When Is Medical Homebound Instruction Used?
Sometimes medical homebound instruction is the best option for students being treated for substance abuse or undergoing mental health treatment or for those who have to be out of school due to severe illness, post-surgery recovery or because of a bad injury.
The Rise in Mental Health-Related Homebound Cases
Unfortunately, due to a spike in children experiencing severe symptoms of anxiety and depression, the number of kids on medical homebound instruction has increased in recent years, even though it is not always recommended for all students.
State Requirements and Unintended Consequences
Although the state of South Carolina requires that school districts provide a medical homebound instruction option for children who, for whatever reason deemed necessary by a doctor, cannot participate in in-person instruction, this could lead to even bigger issues for the student. Problems occur when a student prolongs the at-home instruction for longer than deemed medically necessary.
Short-Term, Not a Long-Term Fix
Dr. Ryan Byrne, a child psychiatrist with Tri-County Behavioral Health, said he appreciates how medical homebound instruction allows students to continue with an education when experiencing chronic absenteeism, but he warns of using it for too long. “A small number of students may benefit from a brief period away from school if there are significant stressors involving school,” he said. “However, medical homebound instruction should be a limited short-term intervention for students to cope with stressors, while getting appropriate treatment.”
He commented that he thinks parents need to know what medical homebound instruction offers, when to use it and how.
Understanding Appropriate Use
“Medical homebound instruction should be used for short-term absenteeism,” Dr. Byrne explained. “Like for a broken leg, post-op surgery, for those on an IV or other medications. It is designated for a short amount of time. Somehow, in recent years, it has morphed into a long-term solution, which it should not be.”
Tracking the Trend in Charleston County
He further explained that an increasing number of students use it when they struggle with attendance. According to Charleston County School District data, 193 students received medical homebound instruction in 2023-24, compared with 271 students through May of the 2024-2025 school year.
The Limits of Homebound Learning
Medical homebound instruction is designed to provide continuity of educational services between the classroom and home setting for students who can’t attend school. However, the services are far less than what a student would receive in school, and medical homebound instruction is meant to be temporary. Its goal is to facilitate the student’s return to the current classroom setting as soon as medically indicated. School teams take medical recommendations into account and develop support plans that are designed to balance medical and educational needs.
Alternative Support Strategies
A few nurses working in behavioral health with CCSD shared some alternatives to medical homebound instruction. “There are many resources and accommodations that support students getting back to school after being on medical homebound or that can be provided to prevent a student from being out of school at all. Some of these include staff check-in upon arrival, early classroom dismissal for quiet transition, having a calming space available and access to counseling services. Other general accommodations may include an altered schedule or shorter days, having therapy in school or access to virtual appointments in a private area at school and extra time to complete assignments. While all students can have access to accommodations to support their learning, physicians should be aware that students may already have plans to support their academic success, such as individual health plans, 504 plans and individualized education plans,” said Tineaka Robinson, medical homebound coordinator in the Department of Student Support Services at CCSD.
Daily Instruction Time and Learning Gaps
A typical day of medical homebound learning can last for as little as 50 minutes. “Students have to maintain their course load during this time and often miss out on special areas and related arts classes, as well as field trips and other school-based activities. The stress of trying to keep up with coursework and losing access to activities can be challenging and can sometimes create more anxiety and frustration for the student,” Lisa Allison, executive director of Student Support Services with CCSD, said.
Recommended Timeframes and Chronic Exceptions
The recommendation is that medical homebound instruction be provided for a maximum of 45 days, except in cases of chronic illnesses where intermittent homebound instruction over a longer period may be needed.
The Mental Health Factor
When it comes to anxiety and depression, the National Institute of Mental Health estimates that, in 2021, 20.1% of 12-to-17-year-olds experienced a major depressive episode. Similarly, 19.7% of those in the same age group reported symptoms of anxiety on the Teen National Health Interview Survey from 2021 to 2023.
Today’s Stress Landscape for Teens
Megan Bocchino, director of school climate in the CCSD Department of Student Support Services, said, “Numerous elements are contributing to the heightened stress levels experienced by students today. Factors such as anxiety, sleep disturbances, high levels of consumption of social media, high work demands, home factors and financial difficulties are among some of the causes. This stress can result in students avoiding school, which in turn leads to setbacks in their education and creates a reluctance to attend, as they now face the challenge of needing to catch up.”
She added, “Typically, most students receive one hour of daily instruction for every school day missed.”
Making the Right Choice for Your Child
Ultimately, understanding what medical homebound instruction is and what it isn’t will be the precursor to its success for your child. To find out if medical homebound instruction is right for your son or daughter, visit HealthyChildren.org. For more information on CCSD’s medical homebound instruction, go to ccsdschools.com/divisions/deputy-superintendent/chief-academic-office/student-support-services/important-links-and-resources/medical-homebound-information.
By Theresa Stratford
