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INTRODUCTION
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794 § 504) is a federal civil rights law that prohibits discrimination against individuals on the basis of disabilities and guarantees access to federally funded programs, including public school, for disabled individuals. The Office for Civil Rights (OCR) is the federal administrative agency within the U.S. Department of Education charged with implementing the law and monitoring compliance.
The law defines an individual with a disability as one with a physical or mental impairment that substantially limits one or more major life activities. For students who are eligible under Section 504, schools must make appropriate accommodations to eliminate barriers to the students’ participation in school and school activities. Implementation of Section 504 provides disabled students with the same access to educational opportunities provided to their non-disabled peers and supports them in achieving positive health and educational outcomes.
BACKGROUND
Section 504 of the Rehabilitation Act of 1973 protects the rights of individuals with disabilities to access programs and services that are supported by federal funds, including public schools. The Section 504 regulations provide a framework for school district policy and procedure.
Institutions receiving federal funds, including public schools, must comply.
Schools must identify students who may have disabling conditions (Child Find).
Schools must establish standards and procedures for evaluation of handicapped students and eligibility determination.
Schools must meet individual needs of disabled students to insure they have the same access to education as non-disabled students.
The law stipulates that identification of students and determination of their individual eligibility for accommodations under Section 504 is to be a collaborative process accomplished by a school-based 504 team. Anyone can make a referral for evaluation of a student’s eligibility. However, OCR has stated in a staff memorandum (OCR memorandum, April 29, 1993) that the school district must also have reason to believe that the child needs services under Section 504 because of a disability.
The 504 team:
Must comprise persons knowledgeable about the student, the disability, and possible accommodations, including the parents, if they choose to participate, and the student, if appropriate;
Must determine eligibility under Section 504; and
If eligibility is confirmed, must design an accommodation plan based on specific individual needs of the student.
To be eligible for accommodations under Section 504, a student must have a physical or mental impairment that substantially limits a major life activity.
Section 504 defines "physical or mental impairment" as:
Any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitor-urinary; hemic and lymphatic; skin; and endocrine,
Or, any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.
"Major life activity" means functions such as: caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and/or working.
Section 504 does not specifically define "substantial limitation." However, the school-based 504 team can look to the Americans with Disabilities Act (ADA) for guidance. The ADA protects the rights of disabled individuals in the workplace and states that an individual is "substantially limited" by a disability if,
He/she is unable to perform a major life activity that the average person in the general population can perform, or
He/she is significantly restricted as to the condition, manner, or duration under which the average person in the general population can perform the same major life activity.
In the school context, the student in question would be compared to an average student of the same age or grade level in the general population.
The school 504 team is charged with applying the definition criteria above and determining whether or not a student has a physical or mental impairment that substantially limits a major life activity. The team must answer three questions:
- Does the student have a physical or mental impairment?
- Does the impairment impact one or more major life activities?
- Does the impairment substantially limit one or more major life activities?
When students are identified, assessed, and determined to be eligible for accommodations under Section 504, the school 504 team must create an individual accommodation plan (IAP or 504 Plan). Section 504 does not outline specific plan components, but suggests that the plan should be written. The key elements of an individual accommodation plan are strategies based on the student’s individual needs that will enable the student to access a free and appropriate education in the least restrictive environment. Accommodations under Section 504 may include related aids and services, such as school health services, and may include specialized instruction.
RATIONALE
Identifying students with physical and mental health disabilities is the first step in prohibiting discrimination on the basis of disability in public schools. By identifying eligible students, school nurses play a crucial role in both preventing further health complications and providing students with disabilities the same opportunities as non-disabled students to benefit from their education.
School districts have inconsistently implemented the requirements of Section 504 because, unlike IDEA, there is no funding attached to the law and interpretation of the law and its requirements were initially unclear. Passage of the Americans with Disabilities Act in 1990 heightened the awareness of school districts and parents of children with disabilities, who both became increasingly aware that Section 504 could offer certain protections and opportunities for disabled students. School districts are now more informed of their obligations under Section 504, and so are parents, who have begun to request that schools provide appropriate accommodations for their children. Some students with disabilities still are subjected to discrimination in public schools, particularly in communities where parents have fewer resources and less information is available to them. Section 504 implies best practice for schools:
Policy and procedures for determining eligibility and developing 504 Plans for eligible students,
Well-informed, collaborative 504 teams,
Procedures for meeting special needs of students with impairments who do not qualify for a 504 Plan
THE ROLE OF THE SCHOOL NURSE
The professional school nurse is an integral member of the 504 team. The school nurse routinely identifies students with physical or mental disabilities and notifies the school that certain students may require accommodations or other services under Section 504. The school nurse is the professional who gathers and interprets health information and who therefore, has the most information about students’ health conditions. He or she routinely develops Individualized Healthcare Plans (IHP) collaboratively with student, family, school staff, community, and health care providers as appropriate (NASN/ANA, 2005). The school nurse is a provider of direct school health services according to the IHP and continuously monitors the health status of students.
The school nurse role as a 504 team member includes:
Becoming familiar with school district policy and procedures related to Section 504 Regulations;
Obtaining from physician(s) information related to diagnosis, nature of disability and related problems, including effects of medications, and then providing clarification to the team;
Explaining the IHP nursing document to the team, if an IHP has been written;
Explaining observed impact of health conditions on student’s school participation; and
Recommending health-related accommodations so that the eligible student has equal access to education.
For students who need health-related accommodations at school, the school nurse develops an IHP, a nursing document. Like the Section 504 processes, the IHP process is collaborative and includes parents, school staff, and health care providers (National Association of School Nurses, 2005). Many districts consider the IHP to be a 504 Plan in the cases where a student needs only the health-related accommodations outlined in the IHP to access education. The IHP then, is subject to the regulations of Section 504. Therefore, once the 504 team has determined eligibility for an individual student, the team then can determine whether academic accommodations are also needed for the student to access education. If classroom or academic accommodations are needed, then those accommodations can be written as the 504 Plan and the IHP can then be added to the 504 Plan as an accommodation.
If a student needs an IHP for health-related accommodations to access education, then the student is likely to be determined to be Section 504 eligible. An example is the student with diabetes who must monitor blood glucose levels and administer insulin during the school day. Blood glucose monitoring and management would require classroom accommodations such as providing an opportunity for the student to be caught up on what was missed when she/he was experiencing a low blood glucose level and could not attend to or comprehend what was being taught or, providing extra time to complete a standardized test because she/he may need breaks to check blood glucose levels during examinations.
A student may also have an IHP because she/he receives medication at school to control symptoms of attention deficit disorder (ADD). If the administration of medication is the only accommodation that the student needs to access education and there is already a procedure in place for administration of medication, then the student would not need a 504 Plan, and the 504 team would not determine that the student is Section 504 eligible. On the other hand, if that student with ADD also needs accommodations provided by the teacher in the classroom, then the student would need a 504 Plan and would be eligible under Section 504.
Once the 504 Plan has been written, the 504 case manager monitors student progress. The case manager for the 504 Plan is the person who is most knowledgeable about the disability and the accommodations. If the student receives medication at school to control symptoms and accommodations are only health-related, the school nurse is the case manager. If the accommodations are primarily academic, then a classroom teacher may be the most appropriate case manager. The school nurse case manager monitors a student’s response to health-related accommodations, communicates with parents and health care providers, modifies the IHP as needed, and calls a meeting of the 504 team to make changes to the 504 Plan as needed. The law mandates that school districts reevaluate a student who has a 504 Plan whenever there is "any significant change in placement" (34 C.F.R. pt. 104.35, Paragraph (a), Preplacement evaluation), and otherwise establish policies "for periodic reevaluation of students who have been provided special education and related services" (34 C.F.R. pt. 104.35, Paragraph (d), Reevaluation). According to 504 regulations, "A Reevaluation procedure consistent with the Education for the Handicapped Act [IDEA] is one means of meeting this requirement" (34 C.F.R. pt. 104.35, Paragraph (d), Reevaluation). Periodic reevaluation consistent with IDEA requirements would occur every three years, however, an annual review is best practice.
The school nurse also plays an important role in interpreting Section 504 for administrators and parents of students with health-related disabilities. Parents often request 504 Plans (in addition to an IHP) because they want greater legal protection and recourse, and if the school district agrees that the student needs services under Section 504, they are entitled to the Section 504 process. Following Section 504 procedures is of primary importance to OCR, and parents can file a complaint with OCR if they feel that their student is not receiving rightful services for a disability.
Section 504 Accommodation Plans are created to eliminate barriers to participation in academic programs and to social development for disabled students. The student’s impairment does not have to impact learning (reflected in documentation of academic performance) for a student to be eligible for services under Section 504, but the disability must substantially limit a major life activity. Although all disabilities may ultimately impact learning without accommodations, poor grades or academic performance below grade level need not be present for a student to be eligible for services under Section 504. School nurses should be members of 504 teams and not only in cases of chronic disease. The school nurse IHP document should stand as the 504 Plan when the accommodations are only health-related and adherence to the IHP should be an accommodation included in the 504 Plan for eligible students who also have academic accommodations.
REFERENCES
Americans with Disabilities Act (ADA). (1990). 42 U.S.C. § 12101 et seq.; Regulations at 28 C.F.R. § 35 and § 36.
Caruso, B. (Ed.). (2001). Section 504 and physical disabilities: Best practices in accommodating students. Horsham, PA: LRP Publications.
Council of Educators for Students with Disabilities. Section 504 procedures, Q&A. Retrieved April 6, 2005, from http://www.504idea.org/504mechanics.html
Goldman, C. (Ed.). (1999). Background of Section 504 and implementing regulations: Section 504 compliance handbook. Tampa, FL: Thompson Publishing Group.
Individuals with Disabilities Education Improvement Act (2004). H.R. 1350 § 602 [Definitions].
Moses, M., Gilchrest, C., & Schwab, N. (2005). Section 504 of the Rehabilitation Act: Determining eligibility and implications for school districts. Journal of School Nursing, 21. 48-58.
National Association of School Nurses (NASN) and American Nurses Association (ANA). (2005). School nursing: Scope and standards of practice. Castle Rock, CO and Scarborough, ME: National Association of School Nurses, 2005.
Office of Civil Rights (OCR). (April 29, 1993). Memorandum to regional civil rights directors (by J.J. Lim). Washington, DC: U.S. Department of Education
Rehabilitation Act of 1973. 29 U.S.C. 794 § 504; Regulations at 34 C.F.R. pt. 104 (1973).
Rosenfield, S.J. (2004). Section 504 and IDEA: Basic similarities and differences: EDLAW briefing paper. Retrieved November 16, 2004, from http://www.Idonline.org/id_indepth/legal_legislative/edlaw504.html
Schwab, N.C., & Gelfman, M.H.B. (2001). Legal issues in school health services. North Branch, MN: Sunrise River Press.
U.S. Department of Education. Protecting students with disabilities: Frequently asked questions about IDEA and Section 504. Retrieved May 11, 2005 from http://www.ed.gov/print/about/offices/list/ocr/504faq.html.
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