This is a question many parents of have – regardless of whether their child receives special education and related services or not.

Recall the Law

Federal law and regulations (IDEA 2004, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act – ADA) require schools to provide services for students with disabilities, special health care needs, chronic illnesses, and those requiring special health care procedures.

Federal and state law and regulations require districts to have policies and procedures for developing Individualized Health Plans (IHP). School administrators also have the responsibility to provide education for staff, students and parents with regard to the provision of providing and planning services and support for children with special health care needs.

Texas Guide to School Health Services

Texas Guide to School Health Services manual from the Texas Department of State Health Services (DSHS) is a resource that can be helpful to parents when faced with questions about the role of the school nurse and IHPs.  Here are some quotes directly from the manual along with insights from Chuck Noe, PRN Education Specialist:

“IHPs are individualized to each student’s medical, nursing, and educational needs. The plan is designed to identify health services the child will need during the school day and develop ways to meet those needs. It should support the child’s participation in school activities both inside and outside of the classroom. The plan should provide for the performance of health care procedures with minimal disruption of the student’s school day. The IHP should also contain an Emergency Care Plan (ECP) for each student.”

Page 11 – “The development of an IHP is a collaborative process that includes the student’s parent or guardian, the student (when appropriate), the school nurse (RN), the student’s physician, other school staff, community health providers, and medical specialists.” “The school nurse (RN) is responsible for planning, coordinating and developing the IHP and serving as the student’s case manager and should work closely with the student’s family.” pg 10 “Any training that will be needed for the school nurse or other school personnel should also be identified at this meeting. Training should be completed for staff who will be involved with the student, including teachers, lunchroom staff, bus drivers, etc. Some elements of training may be specific to a particular student and require one-on-one training (i.e., by a family member)”.

Page 12 – “When the IHP is complete, it should be: (1) signed by the school nurse (RN) who wrote the plan, the student’s parents or guardian, and the student’s primary health care provider; and (2) attached to the student’s IEP or school health record.” pg 11 “The IHP is reviewed and revised, if necessary, at least yearly. A review and/or revision may be performed at any time as the needs of the student dictate. The maintenance of an ongoing, collaborative plan of care can be facilitated by the school nurse attending and being an active participant in all student evaluation and planning meetings.”

Page 18 – “There is increasing pressure to serve more students in regular classrooms, a movement known as inclusion. “Inclusion,” as used by educators, involves more changes to regular education than the earlier concept of “mainstreaming.” Mainstreamed students spent part of the day in the regular classroom, but were often “pulled out” to separate settings for special services. Under inclusion, regular education is expected to change in significant ways so that all or most of the individual student’s special needs are met in the context of the regular classroom.”

Page 19 – Services once rare and/or thought to be clearly outside the responsibility of schools are legally mandated by state and federal statutes for all children who need them. However, some school staff may not know this or agree with this.

Page 20 – A list of nursing procedures or treatments commonly provided at schools is on page 20.

Often the district staff will request parent consent to communicate with the student’s physician(s). The school may feel that the doctor does not have all of the information that they need to make recommendations. The parent can say yes or no or offer another option, e.g. teleconference with the parent, school and physician, or questions from the school to present to the physician.

The Texas Guide to School Health Services manual by the Texas Department of State Health Services (DSHS) is available at

Possible Responses that Parents Can Make

  • “Has the nurse developed the IHP for my child?” “If not, when will it be completed?”
  • “Has the nurse received all of the medical documents that I have provided?”
  • “When will I meet with the nurse to review and sign the IHP?”
  • “How will the IHP be disseminated to appropriate staff, how will they be trained, and who will do the training?”
  • “Why was this recommendation from the doctor not included in the IHP?”

If you would like more information on this topic, check out the Wrightslaw article – Include a Health Care Plan in Your Child’s IEP at