Transition Planning for Students with Healthcare Needs
It is the position of the National Association of School Nurses (NASN) that all students with healthcare needs should receive coordinated and deliberate transition planning to maximize health and well-being. As an essential member of the multidisciplinary school-based team, the registered professional school nurse (hereinafter referred to as school nurse) is ideally placed to provide care coordination and lead the planning team in addressing transitions for students with healthcare needs (American Nurses Association [ANA] & NASN, 2017). The goal of transition planning is to maximize student health and academic success.
Historically, school-based transition planning focused on preparing students for the transition beyond secondary school. We now recognize that transition planning refers to a coordinated set of activities that assist students when entering school, re-entering school, between schools and beyond secondary school for all students, with additional attention to those students with chronic or acute healthcare conditions. Due to advances in medicine and health care, more students are surviving chronic health conditions and disabilities and attending or returning to school (Bargeron, Contri, Gibbons, Ruch-Ross, & Sanabria, 2015).
Transition planning is one of the concepts central to the discipline of nursing (Schumacher & Meleis, 1994) and is supported by the Framework for 21st Century School Nursing PracticeTM (NASN, 2016; ANA & NASN, 2017). Planning requires identification of the problems, issues, and needs of the student in collaboration with the student, family, and the student’s educational and healthcare teams to meet the student’s healthcare needs and serves to decrease stress associated with transition (Selekman, Bochenek, & Lukens, 2013; Schumacher & Meleis, 1994; ANA & NASN, 2017).
Federal laws also provide guidance for transition planning. For students with Individual Education Program (IEP) plans, support strategies for transitioning beyond high school planning must be in place by the time the student is 16 years old (Americans with Disabilities Act Amendments [ADAA], 2010). Students who qualify under Section 504 of the Rehabilitation Act (1973) for accommodations to support their academic achievement may benefit from transition planning (Rehabilitation Act of 1973 [§504], 2000; Alfano, Forbes, & Fisher, 2017).
School nurses are well positioned to support both the health and academic success of students with healthcare needs during periods of transition. School nurses are uniquely qualified to:
- facilitate communication and information sharing across systems and among key stakeholders;
- interpret medical orders and incorporate them into a student’s IHP and other accommodation plans;
- facilitate the implementation of a student’s IHP and/or accommodation plans across transitions;
- monitor and assess the impact of the transition plan on the identified student health and academic outcomes; and
- connect families with resources to meet existing or emerging student needs (Bargeron et al., 2015).
Transition planning includes coordinated, deliberate, and community-based strategies to ensure a seamless approach to achieving positive health and academic outcomes for students with chronic medical, behavioral, or developmental conditions (Bargeron et al., 2015). Transition plans should focus on providing the needed accommodations and services to meet health, academic, social, and emotional needs; stimulate academic motivation; and promote adjustment to the school setting (Leroy, Wallin, & Lee, 2017). The planning for adolescents with healthcare needs transitioning to adulthood includes the development of self-management and decision-making skills to foster active participation in maintaining their own health to attain their goals for quality of life (American Academy of Pediatrics [AAP], 2016; ANA & NASN, 2017). Communication among members of the student’s healthcare team outside the school and the school multidisciplinary team, including the school nurse, is critical to identifying the transition needs of the student and determining how to best address those needs (AAP, 2016).
Transitions are often difficult and associated with behavioral health exacerbations and social/emotional changes, and students undergoing transition, as well as their families, may not know what to expect. Because of this, students may feel overwhelmed, defeated, and isolated (Finch, Finch, W.H., Mcintosh, Thomas, & Maughan, 2015; Schumacher & Meleis, 1994). The school nurse can improve the quality of life for students and families through development and implementation of a transition plan to promote student health, academic success, and success in postsecondary endeavors.
It is important that the school system considers the following issues when transition planning for students who have healthcare needs:
- privacy of student health information as it applies to Health Insurance Portability and Accountability Act and Family Education Rights Privacy Act;
- the role of the school nurse in delegation in accordance with state law (ANA & NASN, 2017);
- identification of students with healthcare needs that would benefit from targeted transition planning; and
- advocacy for clear school policies and guidelines that maintain continuity of education for students with healthcare needs who may experience intermittent and extended absences (Legislative Alliance for Students with Health Conditions, 2017).
To effectively support transitions for students with healthcare needs, school nurses should:
- be knowledgeable about applicable local, state, and federal laws that impact the development and implementation of transition plans;
- maintain clinical competence to provide direct care and/or delegate care to effectively implement, monitor, and evaluate impact of the transition plan (ANA & NASN, 2017);
- identify the training needs of school personnel regarding how to mitigate the impact of healthcare needs on student health and academic outcomes during periods of transition (Morley, 2016);
- develop a relationship with the student's healthcare provider(s) and family to ensure that the medical orders and resulting individualized health and accommodation plans are implemented, monitored, and evaluated (Zhou, Roberts, Dhaliwal, & Della, 2016); and
- provide consultation and/or referral to the medical home and community resources (AAP, 2016).
Transition periods greatly impact students, families, and the health and education systems. This can be especially true of students transitioning from acute or prolonged hospitalizations, entering school, re-entering school, moving between schools or engaging in post –secondary academic or employment pursuits. Planning for timely and seamless transitions can prevent interruptions in student access to medical services and other educational opportunities that support their academic success. The school nurse is uniquely qualified to provide care coordination and lead transition planning teams, including the facilitation of student movement between healthcare and educational settings and beyond (Bargeron et al., 2015).
Alfano, A. L., Forbes, M. S., & Fisher, L. A. (2017). Education law for children with disabilities: The individuals with disabilities education act (IDEA) and section 504 of the rehabilitation act of 1973 (Section 504). In C. A. Resha & V.L.Taliaferro (Eds.), Legal resource for school health services (pp 141-151). Nashville, TN: School Nurse.com.
American Academy of Pediatrics. (2016). Role of the school nurse in providing school health services (Position Statement). Pediatrics , 137(6), e20160852. Retrieved from http://pediatrics.aappublications.org/content/early/2016/05/19/peds.2016-0852
Americans with Disabilities Act Amendments. (2010). 42 U.S.C. § 12102. Retrieved from http://www.ada.gov/pubs/adastatute08.htm#12101
American Nurses Association & National Association of School Nurses. (2017). School nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Authors.
Bargeron, J., Contri, D., Gibbons, L., Ruch-Ross, H.S., & Sanabria, K. (2015). Transition planning for youth with special health care needs (YSHCN) in Illinois schools. The Journal of School Nursing, 2(4) 253-260.
Finch, M.E.H., Finch, W.H., Mcintosh, C. E., Thomas, C., & Maughan, E. (2015). Enhancing collaboration between school nurses and school psychologists when providing a continuum of care for children with medical needs. Psychology in the Schools, 52(7), 635-647. doi: 10.1002/pits.21854
Legislative Alliance for Students with Health Conditions. (2017). School success for children experiencing chronic illness: National recommendations for addressing global barriers. Physical Disabilities: Education and Related Services, 36(2), 8-15. doi: 10.14434/pders.v36i2.24106
Leroy Z., Wallin, R., & Lee, S. (2017). The role of school health services in addressing the needs of students with chronic health conditions: A systematic review. The Journal of School Nursing, 33(1), 64-72.
Morley, R. (2016 ). Re: Comments on Title I, 200.21© School-level needs assessment; Proposed rule. Retrieved from
National Association of School Nurses. (2016). Framework for 21st century school nursing practice. NASN School Nurse, 31(1), 45-53. doi:10.1177/1942602x15618644
Rehabilitation Act of 1973, 29 U.S.C. § 504
Schumacher, K.L., & Meleis, A.I. (1994). Transitions: A central concept in nursing. The Journal of Nursing Scholarship, 26(2), 119-127. doi:10.1111/j.1547-5069.1994.tb00929.x
Selekman, J., Bochenek, J., & Lukens, M. (2013). Children with chronic conditions. In J. Selekman (Ed.), School nursing: A comprehensive text, 2nd ed. (pp. 700-783). Philadelphia, PA: F.A. Davis Company.
Zhou, H., Roberts, P., Dhaliwal, S, & Della, P. (2016). Transitioning adolescent and young adults with chronic
disease and/or disabilities from paediatric to adult care services - An integrative review. Journal of Clinical
Nursing , 25 , 3113-3130. doi:10.11/jocn/13326
Acknowledgment of Authors:
Claire Molner, M.Ed., BS, AASN, RN, NCSNM
Megan S. Fioravanti, BSN, RN, NCSN
Wendy Rau, BSN, BA, RN
Kae Austin Bruch, BSHCA, RN, NCSN, AEMT/FF
Nichole Bobo, MSN, RN
Adopted: January 2019
This document replaces the position statement Transition Planning for Students with Chronic Health Conditions (adopted January 2014).
Suggested citation: National Association of School Nurses. (2019). Transition planning for students with healthcare needs (Position Statement). Silver Spring, MD: Author.
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.