Individual Health Plans (IHPs) and Section 504 Eligibility

He Needs to be Checked by the Nurse 3 Times a Day! IHPs under Section 504 Heather R. Rutland Eichelbaum Wardell Hansen Powell & Mehl, P.C. NELI Bootcamp June 10, 2019

IHP Defined An "individual health plan," or "individualized health plan," typically focuses exclusively on addressing a student's medical needs. It is generally not developed in accordance with formal procedures, such as those required for the development of a 504 plan. Springer (NM) Mun. Schs., 111 LRP 65450 (OCR 06/17/11); Roselle Park (NJ) Sch. Dist., 59 IDELR 17(OCR 2012).

IHP Defined another way A written document that outlines the provision of student healthcare services intended to achieve specific student outcomes. Manage healthcare conditions to promote learning Facilitate communication, coordination, and continuity of care among service providers

IHPs and Section 504 Eligibility When determining if a student has a disability, follow the expanded ADAAA interpretation of disability, including the requirement that the ameliorative effects of mitigating measures, including the provisions of an IHP, not be considered.

IHPs and Section 504 Eligibility Districts may not delay a 504 evaluation based merely on the existence of an IHP. Just because a specific student s health needs can be accommodated with an IHP does not mean the district is relieved of its obligation to create a 504 plan for the student. The key is whether the IHP was developed in accordance with procedures that satisfy the requirements of 504.

IHPs and Section 504 Eligibility In some cases, a student may require both a Section 504 plan and an IHP to receive FAPE. o Section 504 Plan for educational needs o IHP to detail managing student s meds Birdville (TX) Indep. Sch. Dist., 65 IDELR 307 (OCR 2015).

IHPs and Section 504 Eligibility Be wary of becoming a district that has a policy or practice of providing only IHPs to students with a particular health issue, (diabetes, asthma, allergies) instead of determining their eligibility for a 504 plan. You are obligated under Section 504 to evaluate students who may, because of their condition, require related aids and services. Failure to do so may be a denial of FAPE. Tyler (TX) Indep. Sch. Dist., 56 IDELR 24 (OCR 2010).

IHPs and Section 504 Eligibility Addressing the needs of students strictly through IHPs and conducting 504 evaluations only when parents specifically request them has been deemed a violation of Section 504. It should not be (solely) the parent s responsibility to request evaluations. Forest Hills (OH) Local Sch. Dist., 58 IDELR 114 (OCR 2011).

IHPs and Section 504 Eligibility A one-size-fits-all approach to certain conditions can backfire. Example: Seizures Simply distributing a Seizure Protocol form isn t enough. There are other considerations: Medication? Staff training? Staying current with medical info?

IHPs and Section 504 IHP should be referenced in or fully incorporated into the 504 Plan. On its own, the IHP does not provide any procedural safeguards for the student. Only by attaching (or incorporating by reference) the IHP to the 504 plan will it guarantee nondiscrimination rights under the ADAAA.

IHPs and Section 504 IHP should be reviewed and revised as necessary whenever new health information is available. If IHP is part of 504 Plan, a 504 meeting should be convened to consider new info Regardless, IHP should be reviewed annually

Nurses Responsibility Write the Individualized Health Plan (IHP) Non-medical supportive services (not performed by a physician) that are necessary for the student to remain in school during the day. With diabetic students, base the IHP on the Diabetes Management and Treatment Plan (DMTP) in collaboration with the physician

Limits to an IHP? Private Duty Nurses Serious concerns, even if parent funded Employee vs. Contractor status Confidentiality Accountability District should be READY, WILLING and ABLE Detail nursing credentials and care plan Be ready to prove your staff is capable of meeting the student s needs.

Examples of Health Care Services Allergies and multiple chemical sensitivity: Medical monitoring by school nurse at least twice daily, and adoption of a medical protocol concerning oxygen availability (Massachusetts) Implementation of emergency response protocols explaining how staff members should handle and administer epinephrine in the event of an anaphylactic or other serious allergy-related reaction (Virgina)

Examples of Health Care Services Diabetes: Insulin administration services to students who are unable to self-administer the insulin (Florida) Insulin and glucagon administration and calculation of ketones during field trips (Georgia) Provide nutritional information for school lunches (Michigan) Installing insulin pod refills for an insulin pump (Virginia) Insulin injections and/or snacks while traveling on the school bus (Georgia) Change a student's insulin pump infusion site after the pump became dislodged at school (Utah)

Examples of Health Care Services Asthma: Administration of inhaler or medication (Colorado) Transportation services to school placement that implements 504 plan (Alabama) ADHD: Med administration during school day (Letter to Mentink) Hirschsprung's disease: Colostomy bag services (Florida)

Examples of Health Care Services Epilepsy: Medically trained aide to recognize and respond to seizures during band camp (Washington) Adrenal failure: Trained staff members, including transportation personnel, to administer steroid injection and implement in the emergency care protocols in case the student experienced adrenal failure (Florida)

Examples of Health Care Services Tube feeding: Revision of district policy to permit tube feeding in the classroom (Alabama) Tracheotomy care: Carry out physician s orders for suction and other care and care and monitoring (Maryland)

Emergency Care Plans Defined as an emergency plan developed by the school nurse and either based on the IHP or instead of the IHP. Written in clear action steps Using succinct terminology understood by school faculty and staff For use by those charged with recognizing a health crisis and intervening appropriately

Emergency Care Plans Parents are often more interested in the ECP than the IHP. Additional training may be required Document any training conducted As with the IHP, an ECP needs backup staff built in Update ECP when receive new info Review ECP annually

IHPs and FAPE If a student is entitled to receive FAPE under Section 504, the failure to properly implement the student's IHP may result in a Section 504 violation, regardless of whether the student has a separate 504 plan or not. Scarborough (ME) Pub. Schs., 66 IDELR 190 (OCR 2015); Yakima (WA) Sch. Dist. No. 7, 64 IDELR 53 (OCR 2014).

Helping Parents Let Go Acknowledge parent fears or concerns Establish good communication with parents Establish good communication with doctor(s) Conduct additional training if necessary Have parent demonstrate techniques Invite Nurse to each 504 meeting Document all nursing services

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