Individualized Healthcare Plans (IHP or IHCP): A tool to manage student-specific healthcare needs

Most autistic students have a wide range of healthcare issues in addition to their diagnosis that will result in trips to the school nurse. For some, their needs can be managed with periodic check-ins between parents/caregivers and the nurse and standard health office forms.

But for those who need to take medications at school, have a serious co-occurring medical condition, have trouble communicating their pain or illness, suffer from trauma related to their medical needs or medical providers, have expected behavior, frequently or occasionally, that require special medical attention, or have any issue requiring specific health management, their parents/caregivers should consider an Individualized Healthcare Plan (IHP or IHCP).

What is an IHP

An IHP is a formal document written with the professional, licensed school nurse who then communicates the nursing care needs of a student to regular and special education educators, administrators, teachers, health assistants and parents during all school related activities, including riding the school bus, after school events, and field trips. The IHP also covers other aspects of care such as a student’s knowledge about their condition, self-care abilities and any modifications needed to enhance learning and prevent emergencies. The school nurse will work out the amount and intensity of nursing care required in collaboration with the parents/caregivers, school, and healthcare provider.

Some benefits of an IHP are fewer medical emergencies, better managed medical symptoms, better attendance, and an increased ability to participate in learning and social activities.

Who is eligible for an IHP

An IHP is typically for students with special healthcare needs, though there is no law that says such a student has a right to one. Instead, parents/caregivers can request them and ultimately the school nurse makes the determination for them. With a shortage of nurses and an overwhelming caseload among those who remain – 38-49 students a day, or 6 kids an hour in a typical school day, for about 10 minutes eachaccording to one study, the National Association of School Nurses (NASN) strongly advocates for them, calling the IHP a  “vital and practical tool to manage or mitigate student-specific healthcare needs.” Their position is simple: students whose health needs affect their daily functioning should have an IHP.

Not all autistic students necessarily need an IHP. Additionally, an autistic student does not need an IEP or 504 plan to have an IHP; a stand-alone IHP might be okay if the student’s health needs are extremely minimal. Conversely, while health needs can be addressed in an IEP (in the related services section under supplementary aids and services) or 504 plan (as part of the student’s health accommodations), NASN recommends a separate IHP since it is the one document that centers everything health related.

What is included in an IHP

The IHP generally consists of an assessment, nursing diagnosis, goals, interventions, expected outcomes and evaluation. The format and requirements of an IHP may vary from state to state, sometimes from district to district. If it is written outside of an IEP or 504 plan, it’s very much dependent on the nurse to include all required elements. NASN’s School Nursing: Scope and Standards of Practice is a gold standard for what is included in an IHP and how it is developed.

Parents/caregivers should involve their student’s primary care team. In some cases it is helpful to sign waivers with the child’s doctors and providers if they are ok with the school nurse contacting them directly for care instructions. They should also give the school nurse all the necessary medical information and specific doctor’s orders for the student.

From there the school nurse can develop an IHP that could include:

• A list of medical triggers
• Healthcare needs at school
• Self-monitoring procedures, such as level of independence and awareness of symptoms
• Medication management including how medication will be administered, where medication will be stored and accessed and plans for medications for field trips, extracurricular activities or emergencies.
• Accommodations such as special equipment, positioning, or assistive devices
• Precautions and interventions, including emergency plans and who will be responsible if the nurse is not available to respond.
• Special considerations such as a field trip plan, extracurricular activity plan, assembly plan, etc.
• Nutritional and dietary needs. For instance, instructions for assistance during mealtime, precautions about sensory sensitivities, etc.
• Treatments to perform

The IHP should be signed by the parents/caregiver and nurse, and copies should be shared with regular and special education teachers, aides, and administrators as needed. It should be reviewed and updated whenever the student’s medical condition changes.