3.4.7 Other Health Disabilities
| Key Topics: | Criteria | Evaluation | ECSE Criteria Crossover | Services | Terminology | Physicians Authorization Form |
| State Other Health Disabilities Companion Manual |
Minnesota schools are serving students with an extraordinary range of chronic or acute health conditions that may be either congenital or acquired. Students with health conditions may have associated characteristics or symptoms ranging from mild to severe. Some of the health conditions are progressive and some have associated symptoms that vary in intensity from day to day.
Medications, treatments, therapies, frequent doctor's appointments, and repeated hospitalizations can impact the student's ability to learn and function at school. Even relatively mild health conditions can significantly impact academic, behavioral, social, or emotional functioning. A student with such a condition may be considered for special education services under the Other Health Disabilities (OHD) category. However, when the condition is medically managed, and the student can successfully participate in school, then the student may not need special education services under OHD. Many student's with health conditions may only require a 504 plan, an individual health plan completed by a school nurse or accommodations within the general education setting agreed upon by the parent and school staff.
Definition
"Other health disability" means having limited strength, endurance, vitality, or alertness, including a heightened or diminished alertness to environmental stimuli, with respect to the educational environment that is due to a broad range of medically diagnosed chronic or acute health conditions that adversely affect a pupil's educational performance. (M. R. 3525.1335)
A medical diagnosis alone is insufficient to determine eligibility for special education services.
All students with medical diagnoses are not automatically to be considered for eligibility for Other Health Disabilities. Teams are advised to focus on the presenting problems in conjunction with a comprehensive evaluation to determine the appropriate disability category.
Students with some medical diagnoses may demonstrate educational concerns that may lead teams to consider them eligible for other special education categories.
Teams must establish and document a link between the chronic or acute health condition and its adverse effect on a pupil's educational performance.
When determining eligibility for children birth through age six who have been diagnosed with a syndrome or condition known to hinder normal development please refer to Early Childhood Special education criteria.
The team shall determine that a pupil is eligible and in need of special education instruction and services if the pupil meets the criterion in items A and B.
There is:
written and signed documentation by a licensed physician of a medically diagnosed chronic or acute health condition; see list of common diagnoses or
in the case of a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD or ADHD), there is written and signed documentation of a medical diagnosis by a licensed physician. The diagnosis of ADD or ADHD must include documentation that DSM-IV criteria in items A to E have been met. DSM-IV criteria documentation must be provided by either a licensed physician or a mental health or medical professional licensed to diagnose the condition.
For initial evaluation, all documentation must be dated within the previous 12 months.
In comparison with peers, the health condition adversely affects the pupil's ability to complete educational tasks within routine timelines as documented by three or more of the following: See Linking Needs to Conditions
excessive absenteeism linked to the health condition, for example, hospitalizations, medical treatments, surgeries, or illnesses;
specialized health care procedures that are necessary during the school day;
medications that adversely affect learning and functioning in terms of comprehension, memory, attention, or fatigue;
limited physical strength resulting in decreased capacity to perform school activities;
limited endurance resulting in decreased stamina and decreased ability to maintain performance;
heightened or diminished alertness resulting in impaired abilities, for example, prioritizing environmental stimuli; maintaining focus; or sustaining effort or accuracy;
impaired ability to manage and organize materials and complete classroom assignments within routine timelines; or
impaired ability to follow directions or initiate and complete a task.
The health condition results in a pattern of unsatisfactory educational progress as determined by comprehensive evaluation documenting the required components of subpart 2, items A and B. The eligibility findings must be supported by current or existing data from items A to E:
an individually administered, nationally normed standardized evaluation of the pupil's academic performance;
documented, systematic interviews conducted by a licensed special education teacher with classroom teachers and the pupil's parent or guardian;
one or more documented, systematic observation in the classroom or other learning environment by a licensed special education teacher;
a review of the pupil's health history, including the verification of a medical diagnosis of a health condition; and
records review.
The evaluation findings may include data from: an individually administered, nationally normed test of intellectual ability; an interview with the pupil; information from the school nurse or other individuals knowledgeable about the health condition of the pupil; standardized, nationally normed behavior rating scales; gross and fine motor and sensory motor measures; communication measures; functional skills checklists; and environmental, socio-cultural, and ethnic information reviews.
NOTE:
For initial evaluations the student must meet criteria.
For Re-evaluations, the team must "address" all components of criteria.
How to link presenting problems to part B, Items 1-8 of OHD Criteria. For more guidance see Students with Health Conditions Identifying Educational Needs.
In order for students to be eligible for special education, their health condition must be linked to their educational difficulties. Here are some examples that illustrate that relationship:
The student's health condition, which results in excessive absences from school or classroom for specialized treatment, interferes with the student's ability to maintain satisfactory academic progress in comparison to peers. (Part B-1)
The student's health condition, which requires specialized treatments during the school day, interferes with the student's ability to complete classroom assignments within timelines comparable to those of peers. (Part B-2)
The student's health condition, which requires administration of specific medications during the school day, interferes with the student's ability to be in class consistently. (Part B-3)
The student's health condition, causing poor or limited strength, results in the student's inability to handle materials, transition within the building, participate in recreational or leisure playground activities. (Part B-4)
The student's health condition, causing limited endurance, results in the student's inability to complete written assignments and requires intermittent rest time. (Part B-5)
The student's health condition, which causes him to fatigue easily, interferes with the student's ability to remain on task/complete assignments at a level comparable to that of peers. (Part B-4 & 5)
The student's level of pain resulting from the chronic or acute health condition causes limited endurance, strength or increased fatigue and distractibility. (Part B-4, 5, 6, 7, 8)
The student's level of distractibility interferes with ability to attend during lecture in comparison to peers. (Part B-6)
The student's level of distractibility interferes with ability to start work and remain on task at a level comparable to that of his peers. (Part B-6 & 8)
The student's level of distractibility interferes with ability to consistently organize his materials for class/come to class prepared in comparison to peers. (Part B-7)
The student's level of impulsivity interferes with ability to focus and complete activity-based classroom projects in comparison to peers. (Part B-8)
When the student's presenting problems do not link to the chronic or acute health condition:
The student's academic progress is at a level comparable to what would be expected for his or her ability.
The student's lack of progress is attributable to motivational concerns not directly linked to the health condition.
The student's lack of progress is attributable to behavioral/emotional concerns.
There is no causal link between the lack of educational progress and the identified health condition.
Resulting presenting problems from the initial health condition manifest themselves as significant cognitive, motor or behavioral concerns which may lead the team to consider other eligibility criteria. Example: Acute meningitis resulting in significant cognitive, motor or behavior concerns.
| Criterion Components | ||||||||
| Evaluation Components | Normed Standardized Evaluation | Interviews | Observation | Health History | Record Review | Licensed Physician Diagnosis | Licensed Physician Diagnosis of ADHD | |
| Absenteeism lined to Health Condition | X | X | X | X | ||||
| Specialized Health Care procedures necessary during school day | X | X | X | X | X | |||
| Medications that adversely affect learning & functioning | X | X | X | X | X | |||
| Limited physical strength (performance) | X | X | X | X | X | |||
| Limited endurance (maintaining effort) | X | X | X | X | X | X | ||
| Heightened or diminished alertness (focus) | X | X | X | X | X | X | X | |
| Manage/organize materials, complete assignements | X | X | X | X | ||||
| Follow directions, initiate & complete a task | X | X | X | X | X | |||
| Purposed of data: | Gives a picture of the underlying academic skills of the student | Gives teacher/parent a report of the student's day to day educational function | Gives "snapshot in time" of ability to function in educational setting | Gives overall picture of health concern's impact on performance & education | Gives overall picture of educational performance and attendance for each grade completed | Gives current medical diagnosis and any associated conditions or health issues | Gives current medical diagnosis of ADHD and co-morbid conditions |
| Subitem B | Language From Rule | Interpretation for Pupils Prior to Kindergarten |
|---|---|---|
| 1 | Excessive absenteeism | Child is frequently absent from child care or other natural environments |
| 2 | Specialized health care procedures during school day | Child receives specialized health care procedures during hours that older children are typically at school |
| 3 | Medications that adversely affect learning and functioning | Interpreted as written |
| 4 | Limited physical strength resulting in decreased capacity to perform school activities | Limited physical strength resulting in decreased capacity to perform developmentally appropriate tasks |
| 5 | Limited endurance resulting in decreased stamina and decreased ability to maintain performance | Interpreted as written |
| 6 | Heightened or diminished alertness resulting in impaired abilities (ex. prioritizing environmental stimuli, maintaining focus, sustaining effort or accuracy) | Interpreted as written |
| 7 | Impaired ability to manage and organize materials and complete classroom assignments within routine timelines | Impaired ability to manage and organize materials used in developmentally appropriate activities and complete developmentally appropriate tasks within routine timelines |
| 8 | Impaired ability to follow directions or initiate a task | Interpreted as written |
An individually administered, nationally normed standardized evaluation of the pupil's developmental performance.
Documented, systematic interviews conduction by a licensed special education teacher with the pupil's parent or guardian and child care provider, if appropriate.
One or more documented, systematic observations in the (1) home or (2) child care or other learning environment in which the child participated, by a licensed special education teacher.
A review of the pupil's health history, including the verification of a medical diagnosis of a health condition.
Records review.
List of additional evaluation activities is appropriate as written.
If a student is eligible for special education and related services as Other Health Impaired, any licensed special education teacher may provide instruction and service because there is not teacher licensure specifically designated to work with this population. There is frequent confusion over "who serves" and the answer is " we all do!"
Chronic Health Condition: One that is long term and is either not curable or has residual features that result in limitations in functions of daily living requiring special assistance or adaptations, OR, A disease or disorder that develops slowly and persists for a long period of time-often for the remainder of the life span. Examples are epilepsy, sickle cell anemia, Leukemia, diabetes or some autoimmune diseases.
Acute: A disease or disease symptom that begins abruptly and with marked intensity, then subsides after a relatively short period of time. Examples would be Crohn's disease, kidney diseases or conditions that require an organ transplant, OR, A health condition with rapid onset, severe symptoms, and a short course. Sequelae, however, may be short-term or persistent. (Sequelae are conditions that follow and result from a disease. For example, a child who has had meningitis may suffer from sequelae such as motor problems and cognitive impairment.)
Heightened or Diminished Alertness: Inability to maintain awareness, vigilance, mindfulness, or attentiveness. This may be caused by external stimuli in the environment or an internal inability to maintain focus.
Limited Strength: The inability to maintain effort caused by a lack of resilience or stamina.
Excessive Absenteeism: Student is noted to have consistent or intermittent absences that interfere with academic progress and participation in school activities. Absences must be the result of hospitalizations, medical treatments, surgeries, or illness.
Inadequate Academic Progress: Inadequate progress in comparison to peers as measured by these outcomes and which are directly linked to the chronic/acute health condition:
Grades, test scores, and daily work: Academic work is consistently in the poor-to-failing range.
Poor work completion: Failure to consistently complete work in a timely manner and results in poor-to-failing academic performance.
Decrease or change in work output: There is a documented and consistent decrease or change in the amount of work produced that results in poor-to-failing academic performance.
Decrease or change in independent functioning or organizational skills: There is a documented and consistent decrease in student's independent functioning or organizational skills that results in poor-to-failing academic performance.
Specialized Healthcare Procedures: The medically related services necessary during the school day prescribed by the student's licensed physician. These procedures require training for the individual who performs them. Examples include catherization, gastric tube feeding, postural drainage, tracheotomy care, oxygen administration, ostomy care, and the administration of medications: oral, inhaled, injected, or IV.
Page revised 11/10/2009