HOMEBOUND/HOSPITAL INSTRUCTION PARENT INFORMATION PACKET

Transcription

1 HOMEBOUND/HOSPITAL INSTRUCTION PARENT INFORMATION PACKET Revised 9/11/13 Office Address: Department of Special Services, Homebound Office, 236 Grand St., 2 nd Floor, Room 250, Waterbury, CT 06702, Phone ; Facsimile SPECIAL EDUCATION AND PUPIL SERVICES WATEBURY DEPARTMENT OF EDUCATION

2 HOMEBOUND/HOSPITAL INSTRUCTION PARENT INFORMATION PACKET TABLE OF CONTENTS HOMEBOUND POLICY 1-2 HOMEBOUND INSTRUCTION RESORCES 3 HOMEBOUND GENERAL PROCEDURES 4 PARENTS RESPONSIBILITIES 5-6 FORMS 7-13 HOMEBOUND/HOSPITAL INSTRUCTION PARENT REQUEST FORM 7 HOMEBOUND/HOSPITALIZATION AUTHORIZATION FORM FOR DISCLOSURE OF HEALTH INFORMATION 8 LETTER TO PHYSICIAN 9 PHYSICIAN S REFERRAL FORM AUTHORIZATION FORM 12 SCHOOL CALENDAR 13

3 HOMEBOUND AND HOSPITALIZED INSTRUCTION POLICY A Board of Education shall provide instruction to a child in a public school under the jurisdiction of the Board when a child is unable to attend school due to a verified medical reason which may include health issues: 1. The child s treating physician shall provide a statement in writing directly to the Board of Education, Department of Special Services, Homebound Office, on a form provided by the District stating: A. The child s treating physician has consulted with school health supervisory personnel and has determined that attendance at school with reasonable accommodations is not feasible; B. The child is unable to attend school due to a verified medical reason; C. The child s diagnosis with supporting documentation; D. The child will be absent from school for at least ten (10) consecutive days or the child s condition is such that the child may be required to be absent from school for short, repeated periods of time during the school year and; E. The expected date the child will be able to return to school. 2. The PPT shall consider the educational needs of a child with a disability who is medically complex and the need for instruction to be provided in accordance with an IEP of such child when such child isn t able to attend school due to medical reasons. The PPT shall consider and make accommodation for the child s program to be moved: a. From public school to a home or health care facility, including but not limited to a hospital, psychiatric facility, or rehabilitation center and; b. Back to school when the child is able to return to school. c. For purposes of this section, medically complex means a child who has a serious, ongoing illness or chronic condition for at least a year and required prolonged or intermittent hospitalization and ongoing medical treatments or medical devices to compensate for the loss of bodily functions. Commencement of services Instruction for a child who is unable to attend school for medical reasons shall begin no later than the eleventh day of absence from school, provided the board has received notice in writing that meets the requirements stated in 1 above. If the child s condition is such that the child cannot receive instruction, the child s treating physician shall determine when instruction shall begin and shall, in writing, inform the Board. Resolution of Disputes In the event that there is a dispute regarding the basis upon which the child s treating physician has asserted the need for instruction, the child shall receive such instruction pending review of the written statement provided by the child s treating physician by the school medical advisor. The parent of such child shall provide consent for the school medical advisor to consult with the child s treating physician to assess the need for instruction. The Board is not required to begin instruction until such consent is provided. Consultation with the child s treating physician shall include a review of educational and medical records, and if appropriate, accommodations and school health services that can be provided to the child so that the child can attend school safely. 1

4 If there continues to be a disagreement regarding the provision of Homebound Instruction, the Board may offer, at the Board s expense, a review of the child s case by a qualified independent medical practitioner. If the parent fails to make the child available for such review, the obligation of the board to provide Homebound Instruction shall end, and if the child continues to be absent from school, the board shall pursue school attendance interventions. The Board and the parent have the right to request a hearing or mediation under the State Regulations pursuant to Section 10-76h. Time and Place Instruction shall be provided as follows: 1. For children age 3, 4, or 5 with a disability, for the amount if time determined appropriate by the PPT; 2. No less than one hour per day or five hours per week for children in grades kindergarten through six; 3. No less than two hours per day or ten hours per week for children in grades seven through twelve; Where evaluative data indicates that these time requirements should be modified, instruction time may be increased or decreased upon the agreement of the parent and the Board of Education or upon determination made by the PPT as appropriate. Instruction may be provided in the setting of the child s home or the hospital to which the child is confined or the board may offer instruction in other sites such as the City s public library, taking into consideration the child s medical condition. CONTENT OF SERVICES Instruction shall be provided so as to enable the child to continue to participate in the general education curriculum and to progress towards meeting the goals and objectives in the child s IEP. Maintaining the continuity of the child s general education program means the child shall receive instruction in core academic subjects in which the child is enrolled for promotion or graduation. PROVISION FOR SERVICES FOR A CHILD WHO IS PREGNANT OR HAS GIVEN BIRTH A child who is pregnant or who has given birth and cannot attend school pursuant to this section, shall be entitled to be provided with Homebound Instruction and with such other instruction as will enable the child to remain in school or otherwise have access to instruction and support services. The Board shall consider the child s individualized needs and shall provide as appropriate services that may include, but need not be limited to, transportation, a shortened school day, counseling, modified assignments, or modified class schedule. 2

5 HOMEBOUND INSTRUCTION RESOURCES PARENT/GUARDIAN MANUAL FOR HOMEBOUND INSTRUCTION can be obtained through the school principal or school nurse. HOMEBOUND INSTRUCTOR S MANUAL can be obtained through the Homebound Office. CLASSROOM TEACHER MANUAL FOR HOMEBOUND INSTRUCTION can be obtained through the school principal. PRINCIPAL MANUAL FOR HOMEBOUND INSTRUCTION is sent to all principals by the Homebound Office at the beginning of each school year. 3

6 HOMEBOUND GENERAL PROCEDURES The Procedure for Authorization of Homebound Tutoring Services is set forth below. OR Parent/Physician Initiated 1. Parent picks up and signs for Homebound Instruction packet. 2. Parent completes and submits a Request for Homebound/Hospital Instruction to the Homebound Instruction Office and signs a Medical Authorization. 3. Physician completes and submits Physician s Referral Form to the Homebound Office with the information required under the Homebound Policy, consults with designated school health personnel as determined by the Homebound Office and submits supporting documentation for the Homebound Instruction Request. 4. All forms are examined and eligibility for services is determined based on compliance with Homebound Policy. 5. Requests are approved/denied as soon as possible. 6. Homebound Office determines Homebound teacher assignments. PPT/Section 504 TEAM Initiated Copy of IEP or 504 plan and minutes, showing Team decision and plan for Homebound is submitted to Homebound Office. Eligibility and Amount of Tutoring is determined by the PPT Team or Section 504 team. Requests are immediately processed. Homebound Office determines Homebound teacher assignments as required by the Student s plan. 4

7 PARENTS RESPONSIBILITIES Parent contact information. The parent/guardian must provide at least one working phone number in order for homebound tutoring to take place. Homebound Instruction teachers will be calling parents/guardians to set up the tutoring schedule and for verification of tutoring sessions before they travel. If the Homebound Instruction Teacher or Homebound Instruction Office cannot contact the family by phone for whatever reason, services will not start or will be suspended until phone contact can be established. A current, working phone number must be on file with the Homebound Instruction Office at all times. Adult Supervision. There must be an adult, someone over 21 years of age, in the house while the Homebound Instruction Teacher is present. If the parent or any other guardian cannot be in the home, they can authorize an adult over 21 to be present for tutoring. An authorization form to complete is included in this package. The authorization form must be returned to the Homebound Instruction Office with other Homebound forms. If there is no authorized adult in the home, the teacher is instructed to leave the premises immediately and to contact the Homebound Office. Scheduling/Changes. Homebound Instruction will not be conducted during Vacations, Holidays, Snow Days or Weekends. Instruction is provided between the hours of 7:00 am-8:00 pm, Monday Friday only, unless a request is received and approved in advance by the Homebound Instruction Office. The parent/guardian and Homebound Instruction Teacher will be notified of the approval or denial of the request for an alternate schedule. Once a schedule for instruction is completed, it will be mailed out to the home. This schedule must be followed. No changes in the tutoring schedule can be made by the parent or the Homebound tutor unless approved by the Homebound Instruction Office. The tutors have full schedules with other students and changes can affect more than one student and more than one tutor. Tutoring Environment. Parents/Guardians must provide a quiet environment helpful to learning and should not interrupt tutoring or cause or allow any disruption to the learning process. Homebound Timesheets. Parents/Guardians are required to initial the Homebound Teacher s instruction time recorded on timesheets each day and sign at the bottom of each timesheet every two weeks. Two hours of Homebound Instruction means two hours of instruction, not one hour of tutoring and one hour of homework. Parents/Guardians should sign for times only for the duration of the tutoring session, be it a half hour or two hours. Do not sign for any hours beyond the actual teaching time. Please notify the Homebound Office immediately if this rule is not being followed or with any other problem relating to the instruction or the teacher. Cancellation. Parents/Guardians must provide a minimum of twenty-four (24) hours notice of a cancellation to both the Homebound Instruction Teacher(s) and the Homebound Instruction Office. Failure to provide notice of cancellation could cause loss of instruction. Homebound Instructors will not wait more than Fifteen (15) Minutes for the student if the student is not at 5

8 home at the time of tutoring. If it comes to the attention of the Homebound Instruction Office that a student is not home for a scheduled tutoring session or canceling at the last minute Homebound Instruction services may be suspended until such time that the parent, child, and Homebound Office can resolve the problem. Please be courteous and keep in mind that our teachers have other students to tutor and tight schedules to keep. Sickness. If a student is ill, the parent has the obligation to notify the Homebound instructor of the student s illness as soon as possible prior to the tutoring session and an alternate date will be scheduled for tutoring. In addition, if family members in the home are suffering from an infectious illness, the parent/guardian will notify the tutor to enable the tutor to determine whether the session must be cancelled or alternate arrangements need to be made. Student No Shows. If a student is not present within 15 minutes of the scheduled instructional session, it is recorded on the Attestation Sheet as a No Show. Instructional time due to No Shows cannot be re-scheduled. Homebound Instructors will be paid a ¼ hour for No Shows. Homebound Instructors must notify the Homebound Office after the 2 nd No Show. Homebound Instruction students who are habitually absent face the possibility of suspension from the Homebound Instruction Program and loss of academic credit. Homebound Instructors will be notified by the Homebound Office in the event that a student is suspended from the program. Instructors must notify the Homebound Office when they are unable to contact the family within 24 hours to enable the Homebound Office to follow up with the family. Homebound Instructor. If a teacher is failing to show up, or is not staying the full number of hours, the Parent/Guardian should contact the Homebound Instruction Office immediately to enable the office to investigate and resolve any problems. In the event that a Homebound Instructor cannot meet at the scheduled day/time due to illness or other reason, the Homebound Instructors must notify both the Homebound Office and the parent/guardian of the affected student(s). The Homebound Instructor may re-schedule the instructional time. Return to School. Return-to-school dates are determined by the Homebound Instruction Office based on the return date on the Physician s Referral Form or by the decision of the student s PPT or Section 504 team. Homebound Instruction services will not be provided after this date. If the Parent/Guardian needs to extend homebound past the date originally specified by the physician, the parent must obtain another physician referral form from the physician extending the date prior to the end date. When your child is scheduled to return to school, you should obtain a written release from your doctor to your child s school and the release should state any restrictions placed on your child by the doctor (for instance, no gym). The release is sent to the student s school so that your child s return to his/her school can be authorized with a copy sent to the Homebound Instruction Office. Failure to update the doctor s written certification before the student s date of return may result in the interruption and/or loss of instruction services. Makeups. Weekends, snow days, vacations and holidays are not to be used for makeup times unless special written permission is obtained, in advance, from the Homebound Office. 6

9 PLEASE PRINT CHILD S NAME: Waterbury Public Schools Special Education Department Homebound/Hospital Instruction Office 236 Grand St., 2nd Fl. Rm 250, Waterbury, CT (203) FAX (203) PARENT REQUEST FOR HOMEBOUND/HOSPITAL INSTRUCTION SCHOOL: DATE OF BIRTH: GRADE: PLACE OF BIRTH: PARENT OR GUARDIAN: HOME ADDRESS: CITY, STATE, ZIP CODE: ENTRANCE TO HOME LOCATED: Front Rear Side Floor Number HOME PHONE: WORK PHONE: PLEASE LIST PETS IN THE HOME TYPE OF ILLNESS OR INJURY: ANY ADDITIONAL MEDICAL PROBLEMS: (e.g. allergy, seizures, heart problems, etc.) NAME OF REFERRING PHYSICIAN OR CLINIC: Please check the appropriate box if Student is Identified as Section 504 or Special Education. Section 504 Special Ed. I understand that the Waterbury Public Schools may investigate my child s health problem(s) as set forth in the Physicians Referral Form and require a health authorization signed by me. Signature of parent or guardian MAIL TO: WATERBURY PUBLIC SCHOOLS HOMEBOUND PROGRAM 236 GRAND ST., 2 ND FLOOR RM 250 WATERBURY, CT Date

10 Waterbury Public Schools Special Education Department Homebound/Hospital Instruction Office 236 Grand St., 2 nd Fl. Rm 250, Waterbury, CT (203) FAX (203) HOMEBOUND/HOSPITAL SERVICES AUTHORIZATION TO DISCLOSE HEALTH INFORMATION To: Name Address I give permission for the Waterbury Public Schools, the School Medical Advisor and the Waterbury Health Department to obtain the following records of my child, Name Date of Birth, and to consult with the child s health providers(s) for purposes of processing the child s Homebound Instruction Application as set forth under the laws of the State of Connecticut: Any and all health information relating to the student s Homebound Instruction Application for health reasons to Waterbury Public Schools dated. I understand that the information in my child s health record may include information relating to sexually transmitted disease, acquired immunodeficiency syndrome (AIDS), or human immunodeficiency virus (HIV). It may also include information about behavioral or mental health services, and treatment for alcohol and drug abuse. I understand that I have the right to revoke this authorization at any time. I understand if I revoke this authorization, I must do so in writing and present my written revocation to the Homebound Instruction Office. I understand the revocation will not apply to information that has already been released in response to this authorization. Unless otherwise revoked, this authorization will expire on the following date, event or condition: child s completion of Homebound Instruction Program. If I fail to specify an expiration date, event or condition, this authorization will expire in one year. A photocopy of this authorization shall be accepted as an original. I understand that authorizing the disclosure of this health information is voluntary. I can refuse to sign this authorization but my refusal may prevent my child from receiving Homebound Instruction from the Waterbury Public Schools. I understand I may inspect or copy the information to be used or disclosed. I understand any disclosure of information carries with it the potential for an unauthorized re-disclosure and the information may not be protected by federal confidentiality rules. Parent/Guardian Signature Date Please forward the requested information to: Homebound Instruction Office Special Education Department Waterbury Public Schools 236 Grand St., 2 nd Floor, Room 250 Waterbury, CT

11 Waterbury Public Schools Special Education Department Homebound/Hospital Instruction Office 236 Grand St., 2 nd Fl. Rm 250, (203) FAX (203) Dear Doctor: State Department of Education Regulations and the City of Waterbury Board of Education require that the attached form be completed and signed by the prescribing physician for any child who applies to receive Homebound instruction. The child s treating physician must also consult with school health supervisory personnel and provide us with a statement in writing and supporting documentation that this has been done and reasons why the child cannot attend school at this time. Please note new requirement. It is important that we receive all pertinent information requested on the form and please make sure that the return to school date is filled in on the form and the from is signed by a licensed physician. Please return completed form(s) to: Waterbury Public Schools Homebound Instruction Office 236 Grand St., 2 nd Floor Rm 250 Waterbury, CT Sincerely, Waterbury Homebound Office 9

12 Waterbury Public Schools Special Education Department Homebound/Hospital Instruction Office 236 Grand St., 2nd Fl. Rm 250, Waterbury, CT06702 (203) FAX (203) PHYSICIAN S REFERRAL FORM SECTION I (For physician s use only) GENERAL DATA TOWN: WATERBURY STUDENT: GRADE: DOB: PARENT/GUARDIAN: PHONE: ADDRESS: REFERRED BY: TITLE: DATE: ADDRESS: PHONE: SECTION II (For physician s use only) A. DIAGNOSIS: Must consult with School Health Personnel before starting Homebound Instruction and attach supporting medical documentation CONSULTED YES NO 1) CHILD MUST BE ABSENT FOR 10 CONSECUTIVE DAYS OR WILL BE ABSENT FOR SHORT PERIODS THROUGHOUT THE YEAR 2) VERIFIED MEDICAL DOCUMENTATION MUST BE ATTACHED 3) MEDICALLY COMPLEX 4) IF HOMEBOUND INSTRUCTION NEEDS TO BE EXTENDED, PHYSICIAN MUST RUN BY SCHOOL HEALTH PERSONNEL W/NEED FOR EXTENSION BEFORE EXTENSION WILL BE GRANTED B. THIS CHILD CAN ATTEND SCHOOL : YES NO IF NO, ANTICIPATED DATE OF RETURN BACK TO SCHOOL IF YES, REASONABLE ACCOMODATIONS 10

13 C. IF CHILD IS HOSPITALIZED, IS CHILD WELL ENOUGH TO MEDICALLY RESUME HOMEBOUND INSTRUCTION: YES NO IF YES, DATE/OCCURANCE OF WHEN TUTORIGN CAN START D. PREGNANCY INFORMATION: DATE OF EXPECTED DELIVERY: SCHEDULED DATE OF C-SECTION: * DISPUTE MECHANISM IF AN EXTENSION IS REQUESTED TO EXPAND HOMEBOUND INSTRUCTION, MEDICAL ADVISOR CAN ASK FOR A REVIEW OF EDUCAITONAL AND MEDICAL REOCRDS SIGNED: (MUST BE A LICENSED PHYSICIAN) DOCTOR S NAME: NAME OF PARACTICE: DOCTOR S ADDRESS: TELEPHONE: FAX: 11

14 Waterbury Public Schools Special Education Department Homebound/Hospital Instruction Office 236 Grand St., 2bd Fl. Rm 250, Waterbury, CT (203) FAX (203) To Whom It May Concern: AUTHORIZATION FORM I,, hereby authorize to be at Parent/Legal Guardian (Print Name) Print Name home with my child while I am away. This person will be Print Name responsible for my child in the event that I cannot be in the home when the Homebound Instruction Teacher arrives. I understand that this person must be an adult who is over 21 years of age and I authorize this person to make decisions concerning my child for the duration of the tutoring session. I further understand that if I, or the other authorized adult, is not able to be present for tutoring, no one else can sign for my child and the Homebound Instruction Teacher is instructed to leave. If the tutor arrives and no one is at home with my child, the time will not be made up. I am aware that I need to give a minimum of 24 hours notice to the tutor and to the Homebound Office if no one is going to be home or something comes up. Failure to give timely notification will result in an absence and the time lost will not be made up. Parent/Legal Guardian (Print Name) Date Print Name (Authorized Adult) Date Parent/Legal Guardian (Signature) Date Signature (Authorized Adult) Date 12

15 13