Individual Health Plans and Nursing Services

School health services and school nurse servicesare designed to enable a student with a disability to receive FAPE as described in the student's Individualized Education Program (IEP). School nurse services are provided by a qualified school nurse. School health services may be provided by either a qualified school nurse or other qualified person. For specific recommendations and guidance on these qualifications, see California Department of Education (CDE) Program Advisory on Medication Administration, p. 7, www.cde.ca.gov/ls/he/hn/documents/medadvisory.pdf). School health services and school nurse services are considered related services under the Individuals with Disabilities Education Act (IDEA). 

An IHP is a formal written agreement developed in collaboration with the school staff (School Nurse), the student, the student's health care provider(s), and the student's family. An IHP is written for students whose healthcare needs affect or have the potential to affect safe and optimal school attendance and academic performance. An Individual Health Plan (IHP) generally focuses exclusively on addressing a student's medical needs and may be appropriate for a general education student through a 504 Plan as well as a student receiving special education services.  

Per the National Association of School Nurses (NASN) the IHP should include: 

  • Assessment: The data collection phase helps determine the student's current health status and any actual or potential health concerns. 
  • Diagnosis: The school nurse uses the assessment data to formulate a nursing diagnosis, including a diagnostic label, etiology, and presenting signs and symptoms. 
  • Outcome Identification: The school nurse identifies the desired results of nursing intervention and states these in measurable terms. 
  • Planning: Interventions are selected to achieve desired results. 
  • Implementation: The written IHP is put into practice, and the care provided is documented. 
  • Evaluation: The professional school nurse measures the effectiveness of nursing interventions in meeting the identified outcome. Changes are made to the plan as needed. 

According to California Educational Code §49426, "school nurses strengthen and facilitate the educational process by improving and protecting the health status of children and by identification and assistance in the removal or modification of health-related barriers to learning in individual children. The major focus of school health services is the prevention of illness and disability and the early detection and correction of health problems. The school nurse is especially prepared and uniquely qualified in preventive health, health assessment, and referral procedures… It is the intent of the Legislature that the governing board of each school district and each county superintendent of schools maintain fundamental school health services at a level that is adequate to accomplish all the following: 

  • Preserve pupils' ability to learn 
  • Fulfill existing state requirements and policies regarding pupils' health 
  • Contain health care costs through preventive programs and education" 

(EDC §49427) Holders of the School Nurse Services Credential shall be authorized to perform the following services: 

  • Conduct immunization programs pursuant to California Education Code, Section 49403, of the California Code of Regulations. 
  • Assess and evaluate the health and developmental status of pupils. 
  • Interpret the health and developmental assessment to parents, teachers, administrators, and other professionals directly concerned with the pupil. 
  • Design and implement individual student health maintenance plans, incorporating plans directed by a physician. 
  • Refer the pupil and parent or guardian to appropriate community resources for necessary services. 
  • Maintain communication with parents and all involved community practitioners and agencies to promote needed treatment and secure reports of findings pertinent to educational planning. 
  • Interpret medical and nursing findings appropriate to the student's individualized education program and make recommendations to professional personnel directly involved. 
  • Consult with, conduct in-service training for, and serve as a resource person to teachers and administrators. 
  • Develop and implement the health education curriculum. 
  • Act as a participant in implementing a comprehensive health instruction curriculum for students. 
  • Counsel and assist pupils and parents in health-related and school adjustment services. 
  • Teach health-related subjects under the supervision of a classroom teacher 

The California Department of Education has a page of information to assist schools in effectively managing diabetes, one of the most common chronic diseases in school-aged children. https://www.cde.ca.gov/ls/he/hn/diabetesmgmt.asp 

The California Department of Education has a page of comprehensive medical guidelines for Local Education Agencies (LEAs)/districts to use when developing individualized health plans. http://www.cde.ca.gov/ls/he/hn/