Download http://www.medicalhomeinfo.org/ publications/education.html

PARTNERSHIPS WITH
HEALTHCARE PROVIDERS
AND SCHOOLS
Ann T. Behrmann MD
Group Health Cooperative
Janice Cooney, PA-C
UW Family Practice
Liz Hecht
Waisman Center
What is a Medical Home
 What is a Medical Home?
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A medical home addresses how a primary health care professional
works in partnership with the family/patient to assure that all of the
medical and non-medical needs of the patient are met. A medical
home is defined as primary care that is accessible, continuous,
comprehensive, family centered, coordinated, compassionate, and
culturally effective. 1
A medical home includes:
A partnership between the family and the child's/youth's primary
health care professional
Relationships based on mutual trust and respect
Connections to supports and services to meet the non-medical and
medical needs of the child/youth and their family
Respect for a family's cultural and religious beliefs
After hours and weekend access to medical consultation
Families who feel supported in caring for their child
Primary health care professionals coordinating care with a team of
other care providers
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Family’s Role
Notify school of child’s needs
Provide information as appropriate
Participate in plan development with
school and medical team
Provide medication and supplies
Share contact information
Support child/youth to acquire needed
skills
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Your School’s Role
 The Individuals with Disabilities Education Act
(IDEA) grants to eligible children with
disabilities the legal right to receive a free
appropriate public education in the least
restrictive setting. For an increasing number of
children with disabilities, access to education is
only achieved through the provision of necessary
health services (e.g., administration of
intravenous medications, catheterization,
tracheostomy care, gastrostomy tube feedings).
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Your School’s Role
 The 1999 United States Supreme Court ruling in
Cedar Rapids Community School District v.
Garret F. (hereinafter known as "Garret F.") held
that the Individuals with Disabilities Education
Act (IDEA) requires school districts to provide
nursing services when such supportive services
are necessary in order for students to access and
benefit from their educational program.
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Your School’s Role
 "School nurse services" is a new related service
and has replaced "school health services".
 (26) Related Services. The term 'related services'
means transportation, and such developmental,
corrective, and other supportive services
…school nurse services designed to enable a
child with a disability to receive a free
appropriate public education as described in the
individual education program of the child, ...as
may be required to assist a child with a disability
to benefit from special education, …Reference from IDEA
2004 - 20 U.S.C. Section 1401 (26) (A)
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Your School Nurse’s Role
 Identify students
 Arrange meetings to discuss accommodations
 Develop health care plan and emergency care
plan
 Delegate responsibility
 Provide training
 Provide supervision
 Provide health education
 Case management
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Your Pediatrician’s Role
 IEP planning and input on Behavior Intervention Plan
(BIP)
 Medication administration information/forms
 Advocacy with family for services
 Communication re medication and its effect on academic
progress or behavior with school
nurse/teachers/psychologist – phone and email
 Development of an Emergency Care Plan
 Creation of a Signs and Symptoms Checklist
 In service for specific cares—may be done jointly with
family’s help and input
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Your Pediatrician’s Role
MAKING IT WORK
Expanded appointment times
Time commitment
After hours communication
Reimbursement for care coordination
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AAP Resources
 Helpful guidelines from the American Academy
of Pediatrics, Committee on Children With
Disabilities, including: The Pediatrician's Role in
the Development and Implementation of an
Individual Education Plan (IEP) and/or an
Individual Family Service Plan (IFSP) (RE9823)
Pediatrics. 1999;104(1):124-127
 http://www.medicalhomeinfo.org/
publications/education.html
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Child/Youth and Pediatrician
Partnership
 Peds doc/family sharing information with kid—
facts about illness/disabilities and medication and
allowing child to be the expert on herself and her
medications
 Responsibility to always take meds when driving,
working, swimming or participating in dangerous
recreation or sports
 Never taking scheduled medications (prescription
pain meds or stimulants for ADD/ADHD) to
school or giving or selling them to friends
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Child/Youth and Pediatrician
Partnership
With the individual
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it takes time
it takes practice
it involves a little risk on your part
model your speech and behavior from parents
or others who do it well
– it takes extra time
– get to know the child at their typical setting
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Child/Youth and Pediatrician
Partnership
EMPOWER AND TEACH EACH
INDIVIDUAL
Involve the individual in discussions
regarding their health care
Age appropriate level
Engage them in decision making when
possible
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“While a disability may create
challenges, the need for information
or assistance, it does not define a
person’s entire existence.”
Hanft, 1989.
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Language
Language is an extremely powerful tool.
Language reflects concepts.
– Language reflects our ideas and judgements of
others.
Model appropriate language for others.
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Language
People first language refers to individuals
first, and their disease or disability when
necessary.
Demonstrates respect for the person and
recognizes their abilities.
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Choose your words carefully
Medical records and care plans are shared
across environments. Remember that
numerous people may see your written
documentation.Your language reflects your
views and helps paint a picture for the
reader.
People may be offended at language you
use in your medical writing.
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Tools for Communication
 1) Develop partnerships to possibly include these
participants:
– child, family, school nurse, teachers, school
administration (principal, special ed
coordinator), school psychologist or social
worker, special education assistants, fellow
students
2) Schedule a summer or spring pre-school year
planning meeting
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Communication Aides
Forms— school medication, allergies
Daily care plans
Behavioral Intervention Plan (BIP) from
formal Functional Behavioral Assessments
Strategies for ongoing communication—
daily shared notebook, emails, phone
Consider having your pediatrician/FP
complete “signs and symptoms checklist”
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Care Plans for Children With Special
Health Needs
Care Across Various Settings
 Home
 School
 Day Care settings
 Community
 Work
 There may be multiple people of various
disciplines/skill level involved. Develop
communication strategies across all settings.
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Identify Health Issues
Identify/educate those on the team
– SE teacher, SE aide, school nurse, teacher, others
– Day care providers, support /aides at day care
– Home - parents, personal care workers
 Provide information. Information builds confidence!
– articles regarding condition
– handouts regarding tubes, lines, etc.
 Develop a plan
 Identify those that are medical providers and their availability
• Emergency training such as CPR, airway management.
• Medications
• Seizure management
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Developing A Plan - School
 Identify individuals to help
– Nurse
– Teacher
– SE assistant
 Write a plan of care - consider potential problems and
outline solutions
 Provide information
– get articles describing typical health problems and
characteristics of the child’s problems
– medication lists
– emergency contacts
– allergies - include food / meds/ environmental/ latex
 Train necessary individuals at various settings
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School - Identify Need
Justify need via IEP
– documents need for nursing care
– builds nurse into the team
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School - Identify Need
 Identify training needs for school personnel.
Train support staff and teachers prior to, and
during the school year.Utilize the IEP.
Use tools such as training videos.
 Examples: Safe handling and transfers
Feeding
Gastrostomy tube use
Personal cares, toileting
Seizure management
Airway management
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Communication
With parents/caregivers
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cell phones
pagers
contact numbers where available
make a form with contact numbers clearly
outlined
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Communication
May be multiple people involved over
various settings.
Central, organized format is helpful.
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Health Information
Keep information in an organized 3-ring
file.
Include the following:
– Medical diagnosis
– Names and phone numbers of medical
providers
– Medication lists
– Allergies
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Medication List
Carry a list of medications and allergies
Example:
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R.C.
DOB: 5/16/93
Medical Diagnosis: Cerebral Palsy, Asthma, Low Vision, Reflux
Allergies: Amoxicillin and Clindamycin
Baclofen 20 mg TID for spacticity
Valium 2 mg AM and 4 mg PM for spacticity
Dantrolene 25 mg AM and 75 mg PM for spacticity
Prilosec 20 mg BID for reflux
Metoclopramide 5 mg QID for reflux
Flovent MDI 2 puffs BID for asthma
Albuterol MDI 2 puffs TID-QID for asthma
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Flonase Nasal Spray 2 squirts each nostril QD for allergies
Other strategies
Medic Alert Bracelets
 Child Alert Program
– register child through Child Alert Programeducates and alerts EMS to potential problems
of individuals so EMS can react proactively in
an emergency situations
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Signs and Symptoms of Problems
Listen to the parents or primary providers
of care
School personnel may detect changes as
well
“They’re just different”
“Something is wrong”
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Signs and Symptoms of Problems
Remember kids with special health care
needs also develop typical childhood
illnesses. Look for those. Consider where
they spend time - home, day care, school.
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Signs and Symptoms
Do a good once over, including vital signs.
Assess level of response, is it typical?
Include skin and remember that some people
have decreased sensation.
Sleep
– poor sleep or increased sleep
Muscle tone
– Increased / decreased muscle tone
Head banging
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Signs and Symptoms
 Aggressive behavior
 Seizure patterns -
– towards self or others
 Change in bowel or
bladder habits
 Emotional changes
– anger/withdrawal
– crying
 Whining, crying,
vocalizations
 changes over time which
may cause subtle changes
– increase in seizures or
change in pattern may
reflect infection
 Look for signs of abuse
 Medication changes
 Think about poisoning
– can make adverse
reactions and behavior
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Signs and Symptoms
some examples
 Hypoglycemia (low blood sugar or Insulin)
reaction in diabetic student—confusion and
irritability, uncooperative diabetic may signal low blood glucose, so
better to give sugar (OJ, concentrated glucose) than time out!
 Pain manifestations in nonverbal child—
increased agitation, elevated heart rate, sweating
 Response to a seizure in child with
epilepsy— when to call 911/use of Diastat rectally
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Emergency Care
Develop emergency and medical plans pro-
actively.
Develop relationships with parents and
individuals.
 Involve parents and primary care providers.
Look for subtle changes.
Develop teaching tools and training
sessions.
Compile information in central format.
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Emergency Care Plan
Know your emergency plan.
Review plans periodically.
Know who can help you in an emergency.
– School nurse
– 911
Identify individuals trained in schools, may
include students.
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Emergency Contacts
Parents/caregivers
Pediatrician
– plan for after-hours care
Hospital used in emergency
– Services provided via local ambulance
• transportation only
• advanced training
• ability to handle child’s special issues
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Remember the individual involved.
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