School Nurses & Individualized Health Care Plans
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School Nurses and Educators often see symptoms and manifestations of PANS that are not seen at home as is vice versa. They are in a unique position to identify abrupt changes, new symptoms or behaviors previously overlooked, which can be a crucial part of the diagnostic criteria. Continual dialogue is needed between educators, school nurses, and parents to help the student participate meaningfully in school.
Some students will need Individual Health Care Plans (IHCPs) to ensure health and safety needs are met. More NEPANS Resources School Resources Signs of PANS @School School Symptoms & Supports Excused Absences & Home Bound Laws PANS/PANDAS Fact Sheets |
NEPANS School Nurse Presentations
NEPANS presents on PANS/PANDAS to School Nurses across New England and sets up resource tables at School Nurse conferences. We look forward to more opportunities. Would you like to schedule a presentation? Contact: Gabriella True
School Nurse Presentations with Dr. Nancy O'Hara ~Northeast District Department of Health School Nurses ~Southwest CT School Nurse Development Day ~Southeast CT School Nurse Coordinator's Group NEPANS would like to thank Dr. Nancy O'Hara for devoting her time and effort. We have spoken with over 250 School Nurses in 2015-2016. Resource Tables ~Rhode Island School Nurse Convention 2014 |
School Nurse Resources
Is It PANS, CANS, or PANDAS? Neuropsychiatric Pediatric Disorders That Are Not Black and White--Implications for the School Nurse
Kathy Bagian, MSN, RN, CSN, Sheila Q. Hartung, PhD, RN (NASN-2015) Article Abstract PANDAS in the School Setting Kathy O’Rourke, MA (School Nurse News-2003) Read More 
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Individual Health Care Plans - IHCP
The information on NEPANS Individual Health Care Plans is accessible in a .pdf
| NEPANS Individual Health Care Plans |
Individual Health Care Plans (IHCP) for students with PANS are an integral part of promoting success in the school environment. IHCPs foster communication between all members of the school team: Parents, Student, School Staff and School Nurse. Students with chronic and complex healthcare needs, such as PANS, often necessitate specialized care at school to ensure their health and safety is supported so the student can be successful. IHCPs are created for students whose health needs affect their daily functioning and their ability to access the school curriculum. This usually includes students who are medically fragile, require complex health care support, need frequent contacts with a school nurse, and/or have health care needs addressed on a daily basis.
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An individualized health care plan is a detailed and orderly program of action designed to monitor, prevent, reduce or eliminate identified health problems in order to maintain or improve a student’s health status and level of wellness and to promote his or her learning and positive coping. The process of planning requires a team approach and includes the establishment of care priorities, a clear understanding of student specific goals, prescription of appropriate interventions, and delineation of measurements for goal achievement. National Association of School Nurses, 2008 |
The School Nurse with the collaboration of health care providers, parents and school staff, develops IHCPs. The team should consider supports needed during the entire school day, including the classroom, physical education, the school bus, field trips, and extracurricular activities. IHCPs will often require frequent updating as changes in the child's medical condition and needs occur. You can request an IEP or Section 504 Plan meeting at any time to address your concerns.
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Health care plans identify solutions for diagnosed health problems (actual or potential); communicate the student’s specific health needs, and the prescribed nursing and collaborative interventions for directing and evaluating the care given; and provide a mechanism for demonstrating accountability. – Clinical Procedure Guidelines for Connecticut School Nurse |
RI Rules And Regulations For School Health Program 1.30 “Individualized health care plan (IHCP) “means a comprehensive plan for care of children with special health care needs developed by the certified school nurse teacher in collaboration with the student, parents/guardians, school staff, community, and health care provider(s), as appropriate. -RI DOE – Rules and Regulations for School Health Program |
An IHCP may be developed by the school nurse as a standalone document or as part of the IEP or the Section 504 Plan to specifically address the student’s medical needs in the school setting. PANS is a medical condition; it is not a behavioral condition. Therefore a Behavioral Intervention Plan (BIP) should not be used in place of an IHCP. Students however may have both a BIP and an IHCP if appropriate. To put this in perspective, a student with Diabetes is not given a behavioral plan to address consequences due to low blood sugar.
A well-written IHCP will:
A well-written IHCP will:
- Ensure that the school has relevant information and authorization
- Address both family and school concerns
- Clarify roles and responsibilities
- Establish a basis for ongoing teamwork, communication, & evaluation
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IHCPs are usually developed for students with special health needs or whose health needs require daily intervention. These plans describe how to meet an individual child’s daily health and safety needs in the school setting. IHCPs include:
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Resource Links - Individual Health Care Plans - IHCP
NASN
IHP: Role of the School Nurse
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Connecticut
SDECT – Clinical Procedure Guidelines for Connecticut School Nurses - Individual Health Care Plan
This covers what an IHCP Plan is, why it is needed and what elements need to be included.
Online Version
PDF Version (start page 23)
Guidelines for Managing Life-threatening Food Allergies in CT Schools
Although this link is not PANS specific, it does provide a good example of what must be included.
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Massachusetts
Mass Gov – Health & Human Services - IHCP
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Maine
Maine Department of Ed - Individual Health Plans Guide
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New Hampshire
NH Dept of Ed Health Care Plan Templates
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Rhode Island
Rhode Island Department of Ed
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IHP: Role of the School Nurse
Read More
Connecticut
SDECT – Clinical Procedure Guidelines for Connecticut School Nurses - Individual Health Care Plan
This covers what an IHCP Plan is, why it is needed and what elements need to be included.
Online Version
PDF Version (start page 23)
Guidelines for Managing Life-threatening Food Allergies in CT Schools
Although this link is not PANS specific, it does provide a good example of what must be included.
Read More
Massachusetts
Mass Gov – Health & Human Services - IHCP
Read More
Maine
Maine Department of Ed - Individual Health Plans Guide
Read More
New Hampshire
NH Dept of Ed Health Care Plan Templates
Read More
Rhode Island
Rhode Island Department of Ed
Read More
Sample IHCP
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The sample IHCP is available for download.
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Below is a sample Individual Health Plan. Contents were culled from IHPs of several students. It is designed to merely serve as an example of accommodations currently used in some student’s IHPs. This example is not meant to be all-inclusive for every student with PANS as not every student is going to require all these items and some unique considerations will not be on this list.
Individual Health Plan
Name: DOB: Age:
School: Grade:
Created by:
Description of Condition and Manifestations:
Assessments:
Nursing Diagnosis:
Individual Health Plan
Name: DOB: Age:
School: Grade:
Created by:
Description of Condition and Manifestations:
- This is a good place to provide a description of condition
Assessments:
- Allergy Environmental agents: (Mold)
- General Health Status: (overall physically healthy)
- Infection: (Possibility of exposure to contagious infectious agents could result in symptoms associated with PANS)
- Medical conditions: (PANS, Immune Deficiency)
Nursing Diagnosis:
- Ineffective Coping – Related to knowledge deficit of school resources, possible reluctance to seek help.
- Fear – Related to inability to predict or control symptoms.
- Biodefense related to
- Increased susceptibility from contact with any contagious disease. PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) manifests in OCD, ADHD, ODD behaviors, motor and vocal tics, depression
- Student symptoms are unpredictable and present when being exposed to contagious elements
- Altered functioning in daily activities to decrease chance of exposure to contagious diseases
- Changes in health regimen due to possible exposure and reaction to contagious diseases
- Student will identify sources of anxiety and fear.
- Student will identify his support systems at school and will be willing to use them.
- School Staff and School Nurse will recognize signs of PANS episode which include behaviors such as motor and vocal tics, headaches, drooling, anxiety, mood swings, OCD, ADD, ODD, depression, irritability, behavioral regression, deterioration in school performance, sensory issues, urinary frequency.
- School Staff to provide education on proper hand washing and basic hygiene to prevent spread of infections.
- School Staff to encourage infection control measures in the classroom.
- School Staff will understand that student is not to use water fountains.
- School Staff will understand that student is not to use water fountains.
- School Staff will understand that Student has sensitivities to foods that can induce PANS symptoms and is currently dairy-free, peanut-free, gluten-free with respect to any assignments concerning food; if this changes, parents will notify School Nurse.
- School Staff will understand that Student might need to wear a hat with a brim to aid in light sensitivities.
- School Staff will understand that Student might require snacks between meals in order to sustain energy.
- School Staff will clean student work-stations daily before Student works in room.
- School Staff will communicate with School Nurse about any communicable illness in classrooms.
- School Nurse will inform parents of any communicable illness in classrooms.
- Parents will inform school nurse of any health changes.
- Parents will inform school nurse of any planned IVIGs.
- Parents will supply clean water bottles; student will be allowed to keep a water bottle with him.
- Student will be encouraged and will be given means to wash his hands after touching school or other materials.
- School Staff will implement an ANYTIME Nurse/Bathroom pass not to be used by other students.
- School Staff to implement plan to exit to Nurse’s, Counselor’s or Academic Dean’s Office in order to rest or work quietly and to track the amount of Time Out’s needed.
- Student is allowed to use Elevator.
- Option to not participate in select elective programs in order to meet with academic teacher/s for more help or work on homework.
- School Nurse will provide access to cold or hot compresses
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