Special Education Services: A Manual of Policies, Procedures and Guidelines

E.8 Physical Disabilities or Chronic Health Impairments

Definition
A student is considered to have a physical disability or chronic health impairment based on the need for special educational services due to one or more of the following:

• nervous system impairment that impacts movement or mobility;
• musculoskeletal condition; and/or
• chronic health impairment that seriously impacts students’ education and achievement.

A medical diagnosis, by itself, does not determine the need for special educational services by students with physical disabilities or chronic health impairments.

Students are only eligible for funding in this category if their functioning and education is significantly affected by their physical disabilities or chronic health impairments.

Two students with the same physical disability may have very different levels of need. For example, one student with cerebral palsy may be seriously impaired in mobility, independence, cognitive ability and using a wheelchair, while another student with the same diagnosis may participate completely independently in a regular education program.

In some cases, students diagnosed through the Complex Developmental Behavioural Conditions (CDBC) Network as children and youth with complex needs may be included in this category. Regionally, the CDBC Network has been established to assess children and youth with complex needs, including children and youth who may have fetal alcohol spectrum disorder (FASD). A clinical diagnostic assessment by the CDBC Network or by qualified specialists (psychiatrist, registered psychologist with specialized training, or medical professional specializing in developmental disorder) is required. The assessment must include and integrate information from multiple sources and various professions from different disciplines that indicates the student with FASD or the complex developmental behavioural conditions is exhibiting an array of complex needs, with two or more domains being impacted (social-emotional functioning, communication, physical functioning, self-determination/independence, and academic/intellectual functioning). If reported in this category, such students might be receiving extensive intervention and support.

To be eligible for supplemental funding in this category the following must be met:

• The student must meet the above eligibility criteria; and
• A current IEP is in place that includes:
  • individualized goals with measurable objectives,
  • adaptations and/or modifications where appropriate,
  • the strategies to meet these goals, and
  • measures for tracking student achievement in relation to the goals.
• Ongoing special education service(s) must be provided.
• The services being provided are beyond those offered to the general student population and are proportionate to level of need(s).
• The special education services are outlined in the IEP and directly relate to the student’s identified special needs.
• Reduction in class size is not by itself a sufficient service to meet the definition.

Identification and Assessment
Assessments should integrate current, relevant information related to the student's intellectual, social/emotional, sensory, physical and communicative abilities as well as his or her ability to perform activities of daily living at school. Individual Education Plans should take into account specific health care and personal care needs, and outline specific strategies to address those needs. An extended school-based team would typically include medical professionals and consultation with parents in order to develop and implement an effective IEP.

Planning and Implementation
Medical diagnosis, by itself, does not determine the special educational services required by a student with physical disabilities or chronic health impairments. It is the extent and impact of the physical/medical condition on the student’s functioning, and the consequent need for services which enable him or her to access an educational program and participate in a meaningful way, that are the determinants.

For some students, increasing dependence is expected due to degenerative conditions or terminal illnesses. It is important that these students be encouraged to maintain normal routines as long as possible. At the same time, it is essential that the educational system affirm the rights of students and families to participate meaningfully in the individualization of the student's educational program. Health care plans will need regular updating and will need to include emergency procedures to meet individual needs and circumstances.

Students with physical disabilities or chronic health impairments should have opportunities to participate in school activities to the greatest extent possible. Adaptations to facilities or equipment to allow access to school areas and programs should be made where physical barriers exist. Refer to Appendix H.1 Accessible School Facilities Planning for more information.

Evaluation and Reporting
In most cases, students with physical disabilities or chronic health impairments will take part in the regular program with the necessary adaptations. Evaluation will be based on the regular standards (i.e., extent to which learning outcomes were achieved). The method of evaluation will be consistent with the IEP and with ministry reporting policies in respect to the use of comments and/or letter grades.

Some students may require extensive modifications to parts of their program so that some of their learning outcomes will be substantially different from the regular curriculum. In these cases, evaluation will be based on the degree to which the individualized outcomes are achieved.

Reports to parents should be provided on the same schedule used for all students. Progress should be reported with respect to all components of the program, and with reference to progress in relation to IEP goals. Reports should indicate the adaptations and modifications made to the student's educational program. All personnel directly involved in the ongoing educational program (e.g., classroom teacher, specialist teacher, speech-language pathologist) should report on student progress.

Personnel
Teachers and other professionals
The Ministry of Education expects that with sufficient training and experience, classroom teachers will be capable of including most students with physical disabilities and chronic health impairments and providing a program in which they can be successful, provided that specialist support is available when needed. In-service training opportunities and a collaborative team approach are recommended to support and encourage the development of the skills required.

Teachers with responsibilities for supporting students with physical disabilities or chronic health impairments should fulfill the qualifications described for learning assistance (see Section D.1 Learning Assistance Services).

In addition, they should have advanced coursework in:

• the characteristics and needs of students with physical disabilities and chronic health impairments; and
• specialized instructional methodologies and technologies; and adaptation or modification of programs for students with physical disabilities or chronic health impairments.

There also may be a need for a qualified health professional to assess the need for health services.

Whenever there is any doubt as to who should provide health care in the school setting, the district staff and the school principal shall consult with the parents, the local health unit or the attending physician. Districts should ensure that staff who serve students with chronic and complex health needs are trained and qualified to perform the functions required.

Recent and ongoing technological advances in adaptive devices related to computer access, environmental controls, and augmented communication have greatly enhanced learning opportunities for students with physical disabilities. Staff will need to stay informed of current developments and introduce new technology as appropriate. The service of SET-BC may be appropriate for some of these students (see Appendix H.2.5 Special Education Technology-BC (SET-BC)).

Teachers’ assistants
Teachers’ assistants who work in classrooms with students with physical disabilities or chronic health impairments should have sufficient skills and training for the duties they are assigned.

It should be noted that teachers’ assistants work under the direction of a teacher and the general supervision of a teacher or school principal. In-service training should include opportunities to further develop expertise in these and related areas.

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