Michael Farrell looks at a number of different areas in which special provision is needed

A useful orientation for SENCOs is the US Code of Federal Regulations definition of ‘other health impairments’ (taken to exclude orthopaedic impairment). These concern: ‘…having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that (i) Is due to chronic or acute health problems such as asthma, attention deficit or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, haemophilia, lead poisoning, leukaemia, nephritis, rheumatic fever and sickle cell anaemia: and (ii) Adversely affects a child’s educational performance’ (34 CFR, section 300.7 [c] [9] [i] [ii], 1999). Readers will notice ADHD, regarded principally as a behavioural, emotional and social disorder in the United Kingdom, is classified above as a health impairment. Furthermore, there is an arbitrary element to dividing health impairments and orthopaedic impairments (see SENCO Update, 86, June 2007), but it can be justified where conditions necessitate similar approaches or where grouping conditions enhances understanding.


The SENCO will wish to alert colleagues to the stress that serious and long-term illness or disability can place on the child and family. She will want to ensure the school’s policies and procedures support families working closely with others to ensure this is effective. Also, collaboration between parent, school and others such as the doctor can help ensure the child is as fully included as possible in curriculum activities. Curriculum flexibility should help ensure a wide and suitable range of learning experiences is provided, for example the provision of swimming or walking where contact sports pose high risk. Participation in physical education may be restricted by weather conditions, for example for pupils with asthma. Curriculum opportunities may be modified following risk assessments for practical subjects, laboratory-based work and aspects of physical education. For some pupils, such as those with cystic fibrosis, time will need to be allocated for physiotherapy although this should not affect curriculum breadth and balance.


The impact of a health impairment can vary owing to both variations in the condition and different demands of the curriculum or the child’s peer group. Therefore the child’s educational provision needs to be responsive to changes in the child’s physical and motor abilities and to the physical, psychological and any other effects of the medical condition. Particular requirements arise such as, for a child with epilepsy, having a structured framework and routine in which to locate information to help with information processing.


Resources may be required, depending on the condition and its severity. For example, a child with a congenital heart condition in lessons requiring long periods of standing may need standing aids. Architectural/ organisational implications include that the school may ensure that classroom and other facilities are on a lower floor, or minimise the necessity of stair climbing or provide a lift.

Therapy and care

In one survey (Heller et al, 2000), teachers and support professionals stated they regularly carried out specialised healthcare procedures. However, only half considered themselves very knowledgeable about the procedures, suggesting the need for more training, help in developing policies and technical assistance. Individualised healthcare plans, developed under the guidance and leadership of healthcare professionals are likely to include: a description of the condition, a short health history, basic health status and healthcare needs, treatments or medication and their side effects, transportation issues, equipment needs, emergency plans and specific precautions or restrictions on activities (eg Best and Bigge, 2001, p82). Developing an effective plan is likely to involve the child, school staff, medical personnel, and parents (Clay, 2004). School staff will need to be aware of medical aspects of health impairments, be properly trained where they have responsibilities relating to medical needs, and have the knowledge and skills to support healthcare plans, first-aid measures and recording procedures. They will need training and support to carry out procedures and to understand implications of particular symptoms such as haemophilia and how to respond. The pastoral system may include counselling and other provision to raise self-esteem, help teenagers deal with stress associated with delayed sexual maturity, and support pupils with life-limiting conditions. Medical intervention can include surgery to correct the abnormality or improve function, for example for a congenital heart condition.

School building design and use may include taking care that where advisable the child does not unduly exert himself because of carrying equipment round school. Risk assessments are made to avoid situations and activities that may affect the child adversely. Where necessary, the school will develop flexible timescales for returning homework and possibly home tuition. Higher levels of supervision may be needed. Extra supervision may be necessary at specific times such as mealtimes or breaktimes to ensure dietary guidance or medication procedures are followed by pupils.


Heller, KW, Fredrick, LD, Best, SJ, Dykes, MK and Cohen, ET (2000) ‘Providing specialised health procedures in the schools: Training and service delivery’, Exceptional Children 66, 173-186. Best, SJ and Bigge, JL (2001) ‘Multiple Disabilities’ in Bigge, JL, Best, SJ and Heller, KW (2001) (4th edition) Teaching Individuals with Physical, Health or Multiple Disabilities Upper Saddle River, NJ, Merrill-Prentice Hall. Clay, DL (2004) Helping Children with Chronic Health Conditions: A Practical Guide New York, The Guilford Press. Further reading Bigge, JL, Best, SJ and Heller, KW (2001) (4th edition) Teaching Individuals with Physical, Health or Multiple Disabilities Upper Saddle River, NJ, Merrill-Prentice Hall. The author

Dr Michael Farrell is a special education consultant. His recent books include the New Directions in SEN Effective Teachers’ Guides (Routledge, 2006).