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School reentry services for students with chronic health conditions: An

examination of regional practices

Article in Psychology in the Schools · July 2018

DOI: 10.1002/pits.22154

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Ethan J. Schilling Yvette Q. Getch

Western Carolina University University of South Alabama
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Received: 15 November 2017 Revised: 13 May 2018 Accepted: 6 June 2018

DOI: 10.1002/pits.22154

RESEARCH ARTICLE

School reentry services for students with chronic

health conditions: An examination of regional
practices
Ethan J. Schilling1 Yvette Q. Getch2

1 Department of Psychology, Western Carolina

University, Cullowhee, North Carolina Abstract

2 Department of Counseling and Instructional Students experiencing chronic health difficulties represent a grow-
Sciences, University of South Alabama, Mobile, ing population in public schools. Given the unique challenges faced
Alabama by these students including increased absences, resulting academic,
Correspondence and social/emotional/behavioral deficits, it is vital that schools are
Ethan J. Schilling, Department of Psychology,
Western Carolina University, 91 Killian Building
prepared to adequately meet their needs. One of the sometimes
Lane, Room 302B, Cullowhee, NC 28723. daunting tasks faced by these students and their families is the
Email: [email protected] school reentry process, which occurs when the child returns to
Funding information school following an extended period of time away. The purpose
Western Carolina University, Grant/Award
of the current study was to identify and evaluate the extent to
Number: 222906
which these services are currently being provided within school dis-
tricts across a large Southeastern state. Results demonstrated that,
although schools reported proficiency in the provision of formal
school services, adherence to other best practices in school reen-
try, namely establishing multidisciplinary school reentry teams led by
an appointed liaison, developing school reentry protocols and sub-
sequent individualized reentry plans, sharing information with the
student's peers, and formally assessing the student prior to or upon
reentry, was lacking. Implications for schools and areas for future
research are also discussed.

KEYWORDS
pediatric school psychology, school reentry, students with chronic
health conditions

1 INTRODUCTION

Children and adolescents with chronic health conditions (e.g., cancer, diabetes, traumatic brain injury, etc.) repre-
sent a rapidly growing population of public school students. Indeed, research suggests that 10–30% of school age
children will experience a chronic illness significant enough to represent a limitation in school functioning at some
point during their education (Canter & Roberts, 2012). These students often face extended time away from school,
which can lead to a host of negative schooling outcomes including general learning and academic deficits (Wodrich &

Psychol Schs. 2018;55:1027–1040. wileyonlinelibrary.com/journal/pits © 2018 Wiley Periodicals, Inc. 1027

1028
2 SCHILLING AND GETCH S

Cunningham, 2008), difficulties maintaining relationships with peers (Kaffenberger, 2006), and problems readjusting t
to the school environment as they return to school (Khan, 2004). Unfortunately, few universal established guidelines D
exist in meeting the unique needs of students experiencing chronic health difficulties upon school reentry (Annett f
& Erickson, 2009). Complicating the development of universal guidelines is the variability of student needs that are c
present as a result of chronic illness. Even students with the same diagnoses may require vastly different supports s
based on the progression and severity of their condition as well as interpersonal and intrapersonal factors (Worchel- 2
Prevatt et al., 1998). However, it is likely that students with chronic illness will need similar services and supports but
may differ in the intensity of supports, length of time supports are needed, and the speed at which supports are tapered c
(Canter & Roberts, 2012). Although some agreement exists in the literature speaking to the potentially necessary com- w
ponents of an effective school reentry experience for students, “an evidence-based standard of care has not yet been e
established” (Thompson et al., 2015, p. 2). r
In recognizing this fact, the purpose of this study was to examine the current nature and adequacy of services pro- p
vided to students in public schools across a large Southeastern state. Results of this study will hopefully serve as a 2
springboard for the future development of effective, evidence-based school reentry protocols and training materials a
for school districts across this state and beyond. r
f
(S
1.1 What is school reentry?
b
School reentry refers to the return to school and reintegration into the school setting following diagnosis, prolonged s
hospitalization, and/or general time away from school for children who have been chronically sick or injured. The school
reentry process is often stressful for the student and his/her family due to a variety of reasons. Students often expe-
rience some level of anxiety about returning to school and keeping up with the school work missed while they were
away (Dockett, 2004; Herrmann, Thurber, Miles, & Gilbert, 2011; Yi, Kim, Hong, & Akter, 2016). Chronic conditions 1
can cause changes to the student's physical appearance (e.g., loss of hair following treatment for cancer), which may O
lead to concerns related to standing out from others and fitting in with one's peer group (Badger, 2008; McLoone, d
Wakefield, & Cohn, 2013). Furthermore, families might be unsure of whether the school system can adequately meet c
their child's changing needs and the new challenges faced as a result of a chronic health difficulty (Shiu, 2004; Vaidya, c
2002). Given such concerns, it is vital that schools have adequate supports in place for these students and their families t
as they return to school. s
u
1.2 Best practices in the provision of school reentry services e
id
Although a comprehensive standard of care in the provision of school reentry services to students is lacking (Thomp-
2
son et al., 2015), several components have been identified as integral for a more positive and successful reentry experi-
ence for students and families experiencing chronic health difficulties. Many researchers have acknowledged the fact
in
that the identification of appropriate school reentry services should be driven by the needs of students, families, and
s
schools themselves (Canter & Roberts, 2012). As such, the following components of school reentry are typically valued
w
by families and the schools that serve these students when they return to school in ultimately leading to an effective
s
school reentry experience: (a) frequent contact with the student's family while the student is out of school including the
(G
provision of interim services, (b) the development of school reentry plans, (c) sharing appropriate information regard-
in
ing the child's health condition with school staff and the student's peers, (d) the provision of services in the form of IEP
f
and 504 plans including frequent progress monitoring, and (e) open communication between all involved parties (e.g.,
c
school, family, and medical professionals) (Canter & Roberts, 2012; Kaffenberger, 2006; Schilling & Getch, 2012).
o
v
1.2.1 Provision of interim services o
Planning for eventual school reentry should begin immediately upon recognition that the student will face an extended t
absence as a result of their chronic health condition (Kaffenberger, 2006). Moreover, past research has shown that t
if the school reentry process becomes delayed for the student experiencing a chronic health difficulty, the student is w
H SCHILLING AND GETCH 1029
3

g then more likely to experience difficulties upon their return including reduced access to inclusive education (Ballard &
s Dymond, 2016). The beginning stages of this process, at the very least, should include making contact with the student's
t family to assess the level of family support needed while the child is away, informing the family of school services that
e can be implemented before their child returns to school (e.g., homebound instruction), and notifying them of potential
s services their child might be entitled to as he/she returns to the school setting (Kaffenberger, 2006; Shaw & McCabe,
- 2008).
t Given the recent shift in focus toward more outpatient-oriented methods of treatment for children experiencing
d chronic health difficulties, Shaw and McCabe (2008) argue that the burden is often placed on the family and school to
- work together to ensure that interim services provided to the child before he/she returns to school are adequately
n established. Such services often take the form of homebound instruction, particularly if it is clear the student will
require supplemental instruction while away so as not to fall too far behind from grade-level peers academically. To
- provide such services most effectively, it is important that potential barriers are addressed (Shaw, Clyde, & Sarrasin,
a 2014). This includes ensuring interdisciplinary communication occurs and all involved parties are optimally informed
s about what will occur during the student's homebound instruction, the student's school system has specific policies
regarding the provision of homebound services, teachers are supportive of the homebound instruction that occurs,
families are actively included in this process, and that technology (e.g., online instruction) is utilized when necessary
(Shaw et al., 2014). Results from past research have shown that students and parents themselves often perceive home-
bound instruction as a vital component of reentry (Boonen & Petry, 2012), further speaking to the importance of these
d services.
ol
-
e
s 1.2.2 Development of school reentry plans
y Once initial contact has been made with the student's family and interim services have been established, it is vital to
e, develop a plan for reentry initially establishing a timeline for when he/she will return to school and any areas of signifi-
t cant need to be addressed upon reentry (i.e., to account for current difficulties the student is facing as a result of their
a, chronic health condition). Although it is to be expected that the information included in this plan will vary based on
s the individual needs of the student (McAvoy, 2012), researchers have advocated for school systems to adopt general
school reentry protocols that can provide some guidance on the general process to follow in planning for the individ-
ual reentry of students (Canter & Roberts, 2012). Additionally, while the individualized reentry plans for each student
experiencing time away from school often vary, several recommendations for what to include in these plans have been
identified in the school reentry literature (Clemens, Welfare, & Williams, 2011; Goldkind, 2011; Hopkins & Hughes,
-
2016; Lurie & Kaufman, 2001).
-
Although a comprehensive set of best practices in the provision of school reentry services for students experienc-
t
ing chronic health difficulties does not exist (Canter & Roberts, 2012), more is known regarding the information that
d
should be included in school reentry plans, particularly when drawing on the literature not only related to students
d
with chronic physical health difficulties (Hopkins & Hughes, 2016; Lurie & Kaufman, 2001; McAvoy, 2012) but also to
e
students returning to school from prolonged psychiatric hospitalization (Clemens et al., 2011) and from incarceration
e
(Goldkind, 2011). Researchers across these areas appear to agree that the following components should be included
-
in the development of an effective school reentry plan: (a) input provided by schools, families, and other agency pro-
P
fessionals with which the student is involved (e.g., medical professionals overseeing the child's care), (b) clear identifi-
.,
cation of the student's learning needs, (c) clear identification of the student's social–emotional needs, (d) identification
of other factors requiring attention such as any physical limitations, (e) determination of the availability of needed ser-
vices, (f) recommendations including interventions to implement as the child returns to school, and finally (g) plans for
ongoing review of the student's progress (Canter & Roberts, 2012). While some have argued that planning can occur
d through other means including the development of IEP, 504, or Individualized Health Plans (Hopkins & Hughes, 2016),
t the development of a school reentry plan is an important first step in providing an overview of the reentry process that
s will occur for the student.
1030
2 SCHILLING AND GETCH S

1.2.3 Sharing of information

f
Before the child experiencing a chronic health condition returns to school, it is important that individuals at the school
a
are informed about the child's condition, including the role various professionals can play in supporting the student in
e
his/her reentry. This is especially vital given that school staff often do not understand the unique needs of students
d
dealing with such difficulties (Barkon, 2009). Additionally, children with chronic health conditions, particularly those
c
experiencing an altered physical appearance as a result, are at an increased risk for peer rejection and feelings of social
e
isolation when returning to school due to a lack of understanding among their classmates (Worchel-Prevatt et al., 1998;
a
Yi et al., 2016). Thus, it is crucial that all stakeholders are provided with information about the child's condition before
t
reentry occurs.
2

Sharing information with staff 1

Most school reentry programs designed for students with chronic health problems include some element of edu- T
cating teachers and other staff about the child's condition (Canter & Roberts, 2012). This can take many different a
forms including standalone workshops (Prevatt, Heffer, & Lowe, 2000), inclusion of presentations within the school's 2
in-service training schedule (Herrmann, Thurber, Miles, & Gilbert, 2011), videoconferencing (Spaulding, Davis, & t
Patterson, 2008), or more informal methods of sharing information (i.e., in dispelling myths among staff about the K
child's condition; Worchel-Prevatt et al., 1998). Results from past research regarding the outcomes of such staff train- r
ings portray large effect sizes for increasing knowledge and attitudes of teachers about the student's condition (Canter e
& Roberts, 2012), which in turn can help to lead to a more positive reentry experience for the student. p
N
d
Sharing information with peers
(S
It is equally important that the child's peers are adequately prepared for his/her return to school. According to
t
Badger (2008), presentations made to the child's classmates should include both generic and individualized informa-
e
tion regarding the student's condition with a particular focus on promoting empathy and understanding about the
in
disease process that the child has gone through (e.g., causes, hospitalization, recovery, and subsequent effects). Most
s
agree that it is also important to take the developmental level of peers into account when deciding on the best format
c
for delivery of this information (Badger, 2008; Canter & Roberts, 2012; Kaffenberger, 2006). For example, puppets
u
or other engaging materials might be utilized in the presentation of information to younger children (Badger, 2008),
a
whereas information might be best delivered within the context of science classes to emphasize the medical compo-
nents of illness or in homeroom to emphasize social aspects for adolescent peers (Kaffenberger, 2006). Past research
has portrayed medium effect sizes for increasing knowledge and attitudes of peers when a peer education component 1
is included in the school reentry process (Canter & Roberts, 2012). Before information about the student is shared,
A
parental permission to do so must be obtained. Additionally, it is preferable for the student and his/her parents to be
s
involved in deciding what information and the extent to which this information is shared.
s
e
1.2.4 Formal school services
r
When the student returns to school, it is vital that school services are in place that he/she might require in light of s
any newly presenting challenges or academic deficits. If the student is deemed to have a condition directly impeding
his/her educational progress and is subsequently eligible for the receipt of special education services, these services
can be provided through the development of an Individualized Education Plan (IEP), a plan jointly developed by the
2
student's teachers, parents, other related educational staff, and, in some cases, the student him-/herself to identify
needed educational supports. More often, a 504 plan is developed providing the student access to any needed accom-
2
modations with the purpose of removing any barriers to progress within the general education setting (Hay, Nabors,
Sullivan, & Zygmund, 2015). Unfortunately, schools sometimes lack the knowledge and resources to best serve these P
students, resulting in inappropriate placement decisions (i.e., as Other Health Impaired), which might be unnecessary s
and overly restrictive for some students (Irwin & Elam, 2011). s
H SCHILLING AND GETCH 1031
3

As with all students, a formal process should be followed to determine whether students with chronic health dif-
ficulties are eligible for related services. This process should include the completion of a thorough psychoeducational
ol
assessment of the child, determination of eligibility, and developing, implementing, and reviewing the child's IEP (if
n
eligible for Special Education Services). Reassessment should be completed as necessary (Carney & Porter, 2009). A
s
determination of what method of service delivery is most appropriate for the child (e.g., within the special education
e
classroom, inclusion classes, pull-out services, etc.) should also be made at this point (Carney & Porter, 2009). Students
l
experiencing chronic health conditions often benefit from related services such as counseling or other supportive ther-
;
apies, physical accommodations often provided through a 504 plan, individualized accommodations and/or modifica-
e
tions, and school health services outlined in an Individualized Health Plan (Carney & Porter, 2009; Hopkins & Hughes,
2016).

1.2.5 The importance of open communication

- Throughout the school reentry process, it is important for schools to ensure that open communication occurs between
t all involved parties including school staff, families, and the medical community involved in the child's care (Goldkind,
s 2011; Helms et al., 2016; Moore, Kaffenberger, Goldberg, Oh, & Hudspeth, 2009). Previous research has demonstrated
& that these open dialogues are more likely to occur when a school–home–hospital liaison is appointed (Botcheva, Hill,
e Kane, Grites, & Huffman, 2004; Helms et al., 2016; Moore et al., 2009; Schilling, 2014). The individual serving in this
- role should take a three-pronged approached in the coordination of potentially beneficial services to students experi-
r encing chronic health difficulties. First, he/she can consult with medical staff involved in the child's care to determine
presenting areas of weakness that might affect school performance (Schilling, 2014; Worchel-Prevatt et al., 1998).
Next, the appointed liaison can work with the student's family to gain a better understanding of the child's current
developmental level as well as any concerns related to his/her adaptation to or ability to cope with his/her condition
(Schilling, 2014; Worchel-Prevatt et al., 1998). Finally, the individual serving in this role can help to provide information
o
to teachers, school staff, and the child's classmates to dispel any myths regarding the student's condition and to better
-
educate them about his/her situation (Schilling, 2014; Worchel-Prevatt et al., 1998). Although the individual serving
e
in this liaison role may vary as a function of the staff structure within particular districts, many have argued that the
t
school psychologist is well equipped to take on this duty given particular background knowledge and training in psy-
t
chological/educational consultation (Schilling, 2014; Shields, Heron, Rubenstein, & Katz, 1995). Despite the potential
s
usefulness of such a model in facilitating the school reentry process, parents sometimes report lack of communication
),
as a significant barrier to the implementation of school reentry services (Moore et al., 2009).
-
h
t 1.3 Purpose of the current study
d,
Although much has been written related to the components to be included in an effective school reentry process for
e
students experiencing chronic health difficulties, less is known about the extent to which this process is followed by
schools. Furthermore, results of a more recent study examining school reentry services provided to students experi-
encing traumatic brain injuries indicated that these children received only 51% of recommended services related to
reentry (Ennis et al., 2013). Thus, the purpose of the current study was to examine the extent to which these reentry
f services were being provided in a regional sample of school districts across one large Southeastern state.
g
s
e
2 METHODS
y
-
2.1 Participants
s,
e Participants in the current study consisted of 43 Directors of Exceptional Children's (EC) Services representing public
y school districts across a large Southeastern state, which resulted in a 37% response rate. Although many different
school employees may be involved in the provision of school reentry services to students experiencing chronic
1032
2 SCHILLING AND GETCH S

TA B L E 1 Percentage of EC directors reporting level of access to school and community resources 3

Low Medium High
Academic resources 11.6 55.8 32.6
T
r
Social–emotional–behavioral resources 44.2 46.5 9.3
Medical care 7.0 90.7 2.3

health difficulties, EC directors were surveyed in the current study as the overall coordinators of these services. E

Participants also had the option to denote whether other individuals contributed to the completion of the survey in

including EC and General Education teachers, school psychologists, school counselors, and school nurses. However, w

less than 1% of respondents indicated that these individuals were consulted in providing responses. Participants t

reported working mostly in rural districts (84%), whereas fewer characterized their districts as urban (9%) or sub- s

urban (7%). The sizes of districts worked in by EC directors ranged from districts including two to three schools t

to 20 or more schools. Most (94%) participants surveyed indicated that at least 50% of students in their districts t

are eligible for free or reduced lunch programs. Participants were also asked to characterize the level of access to
academic resources, social–emotional–behavioral resources, and medical care for students within the schools and
communities in which they work. A summary of participants’ responses to these latter three questions can be found in 3
Table 1.
T
im
2.2 Measures t
v
2.2.1 School reentry questionnaire
h
A School Reentry Questionnaire was developed for the purpose of the current study to collect information regarding a
current procedures utilized by districts in the provision of services to students experiencing chronic health difficulties e
as they returned to school. This questionnaire was developed by the researchers due to the lack of a validated compre-
hensive measure of these services in the current school reentry literature. The questionnaire consisted of 31 questions
and took participants approximately 15–20 minutes to complete. In supporting the initial face validity of the question-
3
naire as a measure of school reentry services utilized within schools, items were included due to the support given to
each of these components as important predictors of an effective reentry process for students. Questions on this sur- P
vey included basic demographic characteristics of districts (e.g., district setting and size, level of access to resources, h
population of students served) as well as more specific questions regarding current methods utilized in the school a
reentry process for students experiencing chronic health difficulties in their schools. Questions related to school reen- d
try practices included any prior training received, particular accommodations and modifications typically provided to o
students with chronic health problems including the provision of IEP and 504 plans, the presence of structured school w
reentry protocols and plans, level of contact with the family and relevant others when the child is out of school, shar- t
ing of information with school staff and other students regarding the child's condition, the nature of school reentry v
meetings, and assessment and subsequent progress monitoring of the child with a chronic illness as he/she returns to u
school. Although an initial estimate of internal consistency among these items was found to be low (𝛼 = 0.60), it should a
be noted that the sample size utilized in the current study was fairly low and resulting analyses were largely qualitative s
in nature. a
r
r
2.3 Procedures
t
The current study was approved by the institutional review board at the first author's institution. In the Spring semester b
of the 2015–2016 school year, a school reentry questionnaire was sent out to directors of Exceptional Children's Ser- h
vices representing all 115 school districts across one Southeastern state. Online questionnaires were designed in and li
delivered via Qualtrics. Data from resulting completed questionnaires was analyzed using SPSS. r
H SCHILLING AND GETCH 1033
3

3 RESULTS

To determine the current nature of school reentry services being provided across school districts, participants’
responses to questions regarding the extent of current services were examined.

3.1 Previous training received regarding students with chronic health conditions

s. EC directors were asked to indicate whether individuals working in their districts had previously received any train-

y ing related to the needs of students with chronic health conditions. Participants could indicate whether this training

r, was received at the undergraduate/graduate level, as professional development, in the form of in-service training, or

s through conversations with parents of children experiencing chronic health difficulties or medical professionals. Fifty-

- six percent of participants indicated that they had not received any training regarding working with these students

s thus far. Of those who reported having obtained some level of training around these issues, 72% of participants noted

s that this training was mostly to very effective.

o
d
n 3.2 Chronic health conditions seen in schools
To determine the appropriateness of services currently being provided in schools, the researchers believed it was
important to get a sense of the most common chronic health conditions typically identified in the student body within
the districts surveyed. That is, it is reasonable to believe that the types of school reentry services provided might
vary as a function of the severity of student conditions encountered and resulting time away from school. The chronic
health conditions most often identified by EC directors as encountered in students within their schools represented
g a fairly diverse range of disease severity and included asthma, diabetes, cerebral palsy, traumatic brain injury, and
s epilepsy.
-
s
-
3.3 School reentry services typically provided
o
- Participants were also asked to indicate what school reentry services are typically provided to students with chronic
s, health conditions in their districts during their time away and then as they return to school. That is, participants were
ol asked to respond to a series of more specific questions regarding the types of school reentry services provided to stu-
- dents within their respective districts. Regarding the provision of formalized services to students, 93%, 98%, and 100%
o of EC directors surveyed indicated that students with chronic health conditions in their schools are typically provided
ol with IEPs, 504 Plans, and Individual Health Plans, respectively. Within the context of these plans, EC directors noted
- that classroom and testing accommodations, extra time for assignments, supportive counseling, and homebound ser-
y vices were provided most often. Participants also responded to questions asking whether the following procedures,
o usually thought to be predictive of a more effective school reentry experience, were typically followed: development of
d a school-wide school reentry protocol, assignment of a school–home–hospital liaison, information shared with school
e staff, information shared with student's peers, school reentry meeting held, development of individualized reentry plan,
and formal assessment as well as subsequent progress monitoring of the student upon reentry. The most commonly
reported school reentry services currently being provided by districts included sharing information with school staff
regarding the child's condition, establishing contact while the child is away from school, providing homebound instruc-
tion, and holding a school reentry meeting before the student returns to school. School reentry services reportedly
r being provided less frequently included formally assessing the child upon reentry, informing the student's peers about
- his/her condition, using school reentry protocols and/or developing formalized school reentry plans, and appointing a
d liaison to help coordinate services. More specific information regarding whether each of these components was cur-
rently being utilized within the school districts surveyed can be found in Table 2.
1034
2 SCHILLING AND GETCH S

TA B L E 2 Percentage of EC directors reporting the provision of school reentry services m

Typically provided? in

Yes No
d
School reentry protocol 43.6 56.4
f
Liaison appointed 56.4 43.6
s
Contact with family while child is away 90.7 9.3
f
Contact with medical professionals 74.4 25.6
(
Homebound Instruction 88.4 11.6 ip
Information shared with school staff 97.4 2.6 f
Information shared with peers 28.2 71.8
Reentry meeting held 84.6 15.4 s
Reentry plan developed 50.0 50.0 d
Formal assessment upon reentry 17.1 82.9 s
Student progress monitored 85.7 14.3 d
t
r
p
4 DISCUSSION w
a
Exceptional Children's Services Directors in the current study were asked to respond to a series of questions regard- t
ing the nature of school reentry services provided by the school districts in which they work. First, it is reasonable to p
believe that optimal services would be provided to these students if Directors are aware of their unique needs in the
form of previous training received. Only 44% of respondents indicated that they had received training in the past spe- p
cific to meeting the needs of students experiencing chronic health difficulties, with a majority (72%) of those who had b
received such training indicating some level of effectiveness. These findings are consistent with results from previous p
studies indicating that individuals working in schools often lack the requisite knowledge to best serve the needs of stu- t
dents experiencing chronic health conditions (Ball & Howe, 2013; Barraclough & Machek, 2010; Duggan, Medway, & is
Bunke, 2004). Furthermore, findings indicate the need to provide further training to school staff at the in-service level H
around issues related to students with chronic health problems in schools. Fortunately, previous research has demon- o
strated that these trainings can be helpful in increasing knowledge within the school community (Thiess & McAllister, t
2001). Implementing educational in-service programs to increase the knowledge level of school staff regarding chronic s
illness, school reentry services to support students with chronic illness, and the impact of chronic illness on children
who have experienced time away from school is likely to improve school staff knowledge and understanding, as well s
as to increase the implementation of appropriate support services for these students. Administrators should provide ic
school personnel with training specific to the chronic health conditions present within their particular school system. c
Targeted training addressing the chronic illnesses present allows school personnel to more effectively meet the spe- b
cific needs of students within their school. With telehealth becoming a more common practice, schools might consider in
the use of videoconferencing or other forms of online training to provide school staff with the requisite information d
needed to provide more effective supports for students with chronic health conditions. These kinds of trainings offer S
flexibility for staff, can be more cost effective than face to face training, and have also shown promise with regard to
increasing general knowledge about chronic illness (Spaulding et al., 2008).
4
Participants were also asked to indicate the types of chronic health conditions witnessed most often within their
student body. EC directors noted asthma, diabetes, cerebral palsy, traumatic brain injury, and epilepsy as the most com- A
mon health-related concerns seen in their students. This is largely consistent with previous literature regarding the f
incidence of chronic health conditions in schools (Barraclough & Machek, 2010). In contrast, other studies have indi- e
cated a higher population of students with cancer in schools requiring the implementation of school reentry services o
(Canter & Roberts, 2012). Although EC directors in our current study did not report cancer as among the most com- le
H SCHILLING AND GETCH 1035
3

mon health-related concerns, it must be noted that provisions for students diagnosed with cancer should be included
in preservice or in-service training programs to most effectively meet the needs of these students.
Regarding the nature of school reentry services currently being provided by school districts surveyed, most EC
directors indicated that students experiencing chronic health problems in their schools are typically provided with
formalized services in the form of IEP (93%) or 504 Plans (98%). All EC directors surveyed (100%) reported that these
students are provided with Individualized Health Plans. Given these findings, it is apparent that districts are currently
following the recommendation that students are provided with formal school services at some level following reentry
(Ballard & Diamond, 2016; Hopkins & Hughes, 2016; Shaw & McCabe, 2008). Within the context of these plans, partic-
ipants indicated that students are most often provided with the following accommodations/modifications: extra time
for assignments, hospital–homebound services, and classroom/testing accommodations.
Perhaps surprisingly, only 17% of Directors stated that students experiencing chronic health problems in their
schools are formally assessed upon reentry with the purpose of informing plan development. As cognitive and aca-
demic profiles of these students can vary, sometimes quite significantly, postdiagnosis, this can often be an important
step informing the school reentry process (Carney & Porter, 2009; Lurie & Kaufman, 2001). Furthermore, most EC
directors (85.7%) reported that the progress of these students is monitored at least monthly and is consistent with
the recommendation that frequent reassessment procedures occur post-reentry (Carney & Porter, 2009). Although
reported services delivered in these ways appear to be adequate, a further question was not asked regarding how
placement decisions in establishing services were made beyond relying on assessment data. In addition, participants
were not asked to identify the methods typically used to monitor the progress of students and whether resulting data
are used to modify plans for students. Therefore, the question of the appropriateness of these placements, which some-
- times can be questionable for these students (Irwin & Elam, 2011), as well as continued adjustments made to these
o placements could not be answered.
e Participants were also asked whether their district utilizes a school reentry protocol in guiding the school reentry
- process for students as well as whether school reentry plans are developed for students when needed. Answers to
d both of these questions were fairly consistent with 44% of respondents indicating their districts use a school reentry
s protocol and 50% noting they develop school reentry plans for students. In contrast, 85% of EC directors responded
- that a specific school reentry meeting is held for these students in which plans for the student's reentry are discussed. It
& is then reasonable to believe that these plans might be included as part of the student's IEP, 504 Plan, or Individualized
el Health Plan when these are developed and discussed in these meetings (Hopkins & Hughes, 2016). Despite inclusion
- of this information in the student's IEP, 504 Plan, or Individualized Health Plan, many have argued for the merits of
r, the development of a stand-alone reentry plan to guide the overall reentry process including discussions occurring
c specifically around the development of this plan (Canter & Roberts, 2012).
n Finally, related to the level of communication that typically occurs between schools, families, and medical profes-
l sionals responsible for the child's care, a little over half (56%) of the EC directors surveyed noted that a liaison is typ-
e ically appointed to facilitate this communication. Although 93% of participants indicated that information about the
m. child's condition is shared with school staff, only 28% noted that information is shared with the child's peers. It might
- be that schools surveyed are resistant to share this information with other students given the sensitive nature of this
r information; however, many have emphasized the importance of doing so in order to dispel myth about the child's con-
n dition and to reduce stigma for the student when he/she returns to school (Canter & Roberts, 2012; Helms et al., 2016;
r Schilling & Getch, 2012; Shaw & McCabe, 2008).
o

4.1 Limitations and future directions

r
- Although results of the current study add to the literature base regarding the extent to which best practices are being
e followed by schools in the provision of school reentry services to students with chronic health problems experiencing
- extended time away from school, several limitations must be noted. First, data were collected from a regional sample
s of directors of Exceptional Children's Services in largely rural districts across one Southeastern state. It is therefore
- less clear whether findings would be generalizable to schools and districts in other areas of the country or in more
1036
2 SCHILLING AND GETCH S

urban/suburban settings. Additionally, the response rate for those who completed questionnaires was fairly low (37%). T

Future research should continue to examine the extent of these services in more geographically diverse and wider-
ranging samples. Second, although the school reentry questionnaire developed for the current study was thought to
represent a valid measure of school reentry services utilized in schools, the internal consistency of included items was
deemed to be fairly low (𝛼 = 0.60). It is hoped that further evidence for this questionnaire as a sound measure of school
reentry services can be established as it is used in larger samples of participants. Finally, it should be recognized that EC
directors in the current study were asked to self-report the extent to which school-reentry services are currently being
provided in their school districts. Given the inherent bias in using such self-report methods, future research would
benefit from incorporating an examination of school records as a method of verifying this information.

4.2 Implications for schools

As children experiencing chronic health difficulties represent a growing population of students in schools, it is neces-
sary that individuals within the school system are aware of the unique challenges these children face, particularly as
they return to school following extended absences. Additionally, school personnel must recognize the individual nature
of student needs based upon their condition, prior and present functioning level, disease progression, treatments and
medication side effects, and other factors impacting successful school reentry. Just as with IEPs, the school reentry
plan must be individualized to meet the unique needs and circumstances of the student.
Results of the current study indicate that schools appear to be adequate in the provision of formalized services to a
these students when required and in following a basic process for reentry. However, other necessary aspects of this
process appear to be lacking including creating a multidisciplinary team (Deidrick & Farmer, 2005), appointing a liaison
(Helms et al., 2016), utilizing a school reentry protocol followed by the development of an individualized school reentry
4
plan (Canter & Roberts, 2012), and formally assessing the student prior to or immediately upon school reentry (Carney
& Porter, 2009). F
s
a
4.2.1 Forming multidisciplinary teams
m
The multidisciplinary team should include a variety of professionals who bring expertise to the table along with t
the child's family. Potential members of the team may include the child, the child's siblings, the parents/guardians, e
school counselor, school nurse, school social worker, school psychologist, special education teacher, regular education A
teacher(s), administrator, occupational, physical, recreation, and/or speech therapists, physician or nurse practitioner, t
or other professionals and significant others who can provide important information and support for the child's return li
to school (Deidrick & Farmer, 2005). An appointed liaison could serve as a point of contact in the sharing of informa- t
tion between all involved parties, sharing information with the student's peers, developing and maintaining a formal t
school reentry plan, and formally assessing the child upon reentry. The authors believe that many of these shortcom-
ings can perhaps be addressed most efficiently by ensuring that a liaison is appointed as this individual can help to coor-
dinate and ensure that an optimal school reentry process is followed for all students. Additionally, an appointed liaison
5
would be in a pivotal position to facilitate communication between all parties while helping to establish a seamless
reentry process. Although the individual serving in this role may vary depending on the staff structure within particu-
A
lar schools/districts, it is the authors’ purport that the school psychologist is an ideal liaison given advanced training in
t
psychological and educational consultation.
q
d
4.2.2 Utilizing a school reentry protocol in guiding the reentry process s
The development of a school reentry protocol is vital because it provides a structure whereby action can take place p
immediately upon notification that a student is likely to miss school for an extended period of time, thus warranting the t
development of a school reentry plan and the subsequent provision of services. A proposed school reentry protocol v
is provided by the authors in Table 3 and is drawn from the previous literature regarding what students, families, and
schools often report to be the most helpful steps to follow in this process. p
H SCHILLING AND GETCH 1037
3

). TA B L E 3 Proposed school reentry protocol

- Required actionsa
o Before reentry
s
1 School reentry liaison/coordinator of services identified (Diedrick & Farmer, 2005; Prevatt et al., 2000)
ol
2 Initial contact with family to determine needs (Kaffenberger, 2006)
C
3 Provision of interim services as needed (i.e., homebound/online instruction) (Diedrick & Farmer, 2005;
g Shaw et al., 2014)
d 4 Initial school reentry planning meeting held and plan for reentry developed (Canter & Roberts, 2012)
5 Information shared with school staff and peers as necessary (Prevatt et al., 2000; Schilling & Getch,
2012)
Immediately prior to and/or during reentry
6 Student formally assessed to determine areas of need (Lurie & Kaufman, 2001; Schilling & Getch, 2012)
- 7 IEP, 504 Plan, and/or individualized health plan developed when necessary (Carney & Porter, 2009; Hay
s et al., 2015)
e 8 Services provided to address any presenting needs (Schilling & Getch, 2012)
d Following reentry
y 9 Frequent progress monitoring of the effectiveness of services provided (Schilling & Getch, 2012)
10 Revisions to services made as necessary in light of student progress (Worchel-Prevatt et al., 1998)
o a
Important throughout: Open communication between all involved parties (family, school and medical providers).
s
n
y
4.2.3 Assessing students prior to or upon school reentry
y
Formally assessing the student prior to or immediately upon school reentry provides a basis for the development of a
school reentry plan. Assessment information should be gathered prior to students’ return to school so that appropriate
accommodations and supports can be put into place. Lurie and Kaufman (2001) have suggested that the following infor-
mation should be gathered: (1) learning and educational needs and strengths based on results of neuropsychological
h testing, (2) psychosocial needs and strengths based on clinical impressions as well as information gathered from par-
s, ents, teachers, and the child, (3) physical limitations, and (4) appropriate resources and services available at the school.
n Additionally, medication side effects should be noted as well as their potential impact on the child and the child's ability
r, to learn should be documented. After assessment information has been gathered, potential interventions should be
n listed (Lurie & Kaufman, 2001) and personnel responsible for providing the interventions and supports should be iden-
- tified. The multidisciplinary team can then use this information to develop a school reentry plan that takes into account
l the unique needs and strengths of the child who will be returning to school.
-
-
n
5 FUTURE RESEARCH
s
-
As schools begin implementing more formalized school reentry plans, future researchers should focus on evaluating
n
these plans and services. To increase the rigor of these studies, instruments need to be developed that evaluate the
quality and quantity of school reentry services provided as well as correlate service provision with student outcome
data. These data can be collected by individuals outside the school system who are trained to evaluate the quality of
services provided and to collect student outcome data. Measures such as these will help researchers collect data inde-
e pendent of self-report data and will likely provide data that are more objective and contain fewer biases. In addition,
e these data can be compared to data reported by the schools as a means to evaluate whether schools are indeed pro-
ol viding the supports and services reported.
d Additionally, it would be helpful to identify barriers to developing, implementing, and evaluating school reentry
plans and services. If services are not implemented or partially implemented, it would be helpful to identify what
1038
2 SCHILLING AND GETCH S

barriers are present, so plans can be put into place that circumvent these barriers to services. Furthermore, compre- D
hensive, effective evaluation measures need to be developed and put into place to monitor the effectiveness of reentry
plans, supports, and services. D

E
6 CONCLUSION

Students with chronic illness are returning to school in greater numbers than ever before. Students with chronic illness G
vary widely in their time away from school, the severity of their illness, the impact of their condition on their cognitive
abilities, their prognoses, as well as interpersonal and intrapersonal factors (Worchel-Prevatt et al., 1998). As such, H

schools need to be prepared to work with these students and understand what supports, strategies, and accommo-
H
dations may need to be in place for students to be successful. Creating a multidisciplinary team (Deidrick & Farmer,
2005), appointing a liaison (Helms et al., 2016), developing a school reentry protocol followed by the development of a
school reentry plan (Canter & Roberts, 2012), and formally assessing the student prior to or immediately upon school H
reentry (Carney & Porter, 2009) are steps that should be taken to ensure a smooth transition. When school reentry
protocols are followed and parents, children, school personnel, physicians, and other professionals communicate and
collaborate, it is likely that the educational, emotional, and psychosocial needs of children with chronic illness will be H
met.
I

ORCID
K
Ethan J. Schilling http://orcid.org/0000-0002-8825-6507
K

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How to cite this article: Schilling EJ, Getch YQ. School reentry services for students with chronic health condi-
tions: An examination of regional practices. Psychol Schs. 2018;1–14. https://doi.org/10.1002/pits.22154
2018;55:1027–1040. https://doi.org/10.1002/pits.22154

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