Education and Early Childhood Learning

URIS Group A interventions are complex procedures that require the clinical judgment, skill and knowledge of a registered or licensed practical nurse to support the child in the community program.

URIS Group A health care procedures are listed below. (Please see definitions.)

• Ventilator care
• Tracheostomy care
• Suctioning (tracheal/pharyngeal)
• Nasogastric tube care and/or feeding (i.e., while at community program)
• Complex administration of medication (i.e., via infusion pump, nasogastric tube, or injection [other than Auto-injector] while at community program)
• Central or peripheral venous line intervention (i.e., while at community program)
• Other clinical interventions requiring judgments and decision making by a medical or nursing professional

The URIS Interdepartmental committee accepts and reviews URIS Group A applications from community programs and determines eligibility for URIS Group A support. URIS has a continuous intake process. However, community programs are required to apply for support annually.

The following are examples of supports that may be required by a child eligible for URIS Group A:

• Registered nurse or licensed practical nurse to:
  • perform health care procedure(s) required by the child during attendance at or transport to/from community program;
  • directly support the child's participation in the community program;
  • obtain clinical training, and child specific orientation, as required. This is often provided by clinical staff that are involved in the child's care;
  • develop and maintain a written health care plan for the child; and
  • participate in interdisciplinary planning meetings regarding the child.
• Coverage by an alternate staff person to allow the primary nurse breaks during the day.
• Limited consumable health care items specific to the child (e.g., non latex gloves).
• Auditory intercom system/pager/cell phone appropriate to the child and setting.

The following functions are performed by the administrator of the community program (e.g. school division, school administrator, child care director, case coordinator):

• completing an application for URIS Group A support and other relevant documents;
• contracting the services of a nurse to support the child with Group A health care needs; and
• completing the Claim Form for Approved Costs template.

Contracting the Services of a Nurse to Support the Child with Group A Health Care Needs

Administrators of community programs/case coordinators are responsible for engaging a nurse with the appropriate skills and experience to provide care for the child.

Administrators/case coordinators may contract with a private nursing agency to supply a nurse or may recruit an independent nurse with the necessary background and experience. If the administrator/case coordinator is unaware of local nursing service providers, they may contact the URIS Interdepartmental Committee.

Nursing services may be in short supply in some communities. If the applicant is unable to recruit an RN or LPN, they may contact the URIS Interdepartmental Committee to assist in exploring appropriate services.

Contracting the Services of a Nurse through a Nursing Agency

• Contact one or more Nursing Agencies.
• The agency will ask for general information about the needs of the child/youth in the community setting.
• The agency will request permission to contact the parent/guardian to gather further information, specific to the nursing support needs of the child/youth. Agency staff may visit the home and meet with family or may communicate with parents/guardians over the phone.
• The agency will develop a “client profile” based on this information, and will initiate the process of recruiting a nurse who is appropriately qualified to meet the needs of the child/youth in the community setting.
• The agency is responsible for ensuring that appropriate College registration, insurance and training is in place.

Hiring the Services of an Independent Nurse

• The administrator/case coordinator or delegate is responsible to develop a job description that identifies the specific responsibilities of the nurse in the community program. A thoughtfully crafted job description serves as a useful recruitment tool and promotes a mutual understanding of job function. A sample job description is available to assist community programs in the recruitment process. Administrators/case coordinators are encouraged to revise it to reflect the specific needs of the child and community program.
• The typical process used for recruitment and hiring should then be followed by the community program.
• Upon completion of the hiring process, the independent nurse becomes either a contractor or employee of the community program.
• It is essential that the community program, as the hiring authority, ensure the nurse(s) are registered with the College of Registered Nurses of Manitoba (CRNM) or the College of Licensed Practical Nurses of Manitoba (CLPNM). Provincial legislation requires that nurses apply to CRNM or CLPNM annually to maintain their registration. The community administrator/case coordinator should request the nurse produce the certificate of registration prior to hiring, and annually thereafter, to ensure that the registration is current.
• Ensure the nurse(s) receive an orientation that includes the following components:
  • The needs of the child and family.
  • The child’s health care plan, if already developed. The health care portion of the orientation may be provided by a health care professional already involved with the child or the hospital staff discharging the child.
  • Technical aspects of the child's care, including the specific equipment required.
  • Community program setting, routines and programming, location of supplies and equipment.
  • Non-nursing functions to be performed in the community program. The community program should provide guidance and supervision to the nurse regarding the performance of non-nursing functions.
• Ensure the nurse(s) meet(s) expected employment standards of the community program. It is the nurse’s responsibility to monitor his/her own professional conduct in accordance with the Regulated Heath Professions Act.

When a Child is Absent from School

Children with complex medical needs who are classified as Group A by URIS may be absent from school for varying periods of time. Often the absence is due to ill health, a change in health status, or hospitalization. As a nurse is assigned to each child with URIS Group A health care needs attending school, the following is intended to clarify the nurse's assignment in the case of short term and prolonged absence.

Short term Absence

When a child is absent from school for five (5) days or less, the school division will continue to pay the nurse as previously approved by URIS. If the child is ill, at home, and the parents are not present, the school division is authorized to re-direct the nurse to provide direct service during the day to the child at home. If nursing support is not required in the child's home, the school division is authorized to request that the nurse perform other duties.

Prolonged Absence

A prolonged absence from school is a period of six (6) days or more. The Student Services Administrator must advise the URIS Inter-Departmental Committee of such situations immediately. These situations will be considered on a case by case basis. The URIS Committee will advise the community program in writing, of its decision regarding the nurse's assignment within 10 working days.

The College of Registered Nurses of Manitoba (CRNM) and College of Licensed Practical Nurses of Manitoba (CLPNM) have established standards of practice that describe how a RN/LPN is to practice in order to protect the public. The RN/LPN is responsible to provide safe and appropriate care as well as to acknowledge any limitations in knowledge, judgment and/or skill and to function within these limitations.

The nurse's role is to support the child's physical needs while allowing optimal participation in the community program.

The nurse will:

• Develop and maintain a written health care plan that includes health care interventions necessary and appropriate during the child's attendance at the community program. The health care plan should be developed in collaboration with the parent/guardian and community program staff and be consistent with the assessment prepared by the child's medical team. A consent form to share information is included in the plan and signed by the family. The health care plan (see next section for more detail) is shared with case manager and appropriate community program staff.
• Provide direct nursing interventions to support the child's health care needs.
• Seek clinical consultation with appropriate health care professionals, as required (e.g., Children's Hospital, the local hospital, health care professional with expertise in the health care intervention specific to the child, clinical supervisor of a private nursing agency).
• Communicate personal learning needs specific to the child's health care to the administrator of the community program/case coordinator. The nurse is responsible for maintaining competence and identifying learning needs when new skills are required. Training will enable the nurse to attain the new skills and competencies required to support the child requiring care. Training may be provided by participating in the hospital discharge planning process for the child, if possible.
• Collaborate with the community program to ensure health care interventions are scheduled to minimize the child's time away from the program and foster independence. Stand-by or stand-back monitoring of the child should be provided by the nurse when appropriate.
• Facilitate and support the child’s participation in the community program. For example, under the direction of childcare facility staff, a nurse in a childcare facility may assist a child with  play based activities, while monitoring and intervening as necessary with the child's health care needs. In a school, the nurse would work under the direction of a teacher to support implementation of appropriate educational programming, while monitoring and intervening as necessary with the student’s health care needs.
• Participate in interdisciplinary planning meetings regarding the child.
• Direct parental questions and concerns regarding programming to appropriate community program personnel.
• Wherever possible, participate in the hospital discharge planning process for the child.

Children requiring URIS Group A support need an Individual Health Care Plan (IHCP).

The development of the IHCP is the responsibility of the nurse that is providing direct care to the child.  This involves collaboration with  the child/family, primary physician, other medical supports and the team within the community program.

Children do not attend a community program to receive health care. Rather, health care interventions are performed to support the child's participation in the program. The IHCP should reflect this and focus on interventions required to support attendance and participation. It is intended to complement and work with other planning formats that are used in the community program (e.g., Individual Education Planning Process). Typically, a staff member of the community program (e.g., resource teacher/child care coordinator) is designated as case manager.

Evaluation and monitoring are integral to health care planning and to ensure the interventions are adequate and appropriate. Interventions must be tailored over time to allow for changes in health care status and developmental stages of the child. Maintenance of the health care plan involves ongoing collaboration by the nurse with the child and parent/guardian and a broad range of community and health professionals. The nurse responsible for direct care is also responsible to update the IHCP as needed to ensure it remains current.

The IHCP contains personal health information about a child. In accordance with The Personal Health Information Act (PHIA), community programs must respect the privacy of the child and family and adhere to the following guidelines:

• The information contained in the IHCP is confidential and may be accessed only by those individuals responsible for the care of the child in the community program (e.g., nurse, case manager, principal, teachers, educational assistant, special needs child care worker, etc.).
• The information contained in the IHCP should not be copied or shared with others without the permission of the parent/guardian agency.
• The IHCP should be stored in a designated area and safeguards must be in place to ensure that only those who require the information to provide care to the child have access to it.
• The IHCP remains the property of the community program. The family has access to the document and will receive a photocopy of it upon request.

In school divisions, typically the student services administrator (SSA) is involved in the process and is responsible for applying for URIS Group A support and may delegate the writing of the application to the school-based case manager. In funded independent schools, the school principal is responsible for applying for URIS Group A support and may delegate the writing of the application to the school-based case manager.

1. The school division or funded independent school completes the following documentation:
   • Special Needs Categorical Funding Level 2 & 3 Funding Application Form, including cost estimates for the school year.
   • URIS Group A Application Form
   • If a health care plan has been developed, it should be submitted along with the URIS Group A Application.
2. Completed forms are sent to:

Inclusion Support Branch
Manitoba Education and Early Childhood Learning
204-1181 Portage Avenue
Winnipeg MB  R3G 0T3
Attention: URIS Interdepartmental Committee

3. The Manitoba Education and Early Childhood Learning representative submits the required documentation to the URIS Interdepartmental Committee for review of funding eligibility. The URIS Interdepartmental Committee may request additional information or clarification from the applicant at this time.
4. Written notification of eligibility or ineligibility is sent to the school division SSA or funded independent school Principal and copied to the Manitoba Education and Early Childhood Learning Schools Finance Branch. If the application is approved, the notification letter identifies the approved expenditures and the maximum funded amount for the school year.
5. When the school division SSA or funded independent school Principal receives written notification of approval, they may then contract with a nursing agency, or private nurse for the approved services and supports. See What is the Role of the Community Program section for more information.
6. If the child's medical needs change during the course of the school year, the school division SSA or funded independent school Principal or delegate must request in writing approval from the URIS Interdepartmental Committee to adjust the approved expenditures and/or the maximum funded amounts. Should the child no longer require URIS Group A support, the school division SSA must advise the URIS Interdepartmental Committee of this in writing, prior to withdrawal of the service.
7. In order to receive reimbursement, the SSA or funded independent school Principal or delegate must submit the completed Claim Form for Approved Costs template to the Schools Finance Branch. The form must include actual expenditures and should be submitted by the following September 30. Funded independent schools may submit a completed Claim Form for Approved Costs template up to once per term.

School divisions and funded independent schools are reimbursed for the actual costs expended during the school year as specified on the Claim Form for Approved Costs template. Documentation, including copies of invoices, must be retained by the school division or funded independent school for the possibility of a random post audit.

The director of the childcare centre or family childcare provider is responsible for applying for Group A support. The childcare coordinator may assist the childcare facility in this process.

1. The child care facility completes the URIS Group A Application
   • If a health care plan has been developed, it should be submitted along with the URIS Group A Application.

Completed forms are sent to:

Manitoba Department of Families
205-114 Garry Street
Winnipeg MB R3C 4V4
Attention: URIS Interdepartmental Committee

2. The URIS Committee reviews the application for eligibility. The URIS Committee may request additional information or clarification from the applicant at this time.
3. Written notification of URIS A eligibility or ineligibility is sent to the child care facility and copied to:
   • An existing Children’s disABILITY Services, Child and Family Service Agency or Children’s Home Care case manager if identified
   • ELCC Specialist/Supervisor
     Manitoba Department of Families
     205-114 Garry Street
     Winnipeg MB R3C 4V4
     Attention: URIS ELCC representative
4. When the childcare facility receives written notification of approval, they will contact their childcare co-ordinator to discuss the Inclusion Support Program requirements. This may involve a contract with a nursing agency or a private nurse for the approved services and supports.
5. If the child's medical needs change, the child care facility must contact the URIS Committee and their child care co-ordinator to advise them of the changes. Should the child no longer require Group A support, the child care facility must advise the URIS committee of this in writing, prior to withdrawal of the service.

Children receiving respite have a case coordinator assigned to coordinate their service requirements. The case co-coordinator could be from Children’s disABILITY Services, Child and Family Services Agency or Children’s Home Care. The case coordinator is responsible to apply for URIS Group A to determine eligibility. URIS Group A needs may be identified before or during hospital discharge.

1. The case coordinator completes a URIS Group A Application.
2. If a health care plan was developed, it should be submitted along with the URIS Group A Application.
3. If the case coordinator is with Children's disABILITY Services or Children's HomeCare, the required documentation is forwarded to:

URIS Coordinator
Manitoba Department of Families
Children’s disABILITY Services
205-114 Garry Street
Winnipeg MB R3C 4V4
Attention: URIS Committee

If the case coordinator is with a Child and Family Service Agency, the required documentation is forwarded to:

Team Leader, Agency Relations – Winnipeg
Child and Family Support Branch
Manitoba Family Services
102-114 Garry Street
Winnipeg MB R3C 1G1

4. The URIS interdepartmental Committee reviews the application for eligibility. The URIS Interdepartmental Committee may request additional information or clarification from the applicant at this time.
5. The case coordinator receives written notification of eligibility and is responsible to follow their respective program's internal process for funding.
6. If the child's medical needs change during the course of the year, the case coordinator will follow their program guidelines for notification if nursing is no longer required. Should the child no longer require Group A support, the case coordinator must advise the URIS Interdepartmental Committee of this in writing, prior to withdrawal of the service.