Educating Students with Complex Medical Needs Lynn Repetsky, M.S. and Kathy Ho, M.A. Hospital School...
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Transcript of Educating Students with Complex Medical Needs Lynn Repetsky, M.S. and Kathy Ho, M.A. Hospital School...
![Page 1: Educating Students with Complex Medical Needs Lynn Repetsky, M.S. and Kathy Ho, M.A. Hospital School Teachers.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d9c5503460f94a84680/html5/thumbnails/1.jpg)
Educating Students with Complex Medical Needs
Lynn Repetsky, M.S. and
Kathy Ho, M.A.Hospital School Teachers
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How much do you really know?
What percentage of children suffer from a chronic illness?
c) 20%
Today, the overall survival rate for children diagnosed with cancer is:
c) ~80%
What is the survival rate for heart transplant patients after five years?
b) 75%
Usually, hemodialysis for kidney disease lasts how long?
d) four hours, three times a week
Which of the following are possible side-effects from organ transplantation and associated medications? (Circle all that apply)
Stretch marks Diabetes Arthritis
Cancer Cognitive deficits Nausea and vomiting
Unwanted hair growth Mood swings High blood pressure
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THE HOSPITAL SCHOOLAT STANFORD CHILDREN’S
• Part of the Palo Alto Unified School District• 2 classrooms serving over 1,000 students each
year, grades K-12• Attend multidisciplinary rounds as part of health
care team• Shift in population over last 5 years from acute
care to chronic illness
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CHRONIC ILLNESS
• Any condition that interferes with daily functioning for more than 3 months, or results in hospitalization lasting more than 1 month
• As many as 1 in 4 children suffer from a chronic illness; i.e. 15-18 million children aged 17 and under
2012: www.ncbi.nlm.nih.gov/pmc/articles/PMC3319320/
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COMPLEX CHRONIC ILLNESS
Brain injuries, cancer (Leukemia, lymphoma, brain tumors), congenital
heart defects, Cystic Fibrosis, HIV/AIDS, immunodeficiency diseases, kidney disease, pulmonary disease, seizure
disorders, sickle cell
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ONCOLOGY FACTS www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood
• In 2014, an estimated 15,780 children were diagnosed with cancer, with 1,960 deaths
• In 1975, about 50% of children diagnosed survived (>5 years). Between 2004 and 2010, over 80% survived. In the most common childhood cancer, acute lymphoblastic leukemia (ALL), the survival rate is about 90%.
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HEART DISEASE FACTS www.cdc.gov/ncbddd/heartdefects/facts.html
http://www.childrensheartfoundation.org/about-chf/fact-sheets
• ~10% are deemed uncorrectable (heart transplant)
• There are currently 2 million people in the US with a CHD.
• About 1% of babies are born with a Congenital Heart Defect (CHD)
• Over 50% of children with CHD require at least one invasive surgery in their lifetime
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CYSTIC FIBROSIS FACTS http://www.disabled-world.com/health/respiratory/cystic-fibrosis/life-expectancy.php
• Approximately 30,000 people in the US have CF,
with about 1,000 new cases diagnosed each year.
• In the 1950s, few people with CF lived long enough to attend elementary school. In the 1980s, the life expectancy was 14 yrs. Now, it is over 35 years.
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RENAL DISEASE FACTSkidney.niddk.nih.gov/kudiseases/pubs/childkidneydiseases/school_family_problems/school_family_problems_508.pdf
• Dialysis – 3 days a week, ~3-4 hours/day
• Buildup of wastes in the body can hamper nerve and brain function
• Concentration, language development, motor skills, and fatigue
• Kidney transplant
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ACADEMIC IMPACT
• Impact of illness on academic functioning– Missed school days– Academic difficulties due to illness or treatment– Necessity for home schooling
• Difficulties with school reintegration• Presence of appropriate educational
resources
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HEALTH AND LEARNING
• Medical advances – emerging population of students with complex chronic health conditions returning to school
• Educators, physicians, school nurses don’t always discuss impact of health condition on learning
• Health & education needs not well integrated
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ABSENTEEISMLynch, Lewis & Murphy, 1993, Thies 1999
• 58% routinely miss school
• 10% miss more than 25% of year
• 30% days absent in grading period – more likely to fail
• Pattern of absence & degree of condition– Multiple brief absences vs. prolonged absences– Impact on social/academic life of school
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WHAT CAN YOU DO WHEN A CHILD IS ABSENT?
• Provide essential work (homework, reading)
• Work with Hospital School or Home/Hospital instructor
• Don’t wait if you can predict it will happen
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WHAT CAN YOU DO WHEN A CHILD IS ABSENT?
• Use technology to stay connected
• Keep kids engaged socially and emotionally, as well as academically
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HIPAA
• Health Insurance Portability and Accountability Act of 1996
• Primary goal is to make it easier for people to keep health insurance, protect confidentiality and security of healthcare info, and help healthcare industry control admin costs.
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FACTORS AFFECTING SCHOOL: Physical Deficits
• Reactions to medication
• Poor stamina, low energy
• Headaches, stomachaches, nausea
• Impatience, loss of interest, irritability
• Motor weakness or incoordination, palsy
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FACTORS AFFECTING SCHOOL: Uneven Physical Course of Illness
• Return to school plans temporary and frequently modified
• Support staff may not have time to meet frequently and modify program
• School becomes low priority
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FACTORS AFFECTING SCHOOL: Learning Problems
• Academic problems overwhelming for tired and ill children
• Prior learning problems ignored due to illness• Extended absences resulting in lack of sequential
learning experiences (math)• Cognitive deficits due to illness or treatment
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FACTORS AFFECTING SCHOOL: Lack of Normal Social Experiences
• Physically isolated from peers
• Inability to participate in active playground experiences
• Less in common with old friends
• Bullying
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FACTORS AFFECTING SCHOOL: Emotional Responses
• Dependence on parents causing emotional regression
• Feeling uncomfortable around peers• Peer withdrawal or rejection because of difference
in appearance, speech, etc.• Difficulty adjusting to structure and demands of
school after attention from illness• Wisdom beyond years
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FACTORS AFFECTING SCHOOL: Family Issues
• Parents may experience delayed emotional reaction to illness
• Child’s illness puts stress on marriage
• Siblings feel neglected
• Family routine disrupted during illness and is difficult to re-establish normalcy
• Economic impact
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FACTORS AFFECTING SCHOOL: Hidden Issues
• Presents well at school but has treatment regiments at home
• Masking deficits
• Social abilities hide academic deficits
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FACTORS AFFECTING SCHOOL: Pharmacology
• Immunosuppressants– Mood changes, vision impairment, photosensitivity,
food/drug interactions, seizures
• Antibacterials/Antivirals/Antifungals– Rash, photosensitivity, anemia, muscle pain, cognitive
changes, vision changes, seizures
• Neurology– Lethargy, blurred vision, slurred speech, dizziness,
fatigue, memory difficulties
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FACTORS AFFECTING SCHOOL: Pharmacology (cont.)
• Chemotherapy– Memory loss, decline in intellectual ability,
changes in brain structure, behavioral changes– Hair loss, nausea, mouth sores, seizures, muscle
pain, fatigue
• SSRIs– Agitation, nausea, suicidality, irritability,
unusual behavior changes
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A Conversation with David
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NEW DIAGNOSIS vs CONGENITAL CONDITIONS
• What was the student’s level of academic functioning prior to illness?
• Masking deficits• Socio-emotional
issues
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CURRENT DEFINITIONS:Other Health Impairments (OHI)
California Administrative Code, Title 5, Section 3030 (f)
Other health impairment means having limited strength, vitality or alertness,
including a heightened alertness to environmental stimuli, that results in
limited alertness with respect to the educational environment, that:
1.Is due to chronic or acute health problems such as asthma, attention deficit
disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart
condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever,
and sickle cell anemia; and
2. Adversely affects the student's educational performance.
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PROBLEMS WITH CURRENT UNDERSTANDING
• Chronic illness can be invisible – parents may not share
• Unclear guidelines on identifying adverse affects on performance
• Difficulty attributing deficit to illness
• No system in schools/medical setting assessing relationship between academic performance & chronic health condition
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COGNITIVE LATE EFFECTS
• Learning difficulties become evident two to five years after completion of treatment.
• Possible decline in IQ and/or impaired memory and ability to process information
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SCHOOLS NEED TO. . .
• Identify early – schools shouldn’t wait until children fail
• Develop and evaluate education plan– Clearer process
– Information disseminated early
– Ongoing communication/collaboration among professionals
– Present education options
– Preference – dual-enrollment, home & school based instruction
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HOW YOU CAN HELP A CHILD RETURN TO SCHOOL
• Treat the child as normally as possible
• Inform yourself!– Web resources– National organizations– Parents– Social workers– Transition liaisons
• Be a resource at your school in addition to the school nurse
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THE TRANSITION BACK• Updating or creating 504/IEP• Home/Hospital Instruction options• Partial day or blended program• Medical/Health Plan in place• Informing the classroom/classmates with parent
permission• Being aware of hidden stressors
– Family situations
– Emotional issues
– Fatigue
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GOAL
To provide every child an education with
nondisabled children to the maximum extent
appropriate in the least restrictive environment.