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​Plans of Care for Students with Special Health Care Needs

 Federal law and professional nursing standards require the development of individualized plans of care for students with special health care needs. These plans of care include: Individualized Healthcare Plans (IHP); Emergency Care Plans (ECP); Individualized Transportation Plans (ITP); Individualized Education Program with medical component (IEP); andd Section 504 Service Agreements.
School Nursing: A Comprehensive Text, 2nd edition 2013 by Janice Selekman. School nurses and pediatric experts bring you real-world-tested, best practices based on evidence and experience, including the development of appropriate plans of care.
Developed by the PA Department of Education, this form is required for students identified with food allergies.
Individualized Healthcare Plans (IHP) 
 IHPs are required as part of the professional nurse's scope of practice. Divided into several sections: assessment; nursing diagnoses; goals; nursing interventions and expected outcomes, the IHP is a plan written by nurses for nurses. It does not require the signature of the parent/guardian or school administration.
Individualized Healthcare Plans for the School Nurse: Concepts, Framework, Issues and Applications for School Nursing Practice edited by Silkworth, Arnold, Harrigan and Zaiger. This publication is available from several sources. The purpose of this book is to help school nurses develop IHPs that meet the needs of students and clearly document school nursing practice. It provides an overview of a variety of student concerns and a template for the development of the IHP.
NANDA International, Nursing Diagnoses: Definitions and Classification This publication is available from several sources. A nursing diagnosis is defined as a clinical judgment about an individual, family or community responses to actual or potential health problems and are determined as part of the first step of the nursing process and IHP, assessment. The list of nursing diagnoses is also available from the NANDA International website.
Nursing Interventions Classification (NIC), 6th edition, by Bulechek, Butcher, Dochterman and Wagner. This publication is available from several sources. Once nursing diagnoses have been established, appropriate interventions need to be determined. This publication contains more than 550 possible nursing interventions.
Nursing Outcomes Classiciation (NOC), 5th edition, by Moorhead, Johnson, Maas and Swanson. This publication is available from several sources. Promoting safe and effective care, this publication standardizes the terminology and criteria needed to measure and evaluate outcomes that result from nursing interventions. Approximately 500 research-based nursing outcomes are included.

Emergency Care Plans (ECP)
An ECP is developed as a quick reference for school staff when determining that a student requires emergency intervention. The ECP is typically a 1 - 2 page document which is shared with teachers, food service personnel, bus drivers and other school staff.  Examples of ECPs can be found on the Chronic Disease page of this website under the respective disorders.
Individualized Education Program with medical component (IEP)

The IEP is developed by a team of school personnel for students requiring a special education program. The medical component outlines "related services" including nursing services needed for this student. Information regarding the process for developing an IEP can be found on the Department of Education Bureau of Special Education website
Certified School Nurses should be part of the team for all students in their caseload requiring nursing services as a related service. .
Individualized Transportation Plan (ITP)
IDEA and the 504 Rehabilitation Act require schools to discuss transportation issues within the process of developing an IEP or 504 plan. The ITP provides a standard tool for schools in evaluating the transportation needs of students.
Department of Health Individualized Transportation Plan
504 Service Agreement
The 504 Service Agreement is required, under the federal Rehabilitation Act of 1974 for students in regular education who require "accommodations" due to a disability. In Pennsylvania, students are either eligible for an IEP or a 504 Service Agreement, not both. Examples of 504 Service Agreements can be found on the Chronic Disease page of this website under the respective disorders.
Chapter 15 of Title 22 of the regulations of the State Board of Education addresses the responsibility of school districts to comply with the requirements of Section 504 of the Rehabilitation Act of 1973 and its implementing regulations at 34 CFR Part 104 (relating to nondiscrimination on the basis of handicap in activities receiving federal financial assistance).  The purpose of the federal law and the state regulations is to require that public educational agencies ensure that protected handicapped students have equal opportunity to participate in school programs and extracurricular activities to the maximum extent appropriate to the ability of the protected handicapped student in question.

Updated: June 17, 2016