Domain deep dive · 5
Domain 5: Personal Care / Health Supports
The specially designed instruction and supports a student needs for personal care, health, and medically-related care to attend school safely and access the educational environment. Boundaries first — built for when you have a student in front of you, rating this one domain.
What this domain covers
The specially designed instruction (SDI) and supports a student needs for personal care, health, and medically-related care to attend school safely and access the educational environment. It reflects physical support needs and medical complexity — not instruction or behavior. glossary
Includes toileting, feeding, mobility, hygiene assistance, nursing services, health procedures, health-related equipment, and personal-care staffing.
These supports are rated on the student's educational need. They don't have to meet Medicaid's "medically necessary" standard — a support can be required for FAPE here without being Medicaid-billable.
This domain is personal care/health only. Avoid miscategorizing:
- Academic/instructional supports → Domain 1
- Communication systems, unless medically driven → Domain 3
- Behavioral supervision unrelated to health/safety → Domain 2
- Independent functioning, unless primarily medically driven → Domain 4
The four factors, in this domain
Rate each 0–3; the domain takes the highest.
- A — How much personal-care/health SDI
- B — Who delivers it (clinical credential ladder)
- C — Ratio
- D — Equipment
The decision boundaries
Factor A — how much. The Domain-5-specific stake at the top is physical risk:
| Level | Boundary |
|---|---|
| 1 | Targeted, discrete; <60 min/week; schedules around instruction; at least one PC/health goal |
| 2 | Regular, consistent assistance and health monitoring tied to participation; allows periods of independence |
| 3 | Daily/near-continuous; health or safety risk if reduced or delayed; can't be postponed or clustered |
Factor B — who delivers. No specialized credential beyond typical school training (1) → staff with specific health training/competencies; periodic clinical oversight (2) → advanced clinical licensure; continuous/frequent clinical judgment (3).
TEA's rubric describes the credential abstractly — "advanced certifications, licensure, or highly specialized qualifications" with "continuous clinical judgment" for Level 3 — and doesn't name specific nursing roles.
Factor C — ratio. Intermittent (availability more than ratio) (1) → planned reduced ratio for portions of the day tied to health/mobility/care needs (2) → continuous supervision/assistance for safe attendance; may dictate placement (3).
Factor D — equipment. Occasional mobility aid, basic positioning (1) → daily mobility/health-monitoring equipment needing staff assistance (2) → complex mobility/respiratory/feeding systems essential for safe attendance; drives staffing/environment (3).
The domain score
Highest factor wins. A student needing daily care (A=2) who requires continuous RN-level care (B=3) scores the domain 3.
Traps specific to this domain
- Educational need, not Medicaid standard. Don't underrate because a support isn't Medicaid-billable.
- A personal-care ratio that also helps behavior/independence is rated here when health/care is the driver; don't double-count across domains. what is a domain
- Ages 3–5: most young children need hands-on staff help; rate only supports far beyond typical for same-age peers.