Students with Chronic Health Conditions, and Advocating for their Inclusion in School
Does your child suffer from chronic health conditions?
Has your child missed school multiple times throughout the year because of chronic health conditions?
Has your school district not offered you support or services to ensure that your child is still able to access their education?
There is an increasing number of chronic health conditions impacting our youth. Chronic disease in children has become one of the fastest-growing public health concerns. While your school district may recognize some of the more common conditions like asthma, diabetes, and epilepsy, and have may have practices in place to accommodate these conditions (seizure action plan, diabetes emergency care plan, etc.), school districts are less likely to understand and meaningfully program for rare or less well-known conditions, such as Mast Cell Activation Syndrome (MCAS), Postural Orthostatic Tachycardia (POTs), or Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS). Unfortunately, children with both kinds of diseases—common and less common— face multiple obstacles in school due to a lack of knowledge and awareness among school staff regarding the complexity of the disease(s) and the resulting policies that hinder rather than promote student participation and attendance.
What are chronic health conditions, and does your child have one?
The Centers for Disease Control and Prevention (CDC) has a webpage devoted to pediatric chronic health conditions that identifies “seizure disorders/epilepsy, asthma, diabetes, poor oral health conditions, and food allergies” as examples of chronic health conditions commonly observed among school-aged youth, that possibly affect academic achievement, or that use significant resources when addressed at school. Other websites, such as Healthychildren.org or the Coalition Against Pediatric Pain, provide a longer list of conditions, including but not limited to:
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Healthchildren.org defines a chronic illness as a health condition that lasts anywhere from three months to a lifetime. If your child has had a condition that has impacted them for more than three months, then it is very likely considered a chronic health condition.
How does my child’s chronic health condition impact their academic performance?
Has your child been missing days or weeks of school in a row because of a pounding migraine?
Has your child been unable to attend school for full days due to immense fatigue, dizziness and brain fog from POTs?
Has your child begun to experience anxiety because of an increase in physical symptoms, with associated fears of attending school and having an increase in symptoms?
Chronic health conditions have both direct (physical) and indirect (psychological and social) impacts on children’s education. Children with chronic health conditions are at an increased risk of missing school due to recurrent hospitalizations for treatment of the condition. They are at a higher risk of falling behind, scoring lower on standardized tests, and dropping out. Absenteeism attributable to the health condition can be compounded by the presence of mental or behavioral health conditions. Mental health issues may arise directly as a result of the disorder, or indirectly as in a syndrome or as a result of medication for the condition. The time it takes to obtain a diagnosis, especially when accompanied by symptoms, hospitalization(s), procedures, or medications that are painful or unpleasant, also increases anxiety, depression, and/or trauma for the child. Social stigma and isolation from peers may result when the student is absent from school and activities. These students may be bullied by peers because of their differences. All these factors lead to a child having difficulty staying afloat in school.
What services or supports in school can help my child with a chronic health condition?
Does your child have any formal services or supports provided by the school district to address chronic health conditions?
If not, there are several ways that school districts are required to provide services and support to your child. These supports can come through a Section 504 plan, an Individualized Education Plan (IEP), an Individualized Health Plan (IHP), or medical plans catered to specific disabilities.
Section 504 Plan
Section 504 of the Rehabilitation Act of 1973 requires that school districts “provide a free appropriate public education to each qualified handicapped person in the recipient’s jurisdiction, regardless of the nature or severity of the person’s handicap.” A Section 504 plan, also known as a 504 Service Agreement, is a plan developed to ensure that a child who has a disability identified under the law receives accommodations that will ensure equal access to the learning environment. A student with a chronic health condition can become eligible for a Section 504 plan where the student’s impairment substantially limits a major life activity when considered without regard to the ameliorative effects of mitigating measures, such as medication. Generally, a student who has been diagnosed with a short term virus, such as COVID-19, would not be eligible for a Section 504 plan because the infection is not recognized as a chronic contagious disease. In making an eligibility determination, the school district should consider, on a case-by-case basis: 1) the duration (or expected duration) of the impairment; and 2) the extent to which it actually limits a major life activity of the affected individual. Of note, Lyme’s disease is a virus, but can cause significant long term side effects, including but not limited to PANS, which would be considered chronic and therefore fall under a chronic health condition. Long COVID or multisystem inflammatory syndrome in children, known as MIS-C, may also constitute eligibility. Students can benefit from a 504 Plan to specifically accommodate their medical-related symptoms.
Individual Education Plan (IEP)
To qualify for an Individualized Education Plan (IEP) as a “student with a disability” under the IDEA, the student must:
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- Meet the definition of one or more of the categories of disabilities, which include: intellectual disability, a hearing impairment (including deafness), a speech or language impairment, a visual impairment (including blindness), a serious emotional disturbance, an orthopedic impairment, autism, traumatic brain injury, other health impairment, a specific learning disability, deaf-blindness, or multiple disabilities; and
- Need special education and related services as a result of his disability or disabilities.
A student with a chronic health condition will usually become eligible for an IEP under the category of Other Health Impairment (OHI). This results when the condition causes the student to have “limited strength, vitality or alertness” that “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, sickle cell anemia, and Tourette syndrome” and “adversely affects a child’s educational performance.” The list of conditions included in the definition of “other health impairment” is not exhaustive so know that your child’s condition can be recognized even if it is not listed. A student with a chronic health condition can also be eligible for an IEP under other categories of disability noted above, but OHI is generally the most appropriate for students with purely physical conditions. Of note, many students with these conditions also have comorbid mental health conditions such as anxiety or depression, which can accompany their physical illness, and these conditions generally fall under OHI as well. Unlike a 504 plan, an IEP provides specially designed instruction and related services in addition to accommodations for medical-related symptoms.
Medical Plans
Federal law and professional nursing standards require the development of individualized plans of care for students with special health care needs. Children with chronic health conditions can be eligible for these types of medical plans on their own, and/or in addition to having a Section 504 Plan or IEP. One kind of medical plan is called an Individualized Health Plan (IHP)
An IHP is a plan of care written by a registered nurse for students with or at risk for physical or mental health needs. The school nurse is responsible for annually evaluating the IHP and updating the plan if deemed appropriate to reflect changes in the student’s healthcare needs and address nursing interventions and/or student healthcare outcomes.
Depending on the student’s condition, IHPs may prompt the development of student Emergency Evacuation Plans (EEP) and/or Emergency Care Plans (ECP), both of which are initiated and developed by the school nurse. These plans stem from the intervention component of the IHP and provide instruction on addressing healthcare needs or appropriate responses to a student’s emergent healthcare issue.
How can we help?
Obtaining the above services and support for your child can be daunting. The law firm of Raffaele & Associates is dedicated to serving the legal needs of students, children, and families. Our trusted team of attorneys, education consultants, and staff provide skilled, thoughtful representation for your case.
We have experience helping families like yours through various interventions, such as:
- Assessing which services would be most appropriate for your child
- Working with you and your school to draft the best plan for your child
- Ensuring that your school is fulfilling all of its obligations based on current plans in place
To learn more about this topic, see our attorney’s presentation on this topic at the annual COPAA conference in March 2024, https://www.copaa.org/page/2024-conference-breakout-IV.
If you would like to get in touch with us, please contact us here. We look forward to speaking with you.
