Developing Individualized Health Care Plans and Action Plans

In this section

• Emergency Care Plan (ECP) 
• Individualized Health Care Plan (IHCP)

Section 5

Developing Individualized Health Care Plans and Action Plans

Children with life-threatening food allergies and GSD must have an individualized health care plan (IHCP) and action plans (such as emergency care plans) to address how their health and safety needs will be met while in school.

Emergency Care Plan (ECP)

ECPs for students with life-threatening food allergies and GSD may sometimes be called an Allergy Action Plan or GSD Action Plan.  ECPs provide specific directions, appropriate to the student’s diagnosis, about what to do in medical emergencies such as an accidental exposure to allergens, hypoglycemia or safety emergencies (such as a fire drills or lockdowns).  ECPs are often part of IHCPs.  This written plan helps school nurses, school personnel and emergency responders react to emergency situations in a prompt, safe and individualized manner. ECPs may include:

• name and other identifying information (such as date of birth, grade and photo); 
• disease or disorder specific information (such as specific allergen); 
• signs and symptoms of an adverse reaction (such as accidental exposure to an allergen or hypoglycemic reaction); 
• location and storage of emergency medications (such as Epipens [epinephrine auto-injectors] for anaphylaxis and Glucagon for hypoglycemia); 
• who will administer the medication (including self-administration options); 
• follow-up plans (such as calling 911 after the administration of Epipens or Glucagon); and 
• emergency contacts for parents/guardians and medical providers.

To develop ECPs, school nurses should:

• obtain current health information from the family and the student’s health care provider(s), including student’s emergency plan and all medication orders; and 
• consult with the health care provider, when necessary, to clarify emergency medical protocol and medication orders.

Individualized Health Care Plan (IHCP) 

In addition to the development of ECPs, students with life-threatening food allergies and GSD must also have an IHCP.  The process for developing and implementing an individualized plan for the student includes:

• identification of a core team to establish the plan.  School nurses should have the lead role on this team.  In addition to the school nurse, the team should include, at a minimum, parent(s), guardian(s) or other family members; school administrator(s); classroom teacher; and the student (if appropriate).  Other possible members include the school medical advisor, school-based health clinic staff, student’s health care provider, culinary arts teachers and other school staff such as the school food service manager; 
• collaboration between school nurses and parents to consider developmentally and age-appropriate accommodations for consideration at the core team meeting; 
• meeting of team members to finalize IHCPs.  While health care providers can offer recommendations for the types of accommodations needed in school settings, it is the core team’s responsibility for the development of recommendations based on the students’ needs and school environments; 
• determination of the type of plan appropriate for students (such as IHCP or Section 504 plan).  If the team determines that a student does not meet the eligibility requirements for Section 504, the IHCP may be considered one and the same as the Section 504 plan; 
• based on students’ health status, determine the minimum frequency with which health information will be reviewed and update accordingly; and 
• clarify the roles and responsibilities of each core team member. Ensure that all team members’ opinions are considered.

IHCPs are usually developed for students with special health needs or whose health needs require daily intervention.  These plans describe how to meet an individual child’s daily health and safety needs in the school setting.  IHCPs include:

• functional health issues (nursing diagnoses); 
• student objectives (expected outcomes) for promoting self-care and age-appropriate independence; and 
• responsibilities of parents, school nurses, teachers, students and administration, as appropriate.

IHCPs should address student needs both during the normal school day and during before- and after-school activities.  This information may be distributed to all school staff who have responsibility for the student with life-threatening food allergies and GSD.  Considerations to be included in IHCPs for students with life-threatening food allergies and GSD may include:

• classroom environment (such as including allergy free areas in the classroom for students with allergies or allowing students with GSD to have food or dietary supplements when needed in the classroom); 
• cafeteria safety, including allergy free tables or zones; 
• participation in school nutrition programs; 
• snacks, birthday and other celebrations; 
• alternatives to food rewards and incentives; 
• hand-washing; 
• location(s) of emergency medication; 
• risk management during lunch and recess times; 
• classroom projects (such as science activities that may involve food or allergen products); 
• classroom jobs (such as, feeding fish, washing tables, etc.); 
• special events (such as, cultural programs, science programs); 
• field trips, fire drills and lockdowns; 
• staff education and training; 
• who will provide emergency and routine care in school, i.e., administering emergency medication or feeding (Note: in the case of GSD, a parent may designate someone other than themselves to provide the gastrostomy tube feeding if needed); 
• substitute staff notification and training (including nurses, teachers, specials, student teachers, cafeteria staff, school bus drivers and others as appropriate); 
• school transportation; 
• transitions to after-school programs; 
• athletic and extracurricular activities; 
• individualized adaptations of district parental notification letter (if necessary); 
• Parent Teacher Organization or  Parent-Teacher Association sponsored events for students (see reference and resource list for CSDE resources on healthy fundraisers and alternatives to food as reward); and 
• transitions between grade levels and school buildings in the district.

Additional considerations for students include:

• transportation on sports team bus; 
• biology labs; 
• open campus and extended study periods; 
• vending machine options; and 
• culinary arts programs.

IHCPs may also include a summary of nursing assessments.  They are used to document interventions and evaluate outcomes.  Reviews of IHCP should occur:

• at least annually with the school team, including the parents or guardians and when appropriate, students; 
• more frequently if there are changes in students’ ECPs, self-monitoring, competency levels, self-care abilities, school environment or whenever an adjustment to the plan is necessary; and 
• after each emergency event involving the administration of emergency medications (such as EpiPens or Glucagon).  Conduct a summative evaluation to determine the effectiveness of the process, why the incident occurred, what worked and did not work and person(s) involved.