1 For Administrators Leadership Week 2015Hospital/Homebound For Administrators Leadership Week 2015

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3 Learning Goals Discuss the current HHB programLearn about upcoming changes to the HHB program Review administrator responsibilities related to HHB Obtain tips for implementing HHB services Engage in practice using tools to assist with the provision of HHB Discuss questions and answers related to HHB school issues

4 Performance Scale 4 I can access information to facilitate difficult conversations related to the provision of HHB. I know when to collaborate with the district office on unique situations related to my role as an HHB administrator. I can assist others with using the HHB Wiki and Database as resources. 3 I understand the responsibilities of an HHB administrator and can assist my team with implementing procedures. I know how to use the HHB database to initiate and monitor services. I can access resources through the HHB Wiki. 2 I know what the responsibilities of an administrator are related to Hospital/Homebound, but I still need assistance providing services to students. I can locate the HHB Wiki and log into the HHB database, but I do not use it to monitor students. 1 I know that administrators are responsible for some areas related to Hospital/Homebound. I know there is an HHB Wiki and HHB database for monitoring students, but I have not used these resources.

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6 Overview Current HHB Program

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8 Program Demographics Total HHB Students in the HHB Database as of March for : 399 Demographics: Current HHB Students HHB M Primary: 222 HHB M Other: 39 Total HHB (M) Students: 261

9 Elementary School HHB Current Elementary HHB Total: 53 = 4 hours per week Intermittent: 24 Alt Assessment: 11 Regular Standards Full/Part-time HHB: 18

10 Middle School HHB Current Middle HHB Total: 69 = 5 hours per weekIntermittent: 38 Alt Assessment: 3 Regular Standards Full/Part-time HHB: 34

11 High School HHB Current High HHB Total: 130 = 6 hours per weekIntermittent: 41 Alt Assessment: 7 Regular Standards Full/Part-time HHB: 82

12 Number of HHB Students by School (As of March 2015)Elementary NWES = 7 students 25 schools with under 5 students Middle RRMS = 10 students 14 schools with under 10 students High WRHS = 22 RRHS = 18 LOLHS = 15 FHS = 11 WCHS = 11 6 schools with under 10 students

13 Current Instructional Barriers to HHB ProgramLack of rigorous instruction Inadequate instructional time Difficulty of monitoring teachers and students Limited independence and socialization with adults and peers No access to project-based learning

14 Current Limitations of HHB ProgramExtra Responsibilities of the School-based Team Administrators: Hiring highly qualified teachers, monitoring HHB hours and courses Case Managers: All aspects of service provision, compliance and maintaining the student’s red file regarding the following documents: T/IEPs, quarterly goal reports, report cards and progress reports, medical expiration dates and time sheets. Data Entry Operators: Accurate reporting of attendance, schedules and funding Audit Findings/State Complaints (6 findings out of 6 last year) Scheduling in the home after school hours

15 New HHB Program School Year

16 New Program Proposal *Final procedures are being developed in a summer workgroup*Elementary, special standards and intermittent students will continue to be served via itinerant teachers in the home. All secondary students on regular standards will participate in a credit earning (or credit recovery, if needed) curriculum using a virtual learning platform (APEX for High School, Edgenuity for Middle School.) Secondary students who qualify for free and reduced lunch and do not have computers or internet will be provided a loan computer and internet hotspots. The four current Teleclass teachers will become the highly qualified teachers of record for the APEX or Edgenuity program in their content area and will also act as teacher of record for the EBD self-contained students using APEX or Edgenuity Additional course offerings can be accessed through FLVS or Pasco eSchool. K12 may be used on a fee per course basis for unique situations.

17 New Program Proposal *Final procedures are being developed in a summer workgroup*An HHB Compliance Resource Teacher will be designated to assist with complex eligibility staffings, monitoring all HHB students, recommending schedules in line with graduation plans, finding highly qualified itinerant teachers/related service providers, ensuring compliance with IEPs and files. An HHB Case Facilitator (VE Teacher) will be designated to assist with attending complex HHB IEP meetings, developing IEPs for continuing HHB students in the APEX/Edgenuity program, and providing direct ESE supports to secondary students using the virtual curriculum with other exceptionality categories. The HHB secretary will collect all required confidential medical documentation, enter HHB attendance using from program teachers and itinerant timesheets, document eligibility and enter schedules for HHB students in the virtual program.

18 New Program Proposal *Final procedures are being developed in a summer workgroup*For regular standards secondary students: Students who are HHB only will receive instruction via the APEX curriculum with access to four highly qualified teachers to provide support via communication through the computer, phone, webinar and Adobe Connect. Student having additional disabilities and require additional supports in the school setting through support facilitation or behavior support in the school, may receive: Moderate level of support: HHB Case Facilitator (VE Teacher) through communication methods above and possible visits to the home as needed. High level of support: A liaison one hour/week for support for work completion and organization, if data indicates the student cannot be successful through alternate communication modes provided.

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20 Administrator ResponsibilitiesBest Practices for HHB Administrator Responsibilities

21 HHB Wiki Resources http://www. pasco. k12. fl. us/wiki/indexAlways has the most current information/forms Is divided by specific topics for ease of finding information Designates when an administrator or “designee” is responsible Note: A designee is defined as a full-time school based employee appointed by the administrator (e.g., case manager, team leader, department head, secretary).  HHB TIP Use the “printable version” link on the Wiki to print out HHB procedures Meet with your team to identify exactly who will be the designee for each responsibility

22 Current Situation Pasco is finding more students eligible for HHB than like-sized districts: If the team has difficult discussions regarding eligibility during initial conversations, it will decrease the students eligible for HHB, which keeps students in school. Plans are in place to meet with Hillsborough, Pinellas and Hernando to create a consistent HHB application/medical report. Pasco Volusia 261 120

23 When should an HHB medical be provided to a parent?Q&A Initiating HHB When should an HHB medical be provided to a parent?

24 Provide a medical to a parent when:The parent makes a request for a medical. It is known that the student has been hospitalized. The parent informs the school that the student has been absent directly related to a medical/psychiatric condition, and is confined to the home. Example: A student’s anxiety has exacerbated her symptoms of Crohn’s disease. Because she has to use the bathroom at school more often, anxiety has also increased. The student’s medical condition of Crohn’s disease has confined her to the home because of the gastro symptoms, until they can effectively be managed. These symptoms continue into the weekend, and not just during school days. Non-example: A student has anxiety or depression and has been refusing to attend school, but there isn’t a medical reason for not attending. The student participates in other daily activities and the symptoms are not seen on the weekend, so they are not truly confined to the home. A student’s medical/psychiatric condition has resulted in multiple requests for off-campus instruction.

25 Q&A Initiating HHB What should be done when a parent states that absences are due to a medical condition, but does not provide HHB paperwork?

26 When a parent states that absences are due to a medical condition, but does not provide HHB paperwork: The student services team should meet to discuss the student situation. Absences should be documented as excused or unexcused as indicated in the Student Code of Conduct, and truancy should be pursued if criteria are met. If the condition is medical, the school nurse should contact the parent to discuss the condition and ask for a release of records for the physician. If the condition is psychiatric, the school psychologist should contact the parent to ask for a release of records for the psychiatrist. The school social worker should contact the parent and possibly do a home visit to inform the parents that if the appropriate paperwork has not been provided, the student needs to be in school. The school counselor should provide the parent with a copy of the student’s graduation plan and stress the implications of the absences on promotion/obtaining credits.

27 Q&A HHB Eligibility What questions should responsible school staff members ask the physician?

28 If there is a question about the appropriateness of the medical, the school staff should discuss the following, as needed: Is the student truly confined to the home due to the medical condition The accommodations/services that can be provided to the student in the school setting through an IEP or 504 plan (if they already have one in place) The student’s best interest and the effects that being in the most restrictive setting can have on a student’s education HHB is not intended to replicate the school setting and that the student will only be getting limited hours of direct instruction per week The importance of socialization to student growth and development Any unique situations that would warrant HHB, such as changing medications or considering a parental choice of residential placement The anticipated reentry plan to school for the IEP team to consider when developing the IEP

29 Q&A Eligibility Should school refusal due to psychiatric conditions qualify for HHB services?

30 Regarding school refusal, research states:School refusal is different than truancy, because it may be a symptom of a student’s diagnosis. School refusal does not qualify a student for HHB, unless they are truly confined to the home for most activities. School refusal is a description rather than a formal diagnosis. It is often a symptom of other underlying problems. School refusal happens when a child or teen will not go to school at all or frequently experiences severe distress at going to school or is unable to concentrate on learning while in school because of distress about being there. Presenting complaints may include somatic symptoms (that improve if the child is permitted to stay home or leave school early); fear and intense anxiety (sometimes reaching the level of a panic attack); temper tantrums; and crying spells and depressed mood (sometimes with the threat of self harm).  Possible co-morbid psychiatric problems are separation anxiety, social phobia, panic disorder, depression, and generalized anxiety disorder. These problems may complicate school refusal and make a team approach to intervention even more imperative.

31 Regarding school refusal, research states:It is imperative that the physician not request homebound instruction for the child or adolescent school refuser. Longer absence from school is associated with greater severity and prolonging of the symptoms. Absence makes the child temporarily “feel better” and the association between school attendance and pain and discomfort is therefore strengthened.   The goal of treatment should be to facilitate the child returning to normal developmental functioning. The student needs to be able to tolerate normal separation from caregivers without distress or impairment of functioning. The child or adolescent with school refusal should return to school as quickly as is medically and socially possible and consistently attend school without subjective experiencing of distress. Placing the child on homebound instruction is contraindicated because it may prolong the child's symptoms and increase the severity of symptoms because of secondary gain increases (any advantage, as increased attention, disability benefits, or release from unpleasant responsibilities, obtained as a result of having an illness.) Homebound instruction should not be considered the first choice accommodation for the child who refuses school. Rather, it should be considered as an intervention of last resort, and as a means to an end rather than an end in itself. Plans for homebound instruction should include steps to ensure a gradual return to the school or an alternative environment, and should have a time frame for implementation. If the student or family is reporting bullying as the reason for school refusal, it must be reported and investigated.

32 Think-Pair-Share After reading the review of research, think about a school refuser you have had at your school. Discuss this situation and outcome with a partner. Were there any situations that truly required HHB? Why? Were there any situations where the team should have determined the student’s least restrictive environment was the school setting? Were there any situations where the student had difficulty returning to school? Share out your situations and thoughts with the group.

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37 Q&A Eligibility What happens when a team disagrees with a doctor recommendation, even after asking the physician the recommended questions?

38 When a team disagrees with a doctor recommendation:The physician’s medical report is one piece of information that can be considered during a TAD for HHB. If the school has documentation that would justify the student not meeting criteria for HHB, a different level of confinement, or a lesser timeframe, then the team should use this data to make decisions to determine if the student meets eligibility criteria, or the student’s least restrictive environment. The team making a decision against a doctor’s recommendation must include individuals who have knowledge about the medical condition, the meaning of evaluation data and placement options (i.e. nurse, psychologist.)

39 When a team disagrees with a doctor recommendation:The team can reconvene to provide time to speak with the physician and the physician can be formally invited to attend the subsequent meeting. The team must inform the parent that the district will pay for an updated medical evaluation from an approved vendor as an additional piece of data if they are in disagreement with the team’s decision or if more current data is needed to justify the team’s recommendation. A MIS 821 Notice of Denial must be provided to the parent, if the student does not meet eligibility criteria for HHB or if the parent disagrees with the level of confinement. The student is refusing school, but is not confined to the home If the parent wants HHB because the student is failing, but the student is not confined to the home The team should consider the need for a 504 plan and accommodations needed that are related to the medical condition.

40 Responsibilities for Hiring Teachers 2. 5Responsibilities for Hiring Teachers Responsibilities for Hiring Teachers At the beginning of the year, and quarterly, an ad is sent out by SSPS advertising for HHB teachers. Administrators do not have to re-advertise for each HHB position. The process of hiring teachers should take no longer than 10 school days. While attempting to obtain an instructor, the school-based administrator must ensure that the content area teachers send home assignments. It is the student’s and parent’s responsibility to make arrangements to obtain all missing assignments and work that was not completed prior to the staffing. The administrator or designee must ensure that the teachers follow up with the student to make sure all work has been turned in prior to the end of the quarter. Ensure instructional time is provided for any absences after the date that the physician determined the student should not be in attendance (i.e., date the medical is signed) regardless of the date of the HHB staffing.

41 Responsibilities for Hiring Teachers 2. 5Responsibilities for Hiring Teachers Responsibilities for Hiring Teachers For secondary regular standards students, the administrator/designee should provide the new HHB program staff a schedule and outcome of the IEP meeting in writing via . For elementary, special standards or intermittent students who need itinerant teachers, the school- based administrator must find highly qualified teachers by accessing the HHB database, advertising the opportunity to their school and neighboring school staff, and/or placing an ad with Human Resources. If a related service is determined as a need, the case manager must inform the Related Services Supervisor, Glennda McCallister, via a so that a provider can be assigned. If a teacher is still not found after the zoned and neighboring schools have been ed, the HHB database has been searched for highly qualified teachers and they have been contacted, and an ad has been placed with Human Resources, please contact the new HHB program Compliance Resource Teacher.

42 Responsibilities for Hiring Teachers 10 Hospital/Homebound FormsThe school administrator or designee should review the H/HB Instructor Agreement, the HHB Timesheet and the Mileage Tracker with the hired H/HB teacher(s) or other staff who will provide services in the home: Instructor Forms H/HB Instructor Agreement H/HB and OCI Instructor Timesheet Mileage Tracker Link:

43 Using the HHB Database 7 Hospital/Homebound DatabaseOpen FileMaker Pro 13 Select File Select Open Remote If you see as an address under the left hand side "Hosts" box, that is the address for all ESE databases. You can select that and then select "Homebound" which will appear in the "Available Files" box on the right If you do not see the address in the "Hosts" box, you can select "Add" then type it in the "Host's Internet Address" box and name it ESE. Then you can select this on the left and "Homebound" will appear in the "Available Files" box on the right You can also try typing (do not copy and paste) the following address into the "Network File Path" box: fmnet:/ /Homebound For registered administrators: Enter user name as: your name (the part before the lower case letters) Enter your Munis/eSembler/PlanMaker password

44 HHB Database: Finding TeachersSearch by Certification Area Try It! Personnel tab  Certification Area Search tab Enter criteria Select button Select All

45 Responsibilities for Record Keeping 2. 5Responsibilities for Record Keeping Responsibilities for Required Paperwork/Records Each administrator/designee is responsible for using the HHB Database to monitor service provision for elementary, special standards, intermittent and part-time HHB students enrolled in their school and for alerting the HHB secretary if any information needs to be updated (e.g., new teacher, missing students.) The new HHB program staff will monitor services to full-time, secondary, regular standards students.  HHB TIP Use the HHB database to search students by school or to find a specific student.

46 Responsibilities for Record Keeping 2. 5Responsibilities for Record Keeping Responsibilities for Required Paperwork/Records The zoned/school of attendance continues to maintain responsibility for the student receiving H/HB regardless of service delivery models, including: Maintaining all cumulative records, initial or reevaluations, IEP meetings, inclusion in all state/district wide assessments, and notification of all requirements/events and graduation information. The zoned/school of attendance designee must assign a case manager for H/HB student’s enrolled in their school.  HHB TIP Use an Excel spreadsheet to track your HHB students’ service provision.

47 HHB Database: MonitoringSearch by School Try It! Student List tab Find Student Enter school initials

48 HHB Database: MonitoringSearch by School Try It! Student tab Find Student Enter school from drop down Scroll through students using arrow

49 HHB Database: MonitoringSearch by Student Try it! Find Student Type name in Student Name box

50 Example HHB Service Monitoring Spreadsheet

51 Example HHB Status Monitoring Spreadsheet

52 Responsibilities for Grades, Report Cards, & Progress Reports on Goals Responsibilities for Grades & Report Cards Responsibilities for Quarterly Goal Reporting All hospital/homebound students should be receiving report cards at the same time as all other students. The HHB teacher can take these to the home, or they can be mailed by the school. Since HHB students have IEPs, progress reports on goals must be completed at the same time as report cards. HHB teachers can provide input to the student's case manger for developing these reports.  For elementary students, teachers must ask the data entry operator for a blank template to hand- write grades. Copies of report cards must be placed in the student's cumulative folder.  If a student has not had the opportunity to access all standards, they should be given an “I” until the work is completed. Case managers are responsible for ensuring that this has been done. Case managers are responsible for facilitating the collection/blending of grades and ensuring that report cards and progress reports on goals have been provided to the student.

53 Responsibilities for Curriculum Resources 2. 5Responsibilities for Curriculum Resources Responsibilities for Curriculum Resources The administrator must designate classroom teachers to provide the itinerant HHB teacher(s) with textbooks, teachers edition (or access to codes for online textbooks) assignments, tests, etc., that will allow the student to keep up with the curriculum.

54 Responsibilities for Planning and Resuming H/HB Services for the Next School Year 2.6 Responsibilities for Planning and Resuming H/HB Services for the Next School Year For many students, the medical date and IEP do not expire until after the school year has started. During the summer, administrators should review the list of HHB students enrolled at the school for the upcoming year to plan for instruction so that that a break in services does not occur. For secondary, regular standards students, administrators can contact the new HHB program staff during teacher planning week of the next school year to provide the student schedules and discuss recommendations regarding courses they offer. Services should start the same week that school begins for all students.

55 Responsibilities for Articulation 2Responsibilities for Articulation 2.8 Responsibilities for Articulation It is the responsibility of the sending school’s administrator to contact the administrator at the receiving zoned or program school by the district articulation date for all students. Because service delivery for HHB students differs between elementary, middle and high school depending on the student’s schedule, which directly correlates with the minutes of service provided in the home, it is imperative that a IEP meeting be held prior to the end of the school year. The administrator or designee of the sending school will contact the receiving school to invite them and any potential services providers to the IEP meeting, and provide the following information to prepare for the meeting: Student name and contact information Date of expiration of current medical report Student course selection for the upcoming school year Current schedule, service delivery model and actual minutes served Current related services provided Any other pertinent information regarding the family and student

56 Responsibilities for Articulation 2Responsibilities for Articulation 2.8 Responsibilities for Articulation Students who require long-term HHB services for a chronic condition should always be considered as continuations, unless new data is provided and the team meets to consider the information. If the student plans to reenter school because he/she will not continue to meet eligibility for HHB, or his/her confinement level has changed, a reentry plan should be developed to ensure that the proper accommodations are provided and that all restrictions and limitations have discussed and shared with the new teachers and staff.

57 Q&A Reentry What happens when a student wants to return to school prior to the medical expiration date, and the physician will not complete a status update indicating that they are cleared to return to school?

58 When a student wants to enter school without the proper release:For these cases, please contact the supervisor of HHB and Heath Services to facilitate discussions regarding liability and feasibility related to the reentry plan based on the most current educational and medical information available. If updated information is required, the district will pay for an updated medical evaluation from an approved vendor. The parent should be reminded of their right to revoke all ESE services, and the implication of this decision on the student. If the parent would like to revoke ESE services, the supervisor of compliance should be contacted to assist in facilitating the process. The team should consider the need for a 504 plan if the student will be dismissed from HHB.

59 Attendance for HHB 3.1 Attendance for H/HBIt is extremely important for HHB students to attend their scheduled instructional services because they are already getting a limited amount of time compared to students who attend school regularly. If scheduled HHB services are missed frequently, attendance must be addressed in PLS with number of days absent and a statement that attendance is one of his/her priority needs before truancy is pursued. Attendance Code: [B] Hospital/Homebound (H/HB) A new attendance code has been developed to differentiate between time that the student is actually present for services or absent and not receiving services. The [B] code is a placeholder that can only be entered by school Data Entry Operator (DEO) or the HHB secretary once the instructor timesheets have been submitted by the administrator. The [B] code indicates that the student was neither present or absent because they were not scheduled to receive services in the home on that date/time. The [B] code is used by teachers on their timesheets to indicate when they have canceled services, because the student was neither present or absent.

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61 Attendance for HHB 3.1 Attendance for H/HBAttendance Documentation on H/HB Timesheets H/HB teachers must document the provision of H/HB instructional services on the timesheet as follows: [P] The student received instructional services from the H/HB teacher for that date [B] The H/HB teacher cancelled instructional services [M] The parent cancelled the scheduled H/HB instructional services due to a medical reason [U] The parent cancelled the scheduled H/HB instruction for reasons not related to a medical reason, or the parent is refusing services [C] Compensatory services were provided as make up for previous time missed *Note: All efforts should be made to schedule medical appointments during times where regular instruction has not been previously arranged between the family and teacher. If there are repeated absences due to the medical condition, verification of why instruction in the home cannot be tolerated during those times may be requested from the physician. *Note: More than 5 unexcused absences for scheduled services due to parent cancellations should initiate a meeting regarding attendance.

62 Responsibilities for HHB Attendance 3.1 Attendance for H/HBIt is the administrator's responsibility to monitor the provision of services by reviewing timesheets. If timesheets are not being submitted by HHB teachers, the attendance will not be accurate and it may indicate that the teacher is not seeing the student for the courses scheduled. Using the timesheets to monitor attendance will assist in identifying if a student is receiving the services as determined on the IEP. Once the timesheet is signed by the administrator, a designee must provide a copy to the data entry operator to update attendance, place a copy of the timesheet in the student’s red folder, and submit the original timesheet to the SSPS HHB Secretary via courier or fax at

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64 HHB Frequency ★ New Definition of Intermittent ★Students who qualify for intermittent services must have a physician document that they will be out off school due to their medical condition for periods of consecutive days that would result in the student not being able to obtain meaningful benefit from their free appropriate public education (FAPE.) Although a medical report is obtained annually for HHB eligibility for up to 12 months, a status update must be obtained from an intermittent student’s physician for each intermittent period. This status update must indicate the recent date that the student was assessed by the physician since the previous IEP meeting and the dates that the intermittent period starts and is expected to end, so that HHB services can be initiated. For students who are not expected to be out of school for a designated period of consecutive days, medical absences will be excused and students are able to make up work missed as indicated in the Student Code of Conduct.

65 Responsibilities for Assessment 3.9 State and District AssessmentsEach school administrator will schedule who will administer the test to students in the H/HB program on a case-by-case basis. Students who can tolerate a short period of time at school based on their medical condition (including full-time) are encouraged to take the test in the school setting. If teams are unsure if testing in the school is appropriate, the school nurse can contact the physician who signed the medical to discuss restrictions or limitations. If the student is unable to come to the school, testing needs to be coordinated by the school administrator with the testing coordinator and a teacher(s) will be assigned to administer each individual test. Teachers who are familiar with the student and/or teacher the student that course should be the first consideration. If teachers are not available for testing after hours, the administrator could obtain a sub for their classroom and send the student’s teacher to the home during the day.

66 Responsibilities for ESY 3.10 Extended School Year (ESY)ESY can be provided in the student’s least restrictive environment, which would include the home if appropriate. ESY procedures for HHB students are the same for all ESE students, but itinerant instruction must be indicated on the ESY paperwork. After Spring Break, the case manager should review the list of HHB students on their caseload and collaborate with HHB teachers serving the students to review data in regards to consideration of ESY services.

67 Responsibilities for Compensatory 3.11 Compensatory ServicesCompensatory services may be provided to a student who has missed instruction due to medical absences or unintended gaps in services. Compensatory services are calculated based on the number of absences from the date the medical report was signed. All compensatory instruction should be made up as soon as possible, but before the end of the quarter. If missed time can not be made up by the end of the quarter, the remaining compensatory hours will must be approved by the H/HB supervisor. If a student’s medical expires or he/she is dismissed from HHB, but are still owed compensatory instruction, a teacher may still provide the hours in the home when the student has returned to school. Compensatory services are not provided for student absences that are not related to the medical condition on the medical report. For unique situations, contact the HHB supervisor to problem- solve.

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71 Other HHB Considerations8 Other Hospital/Homebound Considerations 8.1 Hospital/Homebound and Participation in After School Activities 8.2 Hospital/Homebound for Pregnant Students 8.3 Hospital/Homebound Students Hospitalized in Other Districts

72 Summary of Best Practices for HHBAlways monitor the provision of HHB services. Always reconvene the team if there are any issues or if the student is not making progress. Always consider reevaluation if there is a suspected need beyond what is being provided or a 504 if accommodations are needed. Always document by taking detailed notes of IEP team discussions. Always inform through a team meeting and proper notices before action is taken. Always contact the HHB Program Supervisor for questions related to unique situations.

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74 HHB Contact Information Hospital/Homebound Contact Information HHB Supervisor: Jennifer Hykes HHB CRT: Sandi Edwards HHB Secretary: Dionne Taylor HHB Bookkeeper: Andrea Jackson For any questions regarding H/HB: 42852 To submit any paperwork to SSPS via fax: 42117