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What’s HEALTH Got to Do with Learning? EVERYTHING!. Patti Hackett, MEd Co-Director, HRTW National Resource Center Bangor, ME Future of Pediatrics Orlando, FL June 30, 2007. Disclosure.

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slide1

What’sHEALTHGot to Do

with Learning?

EVERYTHING!

Patti Hackett, MEd

Co-Director, HRTW National Resource Center

Bangor, ME

Future of Pediatrics

Orlando, FL

June 30, 2007

disclosure
Disclosure
  • Neither I nor any member of my immediate family has a financial relationship or interest with any proprietary entity producing health care goods or services related to the content of this CME activity.
  • My content will not include discussion/reference of any commercial products or services.
  • I do not intend to discuss an unapproved/investigative use of commercial products/devices.
objectives
Review the issues/causes as identified in select research

Understand the connection:

Impact of health on learning

Identify role for Physicians to support student success

Objectives
roots of failure
Roots of Failure
  • Anxiety / Depression
  • Problems in the family
  • Learning disabilities
  • Social: poverty, frequent moves, truancy
  • Health: chronic illness, teenage pregnancy
  • Other causes: inability to speak English, etc
what causes success and failure in school and friendship
Developmental Differentiation of

Children's Beliefs across Middle Childhood

420 children, ages 7-12 years,

reported the perceived effectiveness of five causes

Effort

Attributes

Powerful others

Luck

Unknownfactors

SOURCE: Ellen A. Skinner and Max Planck Institute for

Human Development and Education, Berlin, F.R.G.

International Journal of Behavioral Development, Vol. 13,

No. 2, 157-176 (1990)DOI:10.1177/016502549001300202

What Causes Success and Failure in School and Friendship?
developmental differentiation of children s beliefs across middle childhood
ACADEMIC - Effort was perceived as a more effective

FRIENDSHIP - Attributes, powerful others,and luck were viewed as more important

NOTE: Effort and powerful others, increased with age.

In contrast,the perceived effectiveness of attribute causes

became more similar across domains as children became

older.

SOURCE: Ellen A. Skinner and Max Planck Institute for

Human Development and Education, Berlin, F.R.G.

International Journal of Behavioral Development, Vol. 13,

No. 2, 157-176 (1990)DOI:10.1177/016502549001300202

Developmental Differentiation of Children's Beliefs across Middle Childhood
are we ignoring foster youth with disabilities
Are We Ignoring Foster Youth With Disabilities?

Foster youth

  • who need special education are less likely to receive services than
  • not in foster care often face social isolation
  • disability and/or special education needs are often unknown or overlooked
  • with disabilities lack educational advocates

Professionals receive inadequate information

about the unique needs of foster youth with disabilities

SOURCE: Dr. Sarah Geenen at the OHSU OIDD

Center on Self-Determination: (503) 232-9154 ex. 111;

geenens@ohsu.edu / www.selfdeterminationohsu.org

safe and sound campaign baltimore city
Safe and Sound Campaign / Baltimore City

Children

  • live in nurturing families
  • enter school ready to succeed
  • ..and young adults are educated
  • ..and their families are healthy, with youth avoiding high-risk behaviors
  • live in safe/supportive communities
  • Their families are self-reliant

SOURCE: Suzanne Bronheim, PhD

Social Exclusion in the United States: Policy Implications for Community SolutionsGeorgetown University Child Development Center,

Center for Child Health and Mental Health Policy, June 1999

slide12
Maternal Reports of Raising Children With Chronic

Illnesses: The Prevalence of Positive Thinking

R. Chernoff, MD,D. List, MA, MPH, CHES, K.DeVet, PhD, and

H. Ireys, PhD, Ambulatory Pediatrics: Vol. 1, No. 2, pp. 104–107

Results

80% of the mothers felt better about themselves by

learning to manage child's chronic condition;

70% felt that their families were stronger because of

their child's condition; and

80% felt that their family had benefited in some way

from having a child with a chronic illness.

98% of the mothers endorsed at least 1 positive item;

58% endorsed all 3.

maternal reports of raising children with chronic illnesses the prevalence of positive thinking
Maternal Reports of Raising Children With ChronicIllnesses: The Prevalence of Positive Thinking

Conclusions

Asking mothers about the positive impact on a

family of a child's chronic illness captures an

important part of the experience of caregiving.

Physicians' recognition and encouragement of

this positive outlook may help families continue

to face the challenges of raising a child with a

chronic illness.

objectives1
Review the issues/causes as identified in select research

Understand the connection:

Impact of health on learning

Identify role for Physicians to support student success

Objectives
health impacts all aspects of life
Health Impacts All Aspects of Life

Success in the classroom, within the community, and on the job requires that young people are healthy.

To stay healthy, young people need an understanding of their health and to participate in their health care decisions.

health learning
Health & Learning

"You cannot educate a child who is

not healthy, and you cannot keep a

Child healthy who is not educated.“

Joceyln Elders

Former Surgeon General

screen for life areas
Screen for Life Areas

How does health affect:

  • Employment
  • Leisure, Recreation
  • Community: transportation, housing
  • Higher Education or Training
screen for all health needs
Screen for All Health Needs
  • Hygiene
  • Nutrition (Stamina)
  • Exercise
  • Sexuality Issues
  • Mental Health
  • Routine (Immunizations, Blood-work, Vision, etc.)
  • Elimination: Bowel/Bladder
objectives2
Review the issues/causes as identified in select research

Understand the connection:

Impact of health on learning

Identify role for Physicians to support student success

Objectives
the ultimate outcome transition to adulthood health learning there is a connection
Doctors know, Families Know, students know, but did we tell the teachers?

Teachers

- fear of having to do health services

- failure to consider accommodations based

on impact of health, disability or side affects

of medications

- lack of support from administration

The Ultimate Outcome: Transition to Adulthood!Health & Learning – There is a Connection
disabled special health care needs
Disabled?? Special Health Care Needs?

HEALTH SERVICES CYSHCN

- Children & Youth with Special Health Care Needs

- Genetic

- Chronic Health Issues

- Acquired

EDUCATION SERVICE

- Youth with Disability

- Youth with Health Impairment

ADA & 504

- Disability and/or Health Impairment

what teachers want medical providers to know
We need basic understanding of disability/health impact

We need to know danger signs for health decline (what’s development? health? slacking?)

We speak different language re services for CY

Help us help your patient – We need to share notes, reciprocal support

What Teachers Want Medical Providers to Know
what teachers want medical providers to know1
School Speak

Health  IEP/PLOP, 504, Transition Plan

School mandates

Non-intrusive medical plans for the school setting

Privacy - Balancing FERPA & HIPAA

What Teachers Want Medical Providers to Know
what teachers want medical providers to know2
School Speak

- Getting Health in the IEP, 504, Transition Plan

-  Non-intrusive medical plans for the school setting

-  Privacy: Balancing FERPA & HIPAA

What Teachers Want Medical Providers to Know
mandates idea
THE LAW:Any health issue or limitation can be

incorporated into the PLOP/PEP if it describes how the

child’s disability affects the child’s participation in school

and recreational activities.

(20 U.S.C. Section 1414 (d)(1) (A) of IDEA)

Health supports documented in ……..

The Present Level of Performance

The IEP Goals

The Supports and Services

The list of accommodations and modifications

Mandates: IDEA
present level of performance should also include health
Present Level of PerformanceShould also include HEALTH

“John cannot verbally tell caregivers how to transfer him, making him reliant on his ed. Asst. throughout the day.”

This year, Latrice missed 40 school days because of pressure sores. She needs to learn ways to move in her wheelchair to reduce risk of pressure sores so she doesn’t miss school.”

health in the iep
Health in the IEP
  • Starting at age 14, IEPs can be more closely linked to post-school outcomes.
  • Post-school outcomes can and should include as much self-care and independent management of health conditions as possible
health in the iep1
Health in the IEP
  • Starting at age 14, IEPs can be more closely linked to post-school outcomes.
  • Post-school outcomes can and should include as much self-care and independent management of health conditions as possible
section 504 of the rehab act of 1973
Section 504 of the Rehab Act of 1973
  • Section 504 is a civil rights law that prohibits discrimination against individuals with disabilities. Section 504 ensures that the child with a disability has equal access to an education. The child may receive accommodations and modifications.
  • Unlike the Individuals with Disabilities Education Act (IDEA), Section 504 does not require the school to provide an individualized educational program (IEP) that is designed to meet the child's unique needs and provides the child with educational benefit.
504 plan health
504 Plan & Health
  • Student not in special education
  • Student requires accommodations and modifications to participate in education.
  • May be developed as a result of a request by the school, a request by the parents/guardians, or in response to a problem with the student’s care at school.

Downside: Under Section 504, fewer procedural safeguards are

available to children with disabilities and their parents than under

IDEA. States/local school districts receive NO financial support.

504 plan health1
504 Plan & Health

504 Plan

  • Student not in special education
  • Requires accommodations and modifications to participate in education.
  • May be developed as a result of a request by the school, a request by the parents/guardians, or in response to a problem with the student’s care at school.
  • Testing conditions (extended time, quiet spot, etc)
  • Attendance (absenteeism, late arrivals)
  • Adapted coursework: volume, PE,
family educational rights and privacy act ferpa 1974
Family Educational Rights and Privacy Act (FERPA) 1974
  • PL 94-142  IDEA  IDEIA
  • Protects privacy of educational records
  • Gives parents rights to their child’s school records – until youth turns 18.
  • Right to correct misleading information
health insurance portability privacy and accountability act of 1996 hipaa
Health Insurance Portability Privacy and Accountability Act of 1996 (HIPAA)
  • Insurance Coverage /exclude pre-existing
  • Protect personally identifiable health information – signature @ age 18
  • Reduce costs by standardizing CPT &

ICD-9 codes

hipaa ferpa
HIPAA & FERPA

Signature – consent at age 18

  • Education mandated to start conversation re: education records/sign-offs
  • Health – when does this conversation start?
  • Student/patient needs to practice skill before age 18: ASSENT to CONSENT

- circles of support (stand by, part-time, fulltime)

informed decision makers
Informed Decision Makers

FERPA Family Education Rights & Privacy Act

HIPAA Health Insurance Portability and

Accountability Act

1. Privacy  Records

2. Consent  Signature (signature stamp)

- Assent to Consent

- Varying levels of support

- Stand-by (health surrogate)

- Guardianship (limited to full)

societal context for youth without diagnoses in transition
Societal Context for Youth without Diagnoses in Transition
  • Parents are more involved - dependency

“Helicopter Parents”

  • Twixters = 18-29

- live with their parents / not independent

- cultural shift in Western households - when

members of the nuclear family become adults,

are expected to become independent

  • How they describe themselves (ages 18-29)

61% an adult

29% entering adulthood

10% not there yet

(Time Poll, 2004)

skills for families children and youth
Advocacy without agitation

Negotiation based on law and compromises

If the answer is NO, more information maybe needed

Gather strength – Find an ally

Skills for Families, Children and Youth
take home messages
Support for Success

(screening- eyes, ears, fine motor, intellect and emotional IQ)

2. Partner with the Educator

(tools for families, direct contact)

3. Communication & Information

(Skills for families and children/youth

post info in waiting rooms – teaching moments)

4. Health and Wellness Baseline

Take Home Messages
slide41
What would you do,

if you thought you could not fail?

slide43

Patti Hackett, MEd

Co-Director, HRTW Center

Bangor, ME

pattihackett@hrtw.org

resources family resiliency
Resources - FAMILY RESILIENCY

SOURCE: National Center on Accessibility

"Becoming a Resilient Family: Child Disability and the

Family System"

Monograph addresses not only how having a child with a

Disability can impact the family system, but also how

families can use their circumstances to become a more

resilient and Healthy family.

http://www.ncaonline.org/monographs/17family.shtml

idea 504
IDEA & 504

Discrimination: Section 504 and ADA

http://www.wrightslaw.com/info/sec504.index.htm

Sample Section 504 Plan: Medical Management Plan

for a student with diabetes

http://diabetes.org/advocacy-and

legalresources/discrimination/school/504plan.jsp

IDEA 2004

http://www.wrightslaw.com/idea/index.htm

IEP's vs. 504 Plans

http://www.slc.sevier.org/iepv504.htm

idea 5041
IDEA & 504

Overview of Section 504

http://www.504idea.org/504overview.html

SECTION 504 AND IDEA: Limited vs.

Substantial Protections For Children With

AD/HD and Other Disabilities

http://www.parenttoparentofga.org/roadmap/advocacy/educationlaws504&ideachadd.htm

hipaa ferpa1
HIPAA & FERPA

UNIVERSITY OF MIAMI- ETHICS PROGRAM

Privacy / Data Protection Project

http://privacy.med.miami.edu/glossary/xd_education_records.htm

Legal and easily understood overview of FERPA and HIPAA. Great resource for teachers and young adults- to better understand compliancy and what it means when you sign over permission.

slide49
The Impact of FERPA and HIPAA on Privacy Protections for Health Information at School: Questions from Readers

http://www.healthinschools.org/ejournal/2003/privacy.htm

Summary on HIPAA and FERPA from the Department of Education: The Family Policy Compliance Office has not published any guidance on the applicability of FERPA to HIPAA. However, the Office worked closely with HHS on this issue during the rulemaking process. Because FERPA affords students adequate privacy protections, the Government agreed that records that are protected by FERPA should not be subject to HIPAA.

The HIPAA Final Privacy Rule of December 28, 2000 explains that records that are subject to FERPA are not subject to HIPAA. Additionally, medical records that are excepted from FERPA's definition of "education records" under section 99.3 "education records" provision are also exempted from coverage by HIPAA. (See page 82483 of the December 28, 2000, Federal Register document on the HIPAA final rule.)

how to solve problems and protect parent school relationships
How to Solve Problems and Protect Parent-School Relationships

by Pam Wright & Pete Wright

http://www.wrightslaw.com/info/advo.probs.protect.htm

Offers advice about how to resolve problems with

the school by restructuring relationships, learning

effective advocacy skills, using strategies in

letters, and learning to negotiate and persuade.

Learn why Pam says, "You need to view your

relationship with the school as a marriage

without the possibility of divorce."

learn to ask questions get services
Learn to Ask Questions, Get Services

http://www.wrightslaw.com/info/advo.parent.askqs.htm

How does the school perceive you?

Good article about how to ask questions

and get better services.

tests and measurements for the parent teacher advocate attorney
Tests and Measurementsfor the Parent, Teacher, Advocate & Attorney

by Peter W. D. Wright, Esq.and Pamela Darr Wright, M.A., M.S.W.

www.wrightslaw.com/advoc/articles/tests_measurements.html

preventing school failure
http://www.heldref.org/psf.php

Forum to examine critically emerging and

evidence based best practices that are both data-driven and practical, for children and youths served in traditional and nontraditional education settings.

new research and innovative practices,

debate controversial subjects

international peer-reviewed publication

Preventing School Failure
bibliography 01
Bibliography -01
  • School Failure—Wayne Yankus, MD, FAAP, McInerny, Thomas, MD: Children Who Have Difficulty in School: A Primary Pediatrician’s Approach. Pediatrics in Review. Vol. 16 No. 9 September 1995.
  • Dworkin, Paul, MD, FAAP. School Failure. Pediatrics in Review. Vol 10. No. 10 April 1989.
  • Byrd, Robert S., MD; School Failure: Assessment, Intervention, and Prevention in Primary Pediatric Care. Pediatrics in Review. Vol. 26. No.l 7 July 2005.
bibliography 02
Bibliography - 02
  • Reiff, Michael, MD, Adolescent School Failure: Failure to Thrive in Adolescence. Pediatrics in Review. Vol 19. No. 6 June 1998.
  • Casey, Patrick, MD and Evans, Larry, PsyD; School Readiness: An Overview for Pediatricians. Pediatrics in Review. Vol 14. No. 1. January 1993
  • Committee on Children with Disabilities: American Academy of Pediatrics; The Pediatrician’s Role in Development and Implementation of and Individual Education Plan (IEP) and /or and Individual Family Service Plan (IFSP). Pediatrics. Vol 104. No. 1. July 1999.
bibliography 03
Bibliography - 03
  • Oberklaid, Frank, MBBS, Melvin, MD: Precursors of School Failure, Pediatrics in Review. Vol. 2. No. 1. July 1980.
  • Blancett, Wanda. Mumford, Vincent, Beachum, Floyd: Urban School Failure and Disproportionality in a Post-Brown Era. Remedial and Special Education Vol 26. No. 2 March/April 2005. pg. 70-81.