Health Care Needs

2. Complex medical care supports

The below guidance lists the assistance available to schools to support students needing complex medical care.

Program for Students with Disabilities

This program provides additional resources to schools with students whose health conditions meet the World Health Organisation definitions of disabilities.

Refer to Program for Students with Disabilities on the department's website.

Disability Inclusion

Schools may use Disability Inclusion Tier 2 school-level funding for professional learning activities for school-based staff to meet the specific health needs of students with disability not covered under basic first aid training, including Epilepsy.

Refer to the Disability Inclusion Funding and Support policy for more information.

Student Support Services – including Visiting Teacher Service

Student Support Services are multidisciplinary area-based teams of allied health professionals. They are available to assist students in government schools and include speech pathologists, psychologists, social workers, occupational therapists, youth workers, curriculum consultants, visiting teachers.

For further information, contact department regions.

The Visiting Teaching Service provides educational support to students with a disability or other health impairment in regular school settings. The streams of expertise are:

• physical disabilities or health impairments
• deaf or hard of hearing
• vision impairment.

Referrals of students to the SSS require parent/guardian consent and can be made by:

• principals and teachers
• parents/guardians
• hospitals
• medical agencies
• child and allied health professionals
• community agencies.

For more information, refer to the Student Support Services policy and the Visiting Teacher Service policy.

Schoolcare program

The Schoolcare program is provided by the Royal Children’s Hospital (RCH) and funded by the department to:

• enable students with complex medical needs to safely attend school
• provide specialist training to equip school staff to deliver student-specific medical care in consultation with the student’s parents/carers and medical practitioner.

Training usually takes place twice per year.

Eligibility requirements for the Schoolcare program

The program is available for students who would not be able to attend school without the procedure being performed by appropriately trained staff.

Procedures for which the Schoolcare program provides training include:

• tube feeding (nasogastric or gastrostomy feeding):
  • infection control
  • recognition of breathing difficulties
  • use of correct methods to check position of nasogastric tube
  • correct connection method of feeding device
  • administration of correct volumes of feed at regular intervals, at correct rate and temperature, specific to the individual child
  • use of feeding pump as required
  • making sure stomach is empty of excess air
  • cleaning of equipment
• tracheostomy care:
  • infection control
  • recognition of breathing difficulties
  • use of correct humidification
  • ensuring clear airway and using suction and saline as needed
  • ability to effect efficient tube change if unable to be cleared of blockage
  • implementation of emergency procedures around respiratory needs as required
• suctioning:
  • infection control
  • knowledge of when to suction and why
  • recognition of breathing difficulties
  • use of correct suctioning technique for the specific child
  • awareness of specific types of mucus to observe for and reporting of abnormalities to relevant people
  • prevention of complications of incorrect suction procedure—vomiting, aspiration and damage to mucous membrane
• oxygen therapy:
  • maintenance of oxygen supply and tube patency
  • maintenance of skin integrity, in the case of nasal cannulas and face masks
  • ensuring appropriate humidification
  • observation of child’s general health status and adjustment of oxygen level according to set criteria
  • awareness of dangers of oxygen therapy and prevention of complications
  • change of oxygen cylinders as required
• certain cases of stoma care. If stoma care is the sole medical need of the child, or if it accompanies epilepsy/diabetes management, this will not be deemed eligible for Schoolcare program:
  • ileostomy and colostomy management
  • regular emptying of pouch
  • changing of pouch as required
  • adequate protection of the stoma
  • appropriate surrounding skin care management
  • complete flange changes, as required
• certain cases of seizure management. If seizure management is the sole medical need of the child, or if it accompanies stoma care/diabetes management, this will not be deemed eligible for the Schoolcare program
  • epilepsy introduction
  • keeping a child safe during seizure activity
  • identifying different seizure activity
  • identifying triggers
  • child specific management of seizure activity
  • how to interpret child specific management plans
• certain cases of diabetes management. If diabetes management is the sole medical need of the child, or if it accompanies stoma care/epilepsy management, this will not be deemed eligible for the Schoolcare program
  • infection control
  • when and how to check blood glucose levels (BGL)
  • identifying normal BGL range
  • hypoglycaemia vs hyperglycaemia
  • management of unstable BGLs
  • child specific treatment.

Schools can choose to arrange and fund specialist training outside of the Schoolcare program, for example through local health service providers. The school principal is responsible for ensuring that staff are competent in the provision of daily medical needs and support of their students.

For more information on procedures that are eligible, please refer to the Schoolcare program guidelines (DOCX).

Referrals to the Schoolcare program

The following steps describe the process for completing the Schoolcare program referral form and undertaking training:

1. The school accesses the Schoolcare program guidelines (DOCX) and Schoolcare program referral form (DOCX).
2. The school, parent/carer and medical practitioner complete the referral form, including:
   • Part A – Parent consent and student details
   • Part B – School details
   • Part C – Medical information
3. The school scans and returns the completed referral form to the Schoolcare program via email to schoolcare.program@education.vic.gov.au
4. The Schoolcare program coordinator, in consultation with the RCH, determines eligibility and then notifies the nominated school contact.
5. The school notifies the parents/carers of the referral outcome.
6. The Schoolcare program coordinator arranges a suitable training time with the school contact.
7. The RCH assesses the level of support required to meet the student's medical needs and develops a student-specific care manual for the school.
8. The nurse/s attends the school to deliver student specific training to the nominated school staff carers and assesses the staff carers' competency.
9. Following the initial training:
   • all carers (new and established) must undertake Schoolcare program training every 6 months
   • the Schoolcare program nurse reviews the care manual and school staff competency.

Once training has been provided to the school staff carers, the school staff carers then provide interventional medical care to the student when they are at school, consistent with the care plan.

If the referral is not appropriate for the Schoolcare program, the school will be given advice about other support available.

For information about the program, schools may contact schoolcare.program@education.vic.gov.au or 03 7022 2122.

Medical Intervention Support

If a student requires regular complex medical support at school, the school may be able to apply for Medical Intervention Support (MIS) funding. MIS funding supports schools to engage appropriately trained educational support staff to help students with medical needs at school.

The educational support staff must have completed specific training though a recognised health service or the Schoolcare program.

Eligibility requirements for Medical Intervention Support

The eligibility requirements for Medical Intervention Support are:

• the student has a specific medical condition that needs regular, specialised help at school
• specialised staff training or instruction in the procedure to be performed is needed to support the student at school
• refreshing of the training or instruction is completed at least once a year by a recognised healthcare professional.

Examples of procedures that may be included in Medical Intervention Support include:

• mechanical ventilation
• oxygen
• tracheostomy care
• suction
• tube feeding
• ostomy management
• management of faecal output.

For more information see the Medical intervention support guidelines and application form (DOCX).

Application process

The application must contain:

• a completed Medical Intervention Support form
• current medical and staff training documentation.

New applications for Medical Intervention Support can be submitted by 28 February each year.

Applications submitted after 28 February must be accompanied by a covering letter from the school principal detailing the reasons for submission after the application date. Applications after the close date will be accepted for:

• students transferring during the school year
• students with a deteriorating medical condition with recent onset of complex medical support requirements.

The outcome of the application will be emailed to the school principal.

Responsibilities of the school

For schools with Medical Intervention Support funding, they are responsible for:

• reviewing the medical support needs of eligible student/s as part of the Health Support Planning process completed at least annually or more frequently as needed
• making sure regular refresher training is completed by the educational support staff at least annually delivered by a recognised healthcare professional
• providing confirmation of current support needs and proof of training when requested.

For more information about Medical Intervention Support, schools can contact medical.intervention.support@education.vic.gov.au. Schools may contact their Regional Disability Coordinator for information on other supports available.