Q: What is the role of the MD in confirming eligibility for special education referrals, testing, etc.?
A: In general, the clinician can best help their patient by providing a detailed medical history, including specific health problems, behavioral issues, or learning issues that may interfere with the child's ability to benefit from their education.

Q: What information would be helpful?
A: Detailed information addressing the impact of the child’s health condition or disability on their ability to learn, attend and behave in the classroom, care for themselves in age-appropriate fashion, and their need for special dietary or medical interventions, such as medications, equipment, or other aids. The documented details they provide will help determine their patient's eligibility for Special Education, and may be helpful in the development of their education plan, including special dietary, personal care and medical requirements.

Q: What is the best way to provide documentation?
A: Documentation of the specific health problems, behavioral issues, or learning issues, provided to the parent, is the most helpful. Recommendations on a prescription pad without supplemental information are least helpful. For a sample form, see Medical Home to School Summary Form ( 40 KB).

Q: What are the placement options in the education system?
A: The LEA provides a continuum of placement from receiving services in general education classrooms to receiving services in separate special schools. It is the goal for students with disabilities, including students in public or private institutions, to be educated with students who are not disabled. This is called the Least Restrictive Environment. Program decisions are made by the IEP team. For more information see Student Placement and Section 504, US Dept. of Education.

Q: What are the related services offered by the school?
A: The following services may be provided by school districts to assist eligible students to benefit from special education and may include: counseling, occupational therapy, physical therapy, speech therapy, recreation therapy, adaptive physical education, nursing services, and other therapies, as decided by the IEP team.

Q: How does an eligible student access various therapies and related services (physical, occupational, speech, transportation etc.)?
A: The access is determined by the IEP team, which includes the parent.

Q: What is available for a child with transportation needs?
A: Transportation requirements are considered by the IEP team if a student with a disability cannot benefit from special education without transportation help. More information is available in the American Academy of Pediatrics School Bus Transportation of CSHCN (AAP) policy statement.

Q: What resources are available from the state?
A: There is variation among different states, but there are minimum standards for medication administration in school; immunizations; vision, hearing and spinal curvature screening; and other health and safety policies. For information about your state, see: State Education Contacts and Information.

Q: What is needed so a child can take medication at school?
A: Although policy on this varies by state, the detailed information provided on the clinician's referral will be discussed by their patient's IEP team and, if appropriate, incorporated into their health care plan, which is developed by the school nurse.

Q: How can I help the child who has been sick return to the classroom?
A: The medical team should provide to the parent documentation of the medication plan (side effects, schedule, etc.), release to return to school, treatment plans, and other relevant information.

Q: What is the best way to collaborate with the school system to optimize management of medical problems?
A: A liaison from the treatment team can help school personnel through telephone contacts and in-service programs. The parent should ensure that the school has current and relevant information listed on the school’s emergency contact form. The following is a suggested communication checklist of issues for education personnel:

• Diagnoses and treatment
• Factors affecting attendance:
  • frequency of outpatient visits
  • frequency/duration of inpatient treatment
  • fatigue
• Factors affecting social interaction:
  • changes in physical appearance
  • changes in motor skills
  • medication induced mood changes
  • changes in appetite, toileting, etc.
• Factors affecting learning:
  • neuropsychological effects of treatments and medications
  • changes in fine motor skills
  • changes in vision and/or hearing
  • limitations on physical activity
  • fatigue
  • headaches
  • nausea
• Factors affecting medical care:
  • medication to be administered at school
  • medications to be avoided
  • exposure to infectious diseases
  • availability of school nurse to provide emergency care and troubleshoot
• Who to contact in case of emergency.

Q: What can the clinician expect from the school lunch program if a child needs a special diet? And what paperwork needs to be completed for this?
A: USDA regulations (7 CFR Part 15b) require substitutions or modifications in school meals for children whose disabilities restrict their diets. Another way clinicians can help their 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 meet the definition for "disability", and must also be accommodated, with your written statement. Check with the student’s school to determine the procedure for notifying the school of dietary modifications including food allergies.

For more information and a sample form, see
Accommodating Children with Special Dietary Needs in the School Nutrition Programs ( 849 KB)

Q: What are the roles and responsibilities of school nurses?
A: One role of the school nurse is to bridge the gap between the worlds of medicine/health care and education. Because of the nurse's license and educational background, they are the only member of the school team to adequately address the health needs and procedures that must be carried out in the school setting.

Q: Who is involved in the development of the Health Plan?
A: Depending on the child's specific needs, if there is a Health Plan that does not involve multiple specialties, the school nurse may complete it and provide instruction to teachers and school staff. If the student is determined eligible for special education, a multi-disciplinary approach is needed where an IEP team will include the school nurse in planning the student's academic/health needs. The school nurse should write the Individualized Health Plan (care plan) for the student. Check with your state school nurse association, state education agency, or school district to find the nurse for the student's school.

Q: What can the school nurse be asked/expected to do? And what are their limitations?
A: The state Nurse Practice Act will provide information about limitations. School nurses should complete care plans on students who have a medical need, which may be as simple as a child taking medication for ADHD while at school or more complicated. School nurses should also be included in the IEP process.
With the health needs in mind, nurses cannot be told what they can delegate to another person (including unlicensed assisting personnel). The nurse has the legal license to determine what may be delegated and to whom it may be delegated. While the nurse may delegate the act to another person, the nurse still retains the responsibility and accountability for it.
Nurses may assess, but not diagnose. Generally, state Nurse Practice Acts allows the nurse to assess the medical situation and perform or delegate a specific procedure that will be done in the school. The nurse can give advice on incorporating the health needs of a student. For more information about your state Nurse Practice Act, see Nurse Practice Act Toolkit (NCSBN), or Find Your Nurse Practice Act.