Health Care Needs

Policy

This policy explains the processes, procedures and documentation that are required for schools to adequately support and respond to students with identified health care needs, complex medical needs and who require personal care support.

Summary

• Government schools have a responsibility to provide equitable access to education and respond to diverse student needs, including health care needs.
• Schools must develop a local Health Care Needs policy that addresses supports and management for students with identified health care needs. There is a policy template available on the School Policy Templates Portal (staff login required) that schools can use and adapt to their local context.
• A Student health support plan (DOCX) must be completed for each student with an identified health care need who:
  • needs medical or health-related support at school
  • has a health care need or condition that may impact the student at school
  • has a health care need or condition that may impact their engagement and participation in education.
• A student health support plan is NOT required for anaphylaxis or allergy (refer to Anaphylaxis and Allergies about the requirements for those conditions).
• Schools must designate staff to provide complex medical care and personal care support.
• Schools must ensure that there is continuity of education for students with identified health care needs.
• Schools should refer to the Guidance tab for further advice on health care needs planning, health support planning forms for different conditions and complex medical care supports.

Details

Schools have a responsibility to provide equitable access to education and respond to diverse student needs, including health care needs.

Research and evidence suggest early intervention to address health care needs is critical to mitigate life-long disadvantages, particularly for students in their early years.

Schools must:

• support and make reasonable adjustments for students with health care needs
• develop, review and implement a Student health support plan (DOCX) to support the student’s health care needs when a health care need is identified
• allocate time for relevant staff to discuss and review health support planning policies, processes and individual student plans.

Duty of care

Staff have a duty of care to take reasonable steps to prevent reasonably foreseeable harm to students. This includes supporting and responding to the health care needs of all students. Refer to the department’s policy on Duty of Care for further information.

Development of a local health care needs policy

Schools must have policies and procedures available to the school community for:

• supporting students with specific health care needs
• the management of medication.

Templates to help schools develop their own local policies for Health Care Needs, First Aid (including arrangements for ill students) and Medication are available on the School Policy Templates Portal (staff login required).

Planning for students with identified health care needs

A Student health support plan (DOCX) must be completed for each student with an identified health care need, other than anaphylaxis or an allergy (refer to Anaphylaxis and Allergies about the requirements for those conditions) meeting the criteria below.

A student health support plan is required for students who:

• need medical or health-related support at school
• have a health care need or condition that may impact the student at school
• have health care need or condition that may impact their engagement and participation in education.

To develop a student health support plan, schools must:

• work with families to develop the plan, guided by advice from the student’s treating medical/health practitioner
• include actions in the plan as to how the school will support the student’s health care needs
• communicate regularly with parents about the student’s health care needs at the school and update the plan if necessary.

Students with asthma, diabetes, or epilepsy need to provide their (condition specific) health management plan to the school, and have a student health support plan developed, which outlines how the school will support the student’s health care needs.

Provision of complex medical care at school

The department does not expect or require teachers to provide complex medical care. When it is agreed that specialised medical procedures may be needed to enable a student to attend school then:

• designated school staff must receive specific training to allow them to meet the student’s individual health care need
• the Student health support plan (DOCX) should:
  • be guided by medical advice received by the student’s medical practitioner via the department’s General medical advice form (DOC)
  • describe specific training requirements
  • include procedures that make use of local medical services such as ambulances, local doctors, health centres, hospitals and community nurses when practical.

Further guidance on assisting students with complex medical care needs can be found in Chapter 2 of the Guidance tab.

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.

Refer to Schoolcare program for information about training, eligibility and referrals.

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.

Refer to Medical intervention support for the program guidelines and information about the application process, eligibility requirements and training responsibilities.

Curriculum planning and support for students with specific health care needs

For students with specific health support needs, schools must:

• ensure continuity and relevance of the education program
• design curriculum that allows delivery and assessment for students who need to:
  • transition between hospital, home and school
  • attend school part-time or episodically
  • support the student’s connection to school, including developing and maintaining social networks.

The school in which the student is enrolled retains responsibility for the student’s curriculum when they are in hospital or recuperating at home. Hospital based education staff may also assist the school in supporting the student.

Schools should refer to Chapter 4 of the Guidance tab for further information on supporting students with long term special education and other support needs.

Other management strategies for students with specific health care needs

Training for school staff

Schools must access training for school staff:

• in basic first aid
• to meet specific student health needs not covered under basic first aid training, such as managing asthma or epilepsy
• to meet complex medical care needs, such as the Schoolcare Program.

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.

Training may also be provided by the individual student's treating health teams (for example, clinical nurse educator or consultant) – this would be dependent on each service's resourcing and operations.

Communication, physical activity and camps

Schools must communicate with families about any health or development concerns. It is also important for schools to make reasonable adjustments to enable students with health care needs to participate in physical education and other physical activities, camps and excursions wherever possible.

Personal care support

Schools must:

• fulfil their duty of care to students by assisting with personal care needs
• detail personal care support requirements and the person(s) responsible in the Student health support plan (DOCX).

As with all health and personal care support, assisting a student with the management of personal hygiene routines must be conducted in a manner that maximises the student’s safety, comfort, independence, dignity, privacy and learning. Management practices must also reflect occupational health and safety standards for the school.

Schools should consider whether assistance and advice is required from specialists such as physiotherapists, occupational therapists or speech pathologists, or if the student is eligible for support from the Schoolcare program.

Note that there are specific forms that may be completed by a medical / health care practitioner for the following circumstances:

• Toileting, hygiene and menstrual health management (DOCX)
• Supervision of eating and drinking (DOCX)
• Mobility Assistance (DOC)

Each form is also available in the Resources tab.

Definitions

Complex Medical Care
Complex medical care often requires school staff to undertake specific training to meet the student’s individual health needs. These needs cannot be addressed through basic first aid training and staff may be involved in:

• tracheostomy care
• seizure management
• medication by injection or rectal suppository
• administering suction
• tube feeding
• specialised medical procedures.

Personal Care Support
Personal care support is daily living support, usually provided by parents or carers. Students may require the provision of assistance for:

• toileting and personal hygiene
• eating and drinking
• transferring and positioning of the student.

Students may need personal care support due to:

• age
• developmental delay
• medical conditions
• short term circumstances (such as a student wearing a plaster cast)
• long term circumstances (such as complex medical care needs).

Related policies

• Anaphylaxis
• Asthma
• Continence Care
• Diabetes
• Disability Inclusion Funding and Support
• Duty of Care
• Eating and Drinking Supervision
• Epilepsy and Seizures
• Mobility Assistance
• Personal Hygiene
• Personal Liability of School Employees
• Student Resource Package – Equity Funding (Student-Based Funding)

Relevant legislation

• Disability Discrimination Act 1992 (Cth)
• Equal Opportunity Act 2010 (Vic)
• Occupational Health and Safety Act 2004 (Vic)

Guidance — Planning for and Supporting Students with Identified Health Care Needs

This guidance assists schools in planning for and supporting students with an identified health care need.

It contains the following chapters:

1. The 4 stages of developing a Student Health Support Plan
2. Complex medical care supports
3. Supporting students during transitions between hospital, home and school
4. Supporting students with long term special education and other support needs

1. The 4 stages of developing a Student Health Support Plan

Schools must follow the 4 stages to develop a Student health support plan (DOCX) or any other specific health management plan – for example, the anaphylaxis management plan.

A student health support plan is required for students who:

• need medical or health-related support at school
• have health care needs or conditions that may impact the student at school
• have health care needs or conditions that may impact their engagement and participation in education.

Stage 1 – Before enrolment

Principals should inform parents or carers about the school’s policy for supporting student health prior to and on enrolment.

Stage 2 – When a need is identified

Principals should ensure that parents/carers provide accurate information about a student’s:

• routine health care support needs, such as supervision for medication
• personal care support needs, such as assistance with personal hygiene, continence care, eating and drinking, transfers and positioning, and use of health-related equipment
• emergency care needs, such as predictable emergency first aid associated with an allergic reaction, seizure management, anaphylaxis, or diabetes.

Schools should store information on CASES21 about:

• the student’s health condition
• medication to be stored and supervised at school.

Note: When information is being collected principals must ensure that parents/carers and students are informed about how their personal information will be used and who it might be disclosed to, such as school nurses.

Schools may request relevant information from, or share relevant information with all authorised services under the Child Information Sharing Scheme or the Family Violence Information Sharing Scheme. Refer to Privacy and Information Sharing, and the Child and Family Violence Information Sharing Schemes for further information.

Stage 3 – Planning process

The below information describes how schools plan for a student with health care needs to attend school, camps and excursions.

Step 1 – Medical advice from the student’s medical/ health practitioner

The student’s medical/health practitioner provides a medical advice form that:

• guides the planning
• details:
  • the student’s medical condition
  • medication required at school
  • recommended emergency and routine health and personal care support for the student.

Step 2 – Camps and excursions

In relation to camps and excursions, parents or carers complete a Confidential medical information for school excursions form (DOCX).

Refer to the department's policy on Excursions for further information.

Step 3 – Meeting with students and parents/carers

The principal or nominee organises a meeting to discuss the plan with:

• the student
• parents/carers
• other school staff, if required.

The plan should be developed shortly after the school has received the medical advice from the student’s medical/health practitioner.

If there is a time delay between receiving this advice and developing the plan, the school may put in place an interim support plan containing an agreed strategy, such as calling an ambulance.

Questions for schools and parents or carer to consider

• Is it necessary to provide the support during the school day?
• How can the recommended support be provided in the simplest manner, with minimal interruption to the education and care program?
• Who should provide the support?
• Is this support complex and/or invasive?
• Is there staff training required?
• Are there any facilities issues that need to be addressed?
• How can the support be provided in a way that respects dignity, privacy, comfort and safety and enhances learning?
• Are there any care and learning plans that should be completed for students with personal care support?

Stage 4 – Monitoring and Review

Plans should be reviewed:

• when updated information is received from the student’s medical or health practitioner
• when the school, student or parents/carers have concerns in the support
• if there is a change in support
• at least annually.

The advice received from the medical or health practitioner is reviewed annually unless it is agreed that the annual review of the plan is not required. In this case, it is up to the principal’s discretion whether to request updated medical information.

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.

3. Supporting students during transition between hospital, home and school

The following information describes how schools support students during transition between hospital, home and school.

Transition

The school in which the student is enrolled retains responsibility for the student’s curriculum when they are in hospital or recuperating at home.

Hospital based education staff may also assist the school in supporting the student.

Maintain connections

School should plan ways to maintain connections with peers and the classroom teacher using a range of communication methods.

Liaise with hospitals

Schools should liaise with hospital-based education staff and therapists to:

• provide learning programs that maintain continuity of learning
• determine learning strategies relevant that take into account any changes in the student’s:
  • physical
  • psychosocial, and
  • cognitive capabilities
• acknowledge all learning outcomes achieved through the hospital-based experience.

Provide additional support

Schools should consider accessing additional support to ease transition between learning settings, such as the Visiting Teacher Service or Student Support Services.

Plan re-entry strategies

Schools should plan re-entry strategies that address:

• learning
• support for social and emotional impacts.

Set realistic expectations

Schools should:

• not expect assessment tasks to be completed immediately upon return to school
• not expect students to maintain the pace of curriculum participation
• enable students to participate if and when they feel able.

4. Supporting students with long term special education and other support needs

Long term planning

This information describes how schools support students with long term special educational and other support needs.

Communication

Schools should create an effective and sensitive information exchange system approved by the student and parents/guardians, that:

• allows all relevant staff to understand and make allowances for the student
• prevents the student from repeatedly explaining their circumstances.

Curriculum

Schools should:

• provide students with course overviews
• negotiate key assignments and timelines
• liaise with therapists to ensure opportunities are used within required curriculum to support therapy outcomes.

Support

Schools should:

• hold a student support group
• develop an individual learning plan
• set realistic educational goals.

Equipment

Schools should upgrade equipment to enhance curriculum access, if required.

Camps and excursions

Schools should plan ahead for camps, excursions and other special events to ensure:

• the student is offered the same educational experiences as all other students
• does not miss out due to their condition or specialised health and personal care support needs.

Resources

Forms to support students with identified health care need/s

Student health support plan

A Student health support plan (DOCX) must be completed for each student with an identified health care need other than anaphylaxis or an allergy. The plan outlines how the school will support the student’s health care needs and must be completed in consultation with parents/carers and guided by medical advice. Students whose only health care need is anaphylaxis or an allergy, do not require a student health support plan, but should instead follow the requirements of the Anaphylaxis Policy and/or the Allergies Policy.

Allergy forms

• Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan for allergic reactions (PDF) – must be completed by parents/carers for a student with allergies, in consultation with their child’s medical/health practitioner and provided to the school
• Individual allergic reactions management plan (DOCX) – must be completed by each school for each student who has been diagnosed at risk of allergies

Anaphylaxis forms

• ASCIA Action Plan for Anaphylaxis – available on ASCIA's website and must be completed by parents/carers for a student with anaphylaxis in consultation with their child’s medical/health practitioner and provided to the school
• Annual risk management checklist (DOCX) – must be completed by the school to monitor their compliance with Ministerial Order 706, the Anaphylaxis Guidelines and their legal obligations
• Individual anaphylaxis management plan (DOCX) – must be completed by the school for each student who has been diagnosed at risk of anaphylaxis

Asthma forms

Asthma Action Plan – is available on Asthma Australia's website and should be completed for a student with asthma, by the student’s medical/health practitioner, in consultation with parents/carers. This plan should be attached to the Student Health Support Plan

Medical advice forms

The following forms are used to provide descriptions of a student’s health condition, their support and first aid requirements, and are completed by the student’s medical/health practitioner.

Non-specific conditions

General medical advice form (DOC)

Condition specific

• Acquired brain injury – Medical advice form – for a student with an acquired brain injury (DOC)
• Cancer – Medical advice form – for a student with cancer (DOC)
• Cystic Fibrosis – Medical advice form – for a student with cystic fibrosis (DOC)
• Diabetes – action and management plans
• Epilepsy – epilepsy management plans

Medication and authorisation forms

Schools must use relevant forms to authorise and administer student medications. To access the forms, refer to the School Policy Templates Portal – Medications (staff login required)

Medical information for excursions form

Medical Information form – day excursions (DOCX) – must be completed annually by the parent/carer of each student in advance of approved excursion activities

Personal care advice forms

The following Medical Advice Forms are used to describe a student’s personal care requirements and must be completed by a relevant medical/health practitioner, such as a continence care specialist, speech pathologist or physiotherapist.

• Toileting, Hygiene and Menstrual Health Management – for a student who requires support for toileting, hygiene and/or menstrual health management (DOCX)
• Eating and drinking – for a student who requires support for oral eating and drinking (DOC)
• Transfer and positioning – for a student who requires support for transfer and positioning (DOC)

Schoolcare program

• Schoolcare program guidelines (DOCX)
• Schoolcare program referral (DOCX)

Medical Intervention Support

• Medical intervention support guidelines and application form (DOCX)

Useful websites

Acquired Brain Injury

• ABI Resources, RCH Paediatric Rehabilitation Service
• Brain Australia, the Brain Foundation
• Brain Injury Australia
• Brain Link
• Educating Educators about ABI, Brock University, Ontario

Cancer

• Cancer Council Victoria: Cancer in the School Community – which helps schools to support students, families and colleagues affected by cancer by providing simple answers to questions about what cancer is and how it is treated.
• Cancer Council Victoria: Talking to Kids About Cancer – which can assist in discussing cancer with children.
• Camp Quality puppets
• Cancer, Chronic Illness Alliance
• Children’s Cancer Centre, Royal Children’s Hospital
• ONTrac at Peter Mac: Adolescents and Young Adults

Cystic Fibrosis

• Cystic Fibrosis Australia
• Cystic Fibrosis, Better Health Channel
• Cystic Fibrosis, Chronic Illness Alliance
• Cystic Fibrosis, Parent information, Royal Children's Hospital

Haemophilia

• Haemophilia Foundation Victoria, teachers info kit

Thalassaemia

• Thalassaemia, Better Health Channel