E55 Other Health Impairment (OHI) [Eligibility Category Bonus Series]
Other Health Impairment, otherwise known as OHI, is a difficult category to explain, especially because it tends to be a "catch all" category for any student experiencing lack of endurance (aka fatigue) or attention concerns (aka ADHD like symptoms).
Links to resource mentioned in this podcast: https://www.cde.state.co.us/cdesped/guidance_determiningeligibility_sped_students_ohi
Other Health Impairment, otherwise known as OHI, is a difficult category to explain, especially because it tends to be a “catch all” category for any student experiencing lack of endurance (aka fatigue) or attention concerns (aka ADHD like symptoms).
Our host Beth Liesenfeld, MOT, OTR/L goes through each area of the Colorado State Eligibility checklist as an example to give you a general idea of what the school team is looking for in an evaluation to qualify under this category, as well as opportunities for parent advocacy to make sure your child is supported in every area of need!
Topics discussed in this episode:
- OHI or other health impairment overview
- IEP OHI eligibility requirement
- Where to find the OHI checklist
- Why it is beneficial for parents to understand the checklist
- Definition of OHI
- Missed opportunities for advocacy in the checklist
- Importance of having your own list of challenges for your child
- Where to receive testing for illnesses
- Justifications for specialized instruction
If you need help finding your state’s definition or checklist, hop into the Facebook group and join us!
Make sure to rate and review our podcast so other parents like yourselves can find us.
[00:00:00] If you have a child with a medical condition, this is the episode for you because this week for the bonus eligibility series, we are focusing on OHI or other health impairment, eligibility category. This category is steeped in vagueness and has the reputation of being a catch all category to get children qualified who need the services, but don’t neatly fit into another category. However, we are changing that today.
[00:00:28] To provide not only an example, outline for qualification from the state of Colorado, but also looking into further resources and frameworks to help children who fall into this category. I get a more effective and specific IEP. Stay with me.
[00:00:44] You are listening to the parent IEP lab, the podcast that helps you get an effective IEP plan for your child so that you can get them supported and learning in school. I’m Beth Liesenfeld your host and occupational therapist, who started to notice trends in parents who got [00:01:00] truly effective IEP.
[00:01:01] For their kids. My mission is to help you turn insider knowledge of the system and school culture into effective parent advocacy for your child.
[00:01:11] When we start to look at the eligibility process, you realize that this is the start. Of the IEP process. This is the beginning and every three years, this process starts over again with the re eligibility process. So it’s the perfect time to look at your parent opportunities for making sure. That all of your concerns and your child’s challenges are in the evaluation process. It’s the easiest way to get an effective IEP to start at the beginning. And it’s certainly the most effective.
[00:01:44] So today we are answering the question who qualifies for an IEP under the OHI or other health impaired category.
[00:01:52] And what are the parent opportunities and resources within this category for parents? Looking at a reevaluation [00:02:00] or an IEP coming up this school year under the OHI label. Stick with me we’re digging into ohi and i’m so excited to talk about this category
[00:02:10] Okay. So let’s jump in and talk about the OHI or other health impairment category. And from now on, I’m just going to say OHI, cause I’m going to assume that, you know what I am saying when I say OHI, So how these bonus episodes work is that I have the state of Colorado eligibility checklist up in front of me. And I’m going to read this eligibility with all the checkboxes and try to explain it the best that I possibly can in audio version so that you can get an idea of what the school is looking for, what data they have to have it in that evaluation report.
[00:02:49] In order to qualify. A child under this category to receive an IEP. Now a couple of things before we get rolling. You might not be in Colorado, right? [00:03:00] So every single state has either, even though every state has the OHI category, not every state will have the same checklist and criteria for qualification underneath that category. So I’m using Colorado as an example, but if you need help locating your own state’s checklist or their definition hop into the Facebook group, you can actually find the link in the description of this episode.
[00:03:27] And you can also. I also go to the IEP lab.com/podcast. And if you find the show notes for this episode, which is episode 56, then you’ll see. I mean, in any episode, you can see the, the graphic there that you click to go join the Facebook group, answer the membership questions and get in, and then ask if you need to.
[00:03:49] In help for finding the eligibility definition or the eligibility checklist for your state. Now, some states have a checklist like Colorado does. The actual checklist is [00:04:00] uploaded. Into their state’s website. Not all states are like that. So I know like Illinois off the top of my head only has the definition and doesn’t necessarily have the checklist. You might have to dig a little bit to find the checklist as well. So jump into that group. There might be another parent from your state already.
[00:04:17] That already knows how to find them, or I can always step in and help you locate it as well. Now there’s a couple of different reasons why we’re talking about this specific checklist and you know, talking about the eligibility process, because you might be saying Beth, I’m a parent. I’m not actually working for the school. Why do I need to know this?
[00:04:37] And the cool thing. Is that when you know this process, well, when you start understanding what they’re looking for, then all of a sudden your parent input gets so much better because you have some context. Have you ever been in an IEP meeting and they’re saying, okay, let’s start with strengths. What is your child’s strengths? And you’re a put on the spot.
[00:04:57] And B you’re like, well, what do I provide this [00:05:00] actually relevant to the school? Like what, what are you actually looking for that I can provide? And when you start to understand what things to share. In those moments, all of a sudden your IEP for your child gets more and more and more effective because you are providing really relevant information for what they’re actually looking for. And.
[00:05:23] Teams are not very good at giving you examples of what is helpful. And they’re not very good at being very parent-friendly and leading you through this process. To get the information from you that is truly helpful for them to build a really effective learning plan. So, this is the reason why we’re doing these checklists and looking at eligibility criteria, because the more that you understand the system, the more you can learn what your role is within it and provide an advocate for the things that your child really needs within the context of the system. And it just makes it easier for the school to say yes to things that you’re [00:06:00] asking for.
[00:06:01] So we’re going to go through this checklist. And then the really cool thing about OHI is it’s linked to a bunch of other resources. Because it is known to be kind of a quote, unquote, catch all category. They were like, well, they don’t fit into any of these other categories, but I think they might qualify under OHI.
[00:06:01] And so it gets this reputation that it’s like this very vague. Category. That doesn’t mean much. It’s just like a way to open that door to special education services. But. I I love this is the part I love. I love putting together. What a child’s needs. And what their strengths are, and then looking at these categories and being like, oh yeah, that’s a no brainer. They qualify under this.
[00:06:01] And so many times because I’m coming from a medical background because occupational therapy, like we were part of the med school. And we did anatomy and physiology and all of these medical things. And so I’m coming from the medical world when I sit on IEP teams and not everybody on that team has a medical background.
[00:06:01] It’s pretty much OTs, PTs and nurses, and all three of us. Aren’t very commonly sitting at that table. Even school psychologists, they are. Not there’s a, uh, they’re a social science, they’re not a truly hard science. And so some of this. Really doesn’t make sense to a lot of people. And there’s so many times where I would be sitting in a child find evaluation. So like when the child is turning three.
[00:06:01] And. I would be talking to the case manager. I’d be reviewing the files before we did the evaluation. And. Um, so many times I’d be like, well, you called the nurse in to be part of this evaluation. Right. And they’re like, Uh, no, we didn’t do that yet. And I’m like, oh, you need them. Like, you need them here because I just had more of a context for that medical framework that not everybody on the school team has. And that’s very frequently. Does that come up in this specific category?
[00:06:01] So, just as an idea, before we jump into the checklist. Some. Children diagnosed with ADHD or like you’re suspecting ADHD. You don’t necessarily have to have that diagnosis by the way. Um, if you’re suspecting ADHD, if you’re suspecting, um, a genetic condition, if you have a diagnosis of a genetic condition,
[00:06:18] If there’s epilepsy, if there’s any kind of health impairment. Um, health diagnosis, then they’re probably going to at least consider this category. So. Without further ado, you. Let’s jump into the eligibility checklist just as an example for colorado so you can get some context for what they’re looking for
[00:06:28] Okay. One final thing before we get started with this checklist is that I am not a lawyer. So if you have any questions from of a legal nature about qualification, or if your child didn’t qualify and they meet the criteria, that’s kind of above my area of practice. And I would recommend that you get a consult or, um, talk to your legal.
[00:06:55] Team. In order to talk through the eligibility thing. So this is for [00:07:00] educational purposes only, especially me using the Colorado checklist that might not apply in your state. So just keep that in mind when we’re going through it. So. The first thing at the top of the eligibility checklist is a definition of other health impairment. And it’s so nice that they have these definitions.
[00:07:17] And they might vary state to state, but most of them are going to be very similar. So here’s the definition at the top of the page. A child with an other health impairment shall have limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli that results in limited alertness with respect to the educational environment due to a chronic or acute health problem that prevents a child from receiving reasonable educational benefit from general education alone.
[00:07:47] Okay. So the, um, key words that are in this definition that are going to come up later is. Is limited strength, vitality, or alertness. And they’re talking about even a heightened [00:08:00] alertness. So not within that normal range, they either have too low of alertness and they’re missing things or too high of alertness. And they can’t either filter through that stimuli to understand what isn’t, what’s important and what’s not, um, or it’s making them sensitive or nervous or creating other barriers to, um, actually learning in the classroom.
[00:08:23] So if you’ve listened to another one of these bonus episodes than you will. Really be listening for a theme here. You will be really understand the theme. That is this first section underneath the definition and these three questions, at least in the state of Colorado or the same for every eligibility category in Colorado.
[00:08:42] The first question is the, in my opinion, The most missed opportunity for parent advocacy ever. And that’s because these eligibility checklists are written in double negatives. They’re extremely difficult to understand. [00:09:00] And. This first question, because it’s the first question gets, looked over a lot, so let’s read it and then we’ll talk about it.
[00:09:08] The evaluation is sufficiently comprehensive to appropriately identify all of the child’s special education and related service needs. Whether or not commonly linked to the disability category. And in parentheses, it says answer must be yes. In order for the child to be eligible for services. So. This, even the definition in parentheses, right?
[00:09:32] You have to give a key for how you’re supposed to answer. If they’re able to be. Eligible for services, right? Answer must be. Yes. So what they’re saying. Is there saying that they have enough evaluation data or data in the evaluation? To determine eligibility. Now, I want to direct your attention to the part where it says whether or not commonly linked to a disability category. [00:10:00]
[00:10:00] So oftentimes teams will be like, oh yeah, we did everything that we needed to, to determine eligibility. But if you, as the parent. Have a list of challenges before they even do the evaluation. And you, when you get that draft of the evaluation report home, Hopefully a couple days before the meeting, then you can look at your checklist of challenges and you can compare it to what they were able to test in the evaluation report.
[00:10:27] Now let’s say that you have on your challenge list for your child. That they struggle with emotional regulation. And when you get into the evaluation report. You were seeing. Everything else on the checklist, but you’re not seeing any evidence either way. Of emotional regulation skills. And as a parent, if you want that supported in the final IEP.
[00:10:54] It has to be in the evaluation report. Think of, and, oh my gosh. If you’ve taken [00:11:00] the decoding IEP data workshop, if you’ve taken the ultimate parent IEP prep course, which I changed the name from the intensive to the prep course. Then you will hear me talk in really excruciating detail about this data funnel.
[00:11:17] That we have going on. And if you envision paperwork like a funnel, Evaluation reports are at the very top. And you can’t pull information and challenges and strengths down to the parts of the IEP. As you go down the process without having everything in. The evaluation report. Okay. So. When you get that evaluation report home, I want you to be able to see all the challenges reflected in that eligibility report or that.
[00:11:48] In that evaluation report. And so if you’re seeing something missing, Then I would hope that you would email the team as soon as you can and say, Hey, we’re missing data on this area. [00:12:00] That I’m concerned about. And hopefully they can get that fixed and get that incorporated. But many times when you sit down to the table, they’ll say, well, we don’t have that data on emotional regulation, but we still have enough information to determine an eligibility. And I want you to feel confident enough that you can say no, in here, it says whether or not commonly linked to the disability category, we need that information in there before we can proceed and they have to stop and they have to put that in there.
[00:12:30] Okay. So number one, missed opportunity. So number two, under the same section, his child can receive reasonable educational benefit from general education alone. So again, in parentheses, it has to tell you answer must be no in order for the child to be eligible for services. So they’re there making sure that there is a need, they can’t benefit from just general education alone.
[00:12:53] They need additional services and that’s what the IEP is. And then the third and last one within this section, it has three [00:13:00] different check boxes underneath it. So it says the child’s performance and it says in parentheses, all answers below must be, is not in order for the child to be eligible. So for services.
[00:13:11] Is, or is not due to a lack of appropriate instruction in reading, including the essential components of reading instruction. Is, or is not due to a lack of appropriate instruction in math and is, or is not due to limited English proficiency. So if any of these things is, let’s say that. They are an English language learner.
[00:13:31] Well, we can’t determine if they have a disability. Necessarily. If we’re not sure that they’re actually able to access. Education in this language, right. And that’s a different set of services. That’s a different process for getting help and services. Um, that’s, that’s a whole nother show. When we talk about English language limiters, but we have to make sure that this is truly a disability and not to, to something else.
[00:13:59] So in the next [00:14:00] little section is just one checkbox. It says to be eligible as a child with an other health impairment, there must be evidence of the following criteria. A chronic or acute health problem, including, but not limited to asthma attention deficit disorder or attention deficit, hyperactivity disorder, diabetes epilepsy, a heart condition, hemophilia leukemia, kidney disease, sickle cell anemia or Tourette syndrome.
[00:14:29] And I have no context to give you with where they pulled the specific disorders from.
[00:14:34] The one thing that I want to note is that it says including, but not limited to. So one that I see really commonly following within this category is somebody with a genetic condition, like a deletion or. You know, a diagnosis such as down syndrome, fall into this as well. So it’s not just limited to these specific conditions, but these are given as examples.
[00:14:57] The next set of check boxes. [00:15:00] There’s three of them in this one. And it says the other health impairment as described above. Prevents the child from receiving reasonable educational benefit from general education as evidenced by one or more of the following criteria. And it says, check all that apply. So this isn’t.
[00:15:16] They have to be yes. In all of these to be able to qualify. The first one is limited strength as indicated by inability to perform typical tasks at school. The second one is limited vitality as indicated by an inability to sustain effort or to endure throughout an activity. And or limited alertness as indicated by inability to manage and maintain attention to organize or attend, to prioritize environmental stimuli, including heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment.
[00:15:54] Okay. And then the last checkbox is the child has a disability as defined in the state [00:16:00] rules for the administration of exceptional children’s educational act. And is eligible for special education. And if they qualify, then they would be yes. If they don’t, then that would be no. So this is a shorter checklist. If you’ll notice, I mean,
[00:16:14] You might not have listened to the other ones and that’s okay. But as far as specific learning disability and autism spectrum disorders, which are the two that we’ve done before this. They have a much longer, um, making sure that it’s not the specific things to make sure that they qualify in the right category. Now you can see why this one might be like a catchall because.
[00:16:35] All they have to do is really have evidence of that limited strength, limited vitality or limited alertness. To be able to qualify for this. And they just say like, they have to have something right. Now again, you don’t necessarily have to have an official diagnosis. And school psychologist can do the same testing to get attention deficit disorder.
[00:16:58] Labeled in this [00:17:00] way, they can’t give you a diagnosis that then you can take to the doctor and have insurance color cover services. It stays within the educational realm, but they can do the same testing to gather evidence for this attention deficit disorder as well. For some of the medical things like diabetes, you’re obviously going to have a, an actual diagnosis from a doctor for those kinds of things. Same thing for epilepsy, car, heart condition, you know, the genetic conditions.
[00:17:29] Those you will have to have like, uh, a medical diagnosis for, but you don’t actually like have to have like an ADHD diagnosis to come in here and do that.
[00:17:39] So the second part of this episode, Is when I just wanted to note when I was looking for that eligibility checklist. It’s actually part of a packet and I will link this up in the show notes. The link will be below this in your podcast player and in the description. And then it’ll also be at [00:18:00] theieplab.com.
[00:18:01] Slash episode five, six. And so you’ll see this. Whole kind of packet. Uh, available at the link that I’ll, then I’ll link up in the show notes and. The interesting thing is. The whole thing is called guidance for determining eligibility for special education students with other health impairment. And it goes through.
[00:18:23] It has a bunch of charts in it. It says what OHI is and what OHI is not. It compares the OHI category, two traumatic brain injury category. Which is the category I’m really well familiar with, um, being part of. I started the brain steps team. At my district a couple of years ago. And it has a matrix that can be used to collect data when considering OHI category. So these are like columns where they say like, should you do an interview? Should you do an observation? Should you do a health history? Um, and obviously you would want all [00:19:00] of those things for OHI and really anything.
[00:19:02] But the really cool thing. That I want you to be able to access. Is the state of Colorado. And I think this comes from a national, um, it comes from a national article and it’s really well-researched. But under the citations underneath this graphic, it really cites the Colorado brain injury. Committee as building this graphic and.
[00:19:27] We’ve talked about Maslow’s hierarchy and another episode, and that’s really helpful for determining like priorities and goals. Right. This is really similar, but it’s talking about skills. And so I’d love to do another episode and kind of talk about this. Building blocks of brain development graphic, because it’s so incredibly cool. And we talk about it a lot. When we talk about traumatic brain injury.
[00:19:51] But on the base, it has kind of these, these pods or blocks, right?
[00:19:56] And inside of each of these blocks has a skill. So it says [00:20:00] on the, on the base of it, it says fundamental processes. And the blocks say memory processing, speed, attention, inhibition, and sensory motor. And then the next level up. Is labeled intermediate processes and these have three, so three box. First one is language processes, learning processes and visual spatial processes.
[00:20:23] And then the next level up just has to, and it says higher order processes, social, emotional competency, and executive functionings. And then the very top is overall functioning. So achievement, cognitive ability and reasoning. And. The cool thing about using this graphic is. Say that you have a child with ADHD? Well, attention is on the bottom.
[00:20:48] So if we’re missing that block out of the bottom and that falls out, then everything on the subsequent blocks on top of this attention block. Are going to [00:21:00] be unstable. They’re going to vary. Right? So learning processes. Social emotional competency, executive functionings, and achievement at the top.
[00:21:09] Is really going to be on shaky ground if you have some pieces missing from the bottom and if they’re not supported. So that’s where. Your services come in. That’s where your justification for truly skilled service comes in because if your child has accommodations for attention, But they don’t know how to use them, or they don’t know what they are, or they don’t have any enough self-awareness to really know when they need those accommodations. That is a perfect justification for that specialized instruction. And so many times.
[00:21:44] I see kids come through this process, this evaluation process. And teams because they’re. Not as well educated in this area, as we would really hope that they would be. They say, oh, [00:22:00] well I think they can be served by a 5 0 4 with accommodations and they don’t need specialized instruction. And as a parent, this is your kind of second huge opportunity for advocacy.
[00:22:12] Is if your child needs assistance for attention or for memory or anything else where this OHI category would, would really point out the limited vitality and alertness. And ability to sustain attention. Then this is the perfect opportunity for you to say. I would love for them to just have accommodations, but they don’t know how to use that. And they need specialized instruction to be able to access that
[00:22:41] and this can depend, right? Some students really take off with accommodations and all they need is a couple of reminders. They need their teacher to give them, you know, a couple of reminders, but it’s not a sit-down curriculum. Or it’s not a sit-down dedicated time in their day or their week to really work on these self-advocacy skills or [00:23:00] this ability to ask for what they need and those accommodations. Right. So that’s really the second huge.
[00:23:08] Opportunity for parent advocacy, especially with an OHI, because I see this happening all the time. That they will go through the process and they’ll consider OHI and they’ll say, well, they don’t need this specialized instruction. And so if you’re prepared for that, And you can say, well, actually you noted in the evaluation report that they were lacking this and this, and they really need support in this and this. And so you can justify your argument.
[00:23:35] In that way and really get further, get an actual IEP plan and a more effective IEP plan again, if you know what the pitfalls are of these categories as well. So of course this is especially a category that varies from person to person and student as students so much. So if you’re not in the Facebook group, yet, there’s a link below in this description for [00:24:00] this podcast in your podcast player, and you can request to become a member.
[00:24:04] Member of that Facebook group, because if you’re wondering, Hey, I have an evaluation coming up or Hey, we have an IEP they’re qualified under OHI. And you want to talk through either, you know, the building blocks and how you phrase things or your specific challenges that you’re encountering with your child or your school team. That Facebook group is just so nice to be able to go to and just ask some questions and have a discussion with people that are coming at this process in the same way that you are, right.
[00:24:34] I’m not a proponent of huge conflict. I don’t think that’s more. I don’t think that’s very helpful. To get the most effective IEP plan for your child. So let’s work on how to phrase things. Let’s work on how to build up your data and your case and learn this system so that you can bring the things that are important to the school team. So it’s an easy, yes. So that it doesn’t feel like fighting all the time.
[00:24:58] Right. So, thank you [00:25:00] so much for listening. I’m so excited that you were here, that you went through the Colorado checklist for OHI as an example. Again, if you need help finding your state’s checklist or definition for OHI. And or if you want help in how to advocate through this eligibility or re eligibility system, I would love to hear.
[00:25:23] What you need in the Facebook group and be able to help you out there. So click the link in the description of this podcast, to be able to go to the Facebook group. And or go to
[00:25:32] the IEP lab.com/episode five, six episode 56. And you can click the link there to join the facebook group and you will also find the links to these resources in the building blocks in the example of colorado’s packet for guidance for eligibility for ohi as well so thank you so much for tuning in this week i will see you same time same place next week