Keeping Kids Safe at School with Emergency & Health Plans | Undivided Conversations

Full transcript: The Individualized Health Plan is written to describe how services are provided, what services are provided. And it's think of it like a blueprint document. It's all about health services and special health services. If you think about it, it's the one document that covers everything health related. Now, what can be a bit confusing for families is that we do use nursing diagnoses, but the individual health plan is a separate document. Now some states will say that they want the AHP incorporated as part of the IEP. So they will upload it to the IEP. Attach it to the IEP as long as the location is listed. It's not necessarily mandatory unless your state law requires that it's uploaded. And the reason for that is IEPs. We have to have a meeting. We have to send out meeting notice to let families know when we're making any changes, because they're a critical member of the IEP team. And the 514 with an individual health plan. We want those changes made as soon as they're needed. And so we don't want to wait for the team. And that's why I've always advised to make it a separate document and then reference back and forth. A child wouldn't necessarily need an IEP or 5 or 4 plan to have an IHP, right? You can just be they need these nursing or medical needs that are not special education. Yes, with an individual health plan and a 504 plan. Certainly if there are health services needed, that's when a plan is written. It is possible to have an individual health plan and not have a 504 plan or an IEP. But it is rare. And those health plans would be really more focused on providing immediate care and short term care. So if the parents want to know if they should provide the school with medical information for the IEP. When we asked for medical records, I know that can seem like an intrusion to families, and the purpose of that is to help us understand the full impact, be it a genetic condition, be it a chronic health condition, be it a congenital anomaly, be it there's so many different ways that a child can have a health concern that can impact them educationally. Without having those records, I don't know the full depth and breadth of that particular effect. And I really can't anticipate every child that has the same diagnosis isn't the same impact. It just isn't. So it's very, very important to make sure that I'm getting all that information. The other reason I really it's important to get that is that it kind of triggers me what to ask the family. I rely on families very heavily to give me the gaps, fill in those gaps. What isn't in the record? What do I need to know? And with that combination, it saves parents having to go through some really painful stories and relive difficult times. And is that information treated confidentially by the school that the parents provide? When a parent gives us information. I treated very confidentially everything that I receive and nurses are. It's part of our license as part of our Nurse Practice Act that we maintain confidentiality. There are also two laws. One is HIPAA that protects health facilities. The other is for PBA, for APA protects educational records once a medical record comes into the school, it becomes an educational record. Both of those require strict standards of confidentiality. Just know that we're going to protect that information. But this is the but part of it for FIR. But I can share that information with anybody who requires that knowledge in order to do planning. It's not like that information is going to stay with the nurse. It probably is going to be shared in bits and pieces as needed, to maybe include an accommodation or to include a modification for special education, maybe a shortened school day, maybe all of those things are managed by the school nurse when it comes to those records, or the occupational therapist, or the physical therapist, or the speech and language pathologist, whoever it is that has those records. We're very protective. Let's say, as a nurse, do you want to include information into the health plan that, the child or parent wants to keep private from the teacher? How like how do the teachers come in the privacy? It goes back to the need to know. And and you mentioned that, well, legitimate educational interests would be if I have a student that has say, diabetes type one that is critical for that teacher to know if they're having a high or low blood sugar. That's something that I shouldn't withhold. If it's something related to genetics, related to things that really are private. I make a point to have a conversation with the parent and tell them my rationale for wanting to share that I know that it can become difficult for parents to share information. I don't need to know parents health history. I don't need to know some of the things that are sometimes in those medical records. I'm okay if a parent really wants to keep things locked down. If they would have their pediatrician or their specialists write a letter that describes exactly what the child's condition is, how it impacts, what are the treatments, what are the medications? What are the concerns that the physician has for the child's attending school? All of that can go on the letter, the the nuances, the difficult, translation of that then is lost because I don't have the record, but I can do a decent job with a letter from a from a physician. So I do ask parents to consider that. Or they could provide limited access. Maybe it's just records. Maybe they just want me to have a conversation with that provider and ask all my questions of the provider. Very open, but that information sharing is critical to get a valid IEP. This is supposed to be custom designed for the child. And what if a parent disagrees with the plan or something in the plan? How does that kind of, get resolved? If there's disagreement in the plan, I like to take that back to the IEP team or 514 it depending. It's usually with an IEP, they'll take it back to the IEP team and discuss it. If the parent says, I don't want the nurse involved, I don't want anything to do with an HP. I can tell you the IEP will still be written because as a nurse, we have to write a treatment plan for providing care that covers us for the following the nursing process and staying within code. Now how much is that shared is going to be shared with staff within the school. But in those cases, the parent really has lost that opportunity to give input. So I would advise very strongly for parents to reconsider, try and stay in that mode of listening, negotiating, understanding. I realize we as professionals, we get really. Really involved with the kids and really want what's best for them. And what's best is really an opinion. It's a point of view versus me as a professional versus a parent. Never want to get into a situation where it's a versus kind of thing. Never should be adversarial. Always should be a team approach. What should an emergency plan include? And like if you have any kind of examples of like writing up an emergency plan, like what would that kind of entail? When we talk about emergency health care plans, it's related to students who have need, like medical. There's an emergency health care plan on file for medical purposes. So, like students who have seizures, for example, like, what's the plan? Should the student have a seizure? I've never heard of an emergency plan written into a student's file. However, I don't I definitely agree with you. I think it's something all of these pieces are really important. The most common, I guess emergency drill, if you will, that I think is covered within IEP meetings is fire drills. Fire drills is definitely the most common in my experience, and it's mostly due to this, the noise. So that's definitely one that's brought up often, and it's usually supported by way of the accommodation section. Priming or giving you know, warnings to the student of when to expect the fire drill, sometimes even removing the student from the classroom so they'll still hear it, but it won't be as amplified. Headphones prior to the drill, I mean, those types of things. And then also there's accommodations to this to support the student and what to do when they're outside, because as I'm sure you remember, like when we do fire drills, everybody lines up and we're standing on the blacktop or the grass or what have you. So different accommodations to support. Like should they have something maybe like a bin next to the door that they can quickly access, like a, fire drill tote if you will. So they have something to keep them occupied and they can stay in line and they're not. Maybe it's a student who might elope, for example. So those are common ones. A lot of repetition, I think, would be a really good one. Like, when they're practicing it, like as close to as possible is what it could look like. I mean, God forbid it happens, right? But, making it really almost like a muscle memory for them, but it would be in accommodations. I don't know of a separate plan that any IEP template has that I've seen run, hide, freeze. Like that's a thing when it's like, the general recommendation for if there's like an active shooter or something, but like, like you said, like what if someone has autism and he can't, like, kind of grasp maybe the gravity of the situation or they're like in a wheelchair. You don't see those being in the IEP under accommodations. Like if this happens, this is what the teacher like the plan for the student would be like. So that way of like a plan, like if the emergency happens, like what exactly would they have to do? Yeah. So accommodations are individualized per student and there is no cookie cutter list of accommodations. There are dropdowns, but you can write them to be tailored any which way. So another thing I was going to say is for things like fire drills, anything that where there's accessibility, like you mentioned, the wheelchair, obviously it all has to be ADA compliant. So that shouldn't even be a thing that's written into the IEP. Like that's the law. So if they have fire drills and there's students that have to be able to access, definitely. The accessibility piece should already be embedded throughout the campus. Obviously having a plan in place as far as who's going to be there to help the student if they can't mobilize their wheelchair on their own, for example. But I mean, obviously, if they can't do it on their own throughout the day, then somebody should be there already anyway. So that should be a service written into the IEP as it as it is. But like your example of the acronym, I mean that could be written in as an accommodation. So making sure that those are things that are practiced with the student. So it's that repetition and then they learn until they can like repeat it back. And then if you do an in in vivo and you can even have goals to support these things, you can have an IEP goal where, you know, the student will expressively, you know, re report back like what an acronym means and reenact it, how to carry out that acronym. To me, that's actually a really good IEP goal. So whatever you just said run, freeze, whatever. Like that could be a goal where you say those three letters, the student repeats it back and then you say, okay, show me. And that would be a really great way for them to practice, because in the moment, there's going to be no time to think right? So you need to get it to be like muscle memory for them. If there are certain, very, very specific tailored pieces that require more language, you can always attach a page to the accommodations section. You can label it whatever you want, and it can be really clearly mapped out. As far as for this student, all of these things need to be in place, or all of these things need to happen. If it has to be that, you know, super individualized, if the student has such unique needs that they need a really concise plan for what to do in the event of the fire drill or the active shooter drill, or an earthquake or whatever these emergencies are. There should be a super short version that a sub can read in the moment and know exactly what to do, and that can be attached to the IEP to with the drills. If some students kind of have like if it's detrimental for some students, to constantly have to do these drills, do you think they can be exempt for them? I can the parents request like if their child. Yeah. Is like having a lot of, is having a hard time. Maybe it's like the noises or whatever. I mean, I don't necessarily know why they would be exempt. It's not like they're occurring that frequently. And I guess I think it would be a good discussion to have again as a team, like hearing the reasons why it would be beneficial for the student to be exempt from participating, because in the event of an emergency, they have to know what to do to some degree. So I think it could be dangerous in a way if we aren't exposing them and they aren't prepared. We need to make sure that the students are prepared and they know how to keep themselves safe. So I think it would be a really, you know, good point of discussion for the team and really coming to an agreement of how can we still keep the students safe because we can't predict emergencies? Well, obviously respecting their needs and, and what they're bringing to the table. Right. Because every student's different. Yeah. I think the preparedness is like a key factor in this also just like how would you like what would you recommend for parents? In terms of, you know, explaining the drills and the training and the warning to their child without making it, you know, traumatic know like how to prepare their child, maybe in the home like, this is what is going to happen, having it presented in a way that the student can digest it and make sense of it. Again, maybe pairing it with visuals, some sort of social story, or even there's, videos that can be accessed to describe, and also videos that can be access to explain the active shooter drills and kind of what they consist of. I know there's those resources out there. Every kid is different. As far as what will be better to for presentation and what they'll receive better, and ensuring that you're allowing and affording the child or the student an opportunity to ask questions and having, you know, just open discussion about it because it's really scary. Like, I didn't go through that when I was a kid, so I can't imagine what the experience is like. And then you are going to have kids who quite honestly don't understand it, and they aren't going to understand it. It's going to be above their head. And that is a whole different experience. And they're just motoring through it, if you will. Right. And they don't really understand why we're going through this process. And so I think just making it as visual as possible for them, I mean, generally speaking, having the visual paired with the verbal is helpful. Or like tactile if it's a visually impaired student. But just helping them digest the process at a level that is, accessible for them. And, you know, allows them to be a meaningful participant, and it's not just something that we're forcing on them. And then as parents at home again and, and also asking the school for whatever resources they're using so you can have copies of it at home. So there's consistency. And parents know also what's being exposed and what's being said to their child. So they can utilize the same language. So they're hearing it the same way in both places. So having discussions and if you want, you can invite the school counselor to the IEP to because that's really and from what I understand, that's really the hub of who's overseeing a lot of that piece at the school. So that's a meaningful member to the IEP team that's not generally invited. And parents can definitely invite the school counselor. So it seems like these accommodations for like emergencies might not automatically be in the IEP. So would you recommend to parents kind of coming in if they know their child needs like an extra something like let's say their child can't follow like a multi-step direction if there is an emergency happening. So they need like extra support in something or I think one of the questions we had was, if a child is in a wheelchair, and something's happening, can they be carried by like the teacher? Or if there's like specific things that has to be, you know, individualized for the child? Should the parents kind of come in to the IEP meeting, like, with this information and like asking for it to be included? Let's say the fire just spread really rapidly and there's just not enough time. Can the teacher pick the student up out of the wheelchair? I think that's a really great question too. And to be honest, that's never come up. I've never heard anybody talk about that. And I think common sense in the moment, any person would be like, I'm picking this student up like I'm going to save this child's life. So yes, I would assume any parent in that moment would be like, Thank God you picked up my child. Like, my child is alive. But at the same time, schools are liable if that picking up or lifting of the child then led to them getting injured. So there's like always two sides to a coin. Is that something parents can ask in an IEP meeting and can have documented in a health care plan or an emergency care plan? That's the same thing. They're interchanged. Well, I mean, yeah, I think so. Health care plans require doctor's orders to. So they may say make sure there's a doctor's note reflecting this. Like that. We're allowed to lift the child out of the wheelchair. But there's so many what ifs, I guess is my point. And we're not going to be able to encapsulate every single what if. And there's different diseases in different locations. Like what if there's a hurricane? What if there's a snowstorm? What if the wheelchair can't be moved because there's snow covered? I mean, there's so many what ifs, so it's also location based. And I think they're all great points and great questions. And, and it's something to definitely think about in IEP meetings for sure. Is that what's most important than just knowing kind of what in general is the school's plan when it comes to if there's a disaster and how the classroom is going to deal with emergency situations rather, yeah. Like just being informed in general, like talking to the principal and knowing kind of how, like what's going to be happening, like just to be more informed. Yeah, I definitely think that's, a realistic starting point. Like, what does a fire drill consist of? Or again, we're talking about fires because we're in California. But if they're on the East Coast, you know, what is whatever drills they have, I don't even know their what is a snow storm drill consist of or what is a hurricane drill consist of? Tell me the steps. Explain it to me. What visuals if there are you know, assuming this is a special ed special day class, you know, what visuals do you have to support the drill? Can I see them? Like I said, asked to have copies sent home, asked to have the language sent home. That's a huge piece. And then that will open up the discussion for this is really great. But for my child, like I said earlier, I know that this might work. Or can we change the pictures? You know, I know this is 2D, two dimensional. He needs three dimensional. You know, let's make a 3D version of this. It's just so individual eyes. But parents can ask, you know, for anything. I mean, obviously realistically, you know, staff not anything. But my point being, some kids might need it more, some kids might need it less, some parents might want to opt out. They're all possibilities. As long as there's a rational explanation and it makes sense as far as their ability to be, successful within the educational setting and also, in this case, safe within the educational setting. This is a learning point and safety is important. So, you know, all gen ed students have to partake in these. Therefore they have the right to partake in it. And we need to make sure that when they're partaking in it, it's meaningful. So that's the piece that's most important. How are we making it meaningful and accessible to them in such a way that just like for the gen ed students, if it happened for reals, they could be safe and if that requires reliance on an adult, of course, is that adults, adult fully trained, that would be the big question for me as the parent. Like, I know my kid's not going to be able to do this on their own. Whether you practice at five times or 500 times, he's going to need Sally. Tell me the plan for Sally. How is she going to be trained if Sally is not there? Who is going to be there? Because there's no guarantee that Sally doesn't call out that day who's the backup to me? Those are really important questions as well. Who's keeping my kids safe when my kid isn't going to be able to keep him or herself safe? And if my kid is able to keep him or herself safe, what do we need to have written down to ensure that that's a possibility for him or her?