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Bureau for Students with
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A project funded by the Georgia State Improvement Grant
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On-Line - Fall 2000
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Instructing Students to Perform Their Own Health Care Procedures
News from the Georgia Department of Education/Division for Exceptional Students
A Decade with The Americans with Disabilities Act
Students with physical and health impairments sometimes require specialized health care procedures during school hours. Procedures such as tube feeding, clean intermittent catheterization, colostomy/ileostomy care, suctioning, oxygen delivery, and ventilator care are commonly found in the school. The Division for Physical and Health Impairments of the Council for Exceptional Children recently formed a position statement that stressed the importance of viewing these health care procedures as self-help skills or independent living skills that may be taught to the student to perform (DPHD, 1999). If the educational team decides it is appropriate for the student to be taught his or her health care procedure, it should be included in the IEP as an educational objective.
Students with a variety of disabilities have been taught to perform health care procedures, including those with physical, intellectual, or multiple disabilities. Students may be taught to independently perform the procedure or partially participate in performing some steps of the procedure. In a tube feeding procedure, for example, a student may be taught to perform the entire procedure of giving himself a specific formula (or liquid food) via a tube that goes directly into the stomach or small intestine. Some students may learn only parts of the procedure such as preparing the formula, cleaning the equipment when finished, or helping to hold the syringe barrel in which the formula is poured. In some instances, the student may be too physically impaired to physically assist with the procedure, so he may have the objective to direct another person in the procedure. This promotes active participation and helps protect the student against errors. Some students may also have the objective of learning about the health care procedure. Some students may be taught about the gastrointestinal system, while others may be taught what to do if they have abdominal cramping.
To teach a health care procedure, each procedure should be broken down into small steps (also known as a task analysis). Students should be assessed with performing the steps and appropriate modifications made. Caution steps and time-limited steps must also be identified. Caution steps are any steps that could result in injury should the student make a quick, jerking, or incorrect movement. Time-limited steps are those that need to be completed in a specific period of time (Heller, et. al, 2000). In tube feeding, for example, connecting the syringe barrel to a G-tube or connecting a connecting tube to a gastrostomy button are considered caution steps since the student could accidentally dislodge the tube or button. A time-limited step is pouring more formula into the syringe barrel before it has completely emptied in order to avoid air entering the tube. When these steps are identified, the educational team will need to determine if the student should be taught these steps. If so, the teacher needs to provide shadowing, which means that the teacher's hands should be within 1 inch of the student's hands in order to prevent any problems. After identifying these steps, the teacher would select the most appropriate instructional strategy and systematically teach the procedure.
The educational team decides if it is appropriate for the student to learn the health care procedure. If it is determined that it should taught and it is included as an instructional objective on the IEP, the team needs to work together to assure the success of the student learning the procedure. The nurse provides information regarding the procedure, the teacher provides information on instructional strategies and modifications, the physical and occupational therapists provide information on proper positioning of the student and the equipment, the speech language pathologist provides information on communication strategies regarding the procedure, and the parent (and student) provide information about their experience with the procedure and the student. For many students, learning to participate in the performance of their health care procedure will decrease learned helplessness, increase self-esteem, and enable them to be more independent.
- by Kathy Heller, Professor, Georgia State University
The Georgia Department of Education continues to provide training opportunities and support for school personnel and parents of students with disabilities:
- The Metro East and Metro West GLRS sites are sponsored a combined statewide conference for occupational therapists, physical therapists and teachers of students with orthopedic impairments. The conference was held October 13& 14, 2000 at the Urban Life Center at Georgia State University. The topics of the conference included transition to post-school activities, reading instruction, handwriting and legal issues.
- The Georgia State Improvement Grant (SIG) is a comprehensive statewide initiative designed to foster improved services and outcomes for students with disabilities. One activity of the SIG involves the Center for Collaborative Education (CCE) and the Georgia Learning Resource System (GLRS). The CCE and GLRS offer training to administrators, teachers and parents on providing appropriate supports, services and instructional strategies to students with disabilities served in the regular education environment. To contact the Center for Collaborative Education, call Dr. Paul Alberto, Georgia State University at (404) 651-2310. To register for the GLRS staff development opportunities on this topic or other topics related to special education, contact your local GLRS or call 1-800-282-7552 for information on your local GLRS.
- The Georgia Board of Education recently adopted the Georgia Special Education Rules, which outlines the provision of special education and related services for students with disabilities in Georgia. The Georgia Special Education Rules are posted on the Georgia Department of Education website at www.doe.k12.ga.us.
- by John O'Connor, Grant Program Consultant
This past summer we observed many celebrations of the tenth anniversary of the passage of the Americans with Disabilities Act of 1990 (ADA). Most special educators know that this act, along with Section 504 of the Rehabilitation Act of 1973 and the 1997 reauthorization of the Individuals with Disabilities Education Act, form the legal basis which protect the rights of students with disabilities to a full and rewarding education. Many may not know how the ADA affects our students, however.
The ADA prohibits both public and private facilities, including schools, from discriminating against persons with disabilities or illness, including AIDS. Generally speaking, it is Titles II and III which offer protection to students with physical disabilities and health impairments. Title II is applicable to public agencies, including public schools. It requires that all new buildings constructed with government funds be accessible. In addition, any alterations to an old building must include provisions to make the newly altered portion of the building accessible. Title III affects public accommodations, including private schools, in much the same manner. Thus all public and private schools are required to provide reasonable accommodations which do not cause undue hardship.
The definition of disability is broader under the ADA than that found in the Individuals with Disabilities Education Act Reauthorization of 1997 (IDEA). IDEA requires that the child's disability or illness directly affect school performance. The ADA covers those individuals who have a physical, mental and/or health impairment limiting a major life activity, or who have a history of impairment, or who are regarded as having an impairment. Thus, a child with an orthopedic impairment whose education is not being affected by the impairment and is not covered by IDEA is covered by ADA and by the Rehabilitation Act. So, too, are those students with chronic illness or infectious disease, such as AIDS.
By looking at the broad scope of this law, we can see that the passage of the ADA ten years ago was a landmark in the protection of students with physical and health disabilities. The past ten years have been ones of remarkable growth, both in Georgia and elsewhere, giving us cause for celebration. For more information on the ADA in our state, contact the South East Regional Disability and Business Technical Assistance Center at 404-888-0022 (voice) or 404-888-9098 (TDD).
- by Liz Cohen, Georgia State University
How many times have you completed a task for a student simply because you can get it done faster, with less effort or less mess? At times, completing a task for a student is necessary due to time constraints. However, constantly completing tasks that your students are capable of performing on their own or with assistance can create a condition known as learned helplessness.
Learned helplessness is defined as a condition wherein a person believes that no matter how hard he or she tries, failure will result. In other words, when tasks are constantly done for a student, he or she begins to believe that his or her effort is inadequate to succeed at the expected task. As a result, most students will become reluctant to complete a task, particularly a challenging one.
As a result of learned helplessness, students often appear to others as lazy or incapable. However, a student will most always live up or down to the expectations that others have for them. Thus, if a person expects great things from a student, great things will result. Unfortunately, however, if a person expects little from a student, little will result. Ultimately, a lack of expectations will have a negative effect on a student's self esteem.
Here are several tips for combating learned helplessness:
- set high expectations for your students
- let your students know that you see them as capable individuals
- encourage your students to try it on their own
- provide multiple opportunities for student trials
- positively reinforce the student's efforts
- if completing the entire task is not a possibility, encourage the student to complete the parts that he or she can do
- encourage the student to try a bit more with each success
- if you must complete a task due to time constraints, let the student know that he or she will be expected to do the task when time is not an issue
- allow your students to see you struggle with a difficult task
- by Dawn Swinehart
The Girl Scouts by Mail program was the brainchild of Teresa Laird, who is a Membership Specialist at Girl Scouts of Northeast Georgia. The girls involved are those who are medically fragile or ill and cannot attend regular troop meetings. The communications and activities that the troop is involved in are sent through the mail. As the members of the troop complete the activities, they send them back to the leader so that they can receive badges and credit for what they have done. The leader keeps a scrapbook with the details of each member's activities. The leader then responds with suggestions, comments, encouragement, and new activities.
Initially, troop members were found by contacting special education directors in the counties of the northeast Georgia area. The directors and their teachers were able to suggest names of girls who might be interested in the program.
I became leader of the troop in September 1999. I have tried to determine the interests and abilities of each girl and tailor the activities around their interests. One of the first projects for the troop scrapbook was a 'Me Page' on which the girls were asked questions about themselves. One such question was 'Who is my role model, and why?' The best answer I received was 'My mom, because she helps me with some things and she takes me to all sorts of places with her.'
Future goals include getting the girls of this troop together for an event. Other plans include setting up pen pals so the girls can get to know each other and work together on some badges. For more information on the Girl Scouts- Postal Express program, please contact me through the Northeast Georgia Girl Scouts Association at (770) 536-8656. Or contact Margaret Paschal at (404) 527-7672 or 1-800-771-4046.
- by Donna Westmoreland, Troup Leader, Girl Scouts - Postal Express
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