Transcript Healthy and Ready to Work - Syntiro

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
www.hrtw.org
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.
www.hrtw.org
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
www.hrtw.org
www.hrtw.org
www.hrtw.org
Living Well with a Disability
Youth
Family
Friends
Community
Participation
Personal & Civic
Responsibility
Self
Sufficiency
Employment
www.hrtw.org
Peers
School
Attendance
Self
Advocacy
Independent
Living
Mentors/
Role Models
Other
“Encouragers”
Career
Development
Self-Care
Access to Appropriate use
of Health Care
Wellness:
Physical, Social,
Emotional
Transition to Adulthood
www.hrtw.org
Roots of Failure
• Anxiety / Depression
• Problems in the family
• Learning disabilities
• Social: poverty, frequent moves, truancy
• Health: chronic illness, teenage pregnancy
• Otherwww.hrtw.org
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
Unknown factors
SOURCE: Ellen A. Skinner and Max Planck Institute for
Human Development and Education, Berlin, F.R.G.
International Journal of Behavioral Development, Vol. 13,
www.hrtw.org
No. 2, 157-176 (1990)DOI:10.1177/016502549001300202
Developmental Differentiation of
Children's Beliefs across Middle Childhood
1. ACADEMIC - Effort was perceived as a more
effective
2. 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.
www.hrtw.org
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
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
www.hrtw.org
SOURCE: Dr. Sarah Geenen at the OHSU OIDD
Center on Self-Determination: (503) 232-9154 ex. 111;
[email protected] / www.selfdeterminationohsu.org
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 Solutions
Georgetown University Child Development Center,
www.hrtw.org
Center for Child Health and Mental Health Policy, June 1999
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.
www.hrtw.org
Maternal Reports of Raising Children With Chronic
Illnesses: 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.
www.hrtw.org
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
www.hrtw.org
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.
www.hrtw.org
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
www.hrtw.org
Screen for Life Areas
How does health affect:
• Employment
• Leisure, Recreation
• Community: transportation, housing
• Higher Education or Training
www.hrtw.org
Screen for All Health Needs
• Hygiene
• Nutrition (Stamina)
• Exercise
• Sexuality Issues
• Mental Health
• Routine
(Immunizations, Blood-work, Vision, etc.)
• Elimination: Bowel/Bladder
www.hrtw.org
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
www.hrtw.org
Transition &….Medical Home
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org
What Teachers Want
Medical Providers to Know
School Speak
• Health  IEP/PLOP, 504, Transition Plan
• School mandates
• Non-intrusive medical plans for the
school setting
• Privacy - Balancing FERPA & HIPAA
www.hrtw.org
What Teachers Want
Medical Providers to Know
School Speak
-
Getting Health in the IEP, 504, Transition
Plan
-
Non-intrusive medical plans for the
school setting
-
Privacy: Balancing FERPA & HIPAA
www.hrtw.org
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
www.hrtw.org
Present Level of Performance
Should 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.”
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org educational benefit.
child with
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.
www.hrtw.org
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,
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org
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)
www.hrtw.org
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)
www.hrtw.org
Transition & ……Family & Youth
www.hrtw.org
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)
www.hrtw.org
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
www.hrtw.org
Take Home Messages
1. 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
www.hrtw.org
What
would
you do,
if you
thought
you could
not fail?
www.hrtw.org
www.hrtw.org
www.hrtw.org
Patti Hackett, MEd
Co-Director, HRTW Center
Bangor, ME
[email protected]
www.hrtw.org
Let’s Talk…….Questions ??
www.hrtw.org
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
www.hrtw.org
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
www.hrtw.org
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/e
ducationlaws504&ideachadd.htm
www.hrtw.org
HIPAA & FERPA
UNIVERSITY OF MIAMI- ETHICS PROGRAM
Privacy / Data Protection Project
http://privacy.med.miami.edu/glossary/xd_edu
cation_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.
www.hrtw.org
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.)
www.hrtw.org
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."
www.hrtw.org
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.
www.hrtw.org
Tests and Measurements
for 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_measuremen
ts.html
www.hrtw.org
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
www.hrtw.org
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.
www.hrtw.org
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.
www.hrtw.org
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.
www.hrtw.org