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Education & Schools

This page was developed in collaboration with educators to guide physicians in communicating with teachers and school personnel to assure that patients receive appropriate education-related services. The details you provide for school personnel will help determine 1) your patient's eligibility for Special Education, and 2) the exact nature of the child's special needs in the school setting. Your information will also be used in developing his/her Individualized Education Program (IEP), which may include special dietary, personal care, and medical requirements during school hours.
The three steps detailed on this page will enable you to facilitate communications between you and the school. You will also find information about common issues and questions primary care providers confront as they work with schools, educators, families, and kids.
Check with your state education agency or your local school district for specific information regarding federal regulations and state rules. For information about your state, see "Resources" below or see: State Education Contacts and Information.

1. Initiate communication with the school.

School personnel must have parental permission to communicate with providers about patients. The family or the medical provider will need to provide consent from the parent/guardian to authorize transfer of records, verbal and/or email communications, etc., as appropriate. The Family Educational Rights and Privacy Act (FERPA) stipulates different (often more restrictive) guidelines to schools for communicating about students than the Health Insurance Portability and Accountability Act (HIPAA), with which physicians are more familiar. See: HIPAA and FERPA (scroll down the document more than half way to "The FERPA/HIPAA Interface") and HIPAA Frequently Asked Questions.
Sample forms to enhance communication between medical provider and schools include the Information Release Form (Schools) (PDF Document 51 KB) for students or the Baby Watch Referral Form (PDF Document 156 KB) for an infant or preschool child.
When permission has been obtained, you will need to determine the appropriate contact person at your patient's school. Your patient or their parent will likely have a contact name but, if not, check with your local school district to identify the person to talk with about your patient with special needs. The student’s classroom teacher, school counselor, school nurse, or principal should be able to direct you to the contact person.
Your state school nurse association or board of nursing can help you find a school nurse for your student's school. Your state education agency can help you find a special education director for your student's school. For links to these organizations, see "Resources" below.

2. Request an evaluation.

You can initiate a request for an evaluation for your patient by encouraging the parents to contact the school.
Either a parent or the Local Education Agency (LEA) may initiate a request for an initial evaluation to determine if a student is a student with a disability under Part B of IDEA. [IDEA Regulations: Changes in Initial Evaluation and Reevaluation (PDF Document 45 KB) ]
If the parental request is considered appropriate, the details you provide will be instrumental in determining how education specialists can best help your patient. If the school does not consider the parental request to be appropriate, the parent may follow the due process as outlined in the state rules. The parent may ask the doctor to provide documentation, as specific as possible, describing the educational and medical need for an evaluation.
If your patient is found eligible, the school may provide a variety of special services, based on the individual needs of the child, which may include:
  • specially designed instruction;
  • dietary accommodations;
  • personal care;
  • medical procedures;
  • transportation to/from school;
  • psychological services;
  • physical and/or occupational therapy services or consultation; and
  • speech, vision and/or hearing therapy services or consultation.

3. Request special services.

If appropriate, you can document recommendations for special services for your patient for the school’s consideration. The sample Form for Evaluation and Service Recommendations (PDF Document 40 KB) form provides a list of the most common types of special education services offered.

Evaluation

After receiving the referral from the parent or the (LEA), usually the local school district or school, and the parents’ written Consent for Evaluation (provided by the school), the school team will look at existing data and determine what further evaluation is necessary. Even if the child does not qualify for special education, he/she may be eligible for other services under Section 504 (PDF Document 205 KB) of the Rehabilitation Act of 1973, which applies to all children with disabilities. Section 504 requires schools to make programs and activities accessible and usable for children with disabilities. This may include providing for physical access and special accommodations like modified assignments to help children benefit from their education. If a disability substantially limits one or more of a child's major life activities then Section 504 may apply. (See Eligibility for Section 504 below.)

Eligibility for Special Education Services (IDEA)

A team comprised of school specialists, teachers, the student, and his/her parents, reviews the data from the evaluation and decides if the child qualifies in one of the categories under the Individuals with Disabilities Education Act (IDEA). Physicians or other professionals may participate in such reviews in person, by phone, or through written communications. In order to receive Special Education, the child must (1) meet the definition of one of the disabilities listed below, (2) adversely affects the student's learning ability, and (3) require specialized instructon to benefit from his/her education. It is possible for a child to have a disability and still not be eligible for services under IDEA if they are able to benefit from education without specialized instruction. The requirements for each category are determined by federal regulations and state rules.
The Federal categories include:
  • Autism,
  • Mental Retardation,
  • Emotional Disturbance,
  • Hearing Impairments/Deafness,
  • Orthopedic Impairments,
  • Other Health Impairments,
  • Specific Learning Disabilities,
  • Speech/Language Impairment,
  • Traumatic Brain Injury,
  • Visual Impairment (Including Blindness).
Classification depends upon the particular characteristics associated with the condition and how the condition manifests itself in the student. State definitions may vary slightly. For more information about definitions, please see your state education rules and see "Resources" below. Some states may use a different term other than “mental retardation”. For the Federal definition of a child with a disability, see: IDEA Definitions

Eligibility for Section 504

Those who do not qualify for special education services may qualify for a 504 Accommodation Plan since the eligibility criteria differ. Section 504 protects students with disabilities from discrimination and provides equal access in the educational setting. A 504 Accommodation Plan helps students receive additional supports to assist their participation in educational experiences.
Anyone who meets the eligibility criteria of having a mental or physical impairment which substantially limits one or more major life activities (e.g., caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working) may qualify for a Section 504 Accommodation Plan.

Preschool Children

IDEA eligibility has the same requirements for school-aged students and students ages 3-5. LEAs have a process to find and identify children with disabilities. If there is a concern about a child’s development in the areas of language, social/emotional, motor, cognitive or adaptive skills contact the school district of the child’s residence. The LEA will be able to provide information on how to seek a special education evaluation.

Individualized Education Program (IEP)

Once a student is determined eligible for Special Education, several things happen. First, parents and educators work together to develop an Individualized Education Program (IEP) for the student. The information you have supplied for the referral will also be considered in the development of this plan, including special dietary, personal care and medical requirements. Physicians or other professionals may participate in IEP meetings in person, by phone, or through written communications. Once established, the student's IEP is implemented by his/her school personnel.

Developing the Health Plan

The IEP may include health- or disability-related plans or a separate Individualized Health Plan (IHP) may be developed. [Janz: 1993]
  • If a health issue is identified during an evaluation, the school nurse or the case manager (usually the resource teacher) will request a release of information from the parent to obtain health information from the Medical Home or healthcare providers.
  • The school nurse uses professional judgment to determine if a student requires an individual healthcare plan (IHP) and initiates the IHP to meet student's health needs and the impact on the educational process.
  • The school nurse meets with the parent to take a health history and develop the health plan. The school nurse:
    • Assesses the student to determine the needs and barriers related to student safety and well being;
    • Collaborates with parents and healthcare providers;
    • Coordinates care during school hours;
    • Educates faculty and staff regarding student needs;
    • Promotes communication among family, school, healthcare providers; and
    • Supports the student.
  • The IHP is sent to the parent and healthcare providers.
  • The parent and healthcare provider signs off on the health plan.
  • Ideally, the nurse will attend the IEP meeting to offer health information input. [Utah School Nurse Association] [School Health Care Plans Fact Sheet (PDF Document 48 KB) ]

Dietary Accommodations at School

USDA regulations (7 CFR Part 15b) require substitutions or modifications in school meals for children whose disabilities restrict their diets. Another way you can help your patient is to provide a signed statement clearly defining:
  • the child's disability;
  • an explanation of why the disability restricts the child's diet;
  • the major life activity/activities affected by the disability;
  • the food(s) to be omitted from the child's diet, and food or choice of foods that must be substituted.
Food allergies that may result in severe, life-threatening (anaphylactic) reactions also meet the definition for "disability", and must also be accommodated, with your written statement.
For more information and a sample form see:

Accommodating Children with Special Dietary Needs in the School Nutrition Programs (PDF Document 849 KB)
From the U.S. Department of Agriculture Food and Nutrition Service, this document provides information about modifying school meals for students with disabilities and other dietary requirements including food allergies. The document includes a sample Eating and Feeding Evaluation form (Figure 1, page 34) to be completed by the child's parent and physician and a sample Information Card (Figure 2, page 35) for use by school food service staff in preparing meals for the child.

Medication at School

If your patient will need medication during school hours, you can help by providing as much detail as possible to the school. Although policy on this varies by state, this information will be discussed and, if possible, incorporated into your patient's IEP or Health Plan. For a sample form see: Medication Administration Form (Word Document 40 KB) .

Resources

Information & Support

For Professionals

IDEA
Official U.S. Department of Education description of IDEA Part B (ages 3-21) and Part C (ages birth-3).

Section 504
From the Utah State Office of Education, this site provides links to A Parent Guide to Section 504; sample forms; a training video; and guidelines for public and charter schools.

Baby Watch Referral Form (PDF Document 156 KB)
Information referral and release form to exchange information between the Medical Home and early intervention programs in Utah.

Form for Evaluation and Service Recommendations (PDF Document 40 KB)
A form to facilitate communication between health care providers and school professionals relating to health concerns that impact a student's education.

Utah State Office of Education Special Education Rules
This policy provides detailed, technical information about Utah's Special Education services.

Utah State Office of Education, Special Education
Information about Utah schools including district and special education contact information.

Utah Special Education Directors (PDF Document 34 KB)
Statewide list of Utah special education directors in each school district.

Utah School Nurse Association
Provides lists of school nurses by district, conference information, newsletters, and links to related sites for teachers and school nurses.

IDEA Regulations 34 CFR Parts 300 and 301
"Assistance to States for the Education of Children With Disabilities and Preschool Grants for Children With Disabilities; Final Rule" from the Department of Education, with information about the rule and links to the 307 page document.

Student Placement
From the U.S. Department of Education, this web site discusses placement of students in elementary and sectondary schools in relation to Section 504 and ADA.

National Council of State Boards of Nursing
Links to Boards of Nursing in states for information about licensing, nurse practice acts, and more.

Nurse Practice Acts
Links to Nurse Practice Acts of states and territories.

IDEA Regulations: Changes in Initial Evaluation and Reevaluation (PDF Document 45 KB)
From the U.S. Department of Education, this document provides information about evaluating a child for IDEA. See also: http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,4,

Accommodating Children with Special Dietary Needs in the School Nutrition Programs (PDF Document 849 KB)
From the U.S. Department of Agriculture Food and Nutrition Service, this document provides information about modifying school meals for students with disabilities and other dietary requirements including food allergies. The document includes a sample Eating and Feeding Evaluation form (Figure 1, page 34) to be completed by the child's parent and physician and a sample Information Card (Figure 2, page 35) for use by school food service staff in preparing meals for the child.

USNA Board Recommended Forms
Forms recommended by the Utah School Nurse Association for medication administration including Asthma Self-Administration Form, Glucagon Authorization Form, and Epinephrine Authorization Form.

Medication Administration Form (Word Document 40 KB)
Sample form to be completed by the parent and medical provider to administer medications to students. From the Utah Schools for the Deaf and Blind.

Technical Assistance Alliance for Parent Centers
Funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP), the Alliance provides technical assistance for state Parent Centers - Parent Training and Information Centers (PTIs) and Community Parent Resource Centers (CPRCs). Provides links to local Parent Centers.

For Parents and Patients

A Parent's Guide to Section 504
The GreatSchools web site provides a detailed explanation of Section 504.

Information Release Form (Schools) (PDF Document 51 KB)
When signed by the parent/guardian, this form will authorize communication between the physician and school officials regarding your patient.

Utah Parent Center
A statewide non-profit organization, founded in 1984, to provide training, information, referral and assistance to parents of children and youth with ALL disabilities, including physical, mental, hearing, vision, learning, behavioral and emotional. Staff consists primarily of parents of children and youth with disabilities. The Center provides information on support and advocacy for families of children with special health care needs.

Questions about Section 504
From the U.S. Office For Civil Rights, this web site offers answers to frequently asked questions about Section 504.

Technical Assistance Alliance for Parent Centers
Funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP), the Alliance provides technical assistance for state Parent Centers - Parent Training and Information Centers (PTIs) and Community Parent Resource Centers (CPRCs). Provides links to local Parent Centers.

National Center on Secondary Education and Transition
Provides information about transition during high school and to opportunities after high school including jobs, vocational education, and college. Provides links to contacts in each state for 1) State Transition Contact, 2) Regional Resource Center Contact, 3) State Director of Special Education, 4) Part B Contact, and 5) State Director or Vocational Rehabilitation.

State Education Contacts and Information
From the U.S. Department of Education, links to each state's education agency.

IDEA Definitions
From the U.S. Department of Education, definitions of terms in IDEA including the definition of a child with a disability.

School Health Care Plans Fact Sheet (PDF Document 48 KB)
Information, tips, and resources from the Utah Family Voices Health Information & Support center.

Authors

Authors: Janet Gibbs, 10/2008
Christine Timothy, 10/2008
Barbara Ward RN BS, 10/2008
Contributing Authors: Alfred Romeo RN, PhD, 10/2008
Jamie Ferdinand RN, NCSN, 7/2008
Content Last Updated: 2/2009

Page Bibliography

Janz J, Harrison J, Caldwell T.
Children with Special Health Needs in School: Developing an Individualized Educational Program (IEP) and an Individualized Health Care Plan (IHCP).
Annual Convention of the Council for Exceptional Children, 71st, 1993; San Antonio, TX. / http://eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detailm...
Information about the IHCP and how it helps when there is a lack of necessary health information in school documents; includes information about the role of the school nurse in the IEP and IHCP, case examples, and example forms.