Appendix A: Individualized Plans
Individualized Health Care Plans (IHCPs) are usually developed for students with multiple health needs or whose health needs require daily intervention. These plans describe how the school intends to meet an individual child’s daily health and safety needs in all contexts, while under the care of the school. IHCPs are developed by the school nurse, in conjunction with parents or guardians, the student, healthcare providers and other school personnel. An IHCP includes:
- a summary of health assessments; and
- a nursing diagnosis, goals and plans of action covering the range of possible concerns.
IHCPs should also address student needs outside of the normal school routine. Considerations for students with diabetes include:
- meal times;
- changes in schedules;
- lunch and recess times;
- school transportation;
- transitions to after school programs;
- athletic and extracurricular activities;
- accommodations for test-taking;
- field trips; and
- transitions to new schools or school buildings.
The IHCP is also used to document interventions and evaluate outcomes. IHCPs can and should be updated at least annually and more frequently, as necessary to keep pace with changing student needs and school environment.
Emergency Care Plans
Children with special health care needs should also have a written Emergency Care Plan (ECP) that provides specific directions about what to do in a medical emergency or safety emergency such as fire drill or lockdown. The ECP is often part of the IHCP. This written plan helps the school nurse, school personnel and emergency responders react to an emergency situation in a prompt, safe and individualized manner.
ECPs should provide emergency contacts and address what to do:
- For high and low blood glucose levels;
- If an insulin pump malfunctions or becomes dislodged; and
- To ensure access to equipment and medication if not carried by student, e.g. during lockdown or fire drill.
Appendix B: Sample Core Team Roles and Responsibilities
- Participate in core team meetings.
- Conduct nursing assessment for Individualized Health Care Plan (IHCP).
- Conduct nursing assessment for section 504 accommodation plan, if appropriate.
- Develop section 504 accommodation plan and IHCP with the core team.
- Coordinate development of Emergency Care Plan (ECP).
- Ensure family provides medical supplies, materials and snacks needed at school.
- Obtain necessary physician orders.
- Conduct periodic and ongoing reviews of student needs and update IHCP & ECP as needed.
- Plan and implement diabetes training for appropriate school staff.
- Work with family and health care providers to reinforce and strengthen student self-management skills and promote independence.
- Participate in core team meetings.
- Work with core team to implement the section 504 accommodation plan and IHCP.
- Recognize signs and symptoms of hypoglycemia and hyperglycemia.
- Be prepared to respond to signs and symptoms as identified in the IHCP.
- Provide the student with a supportive classroom environment.
- Provide classroom accommodations as outlined in the section 504 accommodation plan and IHCP.
- Participate in diabetes education, as specified in the student plan.
- Communicate with school team as outlined in the section 504 accommodation plan and IHCP.
- Understand state and federal laws.
- Participate in the development of school policy.
- Promote a supportive learning environment for all students.
- Support and arrange for staff training.
- Work with core team to implement the individual plan as needed.
- Respect the student’s confidentiality and right to privacy.
- Support and facilitate ongoing communication between family, school staff and community members.
- Notify the school of student health needs.
- Provide written medical documentation, written authorizations and all necessary medications, equipment and snacks.
- Work as a full partner with the core team to develop a section 504 plan and IHCP.
- Educate child in self-management skills and promote independence.
- Review plans with schools at least annually and more frequently as needed.
Appendix C: Sample Self-Monitoring Checklist
Appendix D: Sample Agreement Concerning Blood Glucose Self-Monitoring
Appendix E: Recommended Steps for Blood Glucose Monitoring
- Gather supplies.
- Wash hands with warm soapy water.
- Load device with lancet.
- Wipe finger or other target area with warm soapy water. Let dry. Use alcohol swabs only if warm water is not available.
- Hold lancet device to the side of the fingertip or other area, and press button to puncture skin.
- Turn finger or area of punctured skin down to get a full drop of blood. If a larger drop is necessary, squeeze the area around the puncture.
- Put full drop of blood on strip pad.
- Follow directions for use of monitor or read the result on the bottle of strips.
- Record results on log sheets provided by parent/guardian or school nurse.
Adapted from: Provided for general information only. Students should follow theinstructions of their individual health care providers.
Resources on the law
- American School Health Association. 2000. Guidelines for Protecting Confidential Student Health Information.
- American Diabetes Association. 2010. Your School & Your Rights: Protecting Children with Diabetes Against Discrimination in Schools & Day Care Centers.
- Champion, C. 1999. Occupational Exposure to Blood-Borne Pathogens: Implementing OSHA Standards in a School Setting.
- Connecticut State Department of Education, 2003. A Parent’s Guide to Special Education in Connecticut.
- Connecticut State Department of Education, 2000. Section 504 of the Rehabilitation Act of 1975:Procedural Safeguards.
- Connecticut Department of Labor, Division of Occupational Safety and Health (CONN-OSHA)
- Public Act No. 12-128 An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day.
- The United States Department of Education Web site has a wealth of information about FERPA, and IDEA. Go to http://www.ed.gov, and type the relevant acronym into the search window.
- American Association of Diabetes Educators
- American Diabetes Association
- Children with Diabetes
- Diabetes Management in the School Setting (Adopted January 2012)
- Juvenile Diabetes Research Foundation International http://www.jdrf.org
- CSDE 2012. Learning and Diabetes: A Resource Guide for Connecticut Schools and Families
- National Association of School Nurses. 2012. Position Statement: Diabetes Management in the School Setting.
- National Association of School Nurses. 2012. Position Statement: Individualized Healthcare Plans (IHP).
- National Diabetes Education Program
- National Diabetes Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases at NIH, offers a wide range of resources in English and Spanish on treatment, complications, statistics and research, including on the landmark Diabetes Control and Complications Trial.