Student Support Procedures
- Process description
- Q & A Guide DESE – updated August 2021
- Diman Home-Hospital Tutoring Process
- BSEA Decision re: Form content requirements
- Form: Form: Physician’s Affirmation of Need for Home- Hospital Educational Services
- Form: Physician’s Affirmation of Need (60 + days)
- Home-Hospital Tutoring Flow Chart
- Home-Hospital Educational Services Implementation
- Re-entry after disciplinary removal
- Re-entry after hospitalization (surgery/injury)
- Re-entry after hospitalization (behavior/psychological)
- Shelter in-place support
- Fire drill support
- Removal from building support
Section 1: Home-Hospital Tutoring Process
The home-hospital educational services process initially was designed to provide support to students recovering from medical emergencies. Increasingly the home-hospital educational services process has been accessed for students challenged by school attendance, by reluctance to participate in classes or coursework and to encourage students who are encountering challenges in their personal or school life and may be hesitant to actively participate as members of the Diman school community. In June, 2021 the Department of Elementary and Secondary Education revised elements of this process to clarify requirements stemming from Covid 19 as well as compensatory services.
Historically, the home-hospital educational services process is a general education process, overseen by the building principal. Implementation of the process requires on-going collaboration between general and special education departments. The regulatory requirement for both groups differs but centers on the legal mandate to provide students with disabilities a free and appropriate public education. The June 2021 updated Q and A from DESE clarifies both the procedures for determining the need for referrals for special education evaluation of students whose current medical situation may require assessment of services through IDEA. If hospitalization and/or home recovery absences are extended, the student is entitled to receive tutoring services. Eventually the student receiving tutoring services returns to the school setting and transitions successfully back into the life of the Diman student community. Some students are hospitalized for more serious, on-going chronic medical or psychological issues and these students require careful planning to ensure their re- entry to the school does not add additional stress to the trauma or anxiety with which they are already dealing. The third group of home-hospital educational services requests can involve students whose parents have obtained a form from a physician with less than complete information or who obtain a series of forms, similar in their requirement for home tutoring but non-compliant in the information provided by the physician or physician’s assistant. Diman’s Special Education Department’s mandate related to “Child Find” (identifying students with disabilities who require specially designed instruction) can include students manifesting for the first-time signs of a disability. In these situations, the sharing of information between general and special education departments is a necessity to protect students and to support general education staff.
Forms provided in this section are available electronically for parents or physicians. The Bureau of Special Education Appeals has dealt with the required physician information. A sample case and the BSEA decision is included in this packet.
What follows are copies Home-Hospital Educational Services Q and A from DESE as well as samples of mandated forms to access those services and Diman’s internal procedures.
Question and Answer Guide on the Implementation of Educational Services in the Home or Hospital
1999 Revised June 2021
603 CMR 28.03(3)(c)
1. What is the Intent of the Massachusetts Regulations on Educational Services in the Home or Hospital?
The Massachusetts regulation requiring educational services in the home or hospital is 603 CMR 28.03(3)(c). It reads as follows:
Upon receipt of a physician's written order verifying that any student enrolled in a public school or placed by the public school in a private setting must remain at home or in a hospital on a day or overnight basis, or any combination of both, for medical reasons and for a period of not less than fourteen school days in any school year, the principal shall arrange for provision of educational services in the home or hospital. Such services shall be provided with sufficient frequency to allow the student to continue his or her educational program, as long as such services do not interfere with the medical needs of the student. The principal shall coordinate such services with the Administrator for Special Education for eligible students. Such educational services shall not be considered special education unless the student has been determined eligible for such services, and the services include services on the student's IEP.
The intent of this regulation on home or hospital instruction is to provide a student receiving a publicly funded education with the opportunity to make educational progress even when a physician determines that the student is physically unable to attend school. While it is impossible to replicate the total school experience through the provision of home/hospital instruction, a school district must provide, at a minimum, the instruction necessary to enable the student to keep up in his/her courses of study and minimize the educational loss that might occur during the period the student is confined at home or in a hospital.
Although the regulation on home/hospital instruction is included in the Special Education Regulations (603 CMR 28.00), home/hospital instruction is not considered "special education" unless the student has been found eligible for special education. In other words, home/hospital instruction typically is considered a regular education service since it is in the interest of both the individual student and the school to make it possible for the student to keep up with schoolwork while s/he is unable to attend school for medical reasons.
The Special Education Regulations also include a provision relating specifically to students who are likely to be confined to home or hospital for medical reasons for more than 60 school days in any school year. Please see regulation 603 CMR 28.04(4), discussed in 603 CMR 28.04(4) Question #1, below.
Please note that the requirements and guidance discussed in this Question and Answer Guide are separate and distinct from those relating to the approval of parent requests for "home education" or home schooling programs, which are governed by General Laws Chapter 76, § 1. The Department of Elementary and Secondary Education's Home Education Advisory provides guidance on the Massachusetts law governing home schooling programs.
2. Who is Entitled to Educational Services in the Home or Hospital?
Public school students. A public-school student who, due to documented medical reasons, is confined to home or a hospital for not less than fourteen (14) school days during the school year, is entitled to receive home/hospital educational services as described under 603 CMR 28.03(3)(c). In this context "public school student" means a student who is enrolled in a public school district or a charter school, or a student who is being educated with public funds in an educational collaborative or an approved private day or residential special education school. (Please see Question #7, below, for more detail about students in approved private day and residential special education schools.) The requirement for a school district to provide home/hospital instruction to a public-school student who is being educated at public expense is not dependent upon the student's eligibility for special education.
Private school students. A student who is enrolled in a private school at private expense ("private school student") is entitled to receive publicly funded home/hospital instruction as a special education service if s/he has been found to be a student with a disability who requires special education. Mass. General Laws Chapter 71B, § 1defines "school age child with a disability" as follows:
a school age child in a public or non-public school setting who, because of a disability consisting of a developmental delay or any intellectual, sensory, neurological, emotional, communication, physical, specific learning or health impairment or combination thereof, is unable to progress effectively in regular education and requires special education services, including a school age child who requires only a related service or related services if said service or services are required to ensure access of the child with a disability to the general education curriculum. G.L. Chapter 71B, § 1 (emphasis added).
A private school student who has been evaluated and has been found eligible for special education is entitled to receive home/hospital educational services as outlined in Question #8, below. For both public school students and private school students, the justification for any needed home or hospital instruction must be documented by a student's personal physician. A school district that receives a request for home instruction from someone other than a physician, or from a physician who is not personally responsible for a student's care, is not obligated to provide instruction under 603 CMR 28.03(3)(c). In this case, the responsible school district should inquire further with the student's parent or guardian to determine the student's status and any additional information or action that is needed. For example, the school district may need to proceed under the compulsory attendance law if it determines that a student between ages 6 and 16 is not attending school, is not being otherwise educated in a manner approved by the school district and is not medically unable to attend school.
Determining eligibility. As required under M.G.L. c. 71B, § 2, if a parent of a private school student requests an evaluation to determine the student's eligibility for special education and presents the school district with a physician's statement, then the school district must immediately review the physician's statement to determine if there is sufficient information available to consider if the student has a "health impairment" according to the definition provided under 603 CMR 28.02(7)(i). If there is sufficient information in the physician's statement, then the school district should convene the Team within 15 days to make an expedited determination of eligibility and begin provision of services. Please refer to Administrative Advisory SPED 2003-1 for additional information about these requirements.
3. How Can Home or Hospital Education Services Be Accessed?
Once the student's personal physician (for example, a pediatrician, internist, medical specialist, psychiatrist, or nurse practitioner) determines that a student's medical condition will require either hospitalization or home care for not less than 14 school days, the physician must notify the school district responsible for the student in order to begin the home/hospital instruction process. The student's physician must complete a Department of Elementary and Secondary Education form 28R/3 (or equivalent signed statement) and submit it to the student's building principal or other appropriate program administrator. At a minimum the physician's signed notice must include information regarding:
- the date the student was admitted to a hospital or was confined to home;
- the medical reason(s) for the confinement;
- the expected duration of the confinement; and
- what medical needs of the student should be considered in planning the home or hospital education services.
Students with chronic illnesses who have recurring home/hospital stays of less than 14 consecutive school days, when such recurrences have added up to or are expected to add up to more than 14 school days in a school year, are also eligible for home or hospital educational services if they are requested and the medical need is documented by the physician.
Home and hospital educational services under 603 CMR 28.03(3)(c) must begin without undue delay after the school district receives written notice from the student's physician that such services are necessary. Please note that there is no required 14-day waiting period before home or hospital instruction can commence if it is likely that the student will be absent from the school-based program for 14 school days or more in the school year.
Whenever a student is likely to miss 14 school days or more for health-related reasons, the Department strongly recommends that the school district expedite the delivery of educational services as well as any evaluation or Team meetings that may be necessary, in order to minimize the negative impact on the student's educational progress. (See also Question #9, below.)
4. How Should Home or Hospital Services Be Delivered?
School districts may provide home/hospital services in a number of ways, including:
- providing the services directly to the student using district employees;
- contracting with the hospital to provide the needed services;
- contracting with another school district to provide the services;
- contracting with another agency to provide the services; or
- providing the services via live streaming and/or remote instruction.
Home/hospital instruction is typically one-to-one or small group instruction that is provided on an individualized schedule, for less than a full school day or a full school week. The school district should determine the number of instructional hours per day or per week based on the educational and medical needs of the individual student. School districts may not preset the number of instructional hours per week provided to students who must remain at home or in the hospital; the decision must be individualized. Based on the student's medical status, the student's physician may determine that the number of instructional hours should be reduced. In addition, the amount of instructional time deemed necessary by a district may be guided by the instructional approach used in a one-to-one home or hospital setting as compared to the instructional approach normally implemented in the student's school-based program. However, such a reduction in instructional time must be based on the educational benefit received by the student given the reduced teacher-student ratio. Service delivery, including the time of day the services are to be delivered, should be determined in the best interests of the student and in consideration of the medical circumstances of the student.
When planning and delivering home or hospital educational services, the school district should carefully consider all aspects of a student's educational program while attending school, including any current IEP services, Section 504 plans and instructional accommodations, as well as the student's general education services.
5. Is the Academic Content of Instruction and the Certification of Staff Any Different for Home or Hospital Instruction Than for School-Based Instruction?
Instruction that is provided in the home or hospital for public school students under 603 CMR 28.03(3)(c) must include the same academic content as that provided in the student's regular school-based program. While teacher certification requirements apply to the teachers who are providing the instruction, the teachers do not have to be certified in all subject areas. However, in all cases the school district must be able to demonstrate that the assigned staff member effectively provides the necessary instruction to the student. Teachers who provide home/hospital instruction to public school students must coordinate the instructional content, approaches and student progress with the student's teachers at school.
For both public school students and private school students, special education and/or related services that are provided in a home or hospital setting under this provision must be delivered (or closely supervised) by staff certified or appropriately licensed to deliver such services.
6. May A School District Require That a Parent or Other Responsible Adult be in the Home While the District's Instructor is Working With the Student?
If a district requires that an adult is present during homebound instruction, the district should take reasonable steps to ensure that this policy does not conflict with its obligation to provide instruction. A district could likely avert a potential conflict by arranging for instruction at a time (such as late afternoon or evening) when an adult would be at home with the student. If a district were unable to send an instructor at a time when an adult was at home, it would be permissible for the district to send a staff member to accompany the instructor. If a district is unable to arrange for instruction during hours when an adult will be at the home or to send a staff member to accompany the instructor, the district should propose a reasonable alternative to the student's parent that would ensure that the student receives instruction while satisfying the district's legitimate concerns about safety and liability.
7. Under what Circumstances are Educational Collaboratives and Public and Private Day and Residential Special Education Schools Approved Under 603 CMR 28.09 Required to Provide Home or Hospital Instruction?
If the school district continues to pay the costs of the placement in order to hold the enrollment status of the student in a educational collaborative program or a public or private special education school during the student's confinement to home or a hospital, the respective collaborative or public or private school must provide at no additional cost to the school district appropriate educational and special educational services. These services must be provided consistent with requirements of 603 CMR 28.03(3)(c) regarding educational services in a home or hospital, subject only to the limitations outlined in Question #4, above.
If the student is not expected to remain in the placement after the student's confinement to home or hospital, the school district must ensure in another way that the student receives appropriate educational and special educational services or, if appropriate, reconvene the Team consistent with 603 CMR 28.04(4) and consider evaluation needs and/or revisions to the IEP taking into account the services the student needs while s/he is unable to attend school for medical reasons.
8. How Do These Requirements Apply to a Student Who is Enrolled in Private School at Private Expense and Needs Home/Hospital Instruction for Medical Reasons?
As is stated above in answer to Question #1, although the regulation requiring home/hospital instruction is included in the Special Education Regulations (603 CMR 28.00), home/hospital instruction is not considered "special education" unless the student has been found eligible for special education. State law (G.L. Chapter 71B) requires school districts to provide special education to eligible students who are attending private school at the parent's expense or other private expense ("private school students"). Since home/hospital instruction can be a regular education or special education service, this has led to some confusion about the appropriate provision of home/hospital instruction for private school students.
- If the private school student already has an IEP under which the school district is providing special education services, then during the 14+ school days that the physician says the student will be out of school for medical reasons, the school district must provide the specially designed instruction and/or related services described on the student's current IEP, modified as necessary to accommodate the student's medical needs. If the student's medical condition is likely to affect the ability of the student to maintain effective school progress, the student's parent may request that the Administrator of Special Education convene a Team meeting to consider further evaluation of the student and, if appropriate, to amend the existing IEP or develop a new IEP. Modifications to the IEP can include home or hospital instruction. The Administrator of Special Education is required to convene a Team meeting without undue delay for any student with an IEP who, in the judgment of the student's physician, is likely to remain at home or in a hospital for more than 60 school days in any school year. This requirement is found in the Special Education Regulations at 603 CMR 28.04(4) and is discussed in 603 CMR 28.04(4) Question #1.
- If the private school student does not have an IEP and will be confined to home or a hospital for medical reasons, s/he may be eligible for special education services if the student's medical condition is determined to be a health impairment that adversely affects the student's educational performance. Under these circumstances, the parent is entitled, at any time, to request and receive an evaluation of the student by the public school district to determine if the student's medical condition meets special education eligibility requirements. If a physician indicates to a school district that the student has a medical or health condition that is likely to lead to extended school absence(s) or an inability to maintain effective educational progress, the school district shall treat such information as a referral for an evaluation to determine eligibility for special education. In such case, the school district shall, within five school days, send written notice to the student's parent seeking consent for such evaluation to occur (603 CMR 28.04(1)(a)). A Team may find a student eligible for special education based on a chronic or acute health impairment or other disability, as defined in 603 CMR 28.02(7), that adversely affects the student's educational performance. Please see Question #9, below.
Under Massachusetts law, a private school student who has been determined to be a "school age child with a disability" as defined in G.L. Chapter 71B, § 1, is entitled to receive publicly-funded special education services in accordance with an IEP developed by the school district of residence. The school district may not refuse to evaluate the student because s/he is enrolled in private school or because s/he is currently out of school for medical reasons. The Department recommends that the Administrator of Special Education make every effort to expedite assessment(s) and the Team meeting so that services may be provided in a timely fashion. If the student is evaluated and determined to be a student who is eligible for special education, the student will be entitled to receive home/hospital instruction according to the IEP.
- If the private school student does not have an IEP and the parent does not wish to refer the student for a special education evaluation, the parent may contact the school district of residence, providing documentation from the student's physician that the student is confined to home or hospital for medical reasons for not less than 14 school days during the school year. The school district may, at its discretion, provide home/hospital instruction to the student, using the district's resources to provide the instruction, but it is not required to do so unless the student is evaluated and found to be eligible for special education. Please see Question 2 above for additional information on determining eligibility of private school students based on a physician's statement.
Please note that the public school district is under no obligation to be familiar with nor to use the private school's curriculum, textbooks, or related education materials, but shall provide home or hospital services designed to maintain the private school student's progress in general curriculum areas when such services have been included on the IEP. Consequently, if a private school student will be absent from school for medical reasons for an extended period of time, the student's parent should always contact the private school to find out what tutoring services or other home/hospital instruction the private school will provide to help the student keep up with his or her schoolwork. The administrators and teachers in the private school are most knowledgeable about the private school's curriculum and the coursework that the student is covering in class, and they are in the best position to design and provide tutoring or other home/hospital instruction that will enable the student to keep up with school assignments. Depending on the circumstances, the private school itself may have an obligation to provide accommodations or services to the student under federal civil rights laws, Section 504 of the Rehabilitation Act and the Americans with Disabilities Act, or under the contract of enrollment between the school and the parents.
9. Are Students With Chronic or Acute Health Issues Always Eligible for Special Education?
The answer depends on the facts of the individual case. Any student with a medical or health condition that is likely to lead to extended school absence(s) or inability to maintain effective educational progress is a reasonable candidate to be referred to the public school district for initial evaluation to determine special education eligibility. Such referrals should take place as soon as it is known that a student's health condition is chronic or acute and is likely to have a negative educational impact, rather than delaying referral or action until the student is absent for significant periods of time or has begun to experience educational failure.
If assessment information indicates that the student's educational progress will be adversely affected as a result of a chronic or acute medical condition that is not temporary in nature, then the Team will likely determine that the student is eligible for special education. An eligibility determination is an individualized decision that depends on the facts of each case. In most cases, if the Team determines the student is eligible, the type of disability as recognized by federal, and state special education law will be a "health impairment" (see 603 CMR 28.02(7)(i)). In some cases, the assessments may indicate other types of disability, such as "emotional impairment" or "neurological impairment."
If the student has been evaluated and found eligible for special education, the Team will write an IEP describing the special education and related services that the student needs and the school district will provide. If the student will be out of school for medical reasons for an extended period of time, it is appropriate to include on the IEP educational tutoring as a related service that the student needs in order to access the general curriculum while s/he is in the home or hospital setting. The IEP may be tailored to address expected time periods when the student is unable to attend school, if that is deemed appropriate to meet the unique needs of the individual student.
603 CMR 28.04(4)
1. What Requirements Apply if the Student is Likely to Be Confined to Home or a Hospital for More Than 60 School Days?
If, in the judgment of the student's physician, a student with an IEP is likely to remain at home, in a hospital, or in a pediatric nursing home for medical reasons and for more than sixty (60) school days in any school year, the Administrator of Special Education is required, without undue delay, to convene a Team meeting to consider evaluation needs and, if appropriate, to amend the existing IEP or develop a new IEP suited to the student's unique circumstances. (See 603 CMR 28.04(4).) The Department recommends that the Administrator of Special Education convene the Team meeting within 10 school days after the school district is notified that the student is likely to remain at home or in the hospital for more than sixty days. This provision applies to all eligible students, including private school students who have been determined to need special education.
Additional questions or concerns about the provision of home or hospital educational services for students who are unable to attend school should be directed to the Department of Elementary and Secondary Education, Problem Resolution System Office, at (781) 338-3700.
Last Updated: August 25, 2021
BSEA Decision defining elements required from physicians
Oliver vs.Agawam Public Schools
- Documents submitted and 13 hours of oral testimony and argument to support parents’ contention that Agawam failed to provide home tutoring services required by a physician’s letter. Oliver had not attended school for months and was diagnosed with Tourette’s Syndrome, migraine headaches and ADHD and was receiving services through a 504 Plan. This hearing was a second part of an initial hearing around Agawam’s Eligibility Team’s finding of No Special Needs. While initial hearing moved forward, parent’s removed Oliver from school.
- The day after the parents withdrew Oliver from school, Agawam received a completed Physician’s Statement for Temporary Home or Hospital Education. 14 days later Agawam requested a hearing, challenging the sufficiency of the completed form. The BSEA/Hearing Officer consolidated the two cases.
- The physician who completed the form testified: “… that stress is known to worsen the symptoms of both Tourette’s Syndrome and Migraines.” He completed the form due to the parents’ reports of increased stress and symptoms that they attributed to Oliver’s school program. “Dr. Gilmore admits that he doesn’t know what Oliver’s school program was, that he could not determine whether Oliver needed an IEP, nor what an IEP for Oliver should contain. Dr. Gilmore noted that any number of things, apart from school, could be stressful for Oliver. Dr. Gilmore testified that he had last seen Oliver in October (it was now February 1). Dr. Gilmore had not personally observed any worsening symptoms but relied on parental reports about Oliver’s condition to make informed judgments. He had no information from the school. Dr. Gilmore had not changed any of Oliver’s treatment regimens over the past year.” No new meds or interventions were introduced since Oliver’s removal from school.
- The Hearing Officer (Lindsay Byrnes) found that Agawam was correct in disputing the adequacy of the completed form. She wrote a very clear description of what Massachusetts regulations require in terms of completing the form. This is not a lengthy case and one that you might want to have handy to assist principals in their role of being in charge of home-hospital tutoring. It is typical that only general educators and special education staff and administrator(s) were at the BSEA Hearing. This is the conclusion of HO Byrnes’ decision:
- “To summarize the pertinent regulation and the guidance from the Massachusetts Department of Education: qualification for publicly funded home tutoring services requires, at a minimum, a statement from a physician verifying that a student “must remain at home” for “medical reasons.”
- In this matter the record shows that the School District has not received a Home Hospital Education Statement meeting these minimal criteria. The form 28R3 completed by Dr. Gilmore in January contains no language indicating that Oliver must remain at home. Nor does it indicate that there is a new medical condition, an exacerbation of a previous condition, a treatment, or some other identifiable medically related problem, which currently prevents Oliver from attending school. (See also P. 4 supra.) It lacks both an initial date of confinement and a prediction of the anticipated duration of the confinement. That is not surprising as it is clear from the testimony of both Dr. Gilmore and the Parent that Oliver is not actually “confined” to home, or restricted in any activity, due to Tourette’s Syndrome and/or Migraine headaches.
- I note particularly that Dr. Gilmore has not seen Oliver since October at which time Oliver was attending school, has not noted any changes in Oliver’s medical presentation since that visit, and has not recommended any changes in Oliver’s medical treatment.
- The preponderance of the evidence in this record supports the conclusion that Oliver is not attending school because the Parent is unhappy with the school program for him. While there may be legitimate concerns about the school program for Oliver, there is insufficient evidence in this record of the medical reason required by statute and regulation to initiate a publicly funded home tutoring program. Therefore, I find that the decision of the Agawam Public Schools to decline to provide the home tutoring requested by the Parents should be affirmed. “
Diman Home-Hospital Tutoring Process:
- Parent contacts Guidance or School Nurse and receives form to bring to physician overseeing student’s illness;
- Completed form is received by Guidance or School Nurse and forwarded to Ms. Pacheco in Special Education Department for review to ensure completeness of information;
- If complete, form forwarded for assignment of tutor;
- If absence due to medical issue, form forwarded to School Nurse who becomes Re-entry Team Leader if plan is required;
- If absences due to psychological/emotional/trauma issue, form forwarded to Guidance for assignment of Re-entry Team Leader.
- Monitoring of the tutoring/need for Re-entry Team meeting will be done through the Special Education Department, with status reporting by the assigned Guidance Counselor or School Nurse as changes occur (e.g., student discharged, further issues identified, etc.)
- Physician’s Affirmation of Need for Temporary Home or Hospital Education for Medically Necessary Reasons
- Physician’s Affirmation of Medical Reasons That Student is Likely to Remain at Home, in a Hospital, or in a Pediatric Nursing Home for More than 60 School Days
IMPLEMENTATION Of HOME /HOSPITAL-BASED EDUCATIONAL SERVICE GUIDELINES
In accordance with the Massachusetts regulation requiring educational services in the home or hospital is 603 CMR 28.0.J(3)(c) and incorporating procedures at Diman Regional Vocational Technical High School (DRVT HS), the following process will apply:
- Upon receipt of a physician's written order verifying that any student enrolled at DRVTHS must remain at home or in a hospital on a day or overnight basis, or any combination of both, for medical reasons and for a period of not less than fourteen school days in any school year. the principal designee shall arrange for provision of educational services in the home or hospital. Such services shall be provided with sufficient frequency to allow the student to continue his or her educational program and will not interfere with the medical needs of the student. The principal shall coordinate such services with the Administrator for Special Education for eligible students. Such educational services shall not be considered special education unless the student has been determined eligible for such services, and the services include services on the student's IEP.
- Students with chronic illnesses who have recurring home /hospital stays of less than 14 consecutive school days, when such recurrences have added up to or are expected to add up to more than 14 school days in a school year. are also eligible for home or hospital educational services if they are requested and the medical need is documented by the physician. Home and hospital educational services under 603 CM R 28.03(3)(c) will begin without undue delay after DRVTHS receives written notice from the student's physician that such services are necessary.
- Home /hospital instruction is not considered "special education” unless the student has been found eligible for special education. Home /hospital instruction typically is considered a regular education service since it is in the interest of both the individual student and the school to make it possible for the student to keep up with schoolwork while s/he is unable to attend school for medical reasons.
- If, in the judgment of the student's physician, a student with an IEP is likely to remain at home, in a hospital, or in a pediatric nursing home for medical reasons and for more than sixty (60) school days in any school year, the Administrator of Special Education will convene a Team meeting to consider evaluation needs and, if appropriate, to amend the existing IEP or develop a new IEP suited to the student's unique circumstances . (See 603 CMR 28.04(4).)
- Service delivery, including the time of day the services are to be delivered, should be determined in the best interests of the student and in consideration of the medical circumstances of the student.
- When planning and delivering home or hospital educational services, DRVTHS will carefully consider all aspects of a student's educational program, while attending school. including any current IEP services, Section 504 plans and instructional accommodations, as well as the student's general education services.
- Instruction that is provided in the home or hospital for public school students under 603 CMR 28.03(3)(c) will include the same academic content as that provided in the student's regular school- based program.
- Appointments for services will be scheduled when a parent and/or a responsible is at home.
- Any student who does not keep scheduled appointments (unless the student produces medical documentation for the scheduled time period), does not complete assigned work, does not cooperate with the tutor, and/ or fails assessments, tests, etc. may to subject to failure for the trimester/course.
Section 2: Student Re-entry Process
Although some students may easily transition back to the school setting and pick up where they left off following a hospitalization, other students may require re-entry planning to enable them to transition back to the school environment. This is especially true where absences followed trauma or emergency hospitalization due to behavioral, emotional or other psychologically based events. For some students at the high school level, an initial diagnosis of significant mental or emotional disabilities is a result of an unusual and “out of the blue” incident. For these students in particular, re-entry to the school setting can be fraught with anxiety about how they will be perceived, how to explain their absence, how to explain the incident or how to avoid such discussions if conversations may trigger reactions and how to repair their academic standing while continuing to deal with the underlying issues.
Diman has put in place a process for bringing together family members, the student, experienced school staff and specially trained personnel to develop a plan as soon as the student’s issue/hospitalization/school absence is identified. The Diman planning process results in an articulated, coherent blueprint that assesses needs, identifies in-
school supports to be linked with any outpatient clinical service providers and includes support to the family during this stressful time.
Diman has created a planning template for overall guidance of Re-entry Team discussion and task assignments. In addition to the Team guide on the following pages, there are several other documents the appendix including:
- Release to participate in Vocational Education Settings form
- A return to school Treatment Plan form for activities
- The Children’s Hospital/Harvard Medical School Concussion Recovery Guidelines for Academics
Once a student is discharged or once discharge is being discussed by the hospital treatment team, parents are encouraged to inform Diman’s Re-entry Team Liaison (School Nurse or assigned Guidance Counselor) to enable them to begin the initial steps to obtain necessary information for the Re-entry Team meeting. Parents are encouraged to support the participation of their student in this re-entry process. It is an opportunity for the student to enter the school for a meeting about him/her, with no pressures, no demands, to be greeted by familiar encouraging adults and to help develop the best plan for a successful transition back into school and into his/her community of peers.
Section 3: Student Lock-down and Evacuation Support
In planning on-going preparation drills and emergency strategies, Diman is aware that for some students the break in a predictable schedule, the noise associated with alarms or the need to self-regulate for a perceived lengthy amount of time in a quiet, enclosed area can trigger behaviors and responses that can impact the overall effectiveness of the preparation or the long-term utility of the process.
To assist students for whom these drills or the event itself serve as barriers to personal or group safety, Diman’s special education staff have developed a process that involves focusing on individual student needs. This involves direct instruction on teaching students to be safe from a variety of dangers, including natural disasters, school violence and how to participate appropriately in drills.
Using the Council of Exceptional Children resource, ‘Supporting Students With Disabilities During School Crises: A Teacher’s Guide”, Diman has assessed the need to develop Individual Emergency and Lock-down Plans (ILPs) for specific students annually. As Diman’s student population grows more diverse in terms of the level of disabilities of entering students, the Special Education Department has put in place the annual threat assessment support process to ensure that during practices, drills and unforeseen emergencies, students whose individual disability impacts put them at risk for inappropriate or resistant behaviors have the support they need to actively participate and to understand the purpose without experiencing increased anxiety levels.
The following are examples of the tools being used to support students identified as needing ILPs as well as elements for staff review to ensure students have a common understanding of the purpose and the requirements of drills and practices.
How It Can Be Used
Individual Emergency & Lock-down Plan
One created for and kept with each student; ensures that emergency personnel will know what the studen needs to support his or her physical and emotional/communication needs.
Teach steps of lock-down drill in each location; ensure students knows what s/he should do in each environment.
Individual Student Lock- down Bag
To support an anxious or challenged student during lock-downs. Purpose is to keep the student quiet. Bag should include preferred tasks that the student could access if alone during lock-down. Items to include: low-light flashlights for students who are afraid of the dark or social story for students to remind them what they should be doing.
For students with specific sensory needs, include sensory items in the bag. Provide hiding spots in each location that might support those needs. A student who seeks lots of pressure might do well hiding under a counter or near a wall where s/he can press against a cabinet or the wall. Allow the student to practice using this location.
To remind the student of what is happening, review the chart (“First we hear the announcement or the alarm or an adult tells us to hide.”) and what might happen next.
For students who have issues with following directions. Build compliance through access to preferred activity/item for a target amount of time spent appropriately. Include incentives or reinforcers n the emergency bag for self-rewarding if needed.