Providing Education to Students with Complex Health Care Needs.

Ever since enactment of the· Education for All Handicapped Children Act (PL 94142) in 1975, school districts have been opening their doors to students who pose greater and greater challenges to their teachers and administrators. The newest challenge is that of providing education to students with complex health care needs (Sirvis, 1988; Viadero, 1987). There has been a long tradition of providing education to students with chronic illnesses such as diabetes, asthma, spina bifida, sickle cell anemia, hemophilia, cystic fibrosis, and muscular dystrophy (cf. Hobbs, Perrin & Ireys, 1985; Kleinberg, 1982). But typically when those students' conditions progressed to the point that they needed health care services such as catheterization, respiratory therapy, tube feeding ventilation or oxygen, they were hospitalized or remained at home and did not attend school. The school(s) usually made adjustments for their absences or provided home or hospital instruction until their condition improved. Now students are not automatically removed from schools for prolonged periods when they need complex health care services. After their medical conditions stabilize, students with chronic illnesses or other complex health care needs requiring specialized, skilled care, and possibly medical technology to support them, are coming to today's schools. Schools may have to take measures to ensure that serious communicable diseases are not spread within the school. The special needs student may require apnea monitoring, tube feeding, mechanical or machine suctioning, mechanical ventilation, oxygen; or other health care that is different, and often much more complex, than the schools typically have provided in the past. Kathy, an 8-year-old student, is an example of such a child currently attending a public school. She was a healthy, normally developing child until age 2, when she wandered out of the family's summer cottage and found her way to the lake, where she nearly drowned. Kathy was in a coma for 4 weeks. Upon discharge from the hospital after regaining consciousness, Kathy was no longer able to walk, talk, or eat by herself. Kathy has difficulty swallowing and coughing-processes necessary to deal with food and saliva present in her mouth and throat. Consequently, Kathy cannot eat food by mouth, but instead is fed through a tube that enters directly into her stomach. Because she is unable to deal with the build-up of saliva and mucus in her mouth and throat, especially when she gets a cold, those fluids must be removed frequently by use of a suctioning machine. The machine has a long tube that is inserted into her mouth, and into her throat, when necessary, to remove the ~excessive fluid.