CLTS FS Instructions Module 8 - Health-Related Services

Contents

8.1 Overview of the Health-Related Services (HRS) Table
8.2 Medical or Skilled Nursing Needs (PDF)
8.3 Definitions for Particular Health-Related Services (PDF)
8.4 Frequency of Help/Services Needed
8.5 Expected to last, at this frequency, and child is not expected to become independent at this task for at least six months or more?

8.1 Overview of the Health-Related Services (HRS) Table

The Health-Related Services (HRS) Section covers medical conditions, skilled nursing care and treatment needs. “Skilled nursing” describes the task being done, not who is doing it. Often parents and other family members or school professionals are trained to do highly skilled nursing tasks. 

Things to consider when completing the HRS section:

• There are several standards in which a child can meet nursing home or hospital level of care (LOC); therefore, it is important to be thorough and mark all needs that apply. 
• The screen was developed to recognize differences in severity, frequency and age of child.
  • For example: wound care for a baby (considered a “non-reporter”) requires much more oversight than wound care in a healthy teenager who can report problems and get help if needed.
• Medications (except for those administered intravenously) are absent from the HRS section.

The HRS Section is designed to capture the child’s medical needs and the extent of their functional limitations. It is important to be thorough and accurate when completing the functional screen. Remember that responses to all questions on the functional screen are assessed in total when calculating functional eligibility.

8.2 Medical or Skilled Nursing Needs

8.2 Medical or Skilled Nursing Needs (PDF)

8.3 Definitions for Particular Health-Related Services

This table lists conditions and needs with frequency of help needed. See “8.4 Frequency of Help/Services Needed” for instructions on how to fill in the frequency rows on the HRS table. 

8.3 Definitions for Particular Health-Related Services (PDF)

8.4 Frequency of Help/Services Needed

• For each condition or need a child has, the screener must indicate either that the child is independent with the task, or that they need skilled nursing help from others.
• If the child does need skilled nursing help from others, screeners must indicate the frequency at which that help is needed.

Precision is important, and screeners may need to consult with health care providers or other experts familiar with the child and their needs.

Child is INDEPENDENT in Managing a Health-Related Service

• A child is independent in turning the oxygen on and off, taking it on and off, checking their oxygen saturation level (if required), and changing water bottles and tubing (if required). 
• School nurse oversees the child’s self-catheterizing due to school policy, but the child is completely independent with the task and with monitoring for problems. 

If the child is not independent in managing a condition, place one check mark in the column showing the most accurate frequency of “Skilled Nursing Help from Others.”

Skilled Nursing Help from Others

“Skilled nursing” describes the task being done, not who is doing it. Parents and other family members or school professionals are often trained to do highly skilled nursing tasks. Skilled nursing help includes step-by-step cueing. The screen does not capture “unskilled” tasks not listed on the functional screen.

Frequencies of Skilled Nursing Help

The column headings are:

• 1 to 3 times/month
• 1 to 3 times/week
• 4 to 7 times/week
• 2 or more times a day

Indicate Frequency of Skilled TASKS, Not Duration of Condition

For health related services that are continuous (such as an indwelling urinary catheter), check the frequency of tasks related to the service.

Example: Oxygen is often worn continually; screeners should find the frequency at which the child needs help from others with particular tasks related to the oxygen.

Multiple Frequencies of One Health-Related Service

There are often multiple skills with different frequencies for a single health-related service. As a rule of thumb, check the skill with the highest frequency (e.g., there will often be several skilled tasks for one IV, each at a different frequency. Check the one of highest frequency).

Example: Sara has an indwelling urinary (“Foley”) catheter. The catheter is changed (by a nurse) every 30 days. Daily “cath care” is soap and water as a normal part of bathing and is not considered a “health-related service” on the screen. No irrigations are needed. Sara also has a tracheostomy. Tasks related to this include having a nurse change the trach tube once every month, and a parent or caretaker clean the trach site (“trach care”) twice a day. The screener places two check marks: 1) Urinary catheter-related skilled tasks at “1 to 3 times/month” and 2) Tracheostomy Care at “1-2 times/day.”

Averaging Frequencies

The screener will encounter frequencies of health-related services that do not fit the columns in this section. Options are limited for brevity. Here are some guidelines for rounding off or taking averages for differing frequencies:

• If the frequency of treatments varies over weeks or months, select the answer that seems closest to the average frequency of help needed.
• If the frequency of treatments varies day to day, select the answer that most accurately describes their needs on the higher frequency days.
• If something is done less than once every month, the screener will not check it in the HRS section. If a task is done “every month or two,” ask how many times over the past six or 12 months. If that averages to almost once a month, check the “1 to 3 times/month” column.

Expected Frequencies

If the child is expecting to encounter health-related services in the near future, it may be difficult to determine the average frequency of help or services needed. With some conditions, an educated estimate can be made. If a child is expected to get a central line very soon, it might be hard to predict the frequency of skilled tasks. However, since most central lines need to be flushed once a day, that is a safe box to check.

8.5 Expected to last, at this frequency, and child is not expected to become independent at this task for at least six months or more

A child must need long-term support, not just short-term. Sometimes the duration of a child’s health-related needs may be challenging for screeners to discover. Health care professionals routinely make predictions about health conditions and treatments and their expected duration. Ask the parents if the clinicians have explained this to them or look to see if it is documented somewhere. If there is no health care professional prediction, check “Yes” for expected to last.

Check “Yes” if:

• The child currently has a tracheostomy, central line, total parenteral nutrition (TPN), or is on a ventilator, which is expected to be removed in less than six months. The screener is to give the benefit of the doubt in case it takes longer than expected to wean the child from these life-sustaining treatments.
• Child is waiting for an organ transplant.
• Child is receiving physical therapy, outpatient therapy, and speech therapy through the school system, and the individualized education plan (IEP) indicates the therapy will continue next year.
• There is uncertainty regarding how long support is needed.
• A child needs assistance but is expected to need less assistance, but not be independent, within the next six months.

Check “No” if:

• Child is likely to be independent with the task within the next six months.
• Child is expected to have surgery soon and to fully recover within several weeks after that.
• Child has a temporary ostomy that is expected to be repaired within three months.