Other Health Impairment

Other health impairment (OHI) is a disability category that has a variety of conditions, diseases, disorders and injuries. The health impairment may be caused by chronic or acute health problems and has an adverse affect on the student’s educational performance.

Chronic or health problems include, but are not limited to the following: asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome.

According to the Starbright Foundation (2002; cited in Turnball et al., 2004), there are numerous complex challenges facing children with health impairments. Common issues are: “loss of sense of control, lack of understanding about the condition, fear, worry, anxiety, stress, anger, and guilt, changes in family dynamics, isolation, isolation, medical noncompliance, boredom, depression, pain, decreased self-esteem, negative body image, and impact on identity and social interactions, including those at school” (p. 313).

Some general characteristics faced by individuals with OHI may include but are not limited to:

• Fatigue

• Mobility issues

• Issues involving attention

• Coordination difficulties

• Muscle weakness

• Frequent absences or lateness to school

• Stamina

• Inability to concentrate for long periods of time

Other Health Impairments

Attention-Deficit/Hyperactivity Disorder (ADHD)

• • largest percent of students under the OHI category

  • difficulty following behavioral expectations

  • Inattention- difficulty maintaining focus

  • Hyperactivity- constant motion

  • Impulsivity- difficulties with self-control

Diabetes

• An endocrine disorder in which the body cannot produce and/or respond appropriately to insulin

Epilepsy

• A neurological condition characterized by the presence of seizures which can vary in frequency and intensity.

Congenital heart conditions

• • Occur when genetic anomalies or environmental factors cause abnormal development of the heart in utero, include the following: holes in the heart, obstructed blood flow, abnormal blood vessels, heart valve abnormalities, an underdeveloped heart, a combination of defects.

Lead Poisoning

• The body is exposed to lead-based paint or paint dust and poisons the body. Children under the age of six are must vulnerable because their mental and physical abilities are still developing.

Leukemia

• Develops when bone marrow produces too many white blood cells and what's produced is abnormal. Leukemia is considered a cancer of the bone marrow and blood.

Nephritis

• One or both of a person's kidneys are inflamed. This makes it difficult for the body to produce urine.

Rheumatic fever

• Can develop as a complication of untreated or poorly treated strep throat or scarlet fever. It’s not common in the United States, although it is fairly common worldwide. Symptoms include: fever; pain in one joint that moves to another joint; red, hot, or swollen joints; small, painless nodules beneath the skin; rapid, fluttering, or pounding heartbeats (palpitations); shortness of breath; a painless rash with a ragged edge; jerky, uncontrollable body movements, most often in the hands, feet, and face; and unusual behavior, such as crying or inappropriate laughing.

Sickle cell disease

• Characterized by sickle (crescent)-shaped red blood cells that cannot adequately carry oxygen

Tourette syndrome

• A neurological disorder often characterized by tics—repetitive, stereotyped involuntary movements or vocalizations.

Other health impairments not mentioned in IDEA

• • There are other health impairments that can fall under the umbrella of IDEA’s OHI category besides the ones specifically mentioned in the law. The U.S. Department of Education mentions specific other disorders or conditions that may qualify a child for services under IDEA, in combination with other factors—for example: fetal alcohol syndrome (FAS), bipolar disorders, dysphagia, and other organic neurological disorders.

A student shall be eligible for special education services under the category of other health impairment if both of the following criteria are met (HAR Chapter 60 Section 8-60-39):

(1) The student has limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome;

AND

(2) Adversely affects a child’s educational performance.

Evaluations & Assessments

Students who are eligible under the OHI criteria will have medical evaluations administered by a medical professional outside of the school; along with developmental, cognitive, academic achievement, adaptive behavior, and social-emotional development assessments administered by the school team.

Based on evaluations and assessments, a student is eligible when the data supports that a student's health impairment does effect educational performance.

Clarifications for Other Health Impairment Disability

When considering a disability based on the category of other health impairment:

• There must be a chronic, acute health problem, or medically fragile condition.

• A medical diagnosis alone does not qualify a student for special education under IDEA or HAR Chapter 60.

• A student who has a disability but only needs a related service not special education would not be considered a student with a disability under IDEA or HAR Chapter 60.

• It is highly recommended that a health care provider review student records.

Required Evidence

Chronic, acute health condition or a medically fragile condition:

• • Chronic health condition: The condition is long-term and either not curable, has residual features, or the disease develops slowly and persists for a long period of time.

  • Acute health condition: The condition is of quick onset or begins abruptly and with marked intensity, then subsides after a short period of time.

Limited strength, vitality resulting in limited alertness in the educational environment:

• • The health condition leads to limited strength, vitality: Lack of durability, energy, or vigor resulting in decreased capacity to perform school activities.

  • Inability to maintain effort caused by a lack of resilience or stamina.

Limited alertness including a heightened alertness to environmental stimuli which results in limited alertness in the educational environment:

• • Limited or heightened alertness: Inability to maintain awareness, vigilance, mindfulness, or attentiveness that may be caused by environmental stimuli or an internal ability to maintain focus.

  • Examples: Discrepancy from peers in focusing/sustaining effort, organization skills (materials, written work, thoughts).

Educational practices for students with OHI will vary greatly depending on the medical condition and student need. A students IEP (and students individual health plan if available) will be the foundation for selecting what educational practices to use based on the student's health impairment.

Effective Practices

Use data to inform decision-making

• Screening and Standardized Testing may used to measure academic growth and track progression.

• Progress Monitoring can be used for instructional planning to increase student achievement, teacher decision making, and increase student awareness in the learning process. Progress monitoring provides data for teachers to plan effective instruction, collect work samples, and use rubrics/checklists/performance graphs to track student progression.

Teaching Styles

• Inquiry based learning involves problem solving and critical thinking skills to arrive to conclusions. This teaching strategy is student-centered.

• Cooperative Learning includes students of varying abilities to work together.

Collaboration

• Support staff or other professional observation in educational or natural setting.

• Parent/Student Surveys

Longitudinal Data

• Review medical records and health history (specialized health care procedures, medication, etc.)

• Attendance records (absences)

Accommodations for a student with OHI is the responsibility of the IEP team. The IEP team must consider the treatment plan from medical and other professionals while selecting and implementing appropriate instructional practices and accommodations. Students with OHI may require medical care that range from medical appointments, hospitalization, and health related services at the school level. The frequency of medical care may range from daily, weekly, or monthly depending on the severity of the student's health impairment. Students with an OHI may have periodic, and sometimes lengthy absences from school. IDEA states that Special Education can be provided in a range of settings outside of school. A homebound instructor may be arranged by the school in the home or hospital setting if needed.

If a student is suspected of having a OHI disability, both informal and formal assessments and data may used as documentation to determine if a student is eligible for special education services. Informal assessments may include teacher-made tests, skill inventories, behavioral checklists, daily observations, and student interviews. These assessment are used to determine the identified student’s ability to function in relation to age and grade norms and the degree to which the student is comprehending and retaining the skills and concepts presented in class. Formal assessments such as standardized tests and universal screeners are used to assess whether students have the basic abilities and skills needed to succeed in the general education setting.

Documentation Need to Knows

• Documentation should use jargon free language.

• Documentation must be from a variety of sources, identify the sources of information, and explain evidence. All findings should lead to the conclusion that the unique behaviors/challenges the student is experiencing is associated with the disability and are occurring frequently and at a level of intensity that adversely affects performance in the PRESENT educational setting or natural environment.

• Clearly state how ALL data leads to the conclusion of the health disability adversely affecting the student’s performance in the educational setting or natural environment.

Critical questions that a school team should ask/answer when there is suspicion that a student may have a OHI disability:

• What are the unique difficulties or challenges the student is experiencing because of the health disability?

• Is academic learning affected?

• Is communication affected?

• Is independent functioning affected?

• Are social/emotional interactions affected?

• Does the student need interventions that significantly differ in intensity & duration from what can be provided solely through general education resources and services currently in place?

• What specially designed instruction does the student need?

• Was the information gathered from a variety of informants and measured using various tools?

• Appropriate Instruction - Did the student receive appropriate instruction in reading and math? (Consider attendance, standards based instruction, targeted interventions tried and results of interventions, etc.)

• English Proficiency - Was English proficiency addressed and ruled out as the primary cause of the learning difficulty?