Intervention Strategies for Students with Special Health Care Needs

While the specific needs and interventions for students with special health care needs are diverse and plentiful; all students require an active and up to date health services plan and an emergency protocol. The health service plan "is a document that outlines the child's specific needs, the strategies needed to support the child, the responsibility of staff and training and resources needed" (Winzer,2008. p 416) The emergency protocol is "kept by teachers and contains information on emergency practices and strategies developed by parents, school personnel and medical personnel." (Winzer, 2008. p.416) It will contain contact information of the parents, emergency contacts, and the medical specialists involved in the care of the student.

Allergies



Medical Intervention

 The level of medical intervention is dependent on the level of severity of the specific allergy. Medical treatments can range from over the counter distribution of antihistamines to prescribing an epi-pen to be carried at all times on the person with the allergy. 

 

"All individuals receiving emergency epinephrine must be immediately transported to hospital, ideally by ambulance, for evaluation and observation. Following medical treatment, patients must stay within close proximity to a hospital or where they can call 911 for the next 48 hours." (http://www.allerject.ca/en/what-is-anaphylaxis?gclid=CMuM5sGT2bwCFY8-MgodOXwAuQ)

 

 

Therapeutic Intervention

There are a series of holistic and trial interventions available for allergy treatments available, however as these are unproven, it is up to the individual to determine if these options are a best practice for them. For example, peanut flour experimentation trials to develop a resistance in case of accidental ingestion. http://www.theglobeandmail.com/life/health-and-fitness/health/fighting-peanut-allergies-with-peanut-flour-new-therapy-helped-kids-safely-eat-a-few-nuts/article16605537/
 

Educational Intervention

It is important that an action plan be in place both in the classroom and the school office to identify potential anaphylaxis issues with the students. As well, the teaching staff should be aware of all potential triggers for potential life-threatening allergies such as the correlation between latex allergies and banana peels.



Source: http://www.hc-sc.gc.ca/fn-an/pubs/securit/2012-allergen_treenuts-noix/index-eng.php
Source: http://www.kidswithfoodallergies.org/resourcespre.php?id=60

Of interest to those of us planning on staying in a wintery climate: http://www.yummymummyclub.ca/blogs/alexandria-durrell-irritated-by-allergies/20140218/allergic-to-winter?s=FB

Arthritis

Medical Intervention

Eye care: Children with JA need to have regular eye exams. Certain types of JA can affect the eyes. A child may need eye drops or other medications for his eyes.

Dental care: If a child has JA affecting his jaw, it may be difficult for him to hold his mouth open during a dentist appointment and therefore he might need to have more frequent but shorter dentist visits.

Surgical techniques: Very rarely, children with JA might need joint surgery. More commonly, joint injections might be required.

Therapeutic Intervention

Physiotherapy is used to treat the effects of JA, such as pain, weakness, limited range of motion, or reduced physical ability. It can help prevent long-term damage in joints and muscles. Most important, physiotherapy helps to maintain physical abilities and fitness.

Physiotherapists can help to assess and monitor a child or teenager's JA. They can advise how to improve physical abilities and fitness levels.

Occupational therapy can help reduce pain. It can help to maximize strength, endurance, and physical function. Occupational therapy can help the child or teenager to be more independent in activities of daily living.

Occupational therapists provide assessment, treatment, and education for people with JA and other conditions. An occupational therapist can help a child with JA function her best at school, work, and play. Occupational therapists can recommend assistive devices (pencil grips, angled writing surface, recording devices, Velcro fasteners, elevated toilet seats, doorknob extenders, e.t.c.). They can visit the child's school or home to see if he/she needs any special equipment to help in daily routines. They can change existing equipment as needed.

Splints can help improve or maintain her range of motion and reduce contractures. A hand splint helps to reduce pain, swelling, or stress on the wrist or finger joints. Splint for the knee reduce flexion contractures. Splints can be used for many other types of joints as well. Custom made splints can be adjusted as a child's range of motion improves and joint swelling gets better.

Counselling and psychological therapy

There are a number of reasons why a child might need counselling or psychological therapy. Therapy can help with issues that may or may not be related to JA:

     ·         dealing with changes in appearance due to medications

     ·         having difficulties at school because of JA, such as sitting out in gym class or coping with bullying

     ·         feeling anxious and worrying a lot

     ·         having a hard time with her family or friends

In teenagers, other issues may arise that could benefit from counseling:

     ·         being dependent on alcohol, tobacco, or other substances

     ·         needing to stop drinking alcohol to be on a certain medication

     ·         feeling depressed or having thoughts of harming herself

     ·         worrying about her future

     ·         having a hard time making the transition from being treated at a children’s hospital to being a young adult cared for in an adult hospital

Psychiatrists, psychologists, social workers, nurses, and other adolescent health specialists can help a child with emotional problems.

Social workers, psychologists, and nurses are a good resource for helping with school-related issues, such as:

·         coping with workload

·         helping teachers understand JA-related school needs

·         issues with friends

·         problems with bullying

Source: http://www.aboutkidshealth.ca/En/ResourceCentres/JuvenileIdiopathicArthritis/TreatmentofJIA/Pages/default.aspx



Asthma

Medical Intervention

·         Drugs used to treat asthma include some that act directly on the airways to open them, and others that slow or stop the production of antigens (that bring on immune responses)

·         People with asthma usually use two types of medication, controllers and relievers

·         Controllers lessen swelling in the airways, and should be taken on a daily basis

·         Relievers are meant to temporarily alleviate wheezing and coughing 

 

 

 

 

Educational Intervention

      ·         Students with asthma commonly have issues with maintaining regular attendance in school, especially during the early elementary years.

      ·         Missed class time and work puts students at risk for underachieving and should  be supported to supplement their missed time

Video: Asthma - How To Use Your Inhaler:

 https://www.youtube.com/watch?v=ldpAC7mVcQw



Cancer

Medical Intervention

The three most common treatments for cancer are chemotherapy, radiation therapy, and surgery to remove the tumour. The oncologist will determine which approach or combination of approaches are in the best interest of the patient according to their personal cancer diagnosis. In addition to these traditional therapies, the patient (or their parents) may be asked if they wish to be a part of a clinical trial in the hopes of finding better, and less intrusive treatments for cancer.

As these treatments do have side effects that can include, but are not limited to, nausea, diarrhoea, constipation, sleeplessness, etc. additional medical intervention may be prescribed to counteract these side effects.

 http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/treatment/?region=on

Therapeutic Intervention

There are a variety of therapies available to help children with their cancer diagnosis and treatment programs. These include , but are not limited to psychological counseling, occupational therapy, physiotherapy, nutritional counseling and support groups for both the patient and their family members.
http://www.cancer.ca/en/cancer-information/cancer-type/childhood-cancer-information/supportive-care/?region=on

Diabetes

Medical Intervention

Ongoing:  

      ·         Monitor insulin levels    

·         Urine testing

·         Diet adjustment/ balancing

·         Blood testing

·         Students requiring insulin injections at school may require nursing support

It is important for educators, educational assistants and school staff members to understand how to support students with diabetes in terms of their individual and unique needs such as their:

a. glucose monitoring schedule

b. meal schedules/ plans

c. treatment plans for low and high blood sugar

d. emergency contact information

 Therapeutic Intervention

      ·         Children with diabetes may experience feelings of embarrassment, resentment, or depression as a result of their condition and the limitations or needs that accompany it.

·         Counseling may be helpful for students to work through these feelings and to develop skills to overcome them.

Educational Intervention

·         Early development of diabetes may put children at risk for intellectual impairments that often result in difficulty with the acquisition of specific skills, especially in math abilities and visio-spatial areas.

·         Students with diabetes may require additional educational support in specific areas that focuses on their individual needs.

In the case of a diabetic emergency 911 should be called immediately.
 

  Video: What is Diabetes?:

https://www.youtube.com/watch?v=4EEtubB74lM



Paediatric AIDS

Medical Intervention

There is no cure for the HIV infection. Treatments, known as antiretrovirals, only suppress the virus replication in the body and disrupt the action of the virus, thus prolonging the lives and improve the quality of life of people living with HIV/AIDS. However, antiretrovirals are not a cure. If treatment is discontinued, the virus becomes active again. Therefore, a person on antiretrovirals must take them for life.

The drugs are often referred to as: antiretrovirals, ARVs, anti-HIV or anti-AIDS drugs.

Taking two or more antiretroviral drugs at a time is called combination therapy; sometimes referred to as Highly Active Antiretroviral Therapy (HAART).

If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term.

In most cases, the side effects experienced are mild, like a headache or an upset stomach. In some cases, more serious side effects can happen, such as liver damage, heart disease, or a severe skin rash. There may also be long-term side effects we don't know about yet. Many of the HIV drugs have not been on the market long enough for all the possible long-term effects to have been discovered. Some drug treatments for HIV also fail because some new strains of the virus have developed drug resistance.

AIDS, as a last stage of HIV, also requires treatment of “opportunistic infections”. These infections occur more often in students who are not engaged in antiretroviral therapy and other preventive measures, such as vaccination programs and opportunistic infection prophylaxis. These students will require additional medical intervention to treat the opportunistic infections as they occur.

See more at:
http://www.avert.org/hiv-and-aids-treatment-care.htm#sthash.6m1GqIjx.dpuf 
http://healthycanadians.gc.ca/health-sante/disease-maladie/hiv-vih-eng.php
http://www.avert.org/common-hiv-opportunistic-infections.htm

For students who are on HAART, medical intervention at school will include administration of prescribed medication several time a day, monitoring of appearance of side effects, signs of opportunistic infections or behaviour changes.
 

Therapeutic Intervention may be needed in advanced stages of paediatric AIDS.

Occupational therapy

About one-third of people with HIV develop problems with their feet, which can include numbness, burning pain and muscle weakness. The person with HIV/AIDS may also experience pain in other parts of their body. Other physical challenges may include fatigue, problems moving around and managing daily activities. Many people experience changes to their brain which can affect their thinking and their emotional state. People with HIV/AIDS may find their judgment, attention, motivation and ability to deal with emotional situations have changed. These are some occupational therapy strategies to help with these challenges:

·         Adaptive devices and resources are available to make it simpler to dress, bath, go to the bathroom.

·         Good foot care, footwear, protective insoles, and custom-made foot orthotics are important to help with the pain.

·         To manage pain, try relaxation techniques, pacing and planning daily activities.

·         Create and follow a schedule with visual reminders.

More info http://www.caot.ca/otnow/march07/living%20with%20AIDS.pdf

Counseling and psychological therapy

People with HIV/AIDS may also experience some form of depression or difficulty coping with the life changes resulting from the illness. Counseling and psychological therapy for the individual with HIV/AIDS and/or for the whole family will provide necessary support.

Educational Intervention

As Paediatric AIDS and Cancer are potentially terminal, a counselor may come into the classroom/school to be on hand for students who may need to speak with someone about what is going on with their friend;  or the educator may need special training in how to handle the topic of death and dying. They may be called upon to prepare their healthy students for the physical changes they will be seeing in their classmate (weight loss/gain, hair loss, etc.). As well, the teacher may need to work as a liaison between the school and the student as they prepare lesson plans or work that can be done from home or hospital so that they do not fall behind their peers.
 



See: http://www.childhoodcancer.ca/education/educators_guide/helping-students-their-families