OHI on the IEP
IDEA has 14 eligibility categories for an IEP. One of them is OHI. I find that OHI is one of the most frequently misunderstood one by parents, especially when it comes to ADHD. ADHD is, of course, a learning disability. Parents enter into the process fully expecting their child with ADHD to be eligible in the SLD category and then are told it’s OHI. So, let’s take a closer look at this.
First, let’s look at how IDEA defines “OHI-other health impairment.” That definition, in combination with a state’s policies, is a very important factor in whether or not a child is found eligible for services.
Sec. 300.8 (c) (9)
(9) Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that—
(i) 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
(ii) Adversely affects a child’s educational performance.
So, there you go! IDEA specifically lists ADHD under OHI rather than SLD. I point this out just because as IEP parents, we are often skeptical of what the school tells us. But, when you are told that ADHD falls under OHI, that is true. There is more about ADHD and OHI vs. SLD (+ advocacy tips!) at the bottom of this post.
Let’s also note that IDEA uses the phrase “such as…” This is important. It means that the disabilities listed are not the only ones that may be considered when a child’s eligibility for special services under IDEA is decided. A child with another health impairment (one not listed in IDEA’s definition) may be found eligible for special services and assistance. What’s central to all the disabilities falling under “Other Health Impairment” is that the child must have:
- limited strength, vitality, or alertness due to chronic health problems; and
- an educational performance that is negatively affected as a result.
What are Other Health Impairments?
I gave you the specifics that IDEA lists, after the “such as.” But, there are others.
There are many other disorders or conditions that may, in combination with other factors, qualify a child for services under IDEA. For example:
- fetal alcohol syndrome (FAS)
- bipolar disorders
- other organic neurological disorder
However, these are not listed in IDEA. And, as such, I have found it tremendously difficult to advocate for children with FAS. I’ve had 3 clients in the past 10 years with FAS, and 3 different schoool districts. I hit thesame roadblocks each time.
The reason these weren’t specifically mentioned in IDEA’s regulations are, according to the Department:
…because these conditions are commonly understood to be health impairments…The list of acute or chronic health conditions in the definition of other health impairment is not exhaustive, but rather provides examples of problems that children have that could make them eligible for special education and related services under the category of other health impairment.Federal Register 71 Fed. Reg. at 46550
Note the phrase “could make them eligible.” More vague language from IDEA, so frustrating! Other aspects (adversely affected educational performance, a child’s evaluation results, state policies) are considered in determining eligibility for services under IDEA, not solely the existence of the disability or condition.
As IDEA’s definition of OHI states, the health impairment must affect a student’s ability to access and benefit from their education. In order for a child to qualify for special education services in the public schools, the OHI must affect the child’s educational performance. This is why I am constantly berating parents about doctors’ notes. A doctor’s note alone does not guarantee you an IEP or any accommodations or services.
However, when a child is found to be eligible for an IEP, they then will also be eligible to receive related services in school (if the IEP evaluations demonstrate need). IEP Related Services are provided as required to enable children with disabilities to benefit from their special education. While I have gone into IEP related services and a description of them in another post, I want to draw your attention to this one, specifically.
School Health Services/School Nurse: IDEA defines these as “…health services that are designed to enable a child with a disability to receive FAPE as described in the child’s IEP. School nurse services are services provided by a qualified school nurse. School health services are services that may be provided by either a qualified school nurse or another qualified person.” [34 CFR §300.34(c)(13)] You will want to review your state’s guidelines on this. Some states prohibit teachers from providing services such as those listed below. This may strengthen your case for a nurse for your child.
- special feedings, tube feedings
- clean intermittent catheterization
- trach management
- administering and/or dispensing medications like insulin or emergency seizure med
- ensuring that care is given while at school and at school functions to prevent injury (e.g., changing a child’s position frequently to prevent pressure sores)
- chronic disease management
- conducting and/or promoting education and skills training for all (including the child) who serve as caregivers in the school setting
Some children with disabilities cannot attend school without the supportive services of school nurses and other qualified people. However, as one can imagine, having a nurse attend school with a child is expensive. While cost shouldn’t be a factor in determining IEP supports and services, it often is. Just one more reason to advocate and lobby for issues that are important to our families. The fact is, schools are not adequately funded for this, and that needs to change.
ADHD and OHI
Ok, so circling back around to ADHD. You asked that your child (who either you have a hunch or an actual diagnosis) with ADHD be evaluated for Special Education. There are two important takeaways here, from having ADHD listed under OHI.
- First, many times parents are told that with ADHD, you can “only” get a 504 plan. Clearly, that is not true, or it would not be listed under OHI in IDEA.
- Second, if the IEP team (besides yourself) believes that ADHD is the most contributing factor to your child’s learning, then them wanting to place your child in OHI is appropriate. However, ADHD rarely travels alone. Many times the child also has comorbid conditions, specifically the “dys” conditions: dyslexia, dysgraphia, dyscalculia, dyspraxia. To piggyback on the first point above, if you believe that another learning disability is more of a contributing factor than the ADHD, you have choices. Remember, the first eligibility category should be the one that affects the child the most.
- Keep pushing (use your procedural safeguards) for either an IEE or a change of eligibility category.
- Keep OHI as primary, but do not accept a 504. Make sure all needs are adequately addressed in IEP, not just the ADHD needs.