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School Reintegration Following Hospitalization

Sharon Grandinette, M.S.

He was just a typical student at the local school, then he...

• was paralyzed after a surfing accident
• was diagnosed with cancer
• was in an accident and suffered a brain injury
• contracted encephalitis
• was a near drowning victim
• needed heart surgery
• was shot in the neck

For many families, sending their child back to school following a medical illness or injury can be difficult. In a number of cases, the student may have received home/hospital instruction, and parents felt comfortable because they knew their child was supervised by medical personnel or, had their child at home where they were safe. The thought of having them return to school can, in many cases, cause anxiety in the parent, the student and the school staff who will be working with him. Too often, students are left on home instruction for extended periods of time due to parent anxiety, student reluctance and/or a lack of planning and training for the school staff. In short, there is no plan for school reintegration.

All to often, school re-entry is a bumpy process using the "drop and pray" method. While not all medical illnesses/ injuries or conditions require hospitalization, those families who find themselves with a physician's note allowing their child to return to school are caught off guard. In many cases, the families are so grateful that their son/daughter survived the accident or illness, they may not have considered what struggles might lie ahead in school or with regard to activities of daily living. Below are some general steps that should be followed to help facilitate a smooth transition back to school for students who are hospitalized.

1. Hospital instruction should be provided by the school district that the HOSPITAL is located in if the child resides there for more than 10 school days.
2. While the student is still in the hospital or rehabilitation setting, the medical social worker should help the family notify their HOME school district regarding the child's illness and how it might affect his/her schooling.
3. Someone from the HOME school district should be assigned to visit the child while in the hospital (school nurse, psychologist, Program Specialist).
4. Any assessments completed at the hospital (Speech, OT, PT, Neuropsychological) should be shared with the home school district staff with parent written authorization/exchange of information forms so that HIPPA regulations are followed.
5. PRIOR to discharge, if appropriate, a referral to Special Education/504 committee needs to be made in writing to the home school district. (Be aware that not all students with medical issues have to go through the full assessment process).
6. PRIOR to discharge, medical/rehabilitation information about the severity of the student.s illness, injury, behavior, current medications, side effects and ongoing therapies MUST be shared with the school district.
7. Referrals should be made to appropriate outside agencies (Regional Center, CCS, Mental Health, Vocational Rehabilitation).
8. The HOSPITAL teacher should confer with a staff member from the home school district.
9. School staff should TAKE THE TIME to introduce the family to the new world of Special Education/504 accommodations in a simple and informative manner.
10. Hold an IEP/504 meeting that includes parents, student, school nurse, and relevant hospital and school staff
11. Develop an IEP/504 plan that addresses:Develop an IEP/504 plan that addresses:
1. Program accommodations/modifications
2. Develop a plan that does not require student to “catch up” on missed work while hospitalized.
3. Appropriate placement in the LRE with appropriate supports and services
4. Related Services needs (APE, OT, PT, Speech, Vision, Hearing, Counseling)
5. Physical limitations
6. Adaptive devices
7. Toileting and personal care
8. Flexibility in schedule, extra time between classes
9. Behavioral/mental health issues
10. Transportation
11. How to deal with a high number of absences/tardies due to medical appointments and/or on-going treatment (ie: allow for home instruction any time student is going out be absent for more than 3 days vs. waiting for 2 weeks)
12. Student need for adult support, and at the same time help him develop independence
12. Identify resources within and outside the school who can provide consultation and training to school staff about the medical condition and its effects (do not forget Paraeducators, bus drivers, lunchroom & playground supervisors).
13. Provide information to classmates to reduce stares, inappropriate questions and fear regarding the illness or injury 
14. Set up a plan for regular feedback and communication between the educational team and parents. Do not wait for problems to develop

Certainly, implementing a well-planned school re-entry for a student with a medical illness/accident will be beneficial for the student upon returning to school. However, even with a carefully developed and implemented plan, there is no guarantee that school re-entry will be easy. School reintegration is challenging for students as they enter back into a world where they have a difference sense of self, for they were once like all the other students, and now they are disabled. Some will have to adjust to different schools, special education classes, a gradual loss of friends, and difficulty acquiring knowledge and skills, as they once were able to. These student will require a great deal of support, especially in the counseling arena to help them adjust to attending schooling in a far different way than in the past.

This article is from the CAPHI Newsletter, Fall 2005