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SPECIAL HEALTH SERVICES

Special health services are designed to enable a child with a disability to receive FAPE as described in an eligible individual’s IEP. These services may be provided by a qualified school nurse or other designated qualified personnel. 

Special health services include but are not limited to, services to eligible students whose health status requires:

  • interpretation or intervention,
  • administration of health procedures and health care, or
  • use of a health device to compensate for the reduction or loss of a body function.

Health services to be provided at school are determined by the entire IEP team. 

A prescribing healthcare provider can be:

  •  a member of a student’s IEP team.
  •  write medical orders for health treatments and procedures. 

While a health care provider’s recommendation for health service provision may be considered by the IEP team a health care provider cannot order educational services. 

Special Health Services: Policies, Records, and Consents

Each school district is required to have district policies on school health services and administration of medications. (IAC 281.14)

When the AEA or LEA receives medical records from a parent or prescribing healthcare provider, the records become part of the child’s education record and are protected under FERPA.  

For additional information on student health records, refer to the USDOE and USHHS Guidance on Student Health Records, 2019. 

Parental consent is required for the release and/or exchange of health information. For more information on parent consent.

Staff Supporting Special Health Services

 

Licensed Health Professionals

The Iowa Board of Nursing issues licenses to registered nurses in Iowa and regulates practices. (IAC 655.6 Nurse Practice Act)

The licensed health professional will:

  • Supervise special health services
  • Define the level of supervision
  • Document the supervision provided for delegated tasks

Duties of Licensed Health Professional

  1. Participating as a member of the education decision-making team. 
    1. Licensed Health Professionals, such as the school nurse and the child’s primary healthcare provider are members of an eligible individual’s IEP team.  
    2. Teams can access eligible individual’s prescribing healthcare provider by offering alternative methods for their participation in IEP meetings (e.g. calling in versus an in-person attendance)
  2. Providing a health assessment.
    1. This may include interviews with the  student, family, and staff; review of the individual’s health records, medical records, and physical examinations; health history, consultation with other healthcare providers; and nursing observations.  
      1. Parental consent is required when new health information is needed to advise the team for programming.
  3. Developing, planning, implementing and evaluating the written individual health plan and emergency health plan.
  4. Serving as a liaison and encouraging participation and communication with the IEP team, health service agencies and individuals providing health care.
  5. Providing health consultation, counseling, and instruction with the eligible individual, the individual’s parent, or the staff. 
  6. Maintaining documentation of special health services. 
  7. Reporting unusual circumstances to the parent, school administration, and healthcare provider.
  8. Assigning, delegating, instructing, and supervising delegated health services to qualified, designated personnel.
  9. Updating knowledge and skills to meet special health service needs.
    1. Update qualified designated personnel providing special health services to an eligible individual regarding new knowledge pertaining to the child’s condition or special health services. 
    2. Update professional practice knowledge of school nurse pertaining to the child’s condition or special health services (IAC 655.6). (e.g. If the nurse has not done a straight cath for 6 years, he or she will have to obtain that refresher prior to being able to delegate the task to a qualified personnel for patient safety)
Qualified Designated Personnel (QDP)

Qualified designated personnel is a person instructed, supervised, and competent in implementing the individual’s health plan as determined and delegated by the school nurse in accordance with state law (IAC 655.6).

The school nurse, after collecting assessment data, determines under what conditions, if any, the task may be safely delegated, and the level of supervision and ongoing assessment required to support the QDP in safe service delivery. Details related to the provision of health services are contained in the student’s individual health plan. The Board of Education Examiners, Iowa Board of Nursing and Department of Education has provided an interpretative statement regarding delegation of nursing services to assist education teams and school nurses (Iowa Department of Education, 2017)

The school nurse retains accountability for the initial decision to delegate the nursing task and provide ongoing nursing supervision and assessment. The school nurse may not delegate any nursing task that is beyond the ascribed practice level of a licensed practical nurse (IAC 655-6). 

At any time should ongoing assessment dictate that delegation is no longer safe, the school nurse may withdraw delegation and provide the service in question. Notification should be provided to the QDP as well as the administrator if delegation is withdrawn. 

Medication administration may be delegated by the school nurse. The medication administration online course must be taken every five years with an annual in-person skills check completed with the delegating nurse and delegatee at a minimum (Iowa Department of Education Medication Management In Iowa Schools Manual, 2019).

For additional information please reference the Iowa Department of Education, Interpretative Statement: Delegation of Health Services in Iowa Schools 2016-2017.

1:1 Nurse

Some students have health needs that require immediate assessment and nursing judgment as to the next course of action. These skills encompass core nursing competencies and cannot be delegated to unlicensed assistive personnel. If the school nurse cannot respond within minutes to a student’s need, a licensed nurse may be required to accompany the student throughout the day and during transportation.

A Licensed Practical Nurse (LPN) is “permitted to provide supportive and restorative care to a specific student in the school setting in accordance with the student’s health plan when under the supervision of and as delegated by the registered nurse employed by the school district” (IAC 655–6.6(2). The school nurse must be able to provide adequate supervision to an LPN (IAC 655.6.2)

For the purpose of an IEP, the LPN is considered a paraprofessional, and the HS code is selected to note required services on Page F. The NR code is used for the school nurse regarding oversight, planning, and supervision of delegated health services to the LPN for the student.

Student health needs may require a 1:1 registered nurse level of practice. The IEP team may use the NR code twice on page F, by simply describing in one box the duties of the school nurse regarding oversight and planning. In the second box describe the services required by the 1:1 registered nurse during the school day. 

There are families that receive home nursing services for their child paid through Medicaid or private insurance. While a parent may elect to use prior authorized home nursing hours to care for their child at school, the district may refuse to accept these hours even if a 1:1 nurse is required during the school day. Ultimately, the district determines whom to utilize or employ to staff nursing service needs (IAC 281.14.2(2)c). This determination is made as part of a health domain evaluation, conducted by the school nurse, in collaboration with the IEP team and based on the Iowa Board of Nursing laws regarding nursing practice.  The Iowa Department of Education provides resources to school teams regarding private duty healthcare agency nurses.

Individual Health Plans

An Individual Health Plan (IHP) is written documentation of the confidential, preplanned and ongoing special health service using the nursing process in the educational program of an eligible individual which is developed by a licensed health personnel (RN or ANRP) with collaboration from the parent or guardian, student, an individual’s health care provider, or the education team.

The purpose of an IHP is to identify student health needs and determine necessary health services to be provided to ensure an eligible individual’s access to FAPE.  Teams may use a district developed IHP or the Iowa Individual Health Plan template developed by the Iowa Department of Education and AEAs.

An Individual Health Plan must include the steps of the nursing process: 

  • Assessment
  • Nursing diagnosis 
  • Outcomes
  • Planning
  • Interventions
  • Evaluation 
  • Student goals(expected outcomes) and
  • If applicable,  plan for emergencies to provide direction in managing an individual’s health needs.

Emergency Plans/Action Plans

Students with a life-threatening condition that requires special management should have an “Emergency Health Plan” or “Action Plan” to manage individual health needs and a building evacuation plan for safe student evacuation in the case of disaster.  The emergency plan should also address specific measures staff will take while waiting for 911 response.

This plan can either be written in the intervention portion of the IHP or in a separate document referenced in the IHP.

If the team decides to develop a separate “Emergency Health Plan” or “Action Plan,” the plan should include: student demographics, condition, trigger, signs of an emergency, actions to be taken, and special instructions staff need to know. 

Reviewing and Revising an IHP

An Individual Health Plan shall be updated as needed for health changes and at least annually to ensure measurable outcome goals are being attained from the interventions outlined. The review of the IHP may align with the annual review of the IEP and whenever there is a significant health change impacting the relationship to academic or functional skills 

A licensed health professional may revise components of an IHP without reconvening the IEP team when the modification to the IHP is not within the discretion of the IEP team (e.g., a change in prescription or physician’s order).  The IEP team carefully considers the need to convene a meeting any time a revision affects another professional’s practice. 

The licensed health professional, as an integral member of the IEP team, should communicate any changes in required activities (e.g., a change in schedule, medication, responsibilities, etc.) to the IEP team and all relevant school personnel. 

 

Prohibition on Mandatory Medication

It is the policy of the Department of Education to prohibit AEA and LEA personnel from requiring any child with a disability to obtain a prescription for a substance covered by the Federal Controlled Substances Act, for example, Ritalin, as a condition of:

  • Attending school
  • Receiving an evaluation, or
  • Receiving services under IDEA

AEA and LEA staff are permitted to consult and share with parents and guardians their classroom-based observations regarding student:

  • Academic and functional performance, or
  • Behavior in the classroom or school, or
  • Need for evaluation for special education or related services.

 

Special Health Services Resources

For additional information, see the Iowa Department of Education website.