Schedules and Lesson Plans for Moderate/Severe Classes

Schedules and Lesson Plans for Moderate/Severe Classes

March 25, 2021 24 min read

In Part 2 of my interview with Emma Haring, we discuss schedules and lesson plans for moderate/severe classes. Emma gives some great ideas on how to write everything out so all adults and visitors know what is going on with her students who may be medically fragile in a multiple disabilities classroom.

She gives ideas on how to set up your schedule and remember to include everything on it. In fact, she created a freebie to help teachers out as a supplement to the podcast episode. There are sample weekly lesson plan pages. In addition, there are extra pages that explain it all…and some other goodies as well. Link to it in the Resources and Links section below.

Emma also shares how it is important to prepare for emergencies daily at the beginning of the year. She also gives tips on other things to include in your class as well.

Even if you do not teach in a medically fragile or multiple disabilities class, you will get ideas you can use when creating schedules and lesson plans for moderate/severe classes. And the rest will give you perspective on your coworkers who teach this population.

Don’t miss Part 1 of my interview with Emma. Check it out here.

UPDATE10/2021: Terms change all the time, and perhaps some of the terms used are becoming antiquated. For example, in my local area, the title for these classes recently changed from Severe Disability Classes to Extensive Support Needs Classes. See Episode 25 for a number of other names for classes for students with significant special needs.

Episode 26 Show Notes

Guest: Emma Haring

Emma Haring is a retired special educator whose career was over 29 years. She started out as a substitute paraprofessional in a Deaf/Hard of Hearing classroom while working on her teaching credential. Over the years she has taught elementary, junior high/middle school, high school, and adult transition students, sometimes with all those ages in the same class! For a significant portion of her career, she worked with students who had complex health issues and were medically fragile.

Resources and Links

  • News To You Curriculum
  • Boardmaker
  • Emma’s Free Handout: Scheduling Help for Moderate/Severe or Multiple Disabilities Classrooms
  • Here are a few special education terms used in this series:
    • Para – Refers to a special education para-professional (also sometimes calls para-educators or aides) that helps in the classroom.
    • OI teacher: Orthopedic impairment teacher
    • OT: Occupational therapist

Important Note about my FACEBOOK account: I got hacked by scammers and no longer have control of my Facebook Group “Help for Special Educators,” Lisa Goodell Equip Page, or my personal page. Please leave the group, and unfollow/unfriend the page. (I have started a new Facebook just for my art/stamping.)

Woman holding a pretty cat

About the Host

Lisa Goodell, M.A., launched the “Help for Special Educators” Podcast on April 1, 2019. She has taught for over 24 years, including third grade, resource/inclusion (RSP), and mild/moderate self-contained (SDC). Currently, she is an itinerant orthopedic impairment (OI) specialist/teacher for students birth to 21 years old in all general ed and special ed settings.

Lisa has a master’s degree in special education and six special ed and general ed teaching credentials. She has been honored as “Teacher of the Year” at both the elementary and secondary levels. She lives in rural Central California with her family and a bunch of cats.

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Check out other Podcast Episodes!


NOTE: An artificial intelligence transcription service converted the audio file of this podcast episode into the written words below. The file is mostly accurate, however, be aware that spoken words and conversations are not the same as a conversation in a novel. This means that will be some inaccuracies or accidental errors (i.e. missing punctuation, missing words, etc.). I do proofread it and correct some things, but thank you for your patience and grace since I’m sure there are parts that the AI and I both miss.

Schedules and Lesson Plans for Moderate/Severe Classes

Schedules and Lesson Plans for Moderate/Severe Classes

Lisa (00:00):

Episode 26. This is Part two of my interview with Emma Haring so I will title this one “Schedules and Lesson Plans for Moderate/Severe Special Ed Classes.”

Lisa (00:14):

Do you ever find yourself barely able to hold your head above water? Waves of IEPs, data collection, assessments, parent conferences, not to mention lesson plans and seasonal activities are all crashing around you. You need help, but not just from anybody. Grab the lifeline that is the Help for Special Educators podcast. We will equip you with creative solutions and teacher-tested strategies so you can navigate the rewarding, but difficult job as a special ed teacher. This is Lisa Goodell, your host.

Lisa (00:54):

Welcome to part two of my interview with Emma Herring, a special education teacher and expert on teaching classes where the students have complex medical needs and multiple disabilities. If you missed part one, I go over terms and definitions and Emma gives some amazing advice about how to find out and know your students, even if they are non-verbal and have a lot of needs. Today, we’re going to jump right into a deep dive on schedules, emergency procedures, and some other ideas of what to teach.

Lisa (01:34):

I know lots of new teachers are usually preoccupied with trying to figure out the schedule and with good reason. So what advice would you give to new teachers? Just starting out in your type of classroom, Emma?

Emma (01:47):

So I’m talking to the brand new teacher out there. They give you the best case scenario is most of the time in August and September, when you first get the students, just expect that everything is not going to go 100% as you imagine it. You walk into a classroom and it’s kind of like you’re balancing… I kind of picture right now in my head, the cat in the hat, on the ball with the book and the fish bowl. There’s a lot of stuff to juggle and you will get it. You will learn how to make everything work. I always think the beginning of the school year lasts until probably Halloween… Halloween is a the celebration point. Because by that time, a lot of things are in place. You’ve probably have gone through several schedules, you’ve thrown some of them out. And that really is okay. It’s about meeting the needs of the students. So if you just remember that, if you just keep focused that you’re just working on getting the best schedule possible to meet the most needs of all your student., Just give yourself some grace.

Lisa (02:41):

That’s excellent. I think scheduling is probably the hardest thing, because you do, you, you try to plan the best schedule you can, but then something changes… A specialist that comes in has to change their time or something changes for a student. And yeah, I’m constantly changing my schedule and that is good for a new teacher to know that that’s just a part of teaching. So we gotta be flexible.

Emma (03:03):

Yes. Flexibility is so important.

Lisa (03:06):

So Emma, why don’t you give us an example of your daily schedule?

Emma (03:10):

Okay. Let me do a quick rundown of the schedule. So in the morning when they arrive, you want to work on things like personal hygiene. Some students need breakfast, that’s served in the cafeteria, or they may have a medical intervention through G-tube feeding. You want to make sure that those things happen kind of in that first block, if possibl., You’d have a group activity in the morning, and then we have some individual activities. After lunch, we may have a wind down for the day. There again, all the personal care needs that have to be taken care of and you want to have individual activities and then final group activity. That’s the way I set things up.

Lisa (03:44):

That’s a great overview. Can you tell me more?

Emma (03:47):

When students come in for the day… This is after say October. So sometime around Halloween, when things settled down… And my classes, they either were bused or they were brought in by parent. If they were brought in by parents, typically they came completely, almost prepared to learn. If they were coming in from a bus, they may have been on the bus for an hour to two hours.

Lisa (04:06):

Wow. That’s a long time.

Emma (04:08):

So you want to make sure that their personal hygiene needs have been taken care of. You want to just read any notes from the parents and talk to the students about whatever the note said. We would set it up where at least one person is in charge of doing something that they could all do together. So maybe they were listening to music or watching a video that features lots of different kinds of words. Just something that where one person could monitor the majority of the students while the other two staff were taking care of personal hygiene needs

Lisa (04:37):

In your class. The one that you’re describing right now is there three adults in the room with about how many students?

Emma (04:43):

Typically we would have one teacher and two Paras [paraprofessionals], and then up to 12 students. Because I worked with students who had medical issues sometimes we had one-to-one nurses, but even the one-to-one nurse requires help with lifting and positioning during changes (unless it was a medical procedure type of change)… Some people that needed catheterization, that kind of thing. Then of course, the nurse is going to be doing all of the primary work. So you have to work things out with the nurse that’s working with your student. How much help do they want? Some nurses want to do it all, somewhat a lot of help. And so you have to know your staff.

Lisa (05:22):

That makes a lot of sense. I like how you differentiated between at the beginning of the year and in October when things have settled down, because we know our students take time to get used to the routine of going to school. And then also, I really like how you said you were very aware of the students that had a really long bus ride so that you could address the needs that they have as well. So once you get all that taken care of, then what would you do next?

Emma (05:51):

So if a student had a two or three hour bus ride, they may need to be positioned kind of lying down, but within the group. So we were blessed to have some specialized seating and positioning equipment so that if a student needed to kind of be in a more reclined position and rest a little bit, but still be able to focus on what was happening in the classroom, we were able to do that. I will tell you though, that took a lot of work with our staff, with the OI [orhtopedic impairment] teacher and with the OT [occupational therapist.] So it takes a village to slowly get equipment into your classroom that will benefit a variety of students. So just know that it didn’t just come magically in the air. It took a lot of thought, and looking at needs.

Emma (06:33):

Let me just say this while I’m thinking about it, if you don’t mind, Lisa… If you’re a new teacher, one of the things you want to do is you really want to look at the history of your students. If you’re working with medically fragile students, you’d need to find out what all their diagnoses are and what they mean, what medications they’re taking. Because if a student has a medication at seven o’clock in the morning, that makes them a little bit drowsy until 9:00 AM. you need to know that. If they get that same medication again, at noon, you want to plan the bulk of their learning like math and science…You want to put that between those times. I know it’s a lot to juggle, but if you write down what time somebody is taking medication, I have an idea what are the effects of that medication on their learning. So sometimes somebody would come in the room and you would see somebody resting. And it’s really important to make sure that your new staff or substitute staff understand this person needs to lay down for a little bit and then we’ll bring them back into the group. So it’s really important to just be aware of all the medical issues that the students have and kind of time their learning accordingly.

Lisa (07:29):

I think that’s a really excellent point that you make, especially for people that haven’t come from a background that’s more moderate/severe, and medically fragile. In my classroom (that was more mild learning disabilities) I never had students that were off taking a nap or resting.

Emma (07:45):

Thank you for saying it that way because I’ve been in moderate/severe classrooms where students were very healthy and they would be up all day. And even with students who are medically fragile, the older they are, the more time they need to be able to spend positioned upright Think about this: They need to be able to function in the world. So over the course of the school year, you want to increase their active time in a classroom style position. So they may start off where they’re having to lay down a little bit more, but you slowly increase their ability to be in a classroom-like setting as the year progresses. You have to build the stamina.

Emma (08:22):

I worked with students who had a lot of multiple medical conditions and some of them had really severe seizures. So you had to be careful about lighting and stimulation. So we may start the year with a lot of low stimulation activities. Somebody could walk in the room and they could be bored almost, but the students weren’t important. Some of them were having massive seizures. There was a lot of simulation going on for them. So you have to know whether or not you have students with a lot of seizure activity, because you may be doing a lot of more active things with the other students, but they may need to be a little further back so that the screen is not as close to them.

Lisa (08:54):

So how you keep track of all these moving parts, all the medications the kids have, plus what you’re trying to teach and what you have your staff doing…Can you even put that all on one schedule?

Emma (09:07):

There are two parts to the schedule. I have two columns, I made it in Excel or in Word, but one column had all the procedures and all the medical things that had to be done. All the intervention staff, if they had occupational therapy, if they had physical therapy, had adapted physical education, that was all in one column. Then the learning activities during that same period of time, which students were participating in which areas in which groups, because all of those things have to function at the same time. And so you need to make sure you know, but that your program manager, your principal, whoever the person in charge is, can walk in the room and see, Oh, they’re doing special positioning at this time. They’re doing occupational therapy at this time. So that when program manager walks in and you have a student on the mat on the ball and you have a parent taking care of them, you need to know that the rest of the group has activities that are less, one-to-one intense.

Lisa (09:56):

There are so many different things that are going on, whether it’s procedural or medical things going on, or whether it’s learning activities with communication or fine motor. I mean, you could have a student that’s sitting there connected to a G-tube eating their lunch…might not look like they’re doing anything, but they’re doing something.

Emma (10:14):

Yes. Sometimes when students come in the morning after the personal hygiene is taken care of, they may need to eat. Often our students who were fed by G-tube, some… They were on a motor, so that was really easy, it was just maybe start and stop. Others had to have a person with them, very slowly feeding them and others, it may be hanging from an IV pole. For some students that would be all they could handle, for another student while they’re eating, they are actively participating in say a game with a switch. They may be eating during morning meeting and they’re actively participating in morning meeting. They’re answering questions about the calendar, about the date, what happened last night. But some students required quiet and low stimulation during those times.

Lisa (10:57):

I know scheduling is a part of every single thing that we do. So that’s still going to come up, but let’s switch gears a little bit and talk about some of the important concepts and topics that you always try to teach in your classroom. So the first one that I’d like to hear about is how you set things up so that you, your staff and your students are very prepared for that first fire drill or any type of emergency that might happen.

Emma (11:27):

We have all the staff and all the students do emergency planning, emergency drills. The reason why this is important is we work with students who are medically fragile, you have to be concerned about different sounds that they might hear, about different words that they may hear. Why are you trying to put me in my chair, take me back outside when we just got out. And so before we have an actual fire drill, we want to have, in a very calm way, have all the, and students work on planning how to safely get students back into their wheelchairs. If they’re ambulatory maybe they have to have a helmet to walk outside. You want to be able to work on that in kind of a calm manner. After they’re changed back into their chairs, you want to be able to go to the designated spot. The first time you do it after morning meeting, the next thing that we’re going to do is fire drills.

Emma (12:14):

We’ll hear an alarm, we’ll hear a bell, whatever the sound is going to be, name it, claim it. This is what the sound is we’re going to be listening for. And then you just kind of make a funny sound, make them laugh. I’m going to make sure it’s serious, I’ve gone online and I’ve found the sounds and played them. I started playing them very softly. They may get louder. And then louder because students who have a lot of seizure activity who have really strong startle reflexes students with a lot of pain, you just want to make sure that you ease them into it. So that nobody’s frightened. You want this to be kind of an ordinary thing. Of course, there’s an actual emergency, there’s going to be a heightened awareness, heightened sense of stress. But if you’ve practiced the routine every other day or every day for two weeks, and then taper that off, it’s amazing the difference when there’s actually an emergency that you have to get people out. I’ve had students who had really bad seizure disorders who were just completely fine when an alarm went off that we weren’t prepared for.

Lisa (13:09):

That’s really good because you’ve been preparing them every single day. So when it does come time for the monthly fire drill or whatever it is that the school has, then they’re ready for it. And they can be like rock stars when it happens.

Emma (13:21):

Yes, it’s wonderful. It really does help. So some people may think, Oh, that’s a lot of time, but as you’re establishing procedures in your classroom, just know that’s going to take a lot of time. It requires that grace. So that first two, three months, that’s what you’re working on. Establishing procedures, all the things that are routine. If you have to go to the cafeteria, then you want to take the time slowly to develop it so that everyone’s safe. Everybody understands what they’re doing. All the staff feels comfortable because Johnny has one type of fastener or braking system. And Judy has another, as we’re all learning together, you want to use the words, okay, Johnny, your seatbelt works this way and talk the student through every move here you’re making, okay, I’m going to get under your arms and we’re going to move you over. Let me make sure that everybody in the classroom is using the same language, the same jargon, want to make sure that everyone understands so that if one staff person says fastener, then everybody’s saying fastener, and then you want to use a variety of words. You don’t want to just say fastener, you want to ease into using other descriptive words of those things. You really want your students to have a rich language inventory.

Lisa (14:25):

So even in these situations that don’t necessarily seem academic everything is academic because you’re trying to bring in language into all of it. And I also think that doing all this practicing is good for the staff members as well, because say, even if I’m used to helping one student with their wheelchair, somebody else’s wheelchair might work completely different. I need to know how all of those work.

Emma (14:46):

Exactly. It’s very important that every staff member knows how everything works. You don’t want anyone in the room not to feel confident in how to handle any student’s medical needs.

Lisa (14:55):

Now, when you’re working on your lessons with your students, are some students doing more functional academics or doing beginning reading, writing, what type of academics did your students usually have? Or did you have some students that were really high level, but had medical needs?

Emma (15:12):

Yes. To all of those things. I always feel that it’s very important to have functional academics be kind of a core. Everybody needs to know when they hear their name, they need to respond. That may be all you’re looking for is when they hear their name, they look up, they blink, they turn their head. Another student may be writing their name on the board or writing their name on a paper. They can learn to recognize their parents’ names. Even if it’s just like with pictures, you have a picture of mom and dad for this particular student. So all those things, I believe functional learning is so important for all students.

Emma (15:46):

Okay. So back to the academics, I really believe that you look at what core lessons are important for the grade level that that student is in. And you may need to break it down. Let’s say that they have to be able to count from one to 100. So we may start with a song that counts. It may be that we may rap it. We may stop and clap it starting with one to 10. We’re also working with the calendar numbers: today, the first or the 12th, with eye gaze. And for some students, you may only use single digit numbers, for other students you are using the double digit numbers. So just depends on the students. Some students, you may give them a choice of one or 31 or one or 11. So every time it may look really simple in the classroom as you’re doing it, but you want to find small ways to increase the students’ skills. So you need to know where they are academically. Even as you’re doing the same activity with all the students, you can vary it from one person to the next, so that they’re all getting their needs met.

Lisa (16:42):

Right. That makes a lot of sence.

Emma (16:45):

You want to have your students who are not having procedure done or personal hygiene taken care of, you want to have individual activities, helping them build up independent living skills. Because you usually have one staff person watching a group while two people are taking care of personal hygiene. Or you may have four students who eat, depending upon how those things work out. How many students do you have that need to eat? To be honest, that’s a personal preference, some students don’t want to be with other students while they’re eating. Some students will get really angry if they can’t be with other students while they’re eating. We’ve had some different philosophies go through the school, make sure you’re complying with whatever your school requires. If you have that choice yourself, I make sure that I asked my students what they prefer.

Lisa (17:27):

Yeah, that’s really good.

Emma (17:28):

Okay. So then after we’ve finished all those kinds of things, all the personal health things, comfort care, then we want to have our morning meeting. Usually we go over the schedule for the day. What’s happened that day. If there’s any changes to the schedule, we’ll make sure that that’s the point where the students learn with those schedule changes are. We may take those icons and move them around. Okay, we were going to do this. We were looking forward to it and we’re going to go outside, but it’s raining. We can’t go outside. So we’re gonna do an indoor activity. That’s going to be just as fun, so that people are prepared because we have students who just love to go outside or students who now they’re relieved. If at all possible during the morning meeting is when we try and talk about it. Then the next block, we may have some intervention with the orthopedic impairment (OI) teacher or the occupational therapist (OT), depending upon those schedules and they can change. And it may only be half of your students, it may be one of your students, three of your students. We want to make sure that that’s all listed on that schedule that we’ve talked about before. And so that, you know, when they have to go. And so you may even say depending upon how the classroom makeup is, okay. So while George is working with the adapted physical education (APE) specialist, then we’re going to be working with bouncing a different ball or whatever it is that you’re going to be doing. We try and make sure that the students feel like everything that they do is very normal. But also you have to think about for our population, that they miss their friends. So if one friend is going off somewhere, they want to know they’re coming back. They may not during the first part of the school year understand that when that person leaves, they’re actually coming back, it’s all going to be fine. And so just be aware of those kinds of little, little friendship things.

Lisa (18:58):

Oh yeah. You really have to know your students. And that definitely comes with time during the school year or if you have students multiple years, you really get to know them.

Emma (19:08):

Yes. And I think that’s one thing I love about our district, that we were able to have our students for multiple years. So elementary then kind of junior high/middle school, then high school, and then adult. I really think that that really works well for our population. We did a lot of things that were kind of group activities so that they got to know other teachers and wanted to make sure that they were positioning from one grade level to another, that they met and did activities with, with those staff members prior to the transition. So we really work hard to think about how they work and that it’s okay to be adaptable. Those are really important life skills for our students.

Lisa (19:43):

One thing that I always have thought is really great about the school campus where you were at is just that the staff there really do treat each other like family members and their students. They try to treat them as family members as well. And I just really enjoyed seeing a lot of that. Students knew other teachers from other classes, or they’d go by and everyone’s saying hello to everyone else. And I just loved that environment.

Emma (20:08):

Yes, I do too. It was a wonderful, wonderful experience. And I loved the idea that the students could feel safe with multiple people and they excelled in different areas with different people. So that, that really worked out, wonderfully.

Emma (20:25):

We had certain songs that we would do usually toward the end of the day. I like to make sure that the songs were either folk songs or songs that were multi-generational. But the biggest core thing that I liked the music to be really positive, and “you-can-do-it” type songs, just really happy to have the students come in, know that they’re cared for, then at the end of the day that they’re going out cared for and we will miss them and we’re looking forward to seeing them the following day.

Lisa (20:50):

Yeah. That’s great. Great to end on a happy note.

Emma (20:52):

Yes, yes. My classroom, I should say this, I had from first grade all the way through ATP because we were a small campus and the students had really intense medical needs. So when you have students from K basically through adult, you want to find music that meets all their needs. There are people that play popular music, but they may play it on the violin or it may be all orchestral. So you can find a lot of songs that they’re familiar with that are safe to play in school. I think that’s really, really important. I know we had somebody walk in and they recognized the song. It was all I think, violin, but it was like this rock song, you know? And so that was important. The other thing that music did for us though, we were a team. We were a family. We always stressed the idea that we take care of each other. And so everybody gets to hear something that they like and people hear things that they don’t like because we’re sharing and you don’t have to like everything because the next song, may be one you like. So whenever we’re doing activities, even we voted, we voted on the presidential elections. We voted on which team we were going to be for special sports day. I love to tell you how we did that if you want to hear Lisa.

Lisa (22:02):


Emma (22:02):

So we had Boardmaker. I love Boardmaker not necessarily for all the board symbols that it comes with, but because of the platform, you’re able to generate bingo cards and cards of different dimensions. If you know the dimensions, you can put it in Boardmaker.

Lisa (22:15):

Yeah. They have lots of templates.

Emma (22:17):

Yes. Lots of templates. And you can design your own and keep them. So for voting, say on sports teams, then you can go and you can find different icons, different pictures that match those. Or if you’re voting on food, you can get the flyers from grocery stores and cut them out and laminate them that way also. So we wanted to make sure that as often as possible, we have pictures to go along with things and that we had previously taught.

Emma (22:40):

It would be kind of a touchy thing to do an election, but fortunately “News To You” had a wonderful non-biased profiles of different candidates. There were also educational books that you could get at the local teacher store that were really nonpartisan and just wonderful. And one way to tell for sure, if you have any question, is you ask someone who, you know, has an opposite opinion of who you might vote for to read both books, because you want to make sure that everything is equally presented also. If you have a book on one candidate, you want the same company’s book on the other candidate so that they were presented fairly and equitably. So believe it or not, whether my students were severely disabled, medically fragile or students who were going out, working off campus, we voted. So no matter which population of students I’ve worked with, one of the things that we did was vote.

Emma (23:31):

Another thing that we would do is some type of giving back. Whether we would have made a tied off blanket, or whether they, with icons, made cards to send to a nursing home. We always did acts of service as well as making choices and voting.

Lisa (23:45):

That’s really great. It gives students a voice in their classroom. Like you said, they also have to learn sometimes when they don’t get their way.

Emma (23:52):


Lisa (23:55):

Oh my gosh. This has been so epic talking to you, Emma. I am sure that the listeners are just going to be taking lots of notes. I know I’ve learned so much from you.

Emma (24:06):

Thank you! Take care. Okay. Bye.

Lisa (24:07):

Bye! Emma’s going to work on writing out her schedule so that we can post it in the show notes on the podcast website. So please go to to find that we’ll also have links to other things that we talked about in this episode.

Lisa (24:35):

Now, when I start to get stressed or overwhelmed about school stuff, I find it helps to take a moment to slow down, stop and focus on my breathing. Sometimes I also might say the Serenity Prayer aloud or in my head. Here it is, God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

I might also add a few of my own words. Here’s a sample for us special educators: Help us to listen and truly understand our students. Please give us words, actions and solutions, which will help in difficult situations. May our classrooms be peaceful places where teachers, staff, and students learn and thrive. And after that, I try to go out and find someone else to help because helping others keeps me from selfishly dwelling on my own problems.

Thank you so much for listening and I hope you heard something helpful during this episode that you can implement in your teaching. Remember, you are amazing what you do makes a difference and don’t let anyone tell you otherwise. Go find someone else to encourage because they probably need to be reminded that they are amazing, too.

(End at 26:20)

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