18 Other Health Impairments

Other Health Impairments

Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—

(i) Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and

(ii) Adversely affects a child’s educational performance. [§300.8(c)(9)]

Center for Parent Information and Resources, (2017), Categories of Disability under IDEA. Retrieved 3.28.19 from https://www.parentcenterhub.org/categories/   public domain

Table of Contents

  • Introduction to OHI
  • Specific Health Impairments
  • Characteristics and Impact on Learning
  • Accommodations etc.
  • Addressing Medical Issues
  • Videos- OHI Rare Conditions
While ADHD falls under the OHI disability category,  according to IDEA, ADHD will be discussed in a separate chapter.

Introduction to Other Health Impairments (OHI)

The following text is an excerpt from: Center for Parent Information and Resources, (2015), Other Health Impairments. Retrieved 4.1.19 from https://www.parentcenterhub.org/ohi/  public domain

What’s immediately clear from this definition is that there are quite a few disabilities and disorders that fall under the umbrella of “other health impairment.” And those disabilities are very different from one another. This makes it difficult for us to summarize “other health impairment” and connect you with more information and guidance on the subject.

And that’s why, in a moment, we will break this discussion down into closer looks at each of the disabilities listed: ADD or AD/HD, diabetes, epilepsy, heart conditions, and so on.

We’d also like to point out that IDEA’s definition uses the phrase “such as…” That’s significant. It means that the disabilities listed are not the only ones that may be considered when a child’s eligibility for special services under IDEA is decided. A child with another health impairment (one not listed in IDEA’s definition) may be found eligible for special services and assistance. What’s central to all the disabilities falling under “Other Health Impairment” is that the child must have:

  • limited strength, vitality, or alertness due to chronic health problems; and
  • an educational performance that is negatively affected as a result.

Specific Health Impairments

IDEA mentions the following specific health conditions in its definition of Other Health Impairment?

Other health impairments can also fall under the umbrella of IDEA’s disability category besides the ones specifically mentioned in the law. The U.S. Department of Education mentions specific other disorders or conditions that may, in combination with other factors, qualify a child for services under IDEA–for example:

  • fetal alcohol syndrome (FAS),
  • bipolar disorders,
  • dysphagia, and
  • other organic neurological disorders.

The reason these weren’t specifically mentioned in IDEA’s regulations? According to the Department:

…because these conditions are commonly understood to be health impairments…The list of acute or chronic health conditions in the definition of other health impairment is not exhaustive, but rather provides examples of problems that children have that could make them eligible for special education and related services under the category of other health impairment. (71 Fed. Reg. at 46550)

Note that the Department uses the phase “could make them eligible”—could, not does. Other aspects (adversely affected educational performance, a child’s evaluation results, state policies) are considered in determining eligibility for services under IDEA, not solely the existence of the disability or condition.      (Center for Parent Information and Resources, 2015)

Other Health Impairment types, with links to descriptions from NASET (n.d.)  Other Health Impairments- Topic Categories from https://www.naset.org/professional-resources/exceptional-students-and-disability-information/other-health-impairments

Characteristics and Impact on Learning

There is a range of medical diagnoses and subsequent health problems that can have a temporary or chronic impact on a student’s academic performance. Common diagnoses include arthritis, cancer, multiple sclerosis, asthma, and heart disease. Unless the condition is neurological in nature, health impairments are not likely to directly affect learning. However, the secondary effects of illness and the side effects of medications can have a significant impact on memory, attention, strength, endurance, and energy.

Health impairments can result in a range of academic challenges for a student. Problems may include missing school for unpredictable and prolonged time periods and difficulties attending school full-time or on a daily basis. Health problems may also interfere with the physical skills needed to complete writing assignments or other learning activities. Individuals with arthritis, for example, may have difficulty writing due to pain or joint deformities. Some students may not be able to manipulate small laboratory equipment or complete tasks that require precise measuring, graphing, or drawing. Prolonged sitting may pose challenges for an individual with chronic pain or back problems. Illness or injury may result in limitations in mobility that make it necessary to use wheelchairs or scooters. Some students must avoid specific activities that trigger undesirable reactions. For example, students with asthma may need to avoid specific inhalants in a science lab.   (DO-IT, n.d)

GO to: NASET. (n.d.). Comprehensive Overview of Other Health Impairments, from https://www.naset.org/index.php?id=2278, (Characteristics of OHI)


Accommodations

Flexibility plays a key role in supporting the success of students with health impairments as many health conditions by nature are unpredictable. The provision of assignment outlines and task instructions with clear and well-organized information regarding readings, materials, assignments, and exams can help the student plan, organize, and prioritize their schoolwork. Posting information on the web is another way for a student to access important information without the need to be physically present. Prior knowledge of deadlines and exams may help the student and their family plan doctor appointments and/or medical procedures around important dates.

Computer-based instruction and distance learning can provide feasible alternatives for students with illnesses that make regular class attendance difficult.

Examples of typical accommodations for students who have health impairments include:

  • note takers
  • recorded class sessions
  • flexible attendance requirements
  • extended time for classwork, homework, and tests.
  • alternative testing arrangements
  • assignments available in electronic format
  • the use of electronic mail for teacher-student correspondence and for class or small group discussions
  • environments that minimize fatigue and injury
  • an ergonomic workstation with adjustable keyboard trays, monitor risers, glare guards, footrests, adjustable chairs, and/or anti-fatigue matting
  • speech recognition computer input devices, ergonomic keyboards, one-handed keyboards, expanded keyboards, or miniature keyboards

(DO-IT, n.d)

Interventions, Modification, Accommodations and Related Service Providers– GO to: NASET. (n.d.). Educational Issues, from https://www.naset.org/professional-resources/exceptional-students-and-disability-information/other-health-impairments/educational-issues

Addressing Medical Issues

By their very nature, other health impairments involve medical care and medical concerns. The amount of time that must be devoted to doctor visits, medical appointments, hospitalization, and seeing to the child’s well-being will depend greatly on the nature and severity of the child’s health impairment. For many families, the actual medical care of their child can be a daily, weekly, monthly challenge.

As IDEA’s definition of OHI makes clear, a health impairment affects a student’s educational performance. In fact, for a child to qualify for special education services in the public schools, the OHI must affect the child’s educational performance.

When a child is found to be eligible for special education, he or she will also be eligible to receive related services in school—which can be very valuable and relevant to the child’s needs. Related services are provided as required to enable children with disabilities to benefit from their special education. Two in particular come to mind for children who have an OHI:

  • medical services, which are provided for diagnostic and evaluative purposes only, and which are defined as “…services provided by a licensed physician to determine a child’s medically related disability that results in the child’s need for special education and related services.” [34 CFR §300.34(c)(5)]
  • school health services and school nurse services, which are defined by IDEA as “…health services that are designed to enable a child with a disability to receive FAPE as described in the child’s IEP. School nurse services are services provided by a qualified school nurse. School health services are services that may be provided by either a qualified school nurse or other qualified person.” [34 CFR §300.34(c)(13)]

Many children with disabilities, especially those who are medically fragile, could not attend school without the supportive services of school nurses and other qualified people. Over the years, the extent of the health-related services provided in schools has grown, as might be expected when you consider medical advances in the last decade alone.

What was previously called “school health services” in IDEA was expanded in its 2004 reauthorization to distinguish between services that are provided by a qualified nurse and those that may be provided by other qualified individuals. States and local school districts often have guidelines that address school health services and school nurse services. These may include providing such health-related support as:

  • Special feedings;
  • Clean intermittent catheterization;
  • Suctioning;
  • The management of a tracheostomy;
  • Administering and/or dispensing medications;
  • Planning for the safety of a child in school;
  • Ensuring that care is given while at school and at school functions to prevent injury (e.g., changing a child’s position frequently to prevent pressure sores);
  • Chronic disease management; and
  • Conducting and/or promoting education and skills training for all (including the child) who serve as caregivers in the school setting.

Determining what related services a child needs is the responsibility of the child’s IEP team, the group that develops the child’s individualized education program. Key information for decision makers will be available from the evaluation process, since a child must be assessed in all areas related to his or her suspected disability. The IEP team must look carefully at the evaluation results, which show the child’s areas of strength and need, and decide upon which related services are appropriate for the child. The school must then provide these services as part of the child’s education program.

When Health Affects School Attendance

It’s not uncommon for a child with an OHI to have periodic absences from school, sometimes even lengthy ones, especially if hospitalization is necessary for whatever reason. During these times, the public school remains responsible for providing educational and related services to the eligible child with OHI. Because IDEA specifically states that special education can be provided in a range of settings, including the home or the hospital, states and school districts will have policies and approaches for addressing children’s individualized needs and circumstances.

  • When the child is at home, the school may arrange for a homebound instructor to bring assignments from school to home and help the student complete those assignments.
  • When the child is hospitalized, services may be provided by the hospital, through arrangement with the school, although this will vary according to local policies. (In any event, the hospital is likely to have policies and procedures of its own, and it’s important for the family to find out what those are.) The hospital may want to review the child’s IEP and may, with the parent’s permission, modify it during the child’s hospitalization.
  • After the child is discharged, the hospital will share a summary of the child’s progress with the school, in keeping with whatever local school policies are.

After a child has been out of school for an extended period of time, it’s important for parents and school staff to plan carefully for his or her return to that setting and the activities that go on there.

(Center for Parent Information and Resources, OHI, 2015)


OHI Rare Conditions- Video Interviews

Road Forward – Veronica Wain (4:03 minutes)

Watch this video with mom sharing her experiences raising her daughter with “chromosome 18”  (4:03 minutes). In this video, Veronica speaks about being a mother to Allycia, the battles she has fought and how she has learned to build supports around their family so that Allycia will have help in the long-term.

UQx ABLExx Series (Mar. 21, 2016). UQx ABLE101x 1.3.1.2a Road Forward – Veronica Wain [Video File]. From https://youtu.be/56MwfwvNsa8

Complex Care – Mary’s Story (6:38 minutes)

In this video, Mary speaks about her three children, two of whom have an undiagnosed neurodegenerative mitochondrial metabolic disorder, which led to the early death of her son, Jonathan. She speaks about Melissa, who is now living independently with extensive support.

Mary speaks about the many hurdles parents face when dealing with the complex disorders of their children and how medical or health professionals can hinder or help. Mary speaks about her life with her children and how much they have taught her.

UQx ABLEx Series (Mar. 22, 2016). UQx ABLE101x 1.3.1.4a Complex Care – Mary’s Story [Video File]  https://youtu.be/MmLWB8C4gQc


The next chapter will address: Attention Deficit/Hyperactivity Disorder 


Images

Medical Image by Peggy and Marco Lachmann-Anke from Pixabay

Boy Mario Image Image by Sarah Martin from Pixabay


References

Center for Parent Information and Resources, (2015), Other Health Impairments. Retrieved 4.1.19 from https://www.parentcenterhub.org/ohi/  public domain

DO- IT, (n.d.) Health Impairments, from https://www.washington.edu/doit/health-impairments   CC BY-NC-SA-3.0

NASET. (n.d.). Comprehensive Overview of Other Health Impairments, from https://www.naset.org/index.php?id=2278,

NASET. (n.d.). Educational Issues, from https://www.naset.org/professional-resources/exceptional-students-and-disability-information/other-health-impairments/educational-issues

NASET (n.d.)  Other Health Impairments- Topic Categories from https://www.naset.org/professional-resources/exceptional-students-and-disability-information/other-health-impairments

UQx ABLExx Series (Mar. 21, 2016). UQx ABLE101x 1.3.1.2a Road Forward – Veronica Wain [Video File]. From https://youtu.be/56MwfwvNsa8

UQx ABLEx Series (Mar. 22, 2016). UQx ABLE101x 1.3.1.4a Complex Care – Mary’s Story [Video File]  https://youtu.be/MmLWB8C4gQc


Updated 7.4.22