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HOW ARE "SPECIALIZED HEALTH CARE NEEDS" DEFINED? Students with specialized health care needs require specialized technological health care procedures for life support and/or health support during the school day. These students may or may not require special education (CEC, 1988).
This broad-based functional definition was adopted by The Council for Exceptional Children in April 1988. Specialized health care needs is a relatively new term applied to a group of students who previously were unserved in educational settings. Although these students are often considered similar to students with other health impairments, their educational needs are complicated by extreme medical needs. Other terms sometimes used are medically fragile and technologically dependent. Many of these students have survived catastrophic medical events that require intensive and prolonged health care.
NEEDS?Students with specialized health care needs have conditions that include ventilator dependence, tracheostomy dependence, oxygen dependence, nutritional supplement dependence, congestive heart problems, need for long-term care, need for high-technology care, apnea monitoring, and/or kidney dialysis (GLRRC, 1986). These students are similar in their needs for extreme medical care, usually including intervention while they are in school. However, each medical condition presents its own unique set of characteristics. These medical needs must be addressed before students can benefit from educational experiences. Medical concerns also may affect the learning potential of these students. Fatigue, limited vitality, short attention span, and limited mobility may accompany technological dependence and affect students' ability to benefit from educational opportunities. Therefore, their medical conditions must be stabilized before such students can enter educational programs.
Before these students enter the classroom, teachers should consider several possible environmental and intervention adaptations. The classroom should be a hygienically safe but not sterile environment. Classroom schedules should allow for limitations related to fatigue and mobility. Assessment procedures and instructional intervention techniques may need adaptation to maximize students' ability to succeed academically.
Medical complications must be considered when developing schedules and curricular plans. Students may miss school due to medical conditions that require extensive rest or hospital-based intervention. Cooperative programs with home and hospital teachers can decrease the impact of such absences.
Of considerable concern is the tendency to overcompensate. Teachers should avoid "exaggerated deference to the medical implications of a child's handicap" (Hobbs, Perrin, Ireys, Moynihan, & Shayne, 1984, p. 212). Interruptions for suctioning, medication, or other medical interventions should be nondisruptive to the classroom and learning atmosphere. Focus should be on maximizing opportunities for educational success and social interaction, not on limitations and isolation. For example, class parties can include food treats that meet a student's dietary restrictions, or medical intervention can be completed during individual work times rather than during group learning activity periods.
Educational curricula are always chosen to meet individual student needs. Modifications for students with specialized health care needs may be similar to those adopted for students with physical disabilities. For example, adaptive response modes, adjusted timing requirements, or adjustment for limited hand use or mobility may facilitate learning success. Social interaction may be more successful if students use adaptive positioning equipment that enhances their potential for fuller participation in activities (Sirvis, 1988).
Parents, siblings, and families are an important part of the lives of children with specialized health care needs. Their role in habilitation and management of health care needs is critical. In addition, they can be an important support in the development of the independence necessary to make the educational experience successful. Often, families may need support and education in order to understand their own coping mechanisms as well as to develop a model of helping that will not create inappropriate co-dependence (Dunst, Trivette, Davis, & Weeldreyer, 1988).
Interdisciplinary planning can enhance the positive impact of the learning experience if special education personnel assume an active role in the development of plans. The primary role of the teacher is to provide a safe and appropriate learning environment.
REFERENCES
The Council for Exceptional Children (CEC). (1988, March). Report
of The Council for Exceptional Children's Ad Hoc Committee on
Medically Fragile Students. Reston, VA: Author. Dunst, C. J., Trivette, C. M., Davis, M., & Weeldreyer, J. C.
(1988). Enabling and empowering families of children with health
impairments. Children's Health Care, 17(2), 71-81. Hobbs, N., Perrin, J. M., Ireys, H. T., Moynihan, L. C., & Shayne,
M. W. (1984). Chronically ill children in America. Rehabilitation
Literature, 45, 206-213. Sirvis, B. (1988). Students with special health care needs.
TEACHING Exceptional Children, 20(4), 40-44. U.S. Congress, Office of Technology Assessment (OTA). (1987).
Technology-dependent children: Hospital vs. home care--A
technical memorandum (OTA Publication No. OTA-TMH-H-38).
Washington, DC: U.S. Government Printing Office.
OTHER RESOURCES
Aday, L. A., & Wegener, D. H. (1988). Home care for
ventilator-assisted children: Implications for the children, their
families, and health policy. Children's Health Care, 17(2), 112-120. Baird, S. M., & Ashcroft, S. C. (1984). Education and chronically
ill children: A need-based policy orientation. Peabody Journal of
Education, 61(2), 91-129. Great Lakes Area Regional Resource Center (GLRRC). (1986).
"Medically fragile" handicapped children: A policy research paper.
Columbus, OH: Author. Kaufman, J., & Lichtenstein, K-A. (n.d.). The family as care
manager: Home care coordination for medically fragile children. In
Workbook series for providing services to children with handicaps
and their families. Washington, DC: Georgetown University Child
Development Center. Kirkhart, K. A., Steele, N. F., Pomeroy, M., Anguzza, R., French,
W., & Gates, A. J. (1988). Louisiana's Ventilator Assisted Care
Program: Case management services to link tertiary with
community-based care. Children's Health Care, 17(2), 106-111. Kleinberg, S. (1984). Facilitating the child's entry to school and
coordinating school activities during hospitalization. In Home care
for children with serious handicapping conditions (pp. 67-77).
Washington, DC: Association for the Care of Children's Health.
Developed by Barbara Sirvis, Dean, Faculty of Applied Science
and Education, and Professor of Exceptional Education, State
University College at Buffalo, New York. ERIC Digests are in the public domain and may be freely reproduced and disseminated.
This publication was prepared with funding from the U.S. Department of Education, Office of Educational Research and Improvement, under contract no. RI88062207. The opinions expressed in this report do not necessarily reflect the positions or policies of OERI or the Department of Education.
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