The determination as to positive or negative uses your professional nurse judgment. Because our nurse judgement cannot be delegated, you are the only one in the school who has the education, license, and experience to complete a health screening. Remember that the focus of the screening is to identify anything in the student's health history or current health status that MAY impact him or her during the school day. If you are ever doubtful as to whether a screen is positive or negative, first think it through. Is this finding important for me to share with anyone else on the team? If the answer is yes, then error on the side of positive.
This is especially true when the purpose for screening is special education initial eligibility. The special education (IEP) team may not use health information obtained during a screening as part of its evaluation, since the information was obtained with implied consent. If the purpose for screening is disability suspect (DS) or special education please limit what you include on the screening form and be sure to check box G. This box triggers AEA staff and the special education teacher to obtain signed parental consent for a full and individual health evaluation that will result in a formal report. Information obtained from a health evaluation can and should be used to shape the student's Individual Education Program (IEP).
Now is a good time to address a positive screen for Section 504. In this case you would check box F. There is no need to write a report or proceed further. You would write all information on the screening form itself. This is unique to Section 504 and very early district-level problem solving. If you are asked to screen health for a child prior to a disability suspect meeting then the correct box to check would be box G.
Some AEA staff check the first blank, problem solving, for DS, this is actually a pre-special education meeting. If one of your district special education teachers is involved, that is a clue that you would treat it as if special education had been checked. On the other hand, if no AEA staff or district special education teacher is involved, likely the purpose is district level problem solving and you would follow the pre-Section 504 process and check box F for a positive screen. To sum all of this up, when the screening purpose listed is problem solving, make sure that you follow up with the requester to determine which box to check for a positive screen. For a negative screen always check box H.
Our duty in special education is to exhaust all potential reasons for delayed development or learning concerns. Much of the time we will not uncover a direct link between a learning deficit and a health condition or health event. However, the IEP team must prove that it collected adequate information to rule OUT health as a primary or even related cause for learning, social, behavior, vision or hearing difficulties. It is not uncommon to discover during a health screening conditions like preterm delivery, labor or delivery complications such as nuchal cord, failed newborn hearing screen, or low APGAR scores at the 5 minute mark. Any of these would result in a positive screening and the need to obtain parental consent to evaluate health for special education eligibility. A diagnosed chromosome abnormality would also fall into this category. Once health is ruled out as a current concern, then the team can proceed to offer specialized instruction to target learning deficits. Usually in this type of example, once health is ruled out, it will not be evaluated again. The only exception would be if your evaluation turns up additional need or a new health condition is diagnosed. The purpose of a health evaluation in this case is to explore any potential contributing factors and rule them out. This type of evaluation will likely not result in health services written into the IEP and the team can, with solid backing, check 'no' health is not a concern.
An obvious reason to check a health screen as positive for special education is when the child has a diagnosed medical condition. Examples include but are not limited to: seizures, food allergies, autism, asthma, diabetes, ADHD, or mental health diagnoses. Remember that for any student who is eligible for both Section 504 and Special Education, OCR and OSEP (Federal regulatory agencies) have ruled that an IEP is sufficient. This means that during your health evaluation you are looking for not only health services but also the need for health related accommodations. Once again, since you are the health expert in your building, the team relies on you to investigate each health condition presented and determine what services and/or accommodations are needed for the student to access school and benefit from instruction. A full and individual evaluation for health is the only way to uncover this information and have permission to share it with the IEP team.
A more challenging situation to evaluate is when the child has obvious physical disabilities but no chronic health conditions. Examples include but are not limited to cerebral palsy, achondroplasia, traumatic or acquired brain injury, and congenital malformations. Again these conditions result in a positive screen that would warrant a full and individual health evaluation if the team proceeded to a DS meeting and an evaluation for special education eligibility. During the evaluation, focus on what nursing services and/or para services may be needed. To bill Medicaid for personal health services, a student must have both nursing and para services listed on page F. As the school nurse your service then becomes supervision of the para when performing toileting, feeding, personal hygiene, positioning, lifting or assisting with transfers, and mobility. This may be a shared role with PT and/or OT. Again without an evaluation these services cannot be determined.
Please also see the Entry dated Nov. 4, 2015 titled, "How do I complete the health screening form?" for additional information.
If you have additional questions related to what determines a positive health screen please contact your assigned nurse consultant.