[Fwd: SCHOOL SERVICES FOR STUDENTS WITH ARTHRITIS]

[Guest guest]

Hi Ywellen,

Is this the post you were thinking of? I know lots more has been said

about this subject but this is one I kept in my files. If this isn't it,

try a search in the egroups messages archives and they should

all show up.

Take Care,

Georgina

--- SCHOOL SERVICES FOR STUDENTS WITH ARTHRITIS

Date: Tue, 07 Mar 2000 10:47:28 -1000

From: Georgina <gmckin@...>

Hi,

As I prepare for our IEP Meeting later this week, with an emphasis on my

son 's transition from elementary to middle school at the start of

the next school year, I've been doing some online reading. As we have

had some recent discussion here about school-related issues, I thought

this article might also be of interest to others here.

Aloha,

Georgina

SCHOOL SERVICES FOR STUDENTS WITH ARTHRITIS

http://www.arthritis.org/ajao/parentteacher/school_strategies.asp

Schools have several ways to serve children with individual needs. To

create the best program for the child with arthritis, family, teachers

and the physician need to maintain open communications. The following is

a description of services available to students in the school setting.

REGULAR EDUCATION

In the traditional educational setting, the student is assigned to a

classroom by grade level. Modification may be needed to this program,

especially when the child is experiencing a flare. The Arthritis

Foundation brochure, " When Your Student has Arthritis " provides a

variety of resources for the classroom teacher to successfully

mainstream the child with arthritis in the traditional classroom

setting.

HOSPITAL AND HOMEBOUND SERVICES

Students who have frequent or extended absences may qualify for a

homebound teacher to work with them in the home or a hospital setting.

This is typically established by contacting the Hospital/Homebound

Coordinator in your school system or through the student's special

education program as described below.

REGULAR EDUCATION WITH MODIFICATIONS

Modifications in the student's classroom program can be made by the

individual teacher. A more formal way is to go through the local school

student support team to develop an individualized education program

(IEP) or 504 plan, and access the student's rights through Section 504

of the Rehabilitation Act or through Public Law 94-142. The Arthritis

Foundation's manual " Educational Rights for Children with Arthritis, "

explains this process. Please visit Help is at Hand and Current and

Coming Attractions sections of the AJAO section for more information

about the manual and other juvenile arthritis resources.

LOCAL STUDENT SUPPORT TEAM

The student support team or similar group is composed of teachers and

administrators in the child's local school. This group supervises plans

for modifications of students who have been identified by their

classroom teachers as students with specific modification needs for

their regular education program. Many states require that students are

first processed through their local school and that all modifications

are exhausted prior to referral to special education. While notes and

documentation are made about the student, modifications are not legally

binding. Please check with your local school principal to see what

support efforts your school offers.

MODIFICATIONS THROUGH SECTION 504 OF THE REHABILITATION ACT

Students with special needs have the right to have needs met in their

educational program in the regular classroom setting. The modifications

listed in the section " Possible Modifications to the Student's

Educational Program " and implemented under 504 are legally binding. A

student can also be served in the regular classroom setting under an

Individualized Education Plan (IEP). Most students with arthritis

qualify for services under the category of Other Health Impaired.

SPECIAL EDUCATION

About 27% of students with arthritis receive modifications through

Special Education. Typically, they qualify for services in the Other

Health Impaired category, because juvenile arthritis is a medical

illness that can impact a student's strength, endurance and stamina. To

qualify for the Other Health Impaired Category, a letter from the

student's physician is needed to identify the student's medical

diagnosis and how the disease impacts educational functioning. Special

Education has several levels of service:

Regular Classroom with Modifications

Regular Classroom with Monitoring

Regular Classroom with Resource Classroom Support

Self-contained Classroom

Physical and occupational therapy are considered ancillary services in

the school system. They are intended to support a student in an

educational program. This is slightly different than a medical model,

which intends to provide rehabilitation. When a student qualifies for

special education services, an Individualized Education Plan (IEP) is

written that delineates specific goals, objectives and modifications for

the student's school program that are legally binding. The Arthritis

Foundation's manual " Educational Rights for Children with Arthritis, "

specifically outlines this process. AJAO's Partnership Training Program

(PTP) - Partners in Education Workshop describes this process in detail.

To access special education services, contact the Other Health Impaired

Coordinator or Director of Special Education in your school system. For

further guidance, check with your doctor or your " local office " of the

Arthritis Foundation.

Adaptive Physical Education is available to students in both regular and

special education settings. Students with arthritis, like other

students, may have co-existing conditions such as learning disabilities,

attention deficit disorder, hyperactivity syndromes, etc.

IDEAS FOR ENSURING STUDENT SUCCESS

Juvenile arthritis is a chronic condition that requires the development

of coping strategies for the student, family, and the school

environment. Here are some ideas to help:

Communication with the student and family about physical symptoms and

the types of medications the student is taking is very important.

Simple classroom modifications may be needed.

It may be difficult for young children to verbally communicate current

symptoms of pain or change of joint function. Asking the child to color

a " Body Outline " may be an effective communication tool to allow the

teacher to better understand current juvenile arthritis symptoms and

make appropriate accommodations. Please visit Helping Children with

Arthritis Identify Pain for information about the Body Outline for

Childhood Pain, a tool to help assess the location and intensity of a

child's pain.

Develop a plan for medication administration. Younger students will

require more supervision than older students who are working toward

independent medication administration. Many schools require that

medicine be sent in the original prescription labeled container.

Medicines administered at school may be required to be supervised by the

school nurse or other school personnel.

Morning stiffness can cause tardiness. If morning stiffness is a problem

the class schedule should be adjusted if possible.

Frequent communication between the teacher and the student's family

helps the teacher understand current disease symptoms to better meet the

student's educational needs. The student's needs are best served when

open communication about disease symptoms and fatigue is maintained

among teachers, students, and parents.

Homework modifications may be necessary if the child has fatigue or

decreased endurance levels.

POSSIBLE MODIFICATIONS TO THE STUDENT'S EDUCATIONAL PROGRAM

Students who have juvenile arthritis may require modifications to help

make them comfortable, preserve joint function, maximize and best

utilize energy. Limitations may be apparent or invisible. Suggested

ideas are as follows:

Students may need extra time to change classes, particularly in the

morning.

If possible, arrange for classes to be close in proximity, avoiding

stairways

whenever possible. If stairways cannot be avoided, the student may need

an elevator pass.

Stretch breaks may be necessary to relieve stiffness. Seat the student

in the classroom to allow for inconspicuous standing when stiffness

occurs. Students who have knee stiffness may need extra leg room for leg

extension. Other symptoms may make desk or chair adjustments necessary.

Writing may be difficult for students who have hand involvement. These

students may have difficulty holding a pencil and writing for any length

of time. Written timed tests may need to be modified. Joint preservation

will allow the child to maintain maximum use of the hands. To promote

joint protection:

*Use foam shells to build up pens and pencils;

*Felt tip pens require less effort;

*Computers or portable word processors can assist the student with

written assignments;

*Recording lectures, copying another student's notes or giving the

student copies of teacher overheads will help the student gain

information with minimal stress and strain on affected joints;

*Extra time may be needed on " timed tests " if writing is required;

*Students may need to dictate answers to test questions;

*Extensive written assignments may need to be shortened or modified;

*Neck stiffness can be relieved by using a book holder, which keeps the

book at a comfortable reading angle and/or lowering the student's chair;

*Sometimes it is helpful to assign a " buddy " to help the student carry

heavy items such as books and cafeteria trays, or inform the student of

homework assignments during school absence. Some students need

assistance in everyday tasks such as opening milk cartons;

*Students can often participate in physical education and recreational

activities. Modifications may be necessary with disease fluctuations.

Permitting the child to " self limit " activity will provide needed joint

protection in an atmosphere that allows the child to function at her/his

maximum potential. Ask your adaptive PE teacher to help with these

modifications. Appropriate exercise is very important for the child with

arthritis. Students do best with activities that require less stress on

the joints such as swimming. Participation in sports may need simple

accommodation such as using soft playground balls instead of regulation

basketballs, playing baseball with a pinch runner, etc. Communication

among the student, parents and the PE teacher is important to make sure

students can achieve maximum participation;

*It may be necessary to make arrangements for " emergency drills " (fire,

tornado, etc.) to ensure the student can act quickly in a safe manner. A

plan can be developed for this in case a student is experiencing a flare

during an emergency drill;

*Field trips may require adaptations to accommodate the student's

endurance level;

*A second set of textbooks for the student to keep at home will prevent

the child from carrying heavy books and placing stress and strain on

affected joints. This will preserve joint function and reduce fatigue.

PSYCHOSOCIAL ISSUES FOR STUDENTS WITH ARTHRITIS

Juvenile arthritis is a series of chronic diseases that may be with the

child throughout their school career. Families of the student may worry

about:

*The child's ability to be successful in the school setting;

*The physical appearance of their child;

*Delayed growth in the child with uncontrolled disease;

*Peer's reactions to the appearance of the child;

*Peer's reactions to physical limitations of the child;

*Cost of medical care;

*Guilt feelings;

*Siblings fears of developing juvenile arthritis;

*If the child will develop into an independent, self-supporting adult

Students may feel:

* Desire to be like their peers;

* Isolated;

* Inadequate;

* Insecure;

* Pain and fatigue from disease symptoms;

* Anger and depression about the restrictions imposed by the disease;

* Embarrassment about having the disease.

IDEAS FOR BUILDING SELF ESTEEM

Listen to the student. Most children with juvenile arthritis do not

complain and may even hide symptoms of the disease to appear like their

peers. Watch for body language (such as facial expresssions or rubbing

joints) that may indicate the child is in pain or experience fatigue.

Encourage students to look at strengths rather than limitations. Include

the student in planning classroom modifications. Encourage decision

making and acceptance of responsibility. Help the student to participate

in social interactions with peers and extracurricular activities

whenever possible. Encourage acceptance of diversity and individual

differences in your classroom.

Please visit " /ajao/parentteacher/painvarni " for information about how

to identify the location and intensity of juvenile arthritis pain.

Please visit Help is at Hand for a comprehensive description of juvenile

arthritis resources provided by the Arthritis Foundation.