Policy/Program Memorandum 81

Date of issue: July 19, 1984

Effective: Until revoked or modified

Subject: Provision of health support services in school settings

Application: Directors of Education
Superintendents of Schools
Principals of Schools

School boards, parents and local agencies have raised a concern regarding the provision of health support services to school-age children. This concern involves services that extend beyond educational services and are not included in the normal preventive health programs already provided by boards of health to school children.

As a result of a study of this matter, the Ontario Government has decided that the responsibility for ensuring the provision of such health support services will be shared among the Ministries of Education, Health, and Community and Social Services. Responsibility for the direct provision of these services at the local level will be shared by the school boards, the Home Care Program of the Ministry of Health, and agencies operating under the Ministry of Community and Social Services.

The attached chart, developed jointly by staff of the three ministries, summarizes the respective responsibilities.

The Home Care Program of the Ministry of Health, at the request of a school board, will be responsible for assessing pupil needs, and for providing such services as injection of medication, catheterization, manual expression of the bladder, stoma care, postural drainage, suctioning and tube feeding. The Ministry of Health will also be responsible for intensive physio-occupational and speech therapy, and for assisting school boards in the training and direction of school board staff performing certain other support services.

The Ministry of Community and Social Services will continue to be responsible for ensuring the provision of health support services in children’s residential care and treatment facilities.

The school boards will be responsible for the administration of oral medication where such medication has been prescribed for use during school hours. For physically disabled pupils, the school boards will provide such services as lifting and positioning, assistance with mobility, feeding and toiletting, and general maintenance exercises. Boards will also continue to be responsible for necessary speech remediation, correction and habilitation programs.

School boards should establish or update their policies for the provision of these support services. Such policies should define administrative procedures, personnel roles, and routine safeguards. The local boards of health, local Home Care Program administrators, and local medical societies can provide valuable assistance in the development of such policies. The procedures for the administering of oral medication, in particular, should provide:

1. that such procedures be applied only to those services, requested by the parent and prescribed by a physician or other health care professional, which must be provided during school hours
2. that a request for the service and the authorization to provide such service be made in writing by the parent and the physician, specifying the medication, the dosage, the frequency and method of administration, the dates for which the authorization applies, and the possible side effects, if any
3. that the storage and safekeeping requirements for any labelled medication be stated
4. that a record of administration be maintained which includes the pupil’s name, date, time of provision, dosage given, name of person administering, etc.
5. that the telephone numbers of the parent and physician be readily accessible in the school
6. that the medication be administered in a manner which allows for sensitivity and privacy and which encourages the pupil to take an appropriate level of responsibility for his or her medication

The assignment of these responsibilities is not intended to replace the provision of services which some school boards have already established and may choose to continue. The implementation of this policy, however, does ensure that, by 1985, no school-aged child should be denied access to education because of special health support needs during school hours.

Implementation of these services is expected to begin September 1,v1984, with full provision of services by September 1, 1985.

The designation of roles and responsibilities for health support services in school settings does not preclude, in emergency situations, the provision of a health service by designated school board personnel, administered in accordance with section 52(2a) of the Health Disciplines Act and section 10(c) of the Drugless Practitioners Act, and under the policies and procedures of the school board concerned.

Should a need develop for a service which has not already been designated, the matter should be referred by the school board to the Ministry of Education for its consideration in consultation with the Ministry of Health.

School boards will be informed as soon as possible of the procedures to be followed in obtaining the designated health support services from the Home Care Program of the Ministry of Health.

Model for provision of school health support services

Interministerial Guidelines for the Provision of Speech and Language Services (as applicable to the Education Act)

September 1988

Ministry of Education
Ministry of Health
Ministry of Community and Social Services

This document supersedes the Guidelines for the Provision of Speech and Language Services, June 1985, and the references to speech and speech pathology/therapy in the document, Policy/Program memorandum No. 81, July 19, 1984.

Purpose of the Interministerial Guidelines

The following information is provided as a guide for the use of school boards; local Home Care Programs and Agencies of the Ministry of Health; and, Facilities for the Developmentally Handicapped, Schedule I and II (hereafter referred to as Facilities) and Children’s Mental Health Centres (hereafter referred to as Centres) funded by the Ministry of Community and Social Services, in the provision of speech and language services for pupils who are enrolled in and attending publicly-supported schools (hereafter referred to as pupils).

Introduction

Program/Policy Memorandum No. 81, Provision of Health Support Services in School Settings, was issued on July 19, 1984. The interministerial agreement represents the Ontario Government’s commitment to ensure that all pupils with special needs receive the support services required to benefit from an educational program.

The agreement represents a sharing of responsibilities by the Ministries of Education, Health, and Community and Social Services. Furthermore, it requires the direct provision of services at the local level by school boards, Home Care Programs, Agencies, Facilities and Centres operating under the aegis of the Ministries of Education, Health, and Community and Social Services, respectively.

In June 1985, Guidelines for the Provision of Speech and Language Services, a further interministerial agreement approved by the Ontario Cabinet, described the sharing of responsibility for the provision of relevant services so that the speech and language needs of all pupils with communication disorders could be addressed through the co-ordinated services of school boards, Home Care Programs, Agencies, Facilities and Centres.

In June 1987, the Interministerial Advisory Committee on Speech and Language Services, including representation from speech and language professionals and associations, was reconvened. The advisory committee reviewed data from various sources, modified the original guidelines and submitted the revised guidelines for approval of the three ministries.

The guidelines are published to assist in decision-making, at the local level, by providing direction to school board, Home Care Program, Agency, Facility and Centre personnel to determine their responsibilities in the provision of speech and language services in a co-operative mode.

The contributions of all who participated in the review process and in the development of the revised guidelines are gratefully acknowledged.

The revised guidelines are approved by the Ministries of Education, Health, and Community and Social Services.

(Signed)
Assistant Deputy Minister
Learning Programs
Ministry of Education

(Signed) Assistant Deputy Minister
Community Health
Ministry of Health

(Signed) Assistant Deputy Minister
Community Services
Ministry of Community and Social Services

I. Basic principles

The following basic principles are essential to the understanding of the provision of speech and language services:

1. the responsibility of parents to work together with school boards and other service providers to facilitate the provision of required services is acknowledged
2. where a child is receiving speech and language services upon being enrolled in a community school, it is expected that local Home Care Program, Agency, Facility or Centre personnel, in co-operation with the parent(s), will liaise with school-board staff to share information and, where appropriate, to ensure a smooth transition of the speech and language program to the local school setting
3. the implementation of the guidelines does not preclude the provision of speech and language services by other established sources of service to pupils who are enrolled in schools, for example, hospitals or Children’s Treatment Centres
4. where speech and language needs have not been assessed prior to school entry and before making a referral to the Home Care Program or to other service providers, it is the responsibility of a school board, within its early identification process, to develop and implement strategies to:
   1. determine a pupil’s communication needs and, where appropriate
   2. make a referral to the local Home Care Program or to other community resources
5. when addressing the educational needs of pupils with various communication disorders, school boards should provide a comprehensive language and speech program. This program should utilize a spectrum of professional and trained support personnel through a co-operative, interdisciplinary approach
6. school boards will provide services for pupils with communication disorders, where such services are an appropriate part of the pupil’s educational program
7. school boards may continue to purchase speech and language services from other service providers, for example, other school boards, hospitals, Agencies and Centres

Co-ordination and monitoring are essential to the complete and efficient provision of speech and language services by the various service providers within local communities. It is expected that school boards will assume leadership to facilitate the development, co-ordination and ongoing monitoring of speech and language services for pupils who are enrolled in their schools.

II. Development of a local service delivery model

It is expected that school boards, local Home Care Programs and Agencies of the Ministry of Health and Ministry of Community and Social Services Facilities and Centres will:

• be mutually supportive in the provision of speech and language services
• employ or contract appropriately trained staff to provide assessment, treatment and programming
• develop a co-operative model for providing speech and language services within the community, in accordance with the basic principles and proposed service delivery model described herein

School boards should provide leadership in the development of a local service delivery model by initiating regular meetings with local Home Care Programs, Agencies, Facilities and Centres to co-ordinate and monitor services.

Where it is determined that speech and language services are the responsibility of the Ministry of Health and that these services must be provided within the school setting, such services will be requested by the school principal and provided through the local Home Care Program, in accordance with established procedures. Staff providing services through the Home Care Program shall liaise closely with appropriate school board personnel. Where services are not provided through the Home Care Program, service providers are encouraged to liaise with appropriate school board personnel.

The attached model describes the responsibility of school boards, Home Care Programs and Agencies of the Ministry of Health, and Facilities and Centres of the Ministry of Community and Social Services in developing a local service delivery model. Service providers are encouraged to modify and adapt the model to meet identified local needs.

III. Determining responsibility for service delivery

1. For those pupils who are admitted to treatment programs operated by the Ministry of Health and to Facilities and Centres funded by the Ministry of Community and Social Services, and who attend an educational program offered by a school board in the treatment setting, it is expected that the provision of speech and language services will be the responsibility of the Ministries of Health and Community and Social Services, respectively.
2. For those pupils, who are enrolled in publicly supported schools and who are not admitted to a treatment program identified in paragraph A above, the following information will guide the development of service delivery models at the local level.

Language disorders

Language competence is an integral component of the classroom program. Therefore, school boards should be responsible for the assessment and provision of services for pupils with language disorders. These services are most effective when closely integrated with the classroom program, particularly with language problems associated with a learning disability, autism, intellectual and hearing impairment.

Responsibility

Assessment of and services associated with language disorders are the responsibility of school boards.

Non-speech communication

Assessment for, prescription of, and orientation to augmentative and alternate methods of communication for non-speaking pupils will be provided by the Ministries of Health and Community and Social Services, respectively. However, the ongoing development and use of these methods of communication in the educational setting must be part of the school program and the responsibility of school boards, with the support of Home Care Programs, Agencies, Facilities, and Centres of the Ministries of Health and Community and Social Services, respectively.

Responsibility

Non-speech communication is a shared responsibility of the local Home Care Programs and Agencies of the Ministry of Health, the Ministry of Community and Social Services, and the local school boards.

Articulation/speech sound production

While it is recognized that articulation/speech sound production problems may be viewed as a dimension of language competence, the large numbers of pupils experiencing varying degrees of such problems make it necessary for local Home Care Programs and Agencies of the Ministry of Health and school boards to provide services, as follows:

1. 1. specialized assessments and programs for pupils with neuromotor speech disorders, such as dyspraxias and dysarthrias, should be the responsibility of the Ministry of Health
   2. other motor speech disorders requiring the support of a medical, habilitation or rehabilitation team should be provided by the Ministry of Health
2. in cases where it is determined that the articulation/speech sound program should be part of the educational program, school boards are responsible
3. in cases where it is not essential that the speech program be part of the educational program, school board or health staff may provide assistance, as determined locally

Responsibility

Home Care Programs and Agencies of the Ministry of Heath and school. boards have both specific and shared responsibilities for articulation/speech sound production problems.

Fluency disorders

The provision of services for pupils with fluency disorders requires the availability of services and support programs within both the health and education sectors. Therefore, Home Care Programs, Agencies, and school boards should co-operate to develop and deliver diversified services to pupils with fluency disorders.

Where the fluency program is determined to be an integral part of the educational program requiring the support services available in the school setting, the school board should be responsible.

Responsibility

Home Care Programs and Agencies of the Ministry of Health and school boards share the responsibility for pupils with fluency disorders.

Voice disorders and resonance problems

The need for assessment and monitoring by a medical team requires that pupils with voice disorders and resonance problems be served by Home Care Programs and Agencies of the Ministry of Health. This includes therapy needs associated with cleft lip and palate repair and velopharyngeal insufficiency.

Some pupils may require monitoring through the school program after a period of therapy. Monitoring should be provided by school boards, with the support of Home Care Programs and Agencies of the ministry of Health.

Responsibility

Voice disorders and resonance problems are shared responsibilities of the local Home Care Programs and Agencies of the Ministry of Health and the local school boards.

IV. Conflict resolution

Where a pupil has multiple or complex needs, including speech and language, such as multiple-diagnosis, and there is a lack of agreement regarding which service agent is responsible, a supervisory officer designated by the local school board, the director of the local Home Care Program (or designate) and the area manager of the Ministry of Community and Social Services (or designate) will determine which local service provider will deliver and monitor appropriate speech and language services. Duplication of identical services and the provision of speech-language services by more than one speech-language pathologist to one pupil should be avoided.

Where local officials are not able to determine the respective role for each ministry or are unable to provide the required service, the case, supported by documentation, will be referred by the local school board to the appropriate regional office of the Ministry of Education. In seeking a resolution, the Regional Director of Education is expected to refer the matter to appropriate staff of the Special Education and Provincial Schools Branch, Ministry of Education. A mutually satisfactory resolution will be determined in consultation with officials of the Ministries of Health and Community and Social Services.

V. Service review

An interministerial committee will monitor the implementation of the Interministerial Guidelines for the Provision of Speech and Language Services, September 1988 and conduct an annual review of service delivery.

A model for the provision of speech and language services (As applicable to the Education Act)

Criteria

School boards

School boards will be responsible in the following circumstances:

• when assessment or programming for the communication disorder requires close cooperation and liaison with an educational team
• when appropriate programming requires the educational environment for improvement
• when communication programming can and should be part of the pupil’s educational program
• when communication problems are having, or are likely to have a significant impact on educational progress or school adjustment, i.e. when educational development will be impeded without communication skill programming
• when management by a medical team is not essential

Where school boards are responsible for the provision of language and speech services, a spectrum of professional and trained support personnel should be utilized in a co-operative, interdisciplinary approach.

Note: In this document, an educational team includes but is not restricted to one teacher working with other professionals, including a school principal, to develop an educational program.

Criteria

Facilities and centres of the Ministry of Community and Social Services

Facilities and centres will be responsible when a pupil admitted to a facility or centre, funded by the Ministry of Community and Social Services, attends an educational program offered by a school board in the Facility or centre setting, in accordance with the General Legislative Grants regulation of the Ministry of Education.

Criteria

Local home care programs and agencies of the Ministry of Health

Local home care programs and agencies will be responsible in the following circumstances:

• when assessment and/or management of the communication disorder requires the involvement of and liaison with a medical management team
• when co-ordination efforts of other services available within the health setting are required
• when the assessment and/or management plan does not require liaison with an educational team, i.e. the goals of the assessment, treatment or plan of care need not become an integral component of the pupil’s educational program
• when management by an educational team is not essential
• when a pupil in a treatment program, funded by the Ministry of Health, attends an educational program offered by a school board in the approved care and treatment setting, in accordance with the General Legislative Grants regulation of the Ministry of Education

Note: In this document, a medical management team includes but is not restricted to one health professional working with other professionals, including a physician, to develop a plan of care.

Program and Agency service providers are encouraged to liaise with appropriate school board personnel.