School Nurses & Individualized Health Care Plans

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

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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) 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.

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.

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

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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:

• 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

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:

• functional health issues (nursing diagnoses);
  
• student objectives (expected outcomes) for promoting self-care and age-appropriate independence; and
• responsibilities of parents, school nurses, teachers, students and administration, as appropriate.

-Guidelines for Managing Life-threatening Food Allergies in CT School

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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.
Read More
 
Massachusetts
Mass Gov – Health & Human Services - IHCP
Read More
 
Maine
Maine Department of Ed - Individual Health Plans Guide
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New Hampshire
NH Dept of Ed Health Care Plan Templates
Read More

Rhode Island
Rhode Island Department of Ed
Read More

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