ERIC Identifier: ED309590
Publication Date: 1989-00-00
Author: Sirvis, Barbara
Source: ERIC Clearinghouse on
Handicapped and Gifted Children Reston VA.
Students with Specialized Health Care Needs. ERIC Digest #458.
Students with specialized
health care needs require specialized technological health care procedures for
life support and/or health support during the school day. These students may or
may not require special education (CEC, 1988).
This broad-based functional definition was adopted by The Council for
Exceptional Children in April 1988. Specialized health care needs is a
relatively new term applied to a group of students who previously were unserved
in educational settings. Although these students are often considered similar to
students with other health impairments, their educational needs are complicated
by extreme medical needs. Other terms sometimes used are medically fragile and
technologically dependent. Many of these students have survived catastrophic
medical events that require intensive and prolonged health care.
HOW MANY CHILDREN HAVE SPECIALIZED HEALTH CARE
Because classification of this group of students does not exist in
educational databases, estimation of numbers is difficult. However, the Office
of Technology Assessment (OTA, 1987) has estimated that as many as 100,000
infants and children may be technologically dependent in some way. OTA defines
this group as requiring "a medical device to compensate for the loss of a vital
body function and substantial and ongoing nursing care to avert death or further
disability" (p. 3).
WHAT ARE THE CHARACTERISTICS OF CHILDREN WITH SPECIALIZED
HEALTH CARE NEEDS?
Students with specialized health care needs have conditions that
include ventilator dependence, tracheostomy dependence, oxygen dependence,
nutritional supplement dependence, congestive heart problems, need for long-term
care, need for high-technology care, apnea monitoring, and/or kidney dialysis
(GLRRC, 1986). These students are similar in their needs for extreme medical
care, usually including intervention while they are in school. However, each
medical condition presents its own unique set of characteristics. These medical
needs must be addressed before students can benefit from educational
experiences. Medical concerns also may affect the learning potential of these
students. Fatigue, limited vitality, short attention span, and limited mobility
may accompany technological dependence and affect students' ability to benefit
from educational opportunities. Therefore, their medical conditions must be
stabilized before such students can enter educational programs.
WHAT ARE THE EDUCATIONAL IMPLICATIONS OF SPECIALIZED HEALTH
Traditionally, students with specialized health care needs
required such intensive medical attention that they could not attend school
except in isolated settings in institutions and hospitals. Many did not survive
their catastrophic medical conditions. However, modern medical practice and
technology have created extensive interventions that stabilize medical
conditions and provide these students with the physical ability to pursue
classroom learning. In some cases, students still need the protection of
specialized medical settings; however, most students can be placed in classroom
settings that represent the continuum of educational opportunities. Such
placement will depend on decisions made by interdisciplinary teams, parents, and
medical personnel. These teams will consider health care needs, appropriateness
of settings, risks to the student, and training of personnel before deciding on
Before these students enter the classroom, teachers should consider several
possible environmental and intervention adaptations. The classroom should be a
hygienically safe but not sterile environment. Classroom schedules should allow
for limitations related to fatigue and mobility. Assessment procedures and
instructional intervention techniques may need adaptation to maximize students'
ability to succeed academically.
Medical complications must be considered when developing schedules and
curricular plans. Students may miss school due to medical conditions that
require extensive rest or hospital-based intervention. Cooperative programs with
home and hospital teachers can decrease the impact of such absences.
Of considerable concern is the tendency to overcompensate. Teachers should
avoid "exaggerated deference to the medical implications of a child's handicap"
(Hobbs, Perrin, Ireys, Moynihan, & Shayne, 1984, p. 212). Interruptions for
suctioning, medication, or other medical interventions should be nondisruptive
to the classroom and learning atmosphere. Focus should be on maximizing
opportunities for educational success and social interaction, not on limitations
and isolation. For example, class parties can include food treats that meet a
student's dietary restrictions, or medical intervention can be completed during
individual work times rather than during group learning activity periods.
Educational curricula are always chosen to meet individual student needs.
Modifications for students with specialized health care needs may be similar to
those adopted for students with physical disabilities. For example, adaptive
response modes, adjusted timing requirements, or adjustment for limited hand use
or mobility may facilitate learning success. Social interaction may be more
successful if students use adaptive positioning equipment that enhances their
potential for fuller participation in activities (Sirvis, 1988).
Parents, siblings, and families are an important part of the lives of
children with specialized health care needs. Their role in habilitation and
management of health care needs is critical. In addition, they can be an
important support in the development of the independence necessary to make the
educational experience successful. Often, families may need support and
education in order to understand their own coping mechanisms as well as to
develop a model of helping that will not create inappropriate co-dependence
(Dunst, Trivette, Davis, & Weeldreyer, 1988).
Interdisciplinary planning can enhance the positive impact of the learning
experience if special education personnel assume an active role in the
development of plans. The primary role of the teacher is to provide a safe and
appropriate learning environment.
The Council for Exceptional Children (CEC). (1988, March). Report of The Council for Exceptional Children's Ad Hoc Committee on Medically Fragile Students. Reston, VA: Author.
Dunst, C. J., Trivette, C.
M., Davis, M., & Weeldreyer, J. C. (1988). Enabling and empowering families of children with health impairments. Children's Health Care, 17(2), 71-81.
Hobbs, N., Perrin, J. M.,
Ireys, H. T., Moynihan, L. C., & Shayne, M. W. (1984). Chronically ill children in America. Rehabilitation Literature, 45, 206-213.
Sirvis, B. (1988). Students with special health care
needs. TEACHING Exceptional Children, 20(4), 40-44. U.S. Congress, Office of
Technology Assessment (OTA). (1987).
Technology-dependent children: Hospital vs. home care--A technical memorandum (OTA Publication No. OTA-TMH-H-38). Washington, DC: U.S. Government Printing Office.
Aday, L. A., & Wegener, D. H. (1988). Home care for ventilator-assisted children: Implications for the children, their families, and health policy. Children's Health Care, 17(2), 112-120.
S. M., & Ashcroft, S. C. (1984). Education and chronically ill children: A need-based policy orientation. Peabody Journal of Education, 61(2), 91-129.
Great Lakes Area Regional Resource Center (GLRRC).
(1986). "Medically fragile" handicapped children: A policy research paper. Columbus, OH: Author.
Kaufman, J., & Lichtenstein, K-A. (n.d.). The
family as care manager: Home care coordination for medically fragile children. In Workbook series for providing services to children with handicaps and their families. Washington, DC: Georgetown University Child Development Center.
Kirkhart, K. A., Steele, N. F., Pomeroy, M., Anguzza, R.,
French, W., & Gates, A. J. (1988). Louisiana's Ventilator Assisted Care Program: Case management services to link tertiary with community-based care. Children's Health Care, 17(2), 106-111.
(1984). Facilitating the child's entry to school and coordinating school activities during hospitalization. In Home care for children with serious handicapping conditions (pp. 67-77). Washington, DC: Association for the Care of Children's Health.