|RELATED SERVICES FOR SCHOOL-AGED CHILDREN WITH DISABILITIES|
|As defined by federal law, related services are intended to address the individual needs of students with disabilities, in order that they may benefit from their educational program. Occupational and physical therapy, school health services, and special transportation assistance are just some examples of related services that can help eligible students with disabilities participate more fully and successfully in the learning process. This is an overview of the related services enumerated in federal law, with a focus upon those services provided to school-aged children with disabilities. The personnel associated with delivering each service are identified, and their major duties are described.|
- According to the IDEA what are related services?
- What Are Some Examples of Related Services and Who Provides Them?
- Audiology Services
- Occupational Therapy
- Physical Therapy
- Psychological Services
- Medical Services
- School Health Services
- Transportation Services
- Counseling Services
- Speech-Language Pathology
- Social Work Services
- Parent Counseling and Training
- Recreation Therapy
- Assistive Technology Devices and Services
- Artistic/Cultural Therapies
- School Breakfast and Lunch Program
- Related Services under Section 504
- How Are Related Services Obtained for Students?
- How Are Related Services Delivered?
- How Are Related Services Coordinated?
- How Are Related Services Funded?
- Are There Shortages of Personnel for Related Services?
- In Conclusion: Addressing the Problems Togeth
Several important federal laws have been passed to address the rights and educational needs of children and youth with disabilities. One such law is The Education of All Handicapped Children Act, otherwise known as EHA or Public Law (P.L.) 94-142. Recently authorized and renamed the Individuals with Disabilities Education Act, or IDEA (P.L. 101-476), this law mandates that special education and related service programming be made available to all children and youth with disabilities who require them. The law also makes available federal funds to help state and local governments establish and maintain special education programs for students with disabilities, as well as provide the related services these students need in order to benefit from special education.
…transportation, and such developmental, corrective, and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, including therapeutic recreation and social work services, and medical and counseling services, including rehabilitation counseling, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education.
Until the final regulations are available to guide the implementation of the IDEA, the regulations of its predecessor, the EHA, are being used by school districts to determine how and to whom related services will be delivered. The regulations of the EHA (P.L. 94-142) list thirteen related services that students with disabilities may require to benefit from their special education programs. These are:
medical services for diagnostic or evaluation purposes only;
school health services;
social work services;
parent counseling and training;
recreation therapy; and
early identification and assessment of disabilities in children.
Clearly, the regulations define a wide variety of services that must be provided to children and youth with disabilities identified as needing such services to maximize the benefits of their special education. However, the law also states that this long list of services is not exhaustive and may include other developmental, corrective, or support services “as may be required to assist a child with a disability to benefit from special education” [The Individuals with Disabilities Education Act, 20 U.S.C. Chapter 33, Section 1401(17)]. It is through this provision in the law that many school districts are providing students with disabilities with assistive technology devices and services. Furthermore, as states respond to the requirements of federal law, many have legislated their own related service requirements, which may include services beyond those specified in federal law. For example, some states also include mobility training, dance therapy, and artistic and cultural programs as related services that should be provided as necessary to help a student with a disability benefit from his or her special education program.
Because states are required to provide the related services that are necessary for each individual student with a disability to benefit from his or her special education, related services can be quite unique and expensive. Just as special and regular education must be provided to a student with a disability at no cost to the parent or guardian, so, too, must related services. As a result of federal law, it is the state’s responsibility to provide a free, appropriate public education to all students with disabilities, and that includes any related services necessary to ensure they benefit from their education.
Perhaps the best way to develop an understanding of what related services are is to take a look at the types of personnel who are involved in the delivery of services and what responsibilities each of these people typically has in the process. Given the range and diversity of disabilities, this list is quite lengthy. Therefore, the information presented about each related service is intended only as an introduction to that service and the personnel associated with its delivery. It is not the intent of this document, just as it is not the intent of the law, to exhaustively describe each related service. Many variations in service delivery are possible. It is important to read about all the services and personnel in order to know what related services are most commonly provided to students with disabilities and their families.
Audiology Services are generally provided by audiologists who screen, assess, and identify children with hearing loss. Additionally, they:
determine the range, nature, and degree of the hearing loss;
make referrals for medical or other professional attention for the habilitation of hearing;
provide language habilitation, auditory training, speech reading (lip reading), speech conservation, and other programs;
determine the child’s need for group or individual amplification, select and fit an appropriate hearing aid, and evaluate the effectiveness of amplification.
Many school systems do not have the diagnostic facilities necessary to assess the extent of a student’s hearing loss, and so they refer students in need to a clinical setting, such as a hospital. Based on the results of the hearing assessment, related services are then provided by school-based audiologists or, in school systems that do not employ audiologists, by other professionals such as speech pathologists or educators.
Occupational Therapy is provided by therapists who concentrate upon assessing and treating children with disabilities that impair their daily life functioning. Areas of daily life functioning upon which an occupational therapist might focus are:
— activities of daily living, such as eating and dressing;
— school and work skills, such as writing, using scissors, managing books and papers, and sitting effectively in class; and
— play/leisure skills, such as participating in art or physical education class or playing with children at recess.
When occupational therapy is provided as a related service, it is meant to enhance a student’s ability to function in an educational program. By focusing upon the skills of daily living, occupational therapists can often help individual students to function in the least restrictive environment. Generally, occupational therapists:
— provide treatment to strengthen and develop fine motor functions;
— focus on treatment of the small muscles, primarily those of the face, upper trunk, arms, and hands; and
— improve the student’s ability to perform tasks necessary for independent functioning, such as chewing, swallowing, placement of the tongue and mouth for speech formation, eye-hand coordination, and manual dexterity.
Physical Therapy is provided to a child or youth with a disability following referral from a physician and, in some states, from school nurses, teachers, occupational therapists, and other professionals. Physical therapists:
— provide treatment to increase muscle strength, mobility, and endurance;
— focus on gross motor skills that rely on the large muscles of the body involved in physical movement and range of motion;
— help to improve the student’s posture, gait, and body awareness; and
— monitor the function, fit, and proper use of mobility aids and devices.
In relation to special education, physical therapists are primarily concerned with developing and enhancing the physical potential of students with disabilities, so that they can achieve maximum independence and function in all their educational activities.
Psychological Services are also delivered as a related service when necessary to help students with disabilities benefit from their education. Often, the potential need of a child with a disability for psychological services is raised during an Individualized Education Program (IEP) meeting of teachers, school personnel, and parents. Members of the IEP team may have noticed that a student has become withdrawn and that his or her grades have dropped. Or parents may be concerned that their child is reading far below his grade level and want to know if he has a learning disability. School psychologists, then, become responsible for delivering psychological services. Some of their primary duties are to:
— administer and interpret psychological and educational tests and other assessment procedures to determine if, indeed, the student has a disability;
— obtain, integrate, and interpret information about a student’s behavior and conditions for learning. Sources of information may include observations of the student and interviews with teachers, parents, and the student;
— consult with school staff and assist in planning an educational program to meet a student’s special needs, as indicated by psychological tests, interviews, and evaluations of behavior; and
— plan and manage programs to provide psychological services, including counseling for students and parents.
It is important to know that, by law, “no single assessment procedure can be used as “the sole criterion for determining an appropriate educational program for a child” (Code of Federal Regulations [CFR]: Title 34: Education: Part 300.532, 1988). The anticipated regulations for the IDEA are not expected to change this approach to student assessment. One of the school psychologist’s most challenging duties, then, is to gather information about the student from a variety of sources and interpret that information, so that an educational program appropriate to the needs of the student can be developed.
Medical Services are considered a related service only under specific conditions. By definition, medical services:
— are provided by a licensed physician to diagnose a child’s disability, determine the need for special education, and determine the type and extent of related services that may be needed; and
— are permitted for diagnostic reasons, but do not include direct, on-going medical treatment by a physician.
Just how far does a school system’s legal requirement to provide medically-related services go? This has become quite an area of controversy as schools enroll and place students with severe and often life-threatening disabilities. Do the constant medical needs of these students qualify as supportive services a school is obligated to provide or as on-going medical treatment, which is specifically excluded as a related service? Decisions can only be made on a case by case, student by student basis. However, the trend emerging from recent court cases appears to be:
— If the supportive service must be performed by a licensed physician and is not for the purpose of evaluation or diagnosis, the school is not obligated to provide it.
— If the service can be provided by a lay person, such as the teacher, with minimal training, the school must provide it.
— When the service requires some degree of medical insight, such as what to do when an emergency arises, then court decisions can go either way. “The more medically sophisticated the decisions about how to treat the child, the more that service is excluded and the school’s obligation disappears”.
School Health Services are necessary, because many children and youth with disabilities would be unable to attend a day of school without supportive health care. Health services are typically provided by a qualified school nurse or a specifically trained non medical person who is supervised by a qualified nurse. Some of the health services that school nurses or other qualified personnel provide to students with disabilities include:
— special feedings
— clean intermittent catheterization
— administering medications
— planning for the safety of a student in school, and
— ensuring that care is given in the classroom to prevent injury (e.g., changing a student’s position frequently to prevent pressure sores).
A joint task force of members and staff of four associations — the American Federation of Teachers, the Council for Exceptional Children, the National Association of School Nurses, Inc., and the National Education Association — recently released detailed guidelines to help administrators, health care providers, and educators provide health services to children with special health care needs. The guidelines list “66 special health care procedures that some children may need to have provided in educational settings,” as well as “the persons qualified to perform each of the procedures, who should preferably perform the procedures, and the circumstances under which these persons would be deemed qualified”.
Transportation Services are provided to those students who need special assistance because of their disability or the location of the school relative to their home. Not all students with disabilities are eligible to receive specialized transportation services. Many are able to use the same transportation that students without disabilities use to get to school. However, for those who need special assistance, the school district must:
— provide travel to and from school and between schools;
— provide travel in and around school buildings; and
— provide specialized equipment (such as special or adapted buses, lifts, and ramps), if required to provide special transportation for a child with disabilities.
Most school systems have written guidelines to help make decisions about transportation services consistent from student to student. To be in compliance with the IDEA, a school district cannot require the families of students with disabilities to assume any portion of the costs of those transportation services deemed necessary to permit the students to benefit from their education.
Counseling Services are typically provided by school counselors who work with students to develop their career awareness, to improve their understanding of self, and to improve their behavioral adjustment and control skills. This, in turn, makes students with disabilities better able to participate in their educational program. In many schools, the counselor may also perform the functions of school psychologists (described above under Psychological Services). Additionally, school counselors may:
— identify and refer students who may be eligible for special education;
— secure parental permission for referrals;
— provide advice concerning a student’s level of functioning, affective needs, and appropriateness of the IEP;
— provide student guidance and counseling in keeping with the IEP; and
— provide supportive counseling for parents.
Speech-Language Pathology is a service provided by speech-language pathologists to address the needs of children and youth with communication disabilities, such as stuttering and impairments in speech, language, or voice. Typically, speech-language pathologists:
— screen, identify, assess, and diagnose disorders of fluency, language, articulation, voice, and oral-pharyngeal function, and cognitive/ communication disorders;
— provide speech and language services for the habilitation or prevention of communication disorders, including augmentative and alternative communication systems; and
— refer the student for medical or other professional attention necessary for the habilitation of speech or language disorders.
It should be noted that a student with a speech or language impairment does not necessarily have to be manifesting academic problems in order to be considered eligible to receive related services under the IDEA. Effective oral communication is regarded as a skill basic to academic performance (Applestein, 1987).
Social Work Services are provided in order to address the whole welfare of the student with a disability – his or her life at home, in school, and in the community. Historically, social workers have been used in schools as early as 1913. The need for their services arose from “recognition of the need to consider factors beyond the schools that may be affecting a child’s educational performance” (Tabb, 1987, p. 113). Problems at home or in the community can adversely affect a student’s performance at school, as can a student’s attitudes or behaviors in school. Social work services may become necessary in order to help the student maximize benefit from the educational program.
In today’s society, qualified school social workers have completed a two-year master’s degree program in social work and generally have field experience obtained through placement in a public or private facility, where they worked under supervision. Their duties within schools typically include:
— preparing a social or developmental history of a student with a disability;
— providing group or individual counseling to the student and family;
— working with the problems in a student’s living situation (home, school, and community) that are affecting the student’s adjustment in school; and
— mobilizing school and community resources to enable the student to benefit from his or her educational program.
To develop an insightful social or developmental history of a student with a disability requires the school social worker to interact with both the student and the family. This allows the social worker to assess how family dynamics and the home environment are influencing the student’s learning and behavior patterns. This information is useful for determining the student’s educational placement and program, and also serves as a check against inappropriate labeling of a student because of test scores and school behavior. Through interactions with the family, the social worker may identify cultural or language differences that need to be taken into consideration as well.
Parent Counseling and Training is an important related service, because it addresses the needs of the parents and the vital role they play in the lives of their children. The parents of a child or youth with a disability may have great need for counseling and training in order to understand their child’s disability and how it may affect development. When necessary to help the child or youth with a disability benefit from the educational program, school counselors can:
— assist parents in understanding the special needs of their child;
— provide parents with information about child development; and
— provide parents with referrals to parent support groups, financial assistance resources, and professionals outside the school system.
Recreation Therapy is included as a related service, because all children, with or without disabilities, need to learn how to use their leisure and recreation time constructively. For those students with disabilities who are judged to require recreation therapy in order to benefit from special education, the therapy can serve to improve socialization skills, as well as eye-hand coordination and physical, cognitive, or language development. To this end, recreation therapists:
— assess the student’s leisure capacities and functions;
— provide therapy to remediate functional difficulties that limit involvement in leisure activities;
— provide leisure education for learning the skills, knowledge, and attitudes related to leisure involvement; and
— help the student to participate in recreation, based on the student’s need for assistance and/or adapted recreation equipment.
Assistive Technology Devices and Services are not specifically listed in the law as a related service but are often provided as “other corrective or support services” necessary to help students with disabilities benefit from their education. The provision of assistive technology devices and services has changed over the years as technology has been developed and applied to the needs of individuals with disabilities. The EHA (P.L. 94-142) mentions that providing “related aids and services” may be necessary to help a student maximize the benefits of his or her educational program.
As assistive technology has boomed, however, the scope of this related service has expanded. In 1988, Congress passed the Technology-Related Assistance for Individuals with Disabilities Act (P.L. 100-407), recognizing the enormous contribution that assistive technology can make to the lives of individuals with disabilities. The Office of Special Education Programs (OSEP) has issued a policy ruling stating that “consideration of a child’s need for assistive technology must occur on a case-by-case basis in connection with the development of a child’s individualized education program (IEP)”. The OSEP policy letter goes on to say that “assistive technology can be a form of supplementary aid or service utilized to facilitate a child’s education in a regular educational environment. Such supplementary aids and services, or modifications to the regular education program, must be included in a child’s IEP.” Thus, when an IEP of a student with a disability is being developed or reviewed, the school district must assess his or her need for an assistive technology device, determine those devices that will facilitate the student’s education, list them in the IEP, and then provide them to the student.
This policy letter, coupled with the passage of the Technology-Related Assistance for Individuals with Disabilities Act of 1988 and the IDEA, is expected to dramatically affect the level of district responsibility for providing related aids, devices, and technology-related services to students with disabilities.
The IDEA defines an assistive technology device as:
…any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.
The number of assistive technology devices in use across the United States is lengthy, and the list is growing longer by the day. A few examples of such devices are: electronic communication aids, devices that enlarge printed words on a computer screen, speech synthesizers, prosthetic devices, braille writers, and keyboards adapted for fist or foot use.
As more assistive technology devices become available to address the special needs of students with disabilities, districts are confronted with multiple challenges in that they must: (a) identify and acquire technology devices appropriate to the needs of their students with disabilities; (b) train staff in the use of the devices; (c) identify appropriate use of computers, communication devices, and other technology in the classroom; and (d) finance the cost of this related service. Additionally, districts must provide “assistive technology services” to eligible students with disabilities. Assistive technology services are defined by the IDEA as “…any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device”. Thus, school districts are also responsible for helping individuals with disabilities to select and acquire an appropriate assistive technology device and train them in its use.
Artistic/Cultural Therapies are specifically mentioned in federal regulations as other “supportive services” and include “artistic and cultural programs, and art, music, and dance therapy, if they are required to assist a handicapped child to benefit from special education”.
Dance therapy, for example, can develop and promote “good posture, discipline, concentration, coordination, agility, speed, balance, strength, and endurance”. Art therapy provides individuals with disabilities with a means of self-expression and opportunities to expand personal creativity and control. Music therapy is used to foster similar personal growth. Its therapeutic aims are the restoration, maintenance, and improvement of mental and physical health. This type of therapy can affect changes in behavior, social skills, perception, self-esteem, and physical mobility and skills.
Artistic and cultural therapies are designed by art therapists, dance therapists, and music therapists to address the individual needs of students with disabilities. These professionals:
— assess the functioning of individual students;
— design programs appropriate to the needs and abilities of students;
— provide services in which movement or an art form is used in a therapeutic process to further the child’s emotional, physical, and/or cognitive development or integration; and
— often act as resource persons for classroom teachers.
School Breakfast and Lunch Program is not a related service specifically listed in the IDEA. School meal programs are administered at the federal level by the United States Department of Agriculture (USDA). USDA reimburses schools for every meal served, at rates that vary according to family income. Children may receive meals free or at a reduced price if their families meet specific income criteria.
Under USDA’s Section 504 and child nutrition regulations, schools participating in federal school meal programs are required to make a reasonable effort to provide, at no extra charge, special meals to students whose diets are restricted due to their disabilities [7 CFR Section 15b.26(d)(1)].
In order to be eligible for modified meals, a student must present a statement signed by a physician. The statement should include: (a) the disability of the student and how the disability affects the student’s diet; (b) the major life activity affected by the disability; and (c) the food(s) to be omitted from the student’s diet and those that may be substituted [7 CFR Section 210.10(i)(1) and 7 CFR Section 220.8(f)]. Adjustments to meals may include changing the texture of food, modifying the calories, and substituting different foods for those listed on the school menu.
Thus, parents need to be aware that they are responsible for: (a) requesting modification of their child’s meals, if appropriate; and (b) providing the school system with a doctor’s statement certifying their child’s disability and describing the child’s special dietary needs. If officials at the school are not familiar with these regulations, parents should contact their State school food service director, who is usually employed by the State education agency.
Because the IEP serves as a communication tool between service providers, parents, and the student with a disability, stating nutrition goals and objectives in the IEP, when appropriate, “will facilitate instruction on dietary needs and compliance”.
Under the IDEA, a student must be enrolled in special education to be considered eligible for related services. However, there is another federal law, Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), which in many cases broadens a student’s eligibility for related services.
According to Section 504 of the Act, State Education Agencies (SEAs) and Local Education Agencies (LEAs) receiving Federal funds cannot exclude qualified individuals with disabilities from participation in or the benefits of any program or activity offered by the SEA or LEA. Regulations of the Act also specify that a recipient of Federal financial assistance operating a public elementary or secondary education program must provide a free, appropriate public education to each “qualified handicapped person” within its jurisdiction.
The Section 504 regulation defines a “handicapped person” as follows:
(1) “Handicapped persons” means any person who (i) has a physical or mental impairment which substantially limits one or more major life activities; (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment…
(2) (ii) “Major life activities means functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. [34 Code of Federal Regulations (CFR) Section 104.3(j), 1988]
Under the Section 504 regulation:
“Qualified handicapped person” means: …[w]ith respect to … elementary [and] secondary … education services, a handicapped person (i) of an age during which non-handicapped persons are provided such services, (ii) of any age during which it is mandatory under state law to provide such services to handicapped persons, or (iii) to whom a state is required to provide a free appropriate public education under Section 612 of the Education of the Handicapped Act. [34 CFR Section 104.3(k)(2), 1988]
The free appropriate public education must meet the individual needs of students who are “qualified handicapped persons” as adequately as the needs of students without disabilities are met. Such an education, according to the Section 504 regulation, can consist of either regular or special education and must include any related aids or services necessary to provide a free appropriate public education designed to meet the individual student’s needs. The law also requires that recipients of Federal funds operating public elementary or secondary education programs evaluate any person who needs or is believed to need special education or related services because of disability. Thus, Section 504 does not require a student to be enrolled in special education in order to receive related services.
The fact that the IDEA and Section 504 of the Rehabilitation Act define eligibility for, and entitlement to, related services in different ways can complicate how a school district decides if a student is eligible for and/or must be provided with services or not. School districts can fulfill the requirements of certain sections of the Section 504 regulation by complying with the EHA (now IDEA) (Daniels, 1988).1 However, it is possible for a school district to be in violation of the Section 504 regulation while still being in compliance with the IDEA. This can happen when a school district denies services to an individual who has a disability not specified under the IDEA but who is considered “handicapped” under Section 504. For example, there are school districts that have failed to administer medication to students with Attention Deficit Disorder (ADD), because ADD is not listed as a handicapping condition under the IDEA. However, such students may be entitled to have the school district administer medication as a related service under Section 504, if the student meets the Section 504 definition of “handicapped person.”
An individualized evaluation would need to be made by a multidisciplinary team to determine whether the student is “handicapped” within the meaning of Section 504; that is, whether the student has an impairment which substantially limits one or more major life activities (e.g., learning). Once it is determined that a student is handicapped within the meaning of Section 504 and meets other applicable eligibility requirements (such as age requirements), public elementary or secondary education programs receiving Federal financial assistance are required by Section 504 to provide a free appropriate public education to that student, without regard to the nature or severity of the individual’s disability. The free appropriate public education must include any related aids or services, such as administering medication, that are necessary to meet the individual student’s needs.
Because the definition of disability is broader under Section 504 of the Rehabilitation Act than under the IDEA, many parents whose children are ineligible for related services under the IDEA are filing complaints with OCR, alleging that denial of related services denied their children a free appropriate public education. It should be noted that when OCR investigates a complaint, it does so solely on the basis of compliance with the rules and regulations of Section 504. OCR does not make findings of a school district’s compliance or noncompliance with the IDEA. In addition, an OCR investigation focuses primarily on the process used to identify, evaluate, and place students with disabilities, rather than on whether the program ultimately chosen by the district was appropriate. As the Appendix to the Section 504 regulation states:
It is not the intention of [OCR], except in extraordinary circumstances, to review the result of individual placement and other educational decisions, so long as the school district complies with the “process” requirements of this subpart (concerning identification and location, evaluation, and due process procedures). However, [OCR] will place a high priority on investigating cases which may involve exclusion of a child from the education system or a pattern or practice of discriminatory placements or education.
An example of a pattern or practice of discriminatory placements or education is a school district’s refusal to provide related services to any students who are ineligible for such services under the IDEA, even if those students are “qualified handicapped persons” under the Section 504 regulation.
Recent investigations have resulted in OCR rulings that individuals who have disabilities not specified in the IDEA are often eligible for related services under Section 504.
The IDEA and Section 504 differ in another, important aspect besides their definitions of “disability.” The IDEA:
…is a federal grant program, authorizing federal funds to states to assist them in the provision of special education and related services to “eligible” students. Section 504 is a civil rights statute, prohibiting discrimination on the basis of handicap.
Therefore, although school districts must comply with the regulations of Section 504 if they want to retain Federal financial assistance, they do not receive Federal funds to pay for services provided to students with disabilities under Section 504.
Parents and professionals who are interested in more information about how Section 504 regulations affect the provision of related services should contact any of OCR’s regional offices.
Usually, the need for related services is identified during the process of evaluating a student for special education. Because far-reaching decisions are made based upon the evaluation of a student with a suspected disability, it is useful to know that both the IDEA and Section 504 of the Rehabilitation Act state that decisions about the educational program of a student may not be based solely on the findings of a single evaluation instrument. Rather, data must come from a variety of sources, including “aptitude and achievement tests, teacher recommendations, physical condition, social or cultural background, and adaptive behavior” [34 CFR Section 104.35(c), 1988]. Furthermore, data must be collected in all areas related to the student’s suspected disability. This may include, where appropriate, “health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities” (Arena, 1989, p. 23). Federal law also requires that the evaluation must be conducted by a multidisciplinary team, including at least one teacher who is knowledgeable in the area of the suspected disability.
The extensive nature of the evaluation process should provide decision-makers with the information they need to determine an appropriate educational program for the student. It also allows them to identify the related services a student will need. At this point, decision-makers — including the parents and, where appropriate, the student — sit down and write an Individualized Education Program (IEP) for the student. The IEP details the educational goals and objectives for the student and lists the related services that are necessary to help the student attain those goals and objectives. It is useful to note that related services personnel are not required to participate in the IEP meeting. However, it is appropriate for them to participate or otherwise take part in IEP development. The written findings and recommendations of related services personnel should become part of the child’s evaluation report.
Thus, the related services needed by the student must be listed in the IEP, regardless of whether the district currently makes the services available. The IEP establishes the genuine need to be met and must describe related services according to:
— the service(s) needed (e.g., occupational therapy)
— the type of service (e.g., direct service to the child; consulting services to teachers or others)
— the type of service provider(s) (e.g., occupational therapist)
— the frequency and duration of the service (e.g., two 45-minute periods per week).
The IEP then serves as a written commitment for delivery of services to meet a student’s educational needs. The school district must provide all of the services specified in the IEP, in the amount and degree specified. Changes in the amount of services listed in the IEP cannot be made without holding another IEP meeting. However, if there is no change in the overall amount of service, some adjustments in scheduling of services should be possible without the necessity of another IEP meeting.
The above description of the evaluation process, IEP development, and the specification of related services to be delivered to a student with a disability assumes that the student was found eligible for special education and related services. What happens when things don’t go so smoothly? For example, the school district may determine, via its evaluation, that the student does not require special education and, thus, is ineligible under the IDEA for related services. Or perhaps the parents are dissatisfied with the way that related services are being provided to their child or believe that their child needs related services that the school district does not provide or feels are unnecessary. What happens then?
Here are some points parents may want to bear in mind in such situations:
1. The IDEA enumerates procedural safeguards that school districts must adhere to in the delivery of educational services. These safeguards establish due process procedures through which parents and children with disabilities can resolve differences with the school district (34 CFR Sections 300.500 – §300.514, 1988). Among the procedures are: the right to an independent evaluation at public expense, the right to an impartial due process hearing, the right to an administrative appeal and impartial review of the evidence, and the right to take civil action.
2. Therefore, if the school district determines that a student with a disability does not require special education and denies that student related services, parents may request that the district pay for an independent evaluation. If the district should refuse this request, parents may ask for a hearing before an impartial hearing officer to resolve this difference.
3. The parents can also decide to pay for the independent evaluation privately. In this case, they should receive a written evaluation report specifying (a) the problem the child has; (b) precisely how that problem affects the child’s ability to make progress toward the goals of his or her IEP; (c) recommendations on the type of service needed, the way it should be provided, how often and for how long, and the type of personnel who should deliver the services; and (d) a description of the goals of the related service program that is recommended. The school district must take the results of the private evaluation into account when making a decision about a student’s eligibility for related services.
4. Parents may also wish to negotiate with the school district to see if the student is eligible for related services under Section 504 criteria. If parents do not agree with the district’s decision, again, they can ask that a hearing officer review the evidence. As a final step, parents can also file a complaint with the regional office of the Office of Civil Rights (OCR). An OCR hearing officer will also review the evidence and decide if the district is obligated to provide the related services.
5. When a student’s need for related services is not linked to his or her ability to benefit from special education and is, therefore, not part of the IEP, parents have other options apart from the school system. For example, parents may seek services from rehabilitation organizations, private therapists, medical organizations, clinics, and other agencies.
This latter point may be important for parents to consider when trying to obtain related services for their child with a disability. Although parents do have due process rights which they can invoke when differences with the school district arise, they should be aware the problems can often be worked out informally. Many states have alternatives to the formal appeal process, including conciliatory conferences, administrative reviews, and mediation. Flexibility and reasonableness are key factors in working out differences, and compromise on the parts of both the parents and the school district may be necessary. There are many benefits to resolving differences through compromise and mediation. Not only is time saved and the cost of litigation avoided, but the relationship between parents and the school district will remain a working one, where communication is still open, people are still talking, and future decisions are not made impossible by past differences.
The district decides how the services enumerated in the IEP will be delivered to the student. The district may provide these services through its own personnel resources, but if this is not possible, they may contract with another public or private agency, which then provides the services.
There are two kinds of related services interventions offered by schools to meet the range of student needs. These can be defined as follows:
— Direct Therapy refers to hands-on interactions between the therapist and the student. These interactions can take place in a variety of settings. The therapist analyzes student responses and uses specific techniques to develop or improve particular skills. The therapist should also monitor the student’s performance within the educational environment and consult with teachers and parents on an ongoing basis, so that some strategies can be carried out through indirect means at other times.
— Indirect Therapy refers to teaching, consulting with, and directly supervising other team members (including paraprofessionals and parents) so that they can carry out therapeutically-appropriate activities. Trained assistants, such as a certified Occupational Therapy Assistant, are sometimes employed to share in the delivery of related services. Three essentials of indirect intervention are: (a) the intervention procedure is designed by the therapist for an individual student; (b) the therapist has regular opportunities to interact with the student; and (c) the therapist provides ongoing training, follow-up, and support to staff members and parents.
One type of service intervention is not necessarily better than the other. The type of service provided depends upon the student’s needs and educational goals, and the skills and availability of school staff.
In small and rural districts, often there are not sufficient numbers of eligible students to justify employing a full-time therapist, or requirements across schools in a district may add up to the need for one related service provider. In such cases, the district may employ one specialist to move from school to school, or several districts may use a cooperative approach, pooling their resources to hire personnel who travel among districts to provide services. The term itinerant services is used to describe this type of service provision, but it refers to the deployment of personnel, not to a specific type of service intervention.
The IDEA requires that a multidisciplinary team perform an evaluation of a student to determine his or her eligibility for special education and related services. Likewise, a multidisciplinary team must be involved in any placement decisions. This team generally consists of a representative of the public agency who is qualified to provide or supervise the provision of special education and/or related services, the student’s teacher, one or both of the student’s parents, the student (where appropriate), individuals whose input is requested by either the parents or the public agency, and a member of the evaluation team who is knowledgeable about how the evaluation was conducted and its findings. The student’s IEP is developed through the joint efforts of these individuals, and necessary related services are specified.
Obviously, the process of developing an IEP can be complicated, requiring many people to interact and coordinate their efforts. Many school districts appoint a school staff member (such as a teacher, psychologist, or counselor) to act as coordinator or case manager of the IEP process for an individual student or for all children with disabilities in a school. This is not required by law, but it helps the school district manage the complicated task of evaluating students and developing IEPs. The kinds of activities that a coordinator or case manager might do include:
— coordinating the multidisciplinary evaluation;
— collecting and synthesizing evaluation reports and other relevant information that might be needed to the IEP meeting;
— communicating with parents; and
— conducting the IEP meeting.
Beyond development, however, there is implementation of the IEP. Depending on the nature of the related services to be provided, many other professionals may become involved on behalf of the student with a disability. This may include one or more therapists, a special educator, classroom teachers, counselors, the school principal, paraprofessionals, and others. These individuals work not only with the child, but also with the family and community resources. Furthermore, there must be communication between the IEP team and the related service provider(s) to ensure that services are being delivered as specified and that the student is making progress. If the student is not progressing as expected, adjustments in his or her program must be made. The IEP team would need to be involved in any such decisions, and the new plan would need to be communicated to the related services personnel.
Thus, it is highly desirable that related services be delivered in educational settings through a team approach. Related services are not to be isolated from the educational program. Rather, they are to be related to the educational needs of students. The interactions of professional staff, consultants, community, and family, brought together in the delivery of related services for a student, underscore the usefulness of a case management approach in which a team leader coordinates and orchestrates services on behalf of the student.
Under P.L. 94-142 and its amendments, including the recently passed IDEA, students with disabilities are entitled to a free appropriate public education. State education agencies are responsible for assuming the costs of that public education, and no costs of implementing the IEP for school-aged students can be passed on to parents or guardians. This includes the provision of related services. Students and their families are entitled to receive these services at no cost to themselves.
Funding of related services, of course, presents schools with an enormous fiscal obligation. While districts receive federal funds through the IDEA to assist them in providing special education programs and related services for students with disabilities, the costs can nonetheless become quite staggering. Even before the passage of the EHA, the landmark case of Mills v. Board of Education of the District of Columbia affirmed that school districts are responsible for meeting the educational needs of students with disabilities. The school board in Mills argued that it could not afford to offer an appropriate education to all its students with disabilities. The court responded that whatever inadequacies existed in the school system could not be allowed to impact more heavily on the exceptional child than on a child without disabilities.
Clearly, a school district’s responsibility to students with disabilities is extensive and expensive. What other funding sources are available, besides the IDEA, to pay the costs of special education and related services? Since the enactment of the original EHA (P.L. 94-142), several new sources of funding have emerged. The Medicare Catastrophic Coverage Act became Public Law 100-360 on July 1, 1988. Although this legislation primarily concerned Medicare and has been repealed, it also contained an amendment to the Social Security Act that affects Medicaid (which is a joint federal-state program providing health care services for low-income persons). The 1988 amendments authorize Medicaid reimbursements for Medicaid-covered related services in the IEPs of Medicare-eligible students with disabilities. The Omnibus Budget Reconciliation Act of 1989, which further amended the federal Medicaid statute, also provides that treatment needs recommended through Medicaid’s Early and Periodic Screening Diagnosis and Treatment process (EPSDT) “must include any services that are available under Medicaid, regardless of whether the state has opted to include such service as part of its Medicaid state plan”. As a result, some school districts are now receiving funds through Medicaid for certain related services that are provided in the public schools.
Another potential funding source that has come into use in the last decade is third-party billing. Third-party billing means that parents of students with disabilities use their private health insurance to pay for the individual evaluations or related services that their child receives. The idea of third-party billing arose out of somewhat ambiguous regulations under both EHA and Section 504 that state that insurers are not relieved of their obligation to “provide or pay for services provided to a handicapped child” [34 CFR § 300.301(b), 1988]. Third-party billing has been seen as a promising way for school districts to pay for related services, but it has also become controversial. As early as 1980, the U.S. Department of Education released a policy interpretation stating that educational agencies could not compel parents of a child with a disability to file an insurance claim that would pose a realistic threat to the parents in terms of financial loss. Examples of financial loss include, but are not limited to: (1) decreases in available lifetime coverage or other insurance benefits; (2) increases in insurance premiums; (3) discontinuation of the insurance policy; or (4) out-of-pocket expenses such as deductibles. However, the Department of Education did state that districts may require parents to file an insurance claim when: (a) doing so would not result in cost to the parents; and (b) the district ensures that parents do not have to bear even a short-term financial loss, such as paying a deductible.
Moreover, parents should be aware that a district may not terminate services to a student with a disability if parents refuse to file an insurance claim.
Even where parents allow third-party billing, the district may still not be able to get reimbursed by insurance companies for providing related services. Some insurance policies specifically exclude coverage of services that the insured can obtain free under federal, state, or local laws.
The answer is: Yes. The shortage of related services personnel is a recurring theme in state data on special education programs and related services. Personnel reported to be in the shortest supply are occupational therapists, physical therapists, psychologists, counselors, social workers, and speech/language pathologists. The results of several recent studies attest to the problems that school districts face in finding, hiring, and keeping personnel in these important related services areas.
Salaries, of course, are a factor in these shortages, inasmuch as hospitals and private agencies can often offer greater compensation than can schools. But other factors include the lack of trained applicants for school positions and competition with other agencies who provide related services to the elderly population, infants at risk, and accident trauma victims.
Not only are vacancies difficult to fill in many districts, but the scarcity of personnel leads to heavier case loads for those who are employed. To improve assessment and treatment, increase student contact hours, and allow more services for students who need them most, additional personnel time is certainly needed. There is also a pressing need to hire school-employed related service providers, rather than obtaining them through contractual arrangements with other agencies, as is often the case at present. However, many therapists are trained predominantly for clinical work and often prefer clinical rather than school settings. As demographics in the United States change, the shrinking representation of minorities in teaching and related services is also of concern.
All of these personnel shortages impact greatly on the school district’s ability to provide related services to students with disabilities.
Without a doubt, many school districts face very real problems in meeting their responsibility of providing the related services needed by school-aged children with disabilities. Chief among these problems are a shortage of personnel to provide related services and a shortage of monies to fund them. While school districts are required by federal law to provide related services, constructive action is needed on the parts of parents, practitioners, and school administrators in order to improve the situation. Here are some suggestions for action that can ease the budget and personnel crunch experienced by many school districts, without sacrificing the welfare of students who require related services in order to benefit from their education.
1. Write a complete IEP. Related services needed by a student should be listed in the IEP. Not listing related services in the IEP leads to inaccurate reporting of needed personnel in national and state data collection efforts, which distorts the true picture of the supply/demand problem. Therefore, the documentation of related services and personnel needs begins with the IEP. If that documentation is faulty, understanding of supply/demand becomes skewed. Plans that are made based upon this documentation are similarly skewed, and the problem of personnel shortages is perpetuated.
2. Walk in each other’s shoes. The shortage of personnel and monies is real. There are simply not enough qualified related services personnel to fill all vacancies. At the same time, the news is filled with reports of school districts that cannot pay for the educational services they are required by law to provide. Parents, understandably, find it unacceptable that difficulties may exist in meeting their child’s legitimate needs. The law, after all, guarantees their child’s right to a free appropriate public education. Many parents may hold the view that the difficulties faced by school districts in terms of personnel and funding are the school district’s concern, while the child’s welfare is the parent’s concern. Ultimately, however, the difficulties school districts face impact most upon those individuals who need the services _ namely, eligible students with disabilities.
3. Improve coordination of services and responsibility- sharing. No single agency alone can handle the increasingly complex needs of children. There is a major and growing need for coordination of services, for resource and program sharing, and for new patterns of interagency collaboration and cooperative services involving schools, mental health, human services, welfare, health agencies, juvenile justice, homeless centers, and other services. Often, coordination and cooperation can be achieved more effectively at the grass-roots level, with the assistance and involvement of concerned citizens, parents, and professionals, rather than through state and federal mandates.
4. Become a creative networker. There are many ways of finding services and establishing opportunities that go beyond what the school district offers to your child or youth with a disability. Be creative in building a team that utilizes the many resources available within your school and community. These resources can offer valuable learning experiences for your child. Become a networker. Talk to people such as reading specialists in the school, the chairperson of volunteer activities in the school or community, club leaders, librarians, and individuals involved in school or community sports programs. Explore what opportunities can be created for your child in recreational or after-school activities. Many parents have succeeded in networking with people within and outside of special education who are willing to involve children and youth with disabilities in activities offered by their club, organization, or place of employment. Becoming involved in school and community activities can give individuals with disabilities the opportunity to grow and learn academically, vocationally, and socially.
5. Take constructive action. Local parents, practitioners, and principals can activate entire communities in plans to staff the schools with excellent people. Among the strategies that can be carried out, both in rural and urban areas, are:
— encouragement of local students to enter careers in special education and related services;
— roles for high school students as tutors and aides;
— negotiations with higher education institutions anywhere in the country to place student teachers and interns in the district;
— development of community-wide and school-based incentives and a welcoming atmosphere to attract new personnel;
— planning with local businesses to offer jobs to spouses of teachers who might relocate;
— acquiring and/or raising scholarship funds for promising young people who will return to the community after completing professional training;
— arrangements with higher education to deliver locally-based training to increase the population of aides and assistants in the schools, and to provide career ladders whereby these personnel can acquire professional credentials;
— human-centered interagency cooperation that can extend and enrich services to all children;
— planned agendas of school improvement and community pride activities that will make your town a better place to live and work.
CLEARINGHOUSES AND INFORMATION CENTERS–
Clearinghouse on Disability Information – Office of Special Education and Rehabilitative Services (OSERS), Room 3132, Switzer Building, 330 C Street S.W., Washington, DC 20202-2524. Telephone: (202) 205-8241.
ERIC Clearinghouse on Counseling and Student Services – University of North Carolina at Greensboro, 101 Park Building, School of Education, Greensboro, NC 27412-5001. Telephone: 1-800-414-9769.
ERIC Clearinghouse on Disabilities and Gifted Education – The Council for Exceptional Children, 1920 Association Drive, Reston, VA 22091. Telephone: 1-800-328-0272.
National Clearinghouse for Professions in Special Education – Council for Exceptional Children, 1920 Association Drive, Reston, VA 22091. Telephone: 1-800-641-7824; (703) 264-9474.
National Information Center on Deafness – Gallaudet University, 800 Florida Avenue, N.E., Washington, DC 20002-3695. Telephone: (202) 651-5051 (Voice); (202) 651-5052 (TT).
National Resource Center for Paraprofessionals in Education and Related Human Services – 25 West 43rd Street, Room 620N, New York, NY 10036. Telephone: (212) 642-2948.
OTHER NATIONAL INFORMATION RESOURCES–
ABLEDATA – National Rehabilitation Information Center, 8455 Colesville Road, Suite 935, Silver Spring, MD 20910-3319. Telephone: (800) 227-0216 (V/TT); (301) 588-9284 (V/TT).
Alliance for Technology Access – 2175 East Francisco Boulevard, Suite L, San Rafael, CA 94901. Telephone: (415) 455-4575.
American Alliance for Health, Physical Education, Recreation and Dance – 1900 Association Drive, Reston, VA 22091. Telephone: (703) 476-3481.
American Art Therapy Association, Inc. – 1202 Allanson Road, Mundelein, IL 60060. Telephone: (708) 949-6064.
American Counseling Association – 5999 Stevenson Avenue, Alexandria, VA 22304. Telephone: (703) 823-9800.
American Dance Therapy Association (ADTA) – Suite 108, 2000 Century Plaza, Columbia, MD 21044. Telephone: (410) 997-4040.
American Dietetic Association – Practice Team, 216 West Jackson Boulevard, Suite 800, Chicago, IL 60606-6995. Telephone: (312) 899-4815.
American Foundation for Technology Assistance, Inc. – Route 14, Box 230, Morganton, NC 28655. Telephone: (704) 438-9697.
American Occupational Therapy Association, Inc. – 4720 Montgomery Lane, P.O. Box 31220, Bethesda, MD 20824-1220. Telephone: (301) 652-2682.
American Physical Therapy Association – 1111 North Fairfax Street, Alexandria, VA 22314. Telephone: 1-800-999-2782.
American Psychological Association – 750 First Street N.E., Washington, DC 20002-4242. Telephone: (202) 336-5500.
American School Counselor Association – 5999 Stevenson Avenue, Alexandria, Va 22304. Telephone: (703) 823-9800.
American Speech-Language-Hearing Association – 10801 Rockville Pike, Rockville, MD 20852. Telephone: 1-800-638-8255; (301) 897-5700 (voice/TT); (301) 897-0157 (TT).
Council of Administrators of Special Education (CASE) – 615 16th Street N.W., Albuquerque, NM 87104. Telephone: (505) 243-7622.
Helen Keller National Center, – Technical Assistance Center (TAC) -111 Middle Neck Road, Sands Point, NY 11050-1299. Telephone: (516) 944-8900.
National Association for Music Therapy, Inc. – 8455 Colesville Road, Suite 930, Silver Spring, MD 20910. Telephone: (301) 589-3300.
National Association of School Nurses – Lamplighter Lane, P.O. Box 1300, Scarborough, Maine 04070-1300. Telephone: (207) 883-2117.
National Association of School Psychologists – 8455 Colesville Road, Suite 1000, Silver Spring, MD 20910. Telephone: (301) 608-0500.
National Association of Social Workers, Inc. – 750 First Street N.E., Suite 700, Washington, DC 20002. Telephone: 1-800-638-8799.
National Institute of Art and Disabilities (NIAD) – 551 23rd Street, Richmond, CA 94804. Telephone: (510) 620-0290.
National Therapeutic Recreation Society – 2775 S. Quincy Street, Arlington, VA 22206. Telephone: (703) 820-4940.
RESNA, RESNA Technical Assistance Project, 1700 N. Moore Street, Suite 1540, Arlington, VA 22209. Telephone: (703) 524-6686.
Trace Research and Development Center – S-151 Waisman Center, 1500 Highland Avenue, Madison, WI 53705. Telephone: (608) 262-6966 (Voice); (608) 263-5408 (TDD).
Very Special Arts – 1331 F Street N.W., Suite 800, Washington, DC 20004. Telephone: (202) 662-0300 (Voice) and (202) 737-0645 (TT).