the body with the other. Muscle tone of the student may be determined by passive or active range of motion. However, it is best evaluated by observation of active range of motion. Note any resistance, rigidity, hypotonia, flaccidity, paralysis or atrophy. Muscle strength is evaluated by looking at both the upper and lower extremities. Note symmetry and compare extremities. Ask student to flex arm while examiner attempts to pull the forearm into extension. Ask the student to keep the legs extended (straight) while the examiner attempts to push each of the legs into flexion. Ask the student to flex the knees while the examiner attempts to extend the legs.

 

Pronate and supinate hand (alternate hand): Appropriate to test 4 years and older.

Normal 4-7 years: awkward pronation and supination with associated movements noted in opposite extremity (mirroring); gradual improvement noted over this span.

Normal 8 years and older: smooth and correctly performed pronation and supination with no associated movements seen in opposite extremity (mirroring); possibly minimal movements in opposite extremity.

Abnormal: asymmetries and directional confusion.

 

Stand with feet together eyes open: Observe posture and ability to stand still. Push on shoulders.

Normal: student is able to maintain balance.

Abnormal: severe swaying, arm drift, inability to return to original position.

 

Stand with feet together eyes closed: Observe posture and ability to stand still. Push on shoulders.

Normal: student is able to maintain balance.

Abnormal: severe swaying, arm drift, inability to return to original position.

 

Tandem Walking: Appropriate for students 5 years and older.

Ask the student to take at least 8 steps in a straight line forward, then backward, using either tape or the grout lines on the floor, with eyes open, touching each heel of the extended foot to the toe of the previously stepped foot. Demonstrate test to the student.

Normal: age 5-7 years: not required to keep one foot immediately in front of the other, three deviations are acceptable

Above 7 years: able to walk at least 4 steps in a line 2 out of 3 trials.

Abnormal: student is unable to complete 4 sequential steps and requires a wider based gait or has associated movements

 

Walks naturally with eyes open (gait): Observe posture, head, swinging of arms, size/direction of steps, ability to alternate feet.

Normal: smooth movements, alternating feet.

Abnormal: wide gait, tripping, swaying, toe walking, limp, leg preference, drags foot, need for assistive devices.

 

Walk naturally with eyes closed (gait): Observe posture, head, swinging of arms, size/direction of steps, ability to alternate feet.

Normal: smooth movements, alternating feet.

Abnormal: wide gait, tripping, swaying, toe walking, limp, leg preference, drags foot, need for assistive devices.

 

Ambulate toes and heels: Appropriate to test 3 years and older.

 

Toe-Walking:

Normal 3-7 years: able to walk on tip-toes with decreasing associated movements (20 continuous steps).

Normal 7 years and older: able to walk on tip-toes with no associated movements noted.

 

Heel Walking:

Normal 3-9 years: able to walk on heels with decreasing associated movements (20 continuous steps).

Normal findings 9 years and older: able to walk on heels for 20 continuous paces with no associated movements.

Abnormal: note inability to perform as noted above.

 

Balance: Test each foot separately.

Normal 3-5 years: able to stand 5-6 seconds with many extraneous balancing movements.

Normal 5-6 years: able to stand 10-12 seconds with many extraneous balancing movements.

Normal 6-7 years: able to stand 13-16 seconds with minimal extraneous balancing movements.

Normal 7 years and older: able to stand 20 seconds with no extraneous balancing movements.

Abnormal: asymmetries, associated movements.

 

Hop, jump, skip: Appropriate to test 3 years and older.

 

Hop:

Normal 3-4 years: few are able to hop even a few times.

Normal 4-5 years: able to hop 5-8 times consecutively; one leg often better than the other.

Normal 5-6 years: able to hop 9-12 times consecutively; one leg often better than the other.

Normal 6-7 years: able to hop 13-16 times consecutively; one leg often better than the other.

Normal 7 years and older: able to hop 20 times consecutively with each foot.

Abnormal: inability to hop, weakness, ataxia.

 

Jump:

Normal: age 2 ½ able to jump with both feet off the floor simultaneously; by age 3, able to jump over a piece of paper (81/2 inches) placed on the floor, with both feet off the floor simultaneously.

Abnormal: inability to perform as above.

 

Skip:

Normal: rhythmic skipping by age 6.

Abnormal: gallop after age 6, inability to sequence skips.

 

Floor to stand:

Normal: able to stand up from a seated position on the floor without using hands.

Abnormal: The Gower’s Sign describes a student that has to use his or her hands and arms to "walk" up his or her own body from a squatting position due to lack of hip and thigh muscle strength. Note calf muscle weakness, loss of tone.

 

Romberg’s Sign: Have the student stand with feet together, eyes open and hands by the sides. The examiner should stand to the side of the student with one hand in front and one hand in back of the body, without touching, to support the student if the student is unable to maintain balance. Observe for any swaying or movement. Repeat the test with the student’s eyes closed. Observe for any swaying or movement. The test is positive if the student sways, falls or is unable to balance without a wide based foot placement. When the test is positive, postpone other cerebellar testing that requires balance.

 

CRANIAL NERVES

 

Each nerve should be evaluated separately.

 

OLFACTORY (I):

With the eyes closed, the child should be able to identify familiar odors, like coffee or peppermint.

Not required as part of health assessment.

 

OPTIC (II):

Visual acuity should be within normal limits.

 

OCULOMOTOR (III):

The child should be able to follow an object like a red ball or light in all directions with his/her eyes without moving his/her head. Inspect the pupils for size, shape, and reaction to light. Test the ability of the pupils to accommodate by asking them to look at an object far away, then a near object. Test the ability of the student to raise the eyelids by asking them to close their eyes, then open them. The eyelid should not cover the pupil.

 

TROCHLEAR (IV):

The trochlear nerve controls the superior oblique eye muscle, which rotates the eyeball downward. If IV is abnormal, the child will be unable to look downward, and the eye at rest may deviate upward.

 

TRIGEMINAL (V):

Palpate the masseter muscles with your fingertips while the child clenches his/her teeth. There should be no disparity of tension.

 

ABDUCENS (VI):

The abducens nerve controls the lateral rectus muscle that rotates the eye laterally (temporally). If abnormal, the child will be unable to look temporally and the eye at rest may deviate basally. Because the abducens nerve has the longest course in the brain, it is the most frequently involved nerve when brain damage is present.

 

The mnemonic LR 6 SO 4 (Lateral Rectus for VI and Superior Oblique for IV) may help you to remember the innervation of the eye muscle. All other eye muscles are innervated by the oculomotor nerve (III).

 

FACIAL (VII):

The mouth should be symmetrical bilaterally when the child smiles or shows his/her teeth.

 

AUDITORY (VIII):

The child should be able to hear normally.

GLOSSOPHARYNGEAL (IX):

When the posterior pharynx is stimulated with a tongue blade, the child should gag.

 

VAGUS (X):

The uvula should be midline.

 

ACCESSARY (XI):

The child should be able to shrug his/her shoulders symmetrically against mild pressure from your hands.

 

HYPOGLOSSAL (XII):

When the tongue is protruded from the mouth, it should not deviate.

 

DENVER DEVELOPMENTAL SCREENING TEST

 

The Denver Developmental Screening Test is designed to be used with children from birth to age 6 and is administered by assessing a child’s ability to do various age-appropriate tasks. The test is used to screen children for possible developmental problems, to confirm intuitive suspicions with an objective measure, and to monitor children at risk for developmental problems. For specifics on administering and scoring the test, please see Denver II Training Manual.

 

PHYSICAL ASSESSMENT AND EDUCATION: PUTTING IT ALL TOGETHER

 

The school nurse must integrate and synthesize information from the physical assessment, health history, behavioral history, medical records, observations, and parent/guardian interview and then interpret it for the educational team in a way that will be meaningful in the school setting for the educational staff. The school nurse must look at both safety and access issues in the school setting.

 

In terms of safety, the school nurse must determine if the student is medically stable to be in school, ride the bus or walk to school. Is a modified day/week needed due to health conditions? Does the student have a chronic health condition which interferes with school attendance? If so, are supplementary home instruction services needed?

 

Are there any environmental safety needs in the classroom, on campus or on the bus? Does the student have any equipment needs due to health conditions? Does the health condition result in heat sensitivity or difficulty regulating temperature?

 

Does the student’s health condition require any type of assistance, modifications or accommodations: in the classroom, in the lunch room, in the hallways, on field trips, on the bus, for mobility, for activities of daily living, during emergency drills, to monitor health conditions or perform health procedures?

 

Click HERE for a diagram of Safety Issues and Access Issues.

 

The school nurse must also make a determination regarding access issues. Access issues include not only physical access but access to the curriculum. Physical access includes access to the building, classroom, desk, locker, lunchroom, bathroom, bus, and field trips. Curriculum access may include modifications, specialized equipment, adult assistance, or related services.

 

The following checklist may be helpful: 

http://dpi.wi.gov/sped/pdf/tbi-phys-cklst.pdf 

WRITTEN MDT REPORTS

 

The school nurse is required to submit an electronic copy of the heath report to the school psychologist (or speech/language pathologist for speech only) for inclusion into the MDT report. The health portion of the MDT report is to be written in the Comment section of the HMS 213 and copied and pasted into an e-mail to the school psychologist for inclusion in the MDT report.

 

The written reports should include

  • a review of the health and developmental, behavioral histories
  • past hospitalizations/injuries
  • current diagnoses
  • current medications, indications for use, and side effects
  • previous significant medication history
  • significant physical findings
  • adequacy of vision and hearing
  • functional limitations
  • specialized health needs
  • adaptive equipment
  • referrals generated and the reason for the referrals
  • recommendations

           ·         consider optional evaluations/referrals (i.e., orthodontia evaluation, dermatological, counseling, parenting classes)

           ·         monitoring activities (i.e., safety concerns, attention, behavior, growth, medication effectiveness, attendance)

           ·         functional recommendations: high contrast reading materials, water bottles, special seating

           ·         school nurse case management (coordination of medical follow-up, telephone calls, home visits, etc.)

  • accommodations/modifications: i.e., preferential seating, equipment, health plans, shortened day, assignment adjustments, toileting, feeding, safety etc.   

(An accommodation is a change to the environment, instruction, or methods that allows the student to meet the same performance expectation as other students. A modification is a change in the expectation placed on the student- i.e. shorter, less complex assignment).

  • educational impact of health status

             ·         does not adversely impact on learning. No special health needs.

             ·         possible adverse impact on learning (pending medical diagnosis, requires other team member input)         

             ·         does adversely impact learning (medical diagnosis*)

A diagnosis by itself does not guarantee special education eligibility. The student must also require special education services/supports in order to be eligible for service.

 

*Health Impairment based on ADHD can be determined by the educational team. All other medical conditions MUST have medical documentation of diagnosis. Medical diagnosis alone does not necessarily mean there is an impact in the educational setting. If the student’s identified health condition impacts his/her ability to learn, and/or functioning in the educational setting, AND the team has determined the student requires special education services (specialized instruction or programming), then the student qualifies for special education services.

 

TIPS WHEN GIVING VERBAL REPORT AT MDT/ET MEETINGS:

  • Use lay terms. Team members do not know medical terminology.
  • Summarize findings from:
  • Pregnancy, developmental and behavioral histories
  • Medical history
  • Physical exam
  • Note if vision, hearing, and motor skills are adequate.
  • Note referrals and reason for referral.
  • Suggest modifications or accommodations that may be indicated due to health condition.
  • Interpret findings in terms of educational impact.

 

Examples of Verbal Reports:

 

“John has no current or past health concerns and takes no routine medications. His physical exam, vision, and hearing were all normal. Pregnancy was within normal limits. Developmental milestones were reached at typical ages. His health does not impact his learning.”

 

“Harry has asthma and takes routine medications to help prevent asthma attacks and emergency medications when he is having difficulty breathing. The health office has his emergency medications. He may require the medication while at school. Exercise and strong odors trigger his asthma. He was hospitalized twice for his asthma since diagnosis 5 years ago. He should perform warm up exercises prior to PE and perform exercise as tolerated. A health alert was issued. His physical exam was normal. Hearing was normal but he does have difficulty with near vision and tracking. His far vision is normal. A vision referral was made. He may have difficulty reading small print books and lose his place while reading or develop eye fatigue. He also has an abnormal curve in his back which is followed medically, but this should not impact his school performance.”

“Sam has cerebral palsy. He has high muscle tone in his lower extremities. Pregnancy was normal, but he was born early at 30 weeks and was in the hospital for 6 weeks with respiratory and feeding problems. He was delayed in his motor milestones of crawling and walking. He currently is in a manual wheelchair. He can stand with assistance but cannot walk. His arms have not been affected. He takes medication at home to help decrease his muscle tone. Vision and hearing are within normal limits. He is continent but requires assistance in the bathroom for safety and transfers. He fatigues easily. His cerebral palsy impacts his large muscle movement of the lower extremities and his stamina while at school.”

 

DOCUMENTATION

 

ASSESSMENTS:The school nurse may use an optional worksheet Temporary Health Assessment Worksheet (HS) if desired. The assessment must however be documented in the student’s electronic health record and an original copy of the HMS 213 report filed in the confidential folder. A copy of the HMS 213 is placed in the Special Education notebook. A summary of the health and developmental history, behavioral/social history and pertinent physical and neurological findings will be noted in the Comment section of the HMS 213 and will be included in the MDT report. This summary should also include any referrals and recommendations by the school nurse and any possible health effects on the student’s educational progress.

 

ELECTRONIC HEALTH RECORD: This record documents all student related health activities and concerns such as special problems, special needs, medications, physical assessments, referrals, follow-up letters, vision screening, hearing screening, dental screening, and scoliosis screening.

 

NURSE PROGRESS NOTE: The nurse progress note is used for special education students to update health activities such as completion of a physical assessment, review of medical records, referrals issued, changes in procedures or health plans as they pertain to special education.

 

STATUS RECORD: This is a written record of personnel who access a student’s confidential folder, meetings held, procedural safeguard activities, and location of the folder. The school nurse would document review of the folder, request for medical records, receipt/review of medical records, and assessments completed.

 

MDT REPORT: This is the MDT’s written evaluation of a student for special education services and recommendation for the eligibility and IEP team, as appropriate. Each person participating in the evaluation submits a report. The school nurse will summarize findings in the Comment section of the HMS 213, and forward this summary to the psychologist for inclusion in the MDT report.

 

REFERRALS: School nurse referrals should be noted on the student’s electronic health record and in the Nurse Progress Notes, CCF-649. Any follow-up activities to the referral should also be noted in both places.

 

MEDICAL RECORDS:

 

Requests: Specify which medical records are needed and for what dates of service (i.e., discharge summary of birth, discharge hospital summary, latest EEG results, etc.). If requesting psychiatric or behavioral records, be sure to specify psychiatric records, treatment plan, medications etc. For permission to speak with the provider, include “telephone communication with” on the form. Use appropriate release of confidential information (usually CCF 503, but some of the mental health facilities have their own release that is required to obtain records).Document request for records in the student’s electronic health record, on the Status Record, CCF-759 and on the Nurse Progress Note, CCF-649. If the request was done as part of an initial evaluation and records have not been received, note this in the MDT report. Please note that the district does not pay for copies of records. The parent would be requested to obtain records if the provider is requesting payment from the district.

 

Receipt of Records: Review medical records upon receipt. Summarize significant findings in the MDT report or on the Nurse Progress Note, CCF-649 if the records were received after the initial evaluation was completed. Record receipt, review and placement of medical records in the confidential folder on the Status Record, CCF-759.

 

EASYTRAC: The District may receive reimbursement from Medicaid for direct services to students in special education who qualify for Medicaid. Physical assessments (initials, re-evaluations, annuals, etc.) are direct services. Therefore, assessments for all students in special education will be logged in EasyTrac.

 

SUMMARY OF COMPONENTS OF SPECIAL EDUCATION ASSESSMENT

  • Confirm that CCF 555 has been signed by parent/guardian.
  • Complete physical assessment. May use Temporary Health Assessment Worksheet (HS).
  • Document the Physical Assessment(s) findings on the student’s electronic health record using the appropriate HMS template. Any suggested template may be expanded per SN discretion.
  • Print a growth (height, weight, BMI) chart.
  • Initiate a head circumference chart.
  • Print HMS 213
  • Initiate Nurse Progress Note, CCF-649
  • Give HMS 213, CCF 649 and CCF-626(required for initial)andCCF-627(if obtained) to the psychologist.
  • E-mail copy of Comments section of Physical Assessment (HMS 213) to School Psychologist.
  • File a copy of the Physical Assessment(s) in the Special Education Notebook.
  • Refer to Confidential Folders-Appropriate Placement of Forms for proper placement of forms.
  • Request medical records as needed utilizing the Request for Information, CCF-503. An optional cover letter is available Request for Information (HS).

 

DISABILITY/SPECIAL EDUCATION NOTEBOOK

 

The maintenance of special education records such as health assessments and MDT/IEP notes are the responsibility of the school nurse. The Disability/Special Education Notebook Table of Contents (See InterAct→ School Nurses→ Forms & Manuals→ TOC’s) must be used as the standard format for this notebook. A divider is needed for each section. Label the notebook. All notebooks belong to the school health office. New schools are responsible to set up their own notebooks.

 

INDIVIDUAL EDUCATION PLAN (IEPs)

 

An IEP is an individual education plan which the school team develops based on the team’s assessments and collaboration as to the priority areas of need for the up-coming school year. An IEP must be held at least annually but may be re-convened if any team member requests a review or revision.

 

According to IDEA, required team members at IEPs include the LEA, the parent, the general education teacher, the special education teacher. School nurse attendance at meetings to develop/revise Individual Education Plans (IEPs) will be determined individually based upon student health concerns/needs.

 

Per Health Services Department policy, the school nurse is required to attend IEPs for students with significant health concerns, specialized procedures, and students with the following eligibilities:

  • Health Impaired
  • Orthopedic Impaired
  • Traumatic Brain Injury

Per department policy, the school nurse is recommended but not required to attend IEPs for students with the following eligibilities:

  • Visually Impaired
  • Hearing Impaired
  • Dual Sensory Impairment
  • Developmentally Delayed

 

For exit IEPs in which the student is graduating or aging out, school nurse attendance is not required.

 

The school nurse assists the team to develop a present level for student with a health eligibilities and/or significant health concerns which impact education and/or must be addressed at school.

 

The health present level is a narrative to summarize the student’s health condition(s), functioning and needs in lay terms. It must include a statement of how the primary eligibility effects the student’s involvement and progress in the general curriculum or in appropriate developmental activities. It must address what needs the student has in order to be educated with other non-disabled peers and/or across educational settings. A statement of how the student’s age appropriate peers function in the identified area of needs is also required.

 

The school nurse may also assist the IEP team by suggesting appropriate accommodations and modifications for the student. An accommodation is a change to the environment, instruction, or methods that allows the student to meet the same performance expectation as other students. A modification is a change in the expectation placed on the student- i.e. shorter, less complex assignment.

 

The school nurse will determine if the student requires direct or consultative health services to participate in an educational program, if a health plan or medical alert should be developed as well as if there are medical needs related to transportation. Refer to the CCSD Student Support Services Procedure Manual for specific procedures regarding the development of IEPs. There is also an IEP sample icon on InterAct→ School Nurses→ Resources→ IEP.

 

For orientation to special education, acronyms, and the IEP process see: http://sssdprofdev.ccsd.net/SSSDOnlineOrientation.html#

 

 

Click HERE to view the IEP Participation Chart.

 

 

CONFIDENTIAL FOLDERS

 

A confidential folder or Special Student Folder (SSF) is a folder which holds paperwork pertaining to the evaluation, eligibility, and services for special education. Access to the information in this folder is restricted. School nurses do have access to special education folders. The folders are kept in a locked file cabinet in a designated area. Individuals who take a folder out of the cabinet are required to sign the folder in and out and to note the review on the Status Record, CCF-759. Any meetings, evaluations, or updates are also noted on the Status Record, CCF-759.

 

Annual confidential folder reviews are required for all medically involved students, those with health eligibilities, student receiving school health services, and early childhood students. The review should be completed early in the year. Guidelines for folder review may be found in the Confidential Folder Review Checklist (HS). This review should be documented on the Nurse Progress Note CCF-649. The school nurse should ensure that all confidential folders have a Nurse Progress Note CCF-649.

 

The SN should organize the health portion of the confidential folder (Section II, left side) per CONFIDENTIAL FOLDER INDEX APPROPRIATE PLACEMENT OF FORMS, which is found on SN site→ SN Resources→ Assessment. If the student has complex medical needs or lengthy health records, utilize confidential folder dividers available by calling the secretary at Health Services.

 

CONFIDENTIAL FOLDER INDEX

APPROPRIATE PLACEMENT OF FORMS

 

Each form identified in this Index should be placed in the appropriate section of the confidential folder with the most current form(s) on top. The only exceptions to this rule include the Education Records document (Referral section), CCF-759 Status Record (Social History section), and CCF 649 Nurse’s Progress Notes (Medical Section), which must always be placed on top of their respective sections in the confidential folder. For each section of the confidential folder, the forms are listed in this Index in the following order: a) documents always placed on top, b) district forms (numerical order), and c) other forms (alphabetical order). Documents received from outside the district should be separated, if necessary, and placed in the appropriate, designated sections of the confidential folder.

 

 

SECTION I. ALL FORMS MUST BE IN DATE ORDER

 

A.        LEFT SIDE – REFERRAL

 

________                    Educational Records document (always placed on top)

________                    Social Security Certification Memo

________                    Resolution/Settlement/Mediation agreements

CCF-555 (555.1)         Parental Consent for Evaluation Form (i.e., all consent for Evaluation forms) (Spanish)

CCF-556 (556.1)         Parental Consent for Initial Provision of Special Education and Related Services (Spanish)

CCF-563                     Parental Prior Notice of District Proposal (Evaluation)

________                    Parental Prior Notice of District Refusal

CCF-583                     Special Student Services Referral Form

________                    Adoption Papers/Court Orders/Custody Papers

________                    Assorted Referrals and Responses (i.e., referrals for and response from Behavior Mentor Teachers, Social Workers, Region Assistance etc., other than those identified in Section II)

________                    Guardianship Paperwork

________                    Early Childhood Exiting Form

________                    Parent Correspondence

________                    Student Intervention Program (SIP) Team documentation

________                    Surrogate Parent Assignments

 

B.        RIGHT SIDE – SOCIAL HISTORY

 

CCF-759                       Status Records (always placed on top)

                                      Release of Information (Medicaid Form)

CCF-503 (503.1)         Authorization to Release Confidential Information (Spanish)

CCF-755 (755.1)         Review of Student Records (Spanish)

________                    Agency Releases

 

 

SECTION II. ALL FORMS MUST BE IN DATE ORDER

 

A.        LEFT SIDE - MEDICAL

 

            CCF-649                     Nurse Progress Notes (always placed on top)

            CCF-557                     Occupational Therapy Referral Information

            CCF-559                     Physical Therapy Referral Information

            CCF-583.1                  Health Assessment

            CCF-583.2                  Health Assessment (continued Page 2)

            CCF-626 (626.1)         Health/Developmental History (Spanish)

            CCF-627 (627.1)         Behavioral/Social History (Spanish)

            ________                    Audiological Assessments (A-1 to A-4)

            ________                    CCSD Nurse Referrals (Assorted)

            ________                    CCSD Clinic Reports

            ________                    Denver Developmental Profile/Growth Chart

            ________                    Health Services Information Divider

            CCF-665                     Occupational Therapy Treatment Consultation Report

            CCF-644                     Occupational Therapy Progress Notes

            ________                    Out-of-District Medical/Clinic Reports

            CCF-658                     Physical Therapy Treatment Consultation Report

            CCF-645                     Physical Therapy Progress Notes

            ________                    Special Education Annual Update (Health Services Form)

 

B.        RIGHT SIDE – PSYCHOLOGICAL

 

      ________                    Multidisciplinary Team Evaluation Reports (Quickwriter)

      ________                    CRS Assessment Data

      ________                    CRS-101 Status Sheet

      ________                    Level I Assessment (ECSE student/Child Find)

      ________                    Out-of-District Psychiatric Reports

      ________                    Out-of-District Psychological/Psycho-Educational Reports

      ________                    Psycho-Educational Assessment Data (parent interviews, progress reports, protocols, etc.)

      ________                    Student Interview by Psychologist

      ________                    Triennial Re-Evaluation Reports

      CCF-607                     Parent Notification of No Additional Assessment

SECTION III.  ALL FORMS MUST BE IN DATE ORDER

 

A.        LEFT SIDE – EDUCATIONAL (General)

 

            CCF 533-553              Assorted Eligibility Team Reports (must be on top)

                                                Statement of Need for Re-evaluation (Waiver)

(must be on top)

            ________                    Speech-Language Therapy Evaluation MDT Report

            ________                    Adapted Physical Education Evaluation Report

            ________                    Assistive Technology Assessment Team Results

            ________                    Eligibility Report Attachments (OR-1 observation forms, environmental/cultural/economic disadvantage checklist, LDDA printout)

            ________                    Request for Assistive Technology Assessment

            ________                    Speech-Language Assessment Data (protocols, etc.)

            CCF-589                     Student Speech Therapy Records-Daily Notations

            ________                    Vocational Assessment Data

            CCF-624                     Aversive Intervention Incident Report

 

SECTION III.  ALL FORMS MUST BE IN DATE ORDER

 

B.        RIGHT SIDE – EDUCATIONAL (IEP)

          

            CCF-530                     IEP Sections I & II (Student ID/Safeguards)

            CCF-536                     IEP Progress Report for Goals

            CCF-537                     IEP Aids/Services/Modifications/Supports

            CCF-537                     IEP Related Services/ESY/Method for Reporting Progress

            CCF-539                     IEP Manifestation Determination (3 page document)

            CCF-539.2                  IEP Functional Behavioral Assessment Worksheet

            CCF-539.3                  IEP Positive Behavior Intervention Support Plan

            CCF-554                     Notice of Temporary Placement (attached to out-of-district IEP)

            CCF-563 (563.1)         Parental Prior Notice of District Proposal (IEP/Related Issues) (Spanish)

            CCF-564 (564.1)         Parental Prior Notice – Proposed Meeting Arrangements (Spanish)

            CCF-566 (566.1)         Notice of Intent to Implement IEP (Spanish)

             CCF-582                     IEP Team Meeting Follow Up Letter

             CCF-587                     IEP Goals and Benchmarks

             CCF-597 & 597.1       IEP Accommodations for NV Proficiency Exam Program

             CCF-597.2                  IEP Guidelines for Participation in NASAA

            CCF-600                     IEP Present Levels of Performance

            CCF-601.1                  IEP Transportation – Related Services

            CCF-601.2                  Physician’s Request for Air Conditioned Bus

            CCF-601.3                  Notification of IEP Assessment/Consultation Request

            CCF-604                     IEP Special Education Services

            CCF-605                     Transition Planning

            CCF-606                     IEP Placement

                                                Service Plan

 

(Revised 1/28/08)

 

 

DocDNA

 

When students leave the district, or are exited from special education, Student Data Services converts the contents of their confidential folder into an electronic document. These electronic documents are contained in a program entitled DocDNA. A limited number (4) of staff at each school site are given access to these records.

 

If a student re-enrolls in the district, the school may receive a skeleton or empty confidential folder. The documents desired may be viewed and/or printed by accessing them through DocDNA. Documents may be viewed only for students currently enrolled at your school. If the school nurse does not have access to DocDNA, a staff member with access may be asked to retrieve the desired documents.

 

If the desired item cannot be accessed through DocDNA, then a Non-School Confidential Folder Request (AAR-F528) should be emailed to Confidential Records to request the document. Any questions should be directed to Student Data Services at 799-2487.

 

ADDITIONAL PROGRAMS AND RELATED SERVICES

 

CCSD Related Services offers services to student to support academic and non-academic outcomes in the educational setting. Related Services are transportation and other supportive services to assist a student with a disability to benefit from special education. These services operate using an educational model of service rather than the traditional medical model:

  • Educational team collaborates to determine the focus of services based upon the student’s educationally related needs
  • Intervention is directed toward facilitation of the education process
  • Services provided for students ages 3 to 22 who are enrolled in special education programs.
  • Documentation of intervention is related to IEP goals in non-medical or layman terminology
  • There is no cost to the parent.

Related Services include: occupational therapy (OT), physical therapy (PT), transportation, speech/audiology, school health services, interpreting services, psychological services, orientation and mobility services, medical services for diagnostic or evaluation purposes, social work services, and parent counseling/training.

 

Additional instructional and support services available to support the academic and non-academic outcomes include adapted physical education, assistive technology, behavior mentors and low incidence team (vision, hearing, autism, physically challenged).

 

OCCUPATIONAL THERAPY/PHYSICAL THERAPY SERVICES

 

The School team may decide to consult with the OT/PT “when a student is not responding to documented classroom interventions and motor deficits are a concern.” They are available to consult with classroom teachers regarding appropriate types of intervention activities. Referrals to the OT may include concerns about handwriting after documented classroom interventions have been attempted and failed, concerns about activities of daily living – dressing, toileting, feeding/eating issues. Referrals to the PT may include concerns about student mobility, seating/positioning, safe access to the school environment, wheel chairs, as well as safe access to the bus.

  • Services are identified as direct /consult delivery methods as determined by the IEP team.
  • Work with students to improve their performance in a variety of academic environments.
  • Provide support to school staff and parents regarding the carryover of activities for the student.

 

Referral process:

  • The school IEP team requests assessment for students with disabilities at the time of the IEP
  • Present levels should reflect the concerns
  • Goals and benchmarks should be developed to address the concern. Related Service page lists Assess for OT or PT.
  • Parental Consent for Evaluation, CCF -555, stating occupational therapy/physical therapy assessment and signed by the parent/legal guardian
  • OT/PT Referral form (CCF-557) is completed
  • Fax documentation to 799-1502.

 

SPEECH SERVICES

 

Speech Services are offered to students both as a primary service provider and as a related service provider. The speech language pathologist (SLP) functions in two roles: diagnostician and also clinician. Their primary role involves assessment for problems with articulation phonology, fluency, language, communication disorders and voice disorders as defined by Nevada Administrative Code (NAC). Direct Services include:

  • pullout model – taking the student to the speech room for services
  • servicing the student in the classroom
  • co-teaching language lessons in specialized classrooms

As a related services provider: in areas such as articulation, phonology, fluency or voice disorders on IEP goals/benchmarks that are developed by the SLP, or services are attached to a classroom educational IEP goal or benchmark in the area of language or communication.

 

AUDIOLOGY

 

Audiology is a service that is diagnostic and consultative. The diagnostic function is to clinically confirm types of hearing loss and levels of hearing in students enrolled in public and private schools as well as students referred from the Child Find Program. Referrals are made for medical and educational purposes. The audiologist’s function is to assess students and provide communication to the Health Services staff, speech/language pathologists, staff of the Hearing Impaired Program, parent, physician, and others relative to hearing impairment. In addition, the audiologist will provide in-services and information related to various parameters of hearing and related dysfunctions to parents and school personnel.

 

Audiology also screens for Auditory Processing Disorder (APD). Auditory Processing Disorder (APD) (previously known as “Central Auditory Processing Disorder” [CAPD]) is a disorder in the way auditory information is processed in the brain. It is not a sensory /hearing impairment; individuals with APD usually have normal peripheral hearing ability. APD is an umbrella term that describes a variety of problems with the brain that can interfere with processing auditory information.

 

Referral for audiology/hearing evaluations are generated by the school nurse: See Section G for referral information.

 

A referral packet must be completed by the school team for APD.

 

See InterAct→ School Nurse Icon→ Clinic Packets→ Audiology.

 

ADAPTED PHYSICAL EDUCATION (APE)

 

Students with disabilities must be afforded the opportunity to participate in the general physical education program available to children without disabilities (least restrictive environment) unless:

  • The child is enrolled full time in a separate facility; or
  • The child needs specially designed physical education, as prescribed in the child’s Individual Education Program.

 

Adapted physical education is specially designed instruction (thus a special education service) and not a related service. Adapted PE provides students with disabilities a means to access the general physical education curriculum and, whenever possible, with their non-disabled peers. In the Clark County School District, students with disabilities are offered a continuum of services to insure their access to general PE through the Adapted Physical Education (APE) Program. This continuum may include:

  • Student monitoring in general physical education,
  • The cooperative consultative model with the general physical education teacher, and/or
  • Direct student services, depending on the student’s individual needs, which may include:

                ·         Concurrent APE/PE programming,

                ·         Small group activities/practice addressing the PE curriculum,

                ·         One-on-one intervention in the PE class, providing for immediate modifications to lesson being presented.

 

Students must be special education eligible to receive Adapted PE. The referral process is an IEP team decision.

 

REFERRAL PROCESS FOR APE

 

A referral for Adapted Physical Education should be made only after prior interventions have been attempted in the general Physical Education class. If the interventions are not successful, then:

  • A “Request for Observation for APE” may be generated by the parent, PE teacher, nurse, or other school staff. There must be PE teacher input as to student’s inability to access the general PE curriculum, with written documentation of prior interventions. A referral may be requested through the IEP Team (CCF-601.3), but again, PE teacher input is required. All forms may be sent to APE, Seigle I Diagnostic Center (130) or faxed to (799-0104).
  • Appropriate referrals involve students who are:

                ·         Currently accessing physical education

                ·         Eligible for Special Education (under I.D.E.A.), or going through the eligibility process

                ·         Demonstrating motor deficits (not behavior involved only) as indicated by the general PE teacher.

  • The Request is entered into the APE data bank, and then disseminated to the appropriate APE teacher. The APE teacher makes contact with the school and the general PE teacher to arrange for the observation of the student during the student’s PE class.
  • If the APE teacher notes severe delays, further evaluation will be recommended. The APE teacher may recommend that additional interventions be tried before determining the need for assessment.
  • If the interventions recommended by the APE teacher are successful, this is noted in the student’s confidential folder and no further action is needed. The Request is completed and sent back to the APE office.
  • If the APE teacher has recommended further evaluation, or recommended interventions have not been successful, the Assessment process begins.
  • Assessment Process
  1. Send home a CCF-555, (Permission to Assess) to be signed by the parent as well as a CCF-563, (Parental Prior Notice). ALL NEW ASSESSMENTS MUST HAVE A CCF-555 SIGNED FOR APE.
  2. After the Permission to Assess has been returned, the APE teacher will arrange with the PE teacher to conduct the assessment. This will include both formal evaluations (i.e. TGMD2) and observations during the general PE class.
  3. At the completion of the assessment, a written report will be prepared. An IEP meeting will need to be held (addendum) to determine the need for APE services.
  4. If it was determined that APE services are needed, Present Levels of Performance reflecting the assessment results will be presented, and Goals and Benchmarks developed for the student’s deficit areas indicated in the Present Levels. Then, the service delivery options for APE will be discussed and the team will decide what is appropriate (based on the recommendations made by the APE teacher).
  5. APE services do not begin until the IEP is completed.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ APE for further information and forms.

 

ASSISTIVE TECHNOLOGY

 

IEP teams must consider whether or not the student requires assistive devices and services as part of the student’s special education, related services, or supplementary aids and services.

 

Assistive Technology Device is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability.

 

Assistive Technology Service is any service that directly assists the child with a disability in the selection, acquisition, or use of an assistive technology device. These services include evaluation of the child’s needs, purchasing, leasing or providing assistive technology devices for the child with disabilities, selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices, coordinating and using other therapies, interventions or services with assistive technology devices, training or technical assistance for the child with a disability, the child’s family or for professions providing education services.

 

The IEP team determines the need for a referral for Assistive Technology. There are three levels of access for assistive technology: school based, area based (Area KIT/MINI Referral), and district based (referral to the Assistive Technology Services). School based referrals include modifications and accommodations to meet student needs in this area.

Area based referrals include access to loaner kits of low tech items to utilize on a trial basis. In cases where the available site-based technologies are not appropriate and interventions via the area kit do not provide educational access for the student, the IEP team may decide to initiate a referral to the Assistive Technology Services.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ Assistive Technology for further information and forms.

 

LOW INCIDENCE DISABILITIES TEAM

 

The Low Incidence Disabilities Team is a multidisciplinary team that provides support to site school teams providing educational services to students with low incidence disabilities, such as autism, hearing impairment, vision impairment, and orthopedic impairment. Support is requested through the Area Special Education Team or the office of the Low Incidence Team. The school team will be asked to complete a Teacher Support Request Form. Services provided also include orientation/mobility training, wheelchair training (Traveling Partners), and general consultation/assistance for school staff.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ Low Incidence, and click on the desired icon for further information and/or forms.

 

HEARING IMPAIRED PROGRAM

 

The Hearing Impaired Program is designed for students between the ages of 3 and 22 whose hearing loss is considered to be significant. The program develops a symbolic communication system which will enable the child to communicate ideas, thoughts, and concepts by speech or a combination of speech and the language of signs and finger-spelling. Two modes of communication are offered: oral and total communication.

 

Eligible students must meet the criteria for Hearing Impaired Classification contained in the Nevada Administrative Code (NAC). Clark County School District Audiologists serve as a required member of the MDT for all Hearing Impaired Eligibilities. Collaboration between the audiologist, referring/receiving school and related services personnel is essential. If further information on this program is needed, refer to the Student Support Services Manual.

 

ROLE OF SCHOOL NURSE WITH HEARING IMPAIRED STUDENTS

 

INITIAL EVALUATION

Once the referral is initiated, the school nurse completes a Physical Assessment, HMS 213. A current audiogram is required for initial eligibility and every three years.

A school nurse is a recommended member of the Eligibility Team and therefore is recommended to participate in the MDT/Eligibility meeting.

 

THREE YEAR RE-EVALUATION

The re-evaluation process for a hearing impaired student should be consistent with all students receiving special education support services. The Hearing Impaired Program should be contacted to arrange for a representative to assist in determining the scope of re-evaluation and to attend the MDT/IEP. It is recommended that the school nurse should participate in the process.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ Low Incidence→ Deaf and Hard of Hearing (DHH) for further information and forms.

 

VISUALLY IMPAIRED PROGRAM

 

The Visually Impaired Program is designed for students between 3 and 22 years of age with visual disabilities which make it impossible for them to benefit from a program in a regular classroom without additional special services and equipment.

 

The program integrates the child with visual impairments, with the sighted child, both socially and academically. The services include:

Early identification and assessment;

Parent involvement/education;

Orientation/mobility;

Self-help; and

Emphasis on listening skills.

 

These students must meet the criteria for Visually Impaired Classification. (Refer to CCSD Student Support Services Procedure Manual.)

 

The school nurse is part of the diagnostic team for the Visually Impaired student and works with the itinerant vision impaired staff to identify and obtain medical information needed for eligibility information and to plan for the programming needs of these students. Resources for a vision exam are available for those students without medical resources for whom there are eligibility questions. Contact the school nurse/ liaison for vision services.

 

 

ROLE OF SCHOOL NURSE WITH VISUALLY IMPAIRED STUDENTS

 

INITIAL EVALUATION

Once the referral is initiated, the school nurse completes a Physical Assessment, HMS 213. A current vision exam is required for initial eligibility and the referral form Eye Specialist Report Low Incidence Disabilities Department; CCF-532 A school nurse is a recommended member of the Eligibility Team and therefore is recommended to participate in the MDT/Eligibility meeting.should be utilized.

 

THREE YEAR RE-EVALUATION

The re-evaluation process for a visually impaired student should be consistent with all students receiving special education support services. The Visually Impaired Program should be contacted to arrange for a representative to assist in determining the scope of the re-evaluation and to attend the MDT/IEP. It is recommended that the school nurse participate in this process.

 

See InterAct→ SSSD Exchange→ SSSD Departments→ Low Incidence→ Visually Impaired (VI) and/or Forms for further information and forms.

 

EXTENDED SCHOOL YEAR (ESY)

 

Extended school year is a program for students in special education who would academically regress if they had a prolonged period of time off from school. The District provides instructional services during the summer break for those students identified as at risk of losing ground academically or functionally.

 

RESPONSIBILITY OF THE SCHOOL NURSE IN ESY PREPARATION

 

The school nurse should e-mail the special education facilitator or special education teachers to obtain a list of all students being referred to ESY. Early Childhood Programs should be included. The nurse should request this list by April 15th.

 

Review this list to determine any students who receive a procedure at school, medication at school, or have significant medical problems and have a medical alert or health care plan. Check the Extended School Year Enrollment sheet (CCF-606.1) for any Health Services. If the student is to receive health services, the site school nurse must complete the medical section, indicate the procedure or medication and sign. For those students identified, gather the following documentation:

Copy of SASI student atom, tabs 1 and 3

Copy of all phone numbers in SASI

Print HMS 109 Demographic report from Healthmaster

Print Special Problem Summary HMS 517 for each student

For procedures, include copy of physician orders, procedure summary, medical alert or health care plan

For medications, include Parent/Guardian Request for Medication Assistance CCF-643, Prescription Records Detail HMS 502, and any Licensed Healthcare Provider clarifications

Make 2 copies of the documentation, staple each copy together, and write “ESY” at the top

Send one copy to “ESY-Health Services/Seigle II” via school mail by May 1st.

Send the other copy to your area nurse coordinator

Continue to be aware of students who are signed up for ESY