School Nurse Involvment in IEP and 504 Process

[MHDNURSE]

I am at a relatively new (this is our third year) charter school and I am fairly confident that our SPED people are all new and not the most informed about the IEP and 504 process. Our Middle and High School has been around a lot longer than my campus and the process they have there is that the school nurse writes a letter that she sends to the physician informing the physician about the child's medical diagnosis, allergies, immunization status, date of last physical, etc. Then includes a questionnaire that the doctor is to fill out and return to us. Many of the questions ask the very information the nurse has included in her letter. Any the form they are using, I kid you not is from 1986!!!! It was likely typed up on a Commodore 64 back in the day The font looked weird to me, like it was a ditto (I know I am dating myself here) and sure enough at the bottom it says Rev. 9/86!!!!

So anyway, I have many issues with this entire process and I just sent an email to the school nurse at the High School, as well as the person who leads the IEP and 504 eval process to indicate that this process was extremely redundant and a waste of time and resources.

Why am I telling the physician when the kid's last PE was, meds he is taking, what his allergies are, and his immunization status, when they are the ones who tell ME all that information every year???

And the language on the form we give them is embarrassing and outdated! It actually says "are there any handicapping conditions"?!

Anyway, can you tell me what your involvement is as a school nurse in terms of the initial IEP evaluation process? And did I mention that none of these kids even have medical issues, these are all behavioral kids!

If you DO get involved and request anything from a physician, can you share your paperwork or letter? I am very curious. I am going to design my own because the one we use is embarrassing.

[ruby_jane, BSN, RN]

My counselors are in charge of the paperwork so I can't easily lay hands on it.

For an IEP - that's initiated by parent mostly with a metric crap ton of documentation given to us by medical providers. We never initiate....because the school would then be responsible for paying for the assessment. I don't usually get involved, mostly because by high school we're not instituting new IEPs, only maintaining the ones that the kids came with. The exception is medication: if a student needs medication to function I need to know, whether I'm dosing it or not. I had a kid take two of his ADHD meds by accident; he was tachycardic and diaphoretic and panicky and it took a loooong time to figure it out - ever since then, I've asked.

For a 504 - they absolutely, positively have to have a medical/psychological reason to need it. That comes from a doctor, not generated by the school. And our counselors are good at reinforcing this. I usually sit in on those because I am often involved.

Do you have counselors at the school? If not...I guess you are the default person. You might check the NASN website to see their pre-packaged forms.

[nmr79]

I'm new to the school setting, so I just go to the meetings to contribute what I know about the kid (if it's someone who I interact with regularly). Our Social worker and psychologist do the actual writing/case management of it. Now I'm curious to see how old our forms are!

[OldDude]

I'm almost never involved in an IEP and occasionally involved in a 504 when I'm asked for opinions as to interventions at school. Although information from the MD is helpful, a child can be in 504 with no input from the physician.

Question 1 of the 504 Eligibility Determination form is "Does the student have a physical or mental impairment? And then there are "Notes" (1) This is an educational determination only, and not a medical diagnosis for purposes of treatment.

Question 2 is "Does the physical or mental impairment affect one or more major life activities (including major bodily functions)?" Note: For an impairment that is episodic, in remission, or mitigated, identify the activity or function affected when the disability was present or active.

Question 3 is "Does the physical or mental impairment substantially limit a major life activity?" (1) Substantially limits does not mean significantly restricted. Then there are some more clarification.

So, If the answer to all 3 questions is "yes," the student is eligible for 504 and subsequent accommodations can be identified by the 504 committee to put in place at school.

So, MD input is helpful, but not required. And if no health or medical "intervention" is required at school for a 504, I don't attend.

I hope this is helpful.

[WineRN]

For writing IEPs, I have a minimal role. I just check to make sure the medication and dx info matches what I have in my office. Everything else is handled by the SPED team. I attend the meetings of the students that I see on a regular basis but that is a very small number of our IEP kids. As mentioned above, we don't initiate the IEPs unless there is extreme need and the parents are in denial, because then we have to pay for the testing.

For 504s, there is a "team" which is just me, the AP and counselor who reviews all requests and then we pull people in as needed (classroom teachers, etc) Our entire process changed this year, so we are all learning together. I usually send the families a form that gives me permission to communicate with their child's doctor regarding the condition and then get all the big info from the doctor's office. Like you said, I don't understand why I would fax the doctor over everything they already know and a lot of that stuff doesn't usually relate to why I'm contacting them.

[GatezRN]

Elementary School Nurse here. I typically get involved with IEP/504 only if there are medical considerations that may affect the student throughout the school day. I just came from and IEP meeting, actually.

If there is a significant medical history and/or the student will required accommodations due to that medical condition throughout their school day, I am asked to write a health assessment. I usually meet with parents/student and conduct and interview to gather detailed health history, obtain releases to speak with physicians, and discuss concerns that the parent may have if their child were to be enrolled in our school. My reports will summarize the health history and detail my recommendations/ concerns for that particular child during the school day. If there is a health assessment requested, I am invited to the IEP meeting to share my report. Sometimes daily treatments/procedures that will require the student to be out of class are entered onto the IEP. For a student with considerations that may not require leaving the classroom, I have the team note that there is an Individualized Health Care Plan that should be followed on the IEP.

Not sure if this helps, but this is my involvement in the process.

[ohiobobcat]

My answer to this is similar to many of the above answers. I only get involved if it is a medical issue. SpEd does IEPs and guidance does 504s. I attend the meetings when appropriate, and provide input, but SpEd/guidance writes the IEP/504.

[KKEGS, MSN, RN]

In my current district I am only involved in this entire process if a student has significant medical needs. ADHD is not a significant medical need as far as the SPED process is concerned and that is the majority of SPED evals we have here. I get involved when we're talking trachs, feeding tubes, diabetes, shunts, active seizures, CF, etc.

The only time we send anything to a doctor is when we need an official diagnosis for the kids who are being evaluated under OHD (Other Health Disabilities) for ADHD/ADD. There is a specific form that must be filled out for ADHD/ADD kids.

Otherwise I, or usually the student's case manager, has the parents sign a ROI and then request records from clinics and hospitals. I then review the records and write a health history and assessment document with current medications, diagnoses, nursing needs at school, etc.