Other+Health+Impairment

The IDEA defines other health impairments as “ those having limited strength, vitality, or alertness, including a heightened alertness to environment mental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia and adversely affects a child’s educational performance,” In order for student to receive services under the “other health impairment” group the student’s health condition must have a direct impact on their educational progress. The North Carolina Procedures state that “other health impaired students have chronic or acute health problems which cause limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, to such an extent that special educational services are necessary” (Boreson, 2009, p.1). A student must meet four different conditions. The child must first suffer from acute or chronic health conditions. Second, the health condition must limit the alertness of the child in the educational environment. Third, the health condition must hinder the student’s educational performance. Lastly, like other disabilities, OHI must have created a special need for services. Other Health Impairments first must consider the effects of the health condition on the child, and then look at the disability and the effects on the child’s educational performance. The disorder that children qualify the most under OHI is attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). These two conditions most easily fall under the OHI category because it lends to the inability to focus, resulting in the demising of the educational environment. However, ADD and ADHD are not the only disabilities that fall under the OHI category, for example, asthma. Asthma is a chronic lung condition characterized by airway obstruction, inflammation, increased sensitivity” (Turnbull, 2007, p. 292). Many times asthma does not qualify under the IDEA because the health condition must limit the student’s strength, vitality, and alertness to a certain degree. However, because asthma requires certain accommodations to be made at school, for example, the nurse must be able to administer medication at the time of an emergency and all teachers must be trained in CPR. Therefore, the student will automatically qualify under Section 504 of the Rehabilitation Act. Most students only suffer from mild to moderate asthma symptoms. Annually, there are approximately 500,000 hospitalization, two million emergency department visits, 14 million absences from school, and 5,000 deaths, all due to asthma (Turnbull, 2007, p. 292). Asthma is the most common chronic disease in the United States among children. Children from diverse backgrounds run a higher risk of having the chronic illness of asthma. Asthma is most prevalent in Latino children. Research has shown that children from low-income households run a high risk of having asthma. It is caused by their quality of life and many of the things that they are exposed to. Asthma can be treated with medications, for example, nebulizers. Students with asthma have difficulties breathing from simple daily activates, for example, walking. Asthma can be caused by many things for example, food, exercise, cold air, and environmental issues. There many other life factors that contributes to chronic illness of asthma. Another illness that falls under the OHI category is diabetes. Diabetes is a disorder of the metabolism. The food that we eat is broken down into glucose, the form of sugar in the blood. Glucose is a main fuel for our bodies. After we digest our food, glucose is pasted through our bloodstream, where it is use by our body’s cells to grow and create energy. However, in order for glucose to get to our cells insulin must be present. Insulin is hormone produce by the pancreas. The pancreas is a large gland behind our stomach. When a person eats, the pancreas produces the correct amount of insulin to move glucose from our blood into our cells. In people with diabetes, the pancreas produces little or no insulin, or the cells do not respond to the insulin that is being produced. Therefore, glucose builds up in the blood and overflows to into the urine and passes out of the body. As a result, the body loses its main source of energy. Type 1 diabetes is formally known as juvenile diabetes. Type 1 diabetes was first diagnosed in children, teenagers, and young adults. In this type of diabetes the pancreas fails to produce insulin because the body’s immune system has attacked and destroyed the insulin. The treatment plan for type 1 diabetes is taking insulin shots or an insulin pump is needed. It is extremely important that people make good food choices, exercise regularly, control blood pressure, and cholesterol (http://www.naset.org/otherimpairments2.0.html). Type 2 diabetes is the most common form of diabetes. Type 2 of diabetes can be diagnosed at any age, even in childhood. Type 2 diabetes begins to form with the resistance of insulin. This is a condition, in which fat, muscle, and liver cells do not use insulin in the proper form (http://www.naset.org/otherimpairments2.0.html). At first, the pancreas is able to keep up with the added demand of insulin; however, it will fail to keep up will the production of insulin during meals. Being overweight and inactive will increase your chances in developing type 2 diabetes. Treatment for type 2 diabetes is as follows: good choice in food, exercise regularly, control blood pressure, and cholesterol (http://www.naset.org/otherimpairments2.0.html). The needs of students with diabetes need to be managed carefully. A student’s good health is key for their ability to learn. The school staff needs to have the medical training and tools to ensure the child with diabetes are receiving the services necessary to provide them with the best educational environment. The school needs to work with parents to develop a program that best meets the needs of their child. For example, if the child needs to have sacks available in the classroom in case his/her sugar level is lowered, that need has to be met. It is extremely important that the needs of the child are meet at all times. Many parents are unaware that it is their right to have diabetes management for their child in school. Epilepsy also falls under the category of “other health impairments” in special education. Epilepsy is a brain disorder, in which clusters neurons in the brain signal abnormally, resulting in seizures. Sufferings from a seizure just not necessarily mean he/she has epilepsy. In order for a person to have epilepsy, the person needs to suffer from seizures more than two times in a span of twenty-four hours. A common belief is that people with epilepsy only suffer from convulsive seizures. However, students can also suffer from seizures that can cause unconsciousness or change their behavior that can be misunderstood as daydreaming. There are two types of seizures that can change your consciousness. Absence seizures can cause a student to lose consciousness but only for a few seconds. Many may not realized a seizure has taken place because an absence seizure can occur hundred times a day. Absence seizures can really affect a student’s learning because they occur so often. Tonic-clonic seizures also known as grand mal seizures cause a person to lose consciousness and fall to the ground. During a tonic-clonic seizure the student can make noises and lose bladder control. The student is strongly recommended to sleep and rest after the seizure. Often times, the student has no recollection of the seizure that had occurred. Another type of seizure that affects students is partial seizures. Partial seizures affect the motor control of the student. It also affects the sensory, behavioral, and cognitive areas of the child’s brain (Turnbull, 2007, p.291). This type of seizure can only occur in one part of the brain; however, it can spread to other parts of the brain. Partial seizures, affect about 60 percent of children with epilepsy. After a child has his/her first seizure there is a 40 to 50 percent chance that the child will suffer from a second seizure (Turnbull, 2007, p. 291). About three-fourths of children with epilepsy enter remission. Meaning that the child does not suffer from seizures regardless if he/she takes medication or not (Turnbull, 2007, p. 291). About three-fourths of children with epilepsy who are not experiencing seizures for about two-four years will remain seizure free even if they stop taking their medication (Turnbull, 2007, p. 291). Children that experience seizures once they stop taking their medication will remind seizure free once they begin taking their medication again (Turnbull, 2007, p. 292). Children that suffer from epilepsy have about an average IQ. However, children that suffer from epilepsy are more likely to suffer from a learning disability. Many of the subjects that are affected the most are those that require memory, for example, math and reading. Studies have shown that students that suffered from epilepsy are still achieving lower academically. About ten percent of children will suffer from a seizure during their childhood or youth, but only one percent of the population will have epilepsy by the age of 20 (Turnbull, 2007, p. 292). Lead poisoning can lead to serious injury to the brain, nervous system, red blood cells, and kidneys. High levels of lead in the blood can lead to mental retardation, coma, and even death. Exposure to lead is uncommon today, but is still very much present. Low levels of lead in the blood of a developing child can cause damage to his/her brain. Resulting in slowing down a child’s learning development and causing behavior problems. A child that has been exposed to lead may not be as quick when it comes to learning. A child may have trouble hitting a baseball or dibbling a basketball. Although, lead paint was stopped being used in the 1970’s many houses still have surfaces that contain lead. Many young children chew, suck, or eat on surfaces that contain lead, for example, window sills and railings. Children are able to put lead materials in their mouths. As we all know, children like to put objects in their mouths. For younger children their mouths are where they have the most sensory, it becomes their first reaction to place objects in their mouth. Other homes and poor kept homes create a bigger threat to children. Dust and dirt could sometimes carry lead through the air. Many times the dust and the flumes from home renovation on lead-paint buildings are carried in the air. Lead accumulates in our environment. The more lead we use, the more lead will be in our environment. Lead accumulates in our body. The more a child is exposed to lead there will be a buildup in their system and can cause bad health effects. Since, lead is found in older buildings minority children run a bigger risk of coming in contact with lead poising. Lower economic communities have a higher number of children with lead poisoning because of the conditions that they live in or are exposed to. Rheumatic fever is an inflammatory disease which can develop an infection like strep throat and scarlet fever. Rheumatic fever can also involve the heart, joints, skin, and brain. Rheumatic fever is a disease that is known worldwide and is the cause of many damaged heart valves. Although, rheumatic fever is not very common in the United States there was an outbreak in the 1980’s. Rheumatic fever is primarily attacks children between the ages of six through fifteen. Rheumatic fever occurs about twenty days after the child had strep throat or scarlet fever. In many cases, strep throat did not cause any symptoms. The rate of developing rheumatic fever without any threat of strep throat is about three percent. A person that has contracted rheumatic fever is likely to have flare-ups and repeated strep throat inflections. The symptoms of rheumatic fever are agitation, joint pain, and migratory arthritis. Arthritis involves knees, elbows, ankles, wrist, and joint swelling. Other symptoms involved abdominal pain, skin rash, and emotional instability (http://www.naset.org/otherimpairments2.0.html). Many times the person will suffer from rapid movements affecting the face, feet, and hands. Rheumatic fever puts children at higher risk of having nosebleeds, and cardiac problems that result in shortness of breath and chest pains. Given that rheumatic fever has so many different symptoms there are no tests that will diagnosis this disease. A careful test can be done on the heart, skin, joints, and blood samples. To manage acute rheumatic fever involves the reduction of inflammation and anti-inflammatory medications, for example, aspirin and corticosteroids. Strep throat can be treated with antibiotics. Rheumatic fever can reoccur without treatment or medication in the first three to five years of the first case of rheumatic fever. However, heart complications can be a long term effect of rheumatic fever. Many different acute and chronic illness fall under “other health impairments” in special education. It is extremely important that the best possible education is provided to the children that fall under the OHI category. Accommodations need to be made in the classroom so that the student’s illness does not hinder his/her educational experience. A child’s educational performance should not be affected by their illness. The full potential of the student should always be met regardless of their disability.

Reference

Turnbell, A (2007). Exceptional Lives Special Education in Today's School. Upper Saddle River, New Jersey : Merrill Prentice Hall.

State of Missouri (n.d.). Diabetes. Retrieved from http://www.dhss.mo.gov/diabetes/index.html

National Association of Special Education Teachers (2006). Exceptional Teachers Teaching Exceptional Students. Retrieved from http://www.naset.org/otherimpairments2.0.html

Boreson, L (2009). Special Education Eligibility Criteria and Evaluation for Other Health Impairments. 16.

American Academy of Special Education Professionals (2006). Other Health Impairments. Retrieved from http://www.aasep.org/professional-resources/exceptionalstudents/otherimpairments/index.html

Ailed Torres The day in the life of students and families with “other health impairment” can be a difficult one. Disabilities impact the lives of students everyday in many different forms, for example, the impact it has on their educational career. Under the category of “other health impairments” fall many different exceptionalities, for example, asthma, attention deficit hyperactive disorder, and diabetes. During the course of my five interviews, I spoke with families, students, and professionals that have experience with the exceptionalities of asthma, attention deficit hyperactive disorder, and diabetes. They each opened my eyes to a new perspective. Speaking with people directly, I found it to be more beneficial then learning about these exceptionalities from a book. Although, learning from books is beneficial but conducting the interviews gave us a first person perspective. Day in the Life of a student with “other health impairment”: In order for student to receive services under the “other health impairment” group the student’s health condition must have a direct impact on their educational progress. When speaking to mother whose son has ADD it was difficult to hear everyday that her son was not paying attention in school (AT/DT/ADD/9.28.09/A/). She was nervous everyday to pick him up from school because there was a new issue everyday. It becomes very difficult for the parents to hear all the negative things their child did during their time at school. Parents begin to blame themselves for the actions of their children. Many times they begin to doubt their parenting skills. At home many times the behavior continues from school. This mother found it very difficult to get her son to focus and do his homework. When working with children with that have ADD and ADHD there is a lot of time spent re-teaching concepts and getting students to focus. The school psychologist at Atchison Elementary School as a great deal of experience working with students with ADD and ADHD. She has stressed the importance of getting the student to focus on being organized and re-teaching subjects. Many times children with disabilities miss school due to their health conditions, and it sets them back on their schoolwork. However, it is the job of the school to make sure the student is receiving the services necessary to be academically successful in the classroom. The day in the life of a family with a child with “other health impairments” depends on how OHI impacts the student’s education. When speaking with the young lady that was diagnosed with asthma her life was normal. She just has to make sure that she has her inhaler with her at all times. However, when speaking with people that deal with diabetes on a daily bases their day is a little more complicated. When interviewing a young lady with type 1 diabetes. In this type of diabetes the pancreas fails to produce insulin because the body’s immune system has attacked and destroyed the insulin. The treatment plan for type 1 diabetes is taking insulin shots or an insulin pump is needed. It is extremely important that people make good food choices, exercise regularly, control blood pressure, and cholesterol. She has to test her sugar blood level eight times a day (AT/TK/Diabetes/11.18.09/A/). She also has to give her insulin shots four times a day (AT/TK/Diabetes/11.18.09/B/). “If my sugar level is low I have to eat something no matter where I am (AT/TK/Diabetes/11.18.09/C/)”. If her sugar is high she has to give herself insulin shots. Some the side affects of having high sugar is being light headed and grumpy. When her sugar is low, she begins to shake, lose focus, and maybe past out. It is also important for people with diabetes to count carbohydrates; one unit of insulin equals fifteen units of carbohydrates. The normal amount of carbohydrates is between 80-100 carbohydrates (AT/TK/Diabetes/11.18.09/G). As a result, she snacks a lot more throughout the day. Her sugar being low and high really affects her mood everyday. I also interview a principle that has a sixth grade student with diabetes. He follows a very strict schedule. His blood sugar varies from 45-425 on a day, what he has eaten, the amount of exercise he has done, the heat, and his immune system affect his blood sugar level. People with diabetes are often sick because their immune system is weak. His parents do an excellent job of monitoring his blood sugar, supplying appropriate snacks, and providing phone numbers where they can be reached. The student has a health care plan on file from Children’s Mercy. This student checks his blood at 9:00 a.m., 12:00 p.m., and 2:30 p.m. (AT/LL/Diabetes/11.23.09/E/). If his blood sugar is above 150, he must drink a Crystal Light and use his pump to “make a self-correction” (AT/LL/Diabetes/11.23.09/F/). This also affects the number of times he uses the restroom. If the blood level is below 70, he has to eat a 20-crab snack for example a granola bar or chips (AT/LL/Diabetes/11.23.09/H/). His blood sugar needs to be rechecked in 15 minutes. He stays in the office from the time he checks his blood sugar the first time until he checks it again the second time (AT/LL/Diabetes/11.23.09/I/). This results in 20 minutes loss of class time. If the student’s blood sugar is over 200, he has to check his urine for ketones. This results in extra medical equipment. If the student’s blood sugar is low, he cannot be left alone. “If he passes out, we have icing on hand to squirt into his mouth (AT/LL/Diabetes/11.23.09/M/). The school is instructed to call 911 when this occurs. Before the child can have a special treat from school, he must contact his father for permission. There has been an occasion when the student has been refused a treat. He has also been instructed to save the treat for a later time. From the interviews that were conducted, I found that students with diabetes are under a great deal of stress, as well as the people that love and care for them. It is extremely important that the school staff be aware of the health plan and how to follow the instructions and meet the medical needs of the students. Although, the person that I interviewed with asthma led a normal life, there was still some added stress. She has to make sure she has her inhaler for school and practice. The student has an extra inhaler in her locker at school, just in case she forgets one at home. The school and her coaches were made aware of her conditions. She has to make sure that she takes her inhaler before practice or when she does any physical activity. Financial Impacts: With disabilities come financial strains and many times the family’s insurance does not cover the cost of the medical needs. In some of my interviews the insurance covered the cost of their medications. For example, the mother with the son who has ADD, her son’s medication is covered under her insurance. The young lady with asthma had her treatment covered under her parents insurance. However, I quickly discovered that this not true for all families with children with “other health impairments”. The school psychologist at Atchison Elementary School has a case where a student needs to be evaluated for ADHD, however the family cannot afford to have the evaluation done. The family makes too much to qualify for the medical card, but does not make enough to be able to afford the evaluation (AT/LB/OHI/11.19.09/E/). The school cannot afford to evaluate the child. Therefore, the family has no option but to go to their family doctor for the evaluation. Insurance sometimes makes it difficult for the student to fully get their needs met. The sixth grade student with diabetes had to purchase a pump that was very costly. He also has a glucose strips and glucose monitor to check his blood sugar. He checks his sugar 4-5 times per day. He purchases strips in packages of 100. “His mother has reported that she misses work two days each month due to appointment, illness or having to leave work because she is helping him with his blood sugar” (AT/LL/Diabetes/11.23.09/). He also has “special snacks” to keep at home, school, and in their vehicle. The young lady with diabetes also has some financial problems. She goes though two bottles of test strips a week. Each test strip cost one dollar and there are 50 strips per bottle (AT/TK/Diabetes/11.18.09/L/). She also has daytime and nighttime insulin that are very expensive and needles on top of that expense (AT/TK/Diabetes/11.18.09/N/). The insurance does not cover all of her medication. She has to see her eye doctor every six months and has to get the flu shot every year. Every three months she has to drive to Omaha to see her doctor, after insurance she still has to pay $100 dollars of her own money (AT/TK/Diabetes/11.18.09/Q/). Cheaper food has more carbohydrates; therefore, she spends more money on food. The IEP process: I discovered that not every student with OHI went through the IEP process. The student with ADD did not have an IEP meeting. His mother was just simply told by the school social worker to go get her son tested (AT/DT/ADD/9.28.09/F/). “Nothing was really done to help my son” (AT/DT/ADD/9.28.09/H/). He was labeled the problem child and was many times just looked over by his teachers. His school also did not have a special education teacher. The sixth grade student with diabetes came to his school with a health plan. The school made adjustments with their schedules to accommodate his medical needs. “Occasionally, he will need something re-taught because he missed the instruction due to an absence from the classroom” (AT/LL/Diabetes/11.23.09/W). The school also has to monitor the amount of time he is out-of-the-room. The student has good attendance and is an average student with strength in math (AT/LL/Diabetes/11.23.09/Y/). However, he struggles in writing. He has difficulty staying focused, and some of this is due to the fact that he misses classes (AT/LL/Diabetes/11.23.09/Y/). The college student with diabetes also did not go through the IEP process because she was diagnosed her freshmen year in college. She has to make sure she explains to her professors why she is eating in class (AT/TK/Diabetes/11.18.09/T/). On days that her blood sugar is high she has to miss class because she can’t see straight. Diabetes affects her heath; she is unhealthier because her immune system is weakened. During the IEP meeting we focus on the strengths and concerns of the student (AT/LB/OHI/11.19.09/J/). During the meeting IEP professionals make sure that the student’s health is diagnosed. If the student is on medication the nurse needs to be present and a health place needs to be put in place in case of a problem (AT/LB/OHI/11.19.09/L/). Social/ emotional and they interact with others and their concerns with their disability (AT/LB/OHI/11.19.09/M/). It is also important to talk about academics and makes sure we hit every area (AT/LB/OHI/11.19.09/N/). It is important for every student to have an IEP meeting because it gives him or her the opportunity to succeed in school. Impact on family, friends, and marriage: Having a disability does not only impact the student but also impacts family and friends. Children become labeled and are not given the help that they need. The impact that it might have on siblings is that they might start begin to display some of the same behavior (AT/LB/OHI/11.19.09/Q/). Teachers may believe that each child in that particular family will behave in the same manner. Therefore, not realizing that each child is different and has his/her own needs in the classroom. In the case with the young lady with diabetes has a impact on her siblings. Her family has type 2 diabetes and her older brother has type 1 diabetes. He does not take care of himself and her family becomes very worried. Her mother blames herself because type 1 diabetes means that you were exposed to something at some point (AT/TK/Diabetes/11.18.09/2B/). She thinks that she would have been able to prevent it (AT/TK/Diabetes/11.18.09/2C/). Whoever she lives with needs to be aware of her condition. Her roommates need to know how to work her medications. The sixth grader with diabetes has a younger sibling who is in the 4th grade. She is aware of his condition and knows a lot about diabetes because she has heard conversations (AT/LL/Diabetes/11.23.09/2A/). She has to leave school early on occasion because the family has to leave town for appointments. She is concerned about his well-being, but it does not seem to affect her at school (AT/LL/Diabetes/11.23.09/2C/). There is a great strain on marriage. Parents need to adjust to the financial strain, behavior, and fighting. Not knowing how to handle a situation is always a problem. The parents might not agree on how to handle the situation. The parents of the sixth grade student work well together when dealing with his condition (AT/LL/Diabetes/11.23.09/2F/). When his blood sugar is high or low, the school is asked to contact his mother first (AT/LL/Diabetes/11.23.09/2G/). Whenever he wants a special treat the school is asked to contact his father (AT/LL/Diabetes/11.23.09/2H/). The mother has the more prominent role when dealing with his medical needs (AT/LL/Diabetes/11.23.09/2I/). His father wanted him to play soccer this year, but his mother pulled him out after his blood sugar kept dropping during practices (AT/LL/Diabetes/11.23.09/2L/). Both parents are protective of their son. Families need to make accommodations to meet the needs of their children. For families that are dealing with diabetes they have to plan meals and count crabs. No meal can be done fast. For families that are dealing with asthma, they cannot spend too much time in the cold, and physical activities need to me limited. ‘Other Health Impairments” are sometimes difficult to see and understand because you can’t directly see the disability. However, their disability has an impact on their education. Therefore, accommodations need to be made for the student in order for them to be successful in school.

References

/AT/DT/ADD/9.28.09/A-L/ /AT/JR/Asthma/10.05.09/A-N/ /AT/TK/Diabete/11.18.09/A-2G/ /AT/LB/OHI/11.19.09/A-2E/ /AT/LL/Diabetes/11.23.09/A-2G/