Discussion and Next Steps

The theorist Jean Piaget developed a cognitive development theory which explained that the developing child builds successive cognitive structures for understanding and responding to physical experiences within his or her environment as they mature. Educators applied this in the classroom by planning developmentally appropriate curriculum that enhanced their students' logical and conceptual growth (Watson and Kopnicek, 1990).

Cognitive dissonance theory, developed by Leon Festinger (1957) which built on Piaget's work, is concerned with the relationships among cognitions and how individuals deal with situations which arise when they discover dissonant cognitions. The theory of cognitive dissonance holds that contradicting cognitions serve as a driving force that compels the human mind to acquire or invent new thoughts or beliefs, or to modify existing beliefs, so as to minimize the amount of dissonance (conflict) between cognitions.

In 1999, a multidisciplinary sick cell disease (SCD) team sought to improve school attendance and academic performance of students with SCD by ensuring that every qualified student had an Individual Education Program (IEP) and by tracking academic records and school days missed. Despite several years of support from the multidisciplinary team, students showed no significant decreases on number of missed school days or rate of grade failure (King et al, unpublished data).

In 2003 a new two-year pilot program was established for students with SCD and strokes who were willing to participate in an education remediation program. After year one of the program, teachers with students in the program requested more information about SCD when they discovered their students had SCD and a stroke. A teacher education program was developed to test the following hypothesis that, after completing the education program, teachers would show a significant improvement in knowledge about school-related issues for students with SCD (King, Tang, Ferguson & DeBaun, 2005). Emphasis was placed on the need for IEP's for students with SCD. Overall statistical results based on a pretest prior to and a posttest after the education session, indicated teachers' knowledge of SCD improved significantly after the program, but, results suggested that teachers need to know more about the content and intent of IEP's because they could not identify false statements as to the practical use of IEP's and how it might improve academic performance (King, Tang, Ferguson & DeBaun, 2005).

King et el, demonstrated that there is a lack of awareness as to the use of an IEP as a strategy to improve students results where a chronic health condition, such as SCD, exists when you emphasize IEP's. The results indicated that teachers knew some common complications of SCD, but lacked knowledge as to how it affected their students in the classroom via an IEP.

Cognitive dissonance theory may provide insights gained from King et el's research related to a lack of awareness that an IEP may aid in conditions such as SCD. This implies that teachers may, in situations where they teach children with a chronic health issue, be unable to consider changing their learning approach because they rationalize, according to cognitive dissonance theory, that the child is simply no different than any other child in order to relieve the dissonance between their cognitions. The result would be to continue on as usual without ever recognizing the need for an IEP.

Over the past 20 years, there have been many changes in views about the responsibilities society has towards disabled students in the ways we expect to educate students with disabilities. These changes have been given impetus by civil rights movements, by humanitarian concerns and by a better research-based understanding of the education problems faced by people with disabilities. After much effort by researchers, educators, and parents, there is now widespread acceptance and belief that inclusion, through the process of mainstreaming of children with disabilities in the education systems in ordinary schools, is a challenging and important issue and typically one that requires a carefully written Individual Education Program (IEP) to assist the student in the classroom (Clay, Cortina, Harper, Cocco & Drotar, 2004; Shui, 2001; Sexson & Madan-Swain, 1993). Children who have chronic health conditions should be considered to have similar conditions. These children can achieve better results in an educational setting with the implementation of similar inclusion type programs, namely a 504-plan.

On May 16, 2005 the Ontario Legislature unanimously passed Bill 3, Sabrina's law, which requires school boards to have policies that include:

  • training for school staff on dealing with life-threatening allergies on a regular basis
  • creating individual plans for students who have an anaphylaxis allergy
  • having emergency procedures in place for anaphylactic pupils
Sabrina's Law was named after Sabrina Shannon a 13-year old student who died after reacting severely to food served in her school.

 
A lack of clarity in the area of severe allergies and students had been an ongoing source of tension between parents of children with anaphylaxic reactions and schools.  In some instances the school dealt with anaphylaxis through identifying the child as having a "physical" exceptionality and a resulting IEP was laid out. In other cases, boards refused to identify anaphylaxis kids on the grounds that the condition did not interfere with learning. Bill 3 clearly requires that a plan to deal with anaphylaxis MUST be developed. It requires training for staff and clearly signals that this problem must be dealt with by school boards.

Sabrina's Law is a first step in the development of a 504-plan for chronically ill students who do not fit within the IEP scope. It is unfortunate that it took Sabrina's death to establish a new plan for dealing with children who fall into this category.