DOCUMENT RESUME

ED 344 367EC 301 093

AUTHOR Smith-Davis, Judy; Littlejohn, William R.TITLE Related Services for School-Aged Children with

Disabilities.INSTITUTION Interstate Research Associates, Inc., Washington,

D.C.; National Information Center for Children andYouth with Disabilities, Washington, DC.

SPONS AGENCY Special Education Progrp.ms (ED/OSERS), Washington,DC.

PUB DATE 91CONTRACT H030A00002NUTE 25p.AVAILABLE FROM Interstate Research Associates, NICHCY, P.O. Box

1492, Washington, DC 20013-1492 (single copyfree).

PUB TYPE Collected Works - Serials (022) -- Guides -Non-Classroom Use (055)

JOURNAL CIT NICHCY News Digest; vl n2 1991

EDRS PRICE MF01/PC01 Plus Postage.DESCRIPTORS Assistive Devices (for Disabled); Audiology;

Counseling Services; *Delivery Systems;*Disabilities; Educational Finance; EducationalLegislation; Elementary Secondary Education; FederalLegislation; Health Services; Medical Services;Occupational Therapy; Physical Therapy; PsychologicalServices; *Pupil Personnel Services; SchoolDistricts; Social Services; Transportation

IDENTIFIERS *Individuals with Disabilities Education Act;Rehabilitation Act 1973 (Section 504)

ABSTRACT

This theme issue provides an overview of relatedservices for school aged children with disabilities as :equired byfederal law, especially the Individuals with Disabilities EducationAct and Section 504 of the Rehabilitation Act of 1973. It identifiesthe personnel associated with delivering various services includingaudiology, occupational therapy, physical therapy, psychologicalservices, medical services, school health services, transportation,counseling, speech language pathology, social work, parent counselingand training, recreation therapy, assistive technology devices andservices, artistic/cultural therapies, and the school breakfast andlunch program. It discusses how related services are typicallyobtained for students, as well as how school districts deliver,coordinate, and fund related services. Also examined are personnelshortages in such areas as physical and occupational therapy,psychology, counseling, social work, and speech/language pathology.Recent court cases, due process hearings, and the specifics offederal law are noted. School districts are encouraged to writecomplete Individualized Education Programs, to work with parents todevelop services, to improve coordination of services, and to takeconstructive community actions. Includes 50 references, abibliography of 46 items, and a listing of 30 organizations or othernational information resources. (DB)

Related Services forSchool-AgedChildren withDisabilities

Volume I, Number 2, 1991

The Individuals with DisabilitiesEducation Act (IDEA) mandates that "allchildren with disabilities have availableto them...a free appropriate public educa-tion which emphasizes special educationand related services designedto meet theirunique needs..." (Section 60110. In ac-cordance with the IDEA and other federallaws, more than 4 .5 million children withdisabilities across the nation received spe-cial education andlor related services inthe 1989-90 school year.

This issue of NEWS DIGEST fo-cuses upon the provision of related ser-vices to school-aged children with dis-abilities. As defined by federal law, re-lated services are intended to address theindividual needs of students with disabili-ties, in order that they may benefit fromtheir educational program. Occupationaland physical therapy, school health ser-vices, and special transportation assis-tance are just some examples of relatedservices that can help eligible studentswith disabilities participate more fullyand successfully in the learning process.

This NEWS DIGEST provides anoverview of the related services enumer-ated in federal law, with a focus uponthose services provided to school-agedchildren with disabilities. The personnelassociated with delivering each serviceare identified, and their major duties aredescribed. Readers are also given anoverview of how related services are typi-cally obtained for students, as well as howschool districts deliver, coordinate, andfund the related services they provide.Also discussed is one serious problemconfronting school districts, namely ashortage of personnel to deliver relatedservices needed by students. Recent court

cases, due process hearings, and the spe-cifics offederal law are mentioned though-out this NEWS DIGEST, where relevant,to help readers understand the nature of

and limits to school districts' re-sponsibilities to provide related services.A list of readings,or ganizations ,and othersources of further information concludes

istiCHCY

U.& DEPARTMENT OF EDUCATIONOffice of Educational Resealch and Improvement

EDU ATIONAL RESOURCES INFORMATIONCENTER (ERIC)

his document haS Wen reproduced asreceived from the person or organizationoriginating it

11 Minor changes have been made to improvereproduction Quality

Points of view or opinions stated m this document do not necessarily represent officialOERI position or policy

National Information Center for Childrenand Youth with Disabilities

Washington, DC

Several important federal lawshave been passed in recent years

to address the rights and educationalneeds of children and youth with dis-abilities. One such law, passed in 1975,is The Education of All HandicappedChildren Act, otherwiseknownasEHAor Public Law (P.L.) 94-142. Recentlyreauthorized and renamed the Individu-als with Disabilities Ed ucation Act, orIDEA (P.L. 101-476), this law man-dates that special education and relatedservice programming be made avail-able to all children and youth withdisabilities who require them. The lawalso makes available federal funds tohelp state and local governments estab-lish and maintain special education pro-grams for students with disabilities, aswell as provide the related servicesthese students need in order to benefitfrom special education.

But whatare related services? TheIDEA defines "related services" as:

...transportation, and suchdevelopmental, corrective,and other supportive ser-vices (including speech pa-thology and audiology, psy-chological services, physi-cal and occupationaltherapy, recreation, includ-ing therapeutic recreationand social work services,and medical and counsel-ing services, including re-habilitation counseling, ex-cept that such medical ser-vices shall be fordiagnosticand evaluation purposesonly) as may be required toassista child with a disabil-ity to benefit from specialeducation. [20 U.S.C.Chapter 33, Section1401(17), 1991[

Although the IDEA has becomelaw, at the time of this writing regula-tions for the Act have only been issuedin proposed form. Final regulatioas,written to correspond to the changesmade to the EHA by the IDEA, will bepublished after an extensive public com-ment and review period. Until the finalregulations are available to guide imple-mentation of the IDEA, the regulationsof its predecessor, the EHA, are beingused by school districts to determinehow and to whom related services willbe delivered. The regulations of theEHA (P.L. 94-142) list thirteen relatedservices that students with disabilitiesmay require to benefit from their spe-cial education programs. These are:

audiology;occupational therapy;physical therapy;psychological services;medical services for diagnostic orevaluation purposes only;school health services;U.:Importation services;counseling services;speech-language pathology;social work services;parent counseling and training;recreation therapy; andearly identification and assessmentof disabilities in children. [34 CodeofFederal Regulations (CFR) Sec-tion 300.13 (b)(1)-(13), 1988].

Clearly, the regulations define awide variety of services that must beprovided to children and youth withdisabilities identified as needing suchservices to maximize the benefits oftheir special education. However, thelaw also states that this long list ofservices is not exhaustive and may in-clude other developmental, corrective,

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or support services "as may be requiredto assist a child with a disability tobenefit from special educaticin" (TheIndividuals withDisabilities EducationAct, 20 U.S.C. Chapter 33, Section1401(17)]. It is through this provisionin the law that many school districts are,floviding students with disabilities withassistive technology devices and ser-vices. Furthermore, as states respond tothe requirements of federal law, manyhave legislated their own related ser-vice requirements, which may includeservices beyond those specified in fed-eral law. For example, some states alsoinclude mobility trai n ing, dance therapy,and artistic and cultural programs asrelated services that should be providedas necessary to help a studcnt with adisability benefit from his or her specialeducation program.

Because states are required to pro-vide the related services that are neces-sary for each individual student with adisability to benefit from his or herspecial education, related services canbc quite unique. An example of thiscxists in thc 1981 case of Espino v.Besteiro. As a result of an automobileaccidcnt, the student in question couldno longer function in a classroom thatwas not temperature-controlled. Ini-tially, the school system met thisstudcnt's need by providing him with aportable cubicle that was air condi-tioned. However, the court ruled that,in order for the student to benefit fromspecial education,air conditioning quallied as a related service and ordered theschool system to air condition the entireclassroom. The cubicle was not satis-factory, because it did not permit thechild to fully interact with the teacherand his classmates (Esterson & Bluth,1987).

Although related services can bequite expensive, school districts maynot chargc families of students withdisabilities for the cost of the services.Just as special and regular educationmust be provided to a student with adisability at no cost to the parent orgual dian, so, too, must related services.As a result of federal law, it is the state's

responsibility to provide a free, appro-priate public education to all studentswith disabilities, and that includes anyrelated services necessary to ensure theybenefit from their education.

Under the IDEA, P.L. 101-476, thestudent must be enrolled in special edu-cation to be considered eligible for re-lated services. However, there is an-other federal lawtheRehabilitationAct of 1973 (P.L. 93-112) that, inmany cases, broadens a student's eligi-bility for related services. The implica-tions of this law will be discussed laterin this NEWS DIGEST (see the sectionentitled "Related Services under Sec-tion 504" on page 8). First, however, letus take a look at examples of relatedservices and who is typically respon-sible for providing each one.

What Are Some Examplesof Related Services andWho Provides Them?

Pcrhaps thc best way to develop anunderstanding of what related servicesare is to take a look at the typcs ofpersonnel who are involved in the del i v-ery of services and what responsibilitieseach of these people typically has in theprocess. Given the range and diversityof disabilities, this list is quite lengthy.Therefore, the information presentedabout each related service L intendedonly as an introductiun to that serviceand the personnel associated with itsdelivery. It is not the intent of thisdocument, just as it is not the intcnt ofthe law, to exhaustively describe eachrelated service. Many variations inservice delivery are possible. Readersare encouraged to make use of thc re-sources listed at the end of this NEWSDIGEST to find out more about therelated services of relevance to them.(Early identification and assessment ofdisabilities in children is not discussedin this NEWS DIGEST, because it fallsoutside of this document's focus onrelated services for school-aged chil-dren.) It is important to read about all

the services and personnel in order toknow what related services are mostcommonly provided to students withdisabilities and their families.

Audiology Services are generallyprovided by audiologists who screensassess, and identify children with hear-ing loss. Additionally, they:

determine the range, naturt , anddc7rec of the hearing loss;

e referrals for medical or otherpro,. lssional attention for the ha-bilitation of hearing;provide language habilitation, au-ditory training, speech reading (lipreading), speech conservation, andother programs;determi ne the child' s need for groupor individual amplification, selectand fit an appropriate hearing aid,and evaluate the effectiveness ofamplication.

Many school systcms do not havethe diagnostic facilities necessary toassess the extent of a student's hearingloss, and so thcy refer students in needto a clinical setting, such as a hospital.Based on thc results of the hearingassessment, related services are thenprovided by school-based audiologistsor, in school systems that do not employaudiologists, by other professionals suchas speech pathologists or cducators(Friedrich, 1987).

Occupational Therapy is providedby therapists who concentrate upon as-sessing and treating children with dis-abilities that impair their daily life func-tioning. Areas of daily life functioningupon which an occupational therapistmight focus are:

activities of daily living, such aseating and dressing;school and work skills, such aswriting, using scissors, managingbooks and papers, and sitting effec-tively in class; andplay/leisure skills, such as partici-pating in art or physical educationclass or playing with children atIT,Cess.

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Photograph twurtesy of Tlu, American Orcupaiional Therapy Association. Inc.

When occupational therapy is pro-vided as a related service, it is meant toenhance a student's ability to functionin aneducational program. By focusingupon the skills of daily living, occupa-tional therapists can often help indi-vidual students to function in the leastrestrictive environment. Generally,occupational therapists:

provide treatment to strengthen anddevelop fine motor functions;focus on treatment of the smallmuscles, primaril y those of the face,upper trunk, arms, and hands; andimprove the student's ability toperform tasks necessary for inde-pendent functioning, such as chew-ing, swallowing, placement of thetongue and mouth for speech for-mation, eye-hand coordination, andmanual dexterity.

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Physical Therapy is provided to achild or youth with a disability follow-ing referral from a physician and, insome states, from school nurses, teach-ers, occupational therapists, and otherprofessionals. Physical therapists:

provide treatment to increasemuscle strength, mobility, and en-durance;focus on gross m otor skills that rel' yon the large muscles of the bodyinvolved in physical movementandrange of motion;help to improve the student's pos-ture, gait, and body awareness; andmonitor the function, fit, and properuse of mobility aids and devices.

In relation to special education,physical therapists are primarily con-cerned with developing and enhancingthe physical potential of students withdisabilities, so that they can achievemaximum independence and functionin all their educational activities (S.Esterson, 1987).

Psychological Services are alsodelivered as a related service when nec-essary to help students with disabilitiesbenefit from their education. Often, thepotential need of a child with a disabil-ity for psychological services is raisedduring an individual ized Education Pro-gram (LEP) meeting of teachers, schoolpersonnel, and parents. Members of theIEP team may have noticed that a stu-dent has become withdrawn and that hisor her grades have dropped. Or parentsmay be concerned that their child isreading far below his grade level andwant to know if he has a learning dis-ability. School psychologists, then,become responsible for delivering psy-chological services. Some of their pri-mary duties are to:

administer and interpret psycho-logical and educational tests andother assessment procedures todetermine if, indeed, the studenthas a disability;obtain, integrate, and interpret in-formation about a student's behav-ior and conditions for learning.Sources of information may in-clude observations of the studentand interviews with teachers, par-ents, and the student;

consult with school staff and assistin planning an educational pro-gram to meet a student's specialneeds, as indicated by psychologi-cal tests, interviews, and evalua-tions of behavior; andplan and manage programs to pro-vide psychological services, includ-ing counseling for students andparents.

It is important to know that, by law,no single assessment procedure can beused as "the sole criterion for determin-ing an appropriate educational programfor a child" (Code of Federal Regula-tions ICFR.1 : Title 34: Education: Part300.532, 1988). The anticipated regula-tions for the IDEA are not expected tochange this approach to student assess-ment. One of the school psychologist'smostchallenging duties, then, is to gatherinformation about the student from avariety of sources and interpret thatinformation, so that an educational pro-gram appropriate to the needs of thestudent can be developed.

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Medical Services arc considered arelated service only under specific con-ditions. By definition, medical ser-vices:

arc provided by a licensed physi-cian to diagnose a child's disabil-ity, determine the need for specialeducation, and determine the typeand extent of related services thatmay be needed; andare permitted for diagnostic rea-sons, but do not include direct, on-going medical tfeatment by a phy-sician.

Just how far does a school system'slegal requirement to provide inc.d icall y-related services go? This has becomequite an area of controversy as schoolsenroll and place students with severeand often life-threatening disabilities.Do the constant medical needs of thesestudents qualify as supportive servicesa school is obligated to provide or as on-going medical treatment, which is spe-cifically excluded as a related service?

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"The more medically sophisticated the decisions abouthow to treat the child, the more (the medical) service isexcluded and the school's obligation disappears."

Decisions can only be made on acase bycase, student by student basis. How-ever, the trend emerging from recentcourt cases appears to be:

If the supportive service must beperformed by a licensed physicianand is not for the purpose of evalu-ation or diagnosis, the school is notobligated to provide it.If the service can be provided by alay person, such as the teacher,with minimal training, the schoolmust provide it.When the service requires somedegree of medical insight, such aswhat to do when an emergencyarises, then court decisions can goeither way. "The more medicallysophisticated the decisions abouthow to treat the child, the more thatservice is exc luded and the school'sobligation disappears" (McKee &Barbe, 1990, p. 199).

School Health Services arc neces-sary, because many children and youthwith disabilities would be unable toattend a day of school without support-ive health care. Health services aretypically provided by a qualified schoolnurse or a specifically trainednonmedical person who is supervisedby a qualified nurse. Some of the healthservices that school nurses or othe.r quali-fied personnel provide to students withdisabilities include:

special feedingsclean intermittent catheterizationsuctioningadministering medicationsplanning for the safety of a studentin school, andensuring that care is given in theclassroom to prevent injury (e.g.,changing a student's position fre-quently to prevent pressure sores)(Black & Dorsett, 1987).

A joint task force of members an'staff of four assodnions the Ameri-can Federation of Teachers, the Coun-cil for Exceptional Children, the Na-tional Aaociation of School Nurses,Inc., and the National Education Asso-ciation recentl) released detailedguidelines to help administrators, healthcare providers, and educators providehealth services to children with specialhealth care needs (The Joint Task Forcefor the Management of Children withSpecial Health Needs, 1990). The guide-lines ;ist "66 special health care proce-dures that some children may need tohave provided in educational settings,"as well as "the persons qualified toperform cach of the procedures, whoshould preferably perlbrm the proce-dures, and the circumstances underwhich these persons would be deemedqualified" (p. 9).

The same controversy that is com-ing to light about medical services issurfacing in regard to school healthservices. How far does the school'sobligation to provide these services go?In the case ofBevin H.v.Wright (1987),the cou rt decided that the school districtwas not responsible for providing anurse to monitor Bevin's condition andassist her because of the intensive na-ture of her need. Other courts had foundthat schools were responsible for pro-viding nursing care, but the studentsinvolved in those cases only requiredintermittent nursing care that could beprovided by the school nurse, leavingthe nurse free to care for other students.The "private duty" service that Bevinrequired distinguished her case fromothers previously heard. Thus, the courtstated that placing the burden of theservices Bevin required "on the schooldistrict in the guise of 'related services'does not appear to be consistent with thespirit of the Act arid the regulations"

(Bevin ii. v.Wright,1987-88EducationofthellandicappedLawReport[EHLR]DEC. 559:122, as cited in "RelatedServices: Daily Nursing Care", 1987,P. 3).

Transportation Services are pro-vided to those students who need spe-cial assistance because of their disabil-ity or the location of the school relativeto their home. Not all students withdisabilities are eligible to receive spe-cialized transportation services. Manyarc able to use the same transportationthat students without disabilities use toget to school. However, for those whoneed special assistance, the school dis-trict must:

provide travel to and from schooland between schools;provide travel in and around schoolbuildings; andprovide specialized equipment(such as special or adapted buses,lifts, and ramps), if required toprovide special transportation for achild with disabilities.

Most school systems have writtenguidelines to help make decisions abouttransportation services consistent fromstudent to student. To be in compliancewith the IDEA, a school district cannotrequire the families of students withdisabilities to assume any portion of thecosts of those transportation servicesdeemed necessary to permit the stu-dents to benefit from their education.

Counseling Services arc typicallyprovided by school counselors who workwith students to develop their careerawareness, to improve their understand-ing of self, and to improve their behav-ioral adjustment and control skills. This,in turn, makes students with disabilitiesbetter able to participate in their educa-tional program. In many schools, thecounselor may also perform the func-tions of school psychologists (describedabove under Psychological Services).Additionally, school counselors may:

identify and refer students who maybe eligible for special education;

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secure parental permission for re-ferrals,provide advice concerning astudent's level of functioning, af-fective needs, and appropriatenessof the IEP;providestudentguidanceandcoun-seling in keeping with the IEP; andprovide supportive counseling forparents.

Speech-Language Pathology is aservice provided by speech-languagepathologists to address the needs ofchildren and youth with communica-tion disabilities, such as stuttering andimpairments in speech, language, orvoice. Typically, speech-languagepa-thologists:

screen, identify, assess, and diag-nosedisordersof fluency, language,articulation, voice, and oral-pha-ryngeal function, and cognitive/communication disorders;provide speech and language ser-vices for the habilitation or preven-tion of communication disorders,including augmentative and alter-nativecommunication systems; andrefer the student for medical orother professional attention neces-sary for the habilitation of speechor language disorders.

It should be noted that a studentwith a speech or language impairmentdoes not necessarily have to be mani-festhig academic problems in order tobe considered eligible to receive relatedservices under the IDEA. Effectiveoralcommunication is regarded as a skillbasic to academic performance(Applestein, 1987).

Social Work Services are providedin order to address the whole welfare ofthe student with a disability - h;s or herlife at home, in school, and in the com-munity. Historically, social workershave been used in schools as early as1913. The need for their services arosefrom "recognition of the need to con-sider factors beyond the schools thatmay be affecting a child's educational

performance" (Tabb, 1987, p. 113).Problems at home or in the communitycan adversely affect a student's perfor-mance at school, as can a student'sattitudes or behaviors in school. Social

the social worker may identify culturalor language differences that need to betaken into consideration as well (Tabb,1987).

"Social Work Services are provided in order to addressthe whole welfare of the student with a disability - his orher life at home, in school, and in the community."

work services may become necessaryin order to help the student maximizebenefit from the educational program.

In today's society, qualified schoolsocial workers have completed a two-year master's degree program in socialwork and generally have field experi-ence obtained through placement in apublic or private facility, where theyworked under supervision. Their dutieswithin schools typically include:

preparing a social or developmen-tal history of a student with a dis-ability;providing group or individualcoun-seling to the student and family;working with the problems in astudent's living situation (home,school, and community) that areaffecting the student's adjustmentin school; andmobilizing school and communityresources to enable the student tobenefit from his or her educationalprogram.

To develop an insightful social ordevelopmental history of a student witha disability requires the school socialworker to interact with both the studentand the family. This allows the socialworker to assess how family dynamicsand the home environment are influ-encing the student's learning and be-havior patterns. This information isuseful for determining the student'seducational placement and program,and also serves as a check against inap-propriate labeling of a student becauseof test scores and school behavior.Through interactions with the family,

Parent Counseling and Trainingis an important related service, becauseit addresses the needs of the parents andthe vital role they play in the lives oftheir children. The family is the "mostpowerful agent of change in the life ofa child" (Blumberg, 1987, p. 70). Theparents of a child or youth with a dis-ability may have great need for counsel-ing and training in order to understandtheir child's disability and how it mayaffect development. When necessary tohelp the child or youth with a disabilitybenefit from the educational program,school counselors can:

assist parents in understanding thespecial needs of their child;provide parents with informationabout child development; andprovide parents with referrals toparent support groups, fmancial as-sistance resources, and proftssion-als outside the school system.

Recreation Therapy is includedas a related service, because all chil-dren, with or without disabilities, needto learn how to use their leisure andrecreation time construe ti vely. For thosestudents with disabilities who are judgedto require recreation therapy in order tobenefit from special education, thetherapy can serve to improve socializa-tion skills, as well as eye-hand coordi-nation and physical, cognitive, or lan-guage development. In the case ofchildren with severe disabilities, "rec-reation activities arc necessary for thepurpose of initiating greater pride andindependence" (KM. Esterson, 1987,

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p. 99). To this end, recreation thera-pists:

assess the student's leisure capaci-ties and functions;provide therapy to remediate func-tional difficulties that limit involve-ment in leisure activities;provide leisure education for learn-ing the skills, knowledge, and atti-tudes related to leisure involve-ment; andhelp the student to participate inrecreation, based on the student'sneed for assistance and/or adaptedrecreation equipment.

Disabilities Act (P.L. 100-4C7), recog-nizing the enormous contribution thatassistive technology can make to thelives of individuals with disabilities.The Office of Special Education Pro-grams (OSEP) has issued a policy rulingstating that "consideration of a child'sneed for assistive technology must oc-cur on a case-by-case basis in connec-tion with the development of a child'sindividualized education program(IEP)" (Goodman, 16 EHLR 1317,OSEP 1990). The OSEP policy lettergoes on to say that "assistive technol-ogy can be a form of supplementary aid

"Consideration of a child's need for assistive technologymust occur on a case-by.case basis in connection withthe development of a chikl's . . . IEP."

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Assistive Technology Devices andServices are not specifically listed inthe law as a related service but are oftenprovided as "other corrective or supportservices" necessary to help students withdisabilities benefit from their educa-tion. The provision of assistive technol-ogy devices and services has changedover the years as technology has beendeveloped and applied to the needs ofindividuals with disabilities. The EHA(P.L. 94-142) mentions that providing"related aids and services" may be nec-essary tc, help a student maximize thebenefits of his or her educatioul pro-gram. The early interpretation of whatqualified as a permissible related aidwas controversial. "Generally, equip-ment such as glasses, wheelchairs, andhearing aids have been considered to beoutside of the school districts' responsi-bility because these were individuallyprescribed and were used at home aswell as during school" ("Districts MustProvide", 1990, p. 76).

As assistive technology hasboomed, however, the scope of thisrelated service has expanded. In 1988,Congress passed the Technology-Re.lated Assistance for Individuals with

or service utilized to facilitate a child'seducation in a regular educational env i-ronment. Such supplementary aids andservices, or modifications to the regulareducation program, must be included ina child's IEP." Thus, when an IEPof astudent with a disability is being devel-oped or reviewed, the school districtmust assess his or her need for anassistive technology device, determinethose devices that will facilitate thestudent's education, list them in theIEP, and then provide them to the stu-dent.

This policy letter, coupled with thepassage of the Technology-Related As-sistance for Individuals with Disabili-ties Act of 1988 and the IDEA, is ex-pected to dramatically affect the levelof district responsibility for providingrelated aids, devices, and technology-related services to students with dis-abilities.

The IDEA defines an assistive tech-nology device as:

...any item, piece of equip-ment, or product system,whetLer acquired commer-cially off the shelf, modified,or customized, that is used to

increase, maintain, or improvefunctional capabilities of in-dividuals with disabilities. [20U.S.C. Chapter 33, Section1401(25)]

The number of assistive technol-ogy devices in use across the UnitedStates is lengthy, and the list is growinglonger by the day. A few examples ofsuch devices are: electronic communi-cation aids, devices that enlarge printedwords on a computer screen, speechsynthesizers, prosthetic devices, braillewriters, and keyboards adapted for fistor foot use.

As more assistive technology de-vices become available to address thespecial needs of students with disabili-ties, districts are confronted with mul-tiple challenges in that they must: (a)identify and acquire technology devicesappropriate to the needs of their stu-dents with disabilities; (b) train staff inthe use of the devices; (c) identify ap-propriate use of computers, communi-cation devices, and other technology inthe classroom; and (d) finance the costof this related service. Additionally,districts must provide "assistive tech-nology services" to eligible studentswith disabilities. Assistive technologyservices are defined by the IDEA as"...any service that directly assists anindividual with a disability in the selec-tion, acquisition, or use of an assistivetechnology device" [20 U.S.C. Chapter33, Section 1401(26)]. Thus, schooldistricts are also responsibl e for helpingindividuals with disabilities to selectand acquire an appropriate assistivetechnology device and train them in itsuse.

Fortunately, for parents and pro-fessionals alike, there are a number oforganizations that provide informationon the latest developments in assistivetechnology devices. Some are listed inthe resources section of this NEWSDIGEST. Another useful resource isNICIICY's News Digest on AssistiveTechnology (1989), available free ofcharge from NICHCY.

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trArtistic/Cultural Therapies are

specifically mentioned in federal regu-lations as other "supportive services"and include "artistic and cultural pro-grams, and art, music, and dancetherapy, if they are required to assist ahandicapped child to benefit from spe-cial education"(34 CFR Part 300.13,Comment, 1988).

Dance therapy, for example, candevelop and promote "good posture,disc ipline, concentration ,coordination,agility, speed, balance, strength, andendurancz"(Salyers,1983). Arttherapyprovides individuals with disabilitieswith a means of self-expression andopportunities to expand personal cre-ativity and control. Music therapy isused to foster similar personal growth.Its therapeutic aims are the restoration,maintenance, and improvement of men-tal and physical health (National Asso-ciation for Music Therapy, 1988). Thistype of therapy can affect changes inbehavior, social skills, perception, self-esteem, and physical mobility and skills.

Artistic and cultural therapies aredesigned by art therapists, dance thera-pists, and music therapists to addressthe individual needs of students withdisabilities. These professionals:

assess the functioning of individualstudents;design programs appropriate to theneeds and abilities of students;provide services in which move-ment or an art form is used in atherapeutic process to further thechild's emotional, physical , and/orcognitive development or integra-tion; andoften act as resource persons forclassroom teachers.

School Breakfast and Lunch Pro-gram is not a related service specifi-cally listed in the IDEA. The programis discussed in this NEWS DIGESTbecause of its importance to those stu-dents with disabilities who have specialnutritional requirements. Because manystudents wi th disabilities do have uniquenutritional needs, they are unable to

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Photograph courtesy of 77te American Occupational Therapy Association. kr.

participate in the national meal pro-gram unless these meals are modified.

School meal programs are admin-istered at the federal level by the UnitedStates Department of Agriculture(USDA). USDA reimburses schools forevery meal served, at rates that varyaccording to family income. Childrenmay receive meals free or at a reducedprice if their families meet specificincome criteria.

Under USDA's Section 504 andchild nutrition regulations, schools par-ticipating in federal school meal pro-grams are required to make a reason-able effort to providc.:,atnoatracharge,special meals to students whose dietsare restricted due to their disabilities [7CFR Section 15b.26(dX1)].

In order to be eligible for modifiedmeals, a student must present a state-ment signcd by a physician. The state-ment should include: (a) the disabilityof the student and how the disabilityaffects the student's diet; (b) the majorlife activity affected by the disability;and (c) the food(s) to be omitted fromthe student's diet and those that may besubstituted [7 CFR Section 210.10(i)(1)and 7 CFR Section 220.8(01. Adjust-ments to meals may include changingthe texture of food, modifying the calo-ries, and substituting different foods forthose listed on the school menu (Horsley,1988).

In a recent floor statement, SenatorBob Dole of Kansas, Senate RepublicanLeader, expressed concern about theparticipation in school meal programs

by students whose disabilities restricttheir diets. Federal regulations, SenatorDole said, "put the burden on parents torequest special meals. Yet many par-ents, school administrators, and teach-ers do not know these regulations exist"(Dole, 1991).

Thus, parents need to be aware thatthey are responsible for: (a) requestingmodification of their child's meals, ifappropriate; and (b) providing the schoolsystem with a doctor's statement certi-fying their child's disability and de-scribing the child' s special dietary needs.If officials at the school are not familiarwith these regulations, parents shouldcontact their State school food servicedirector, who is usually employed bythe State education agency. If parentshave further questions or problem s, theycan contact the Child Nutrition Divi-sion of the Food and Nutrition Serviceof USDA at 3101 Park Center Drive,Alexandria, Virginia 22302 orcall (703)305-2620.

To address the special nutritionalneeds of students with disabilities, Sena-tor Dole also recommended the follow-ing:

greater coordination between teach-ers, school food service personnel,and children's health care provid-ers;more training of school staff in thearca of nutrition and meal modifi-cation;greater dissemination of the manyexcellent manuals on special nutria.lion already available; and

7

greater attention to nutritional needsin the development of individualeducation programs (IEPs). (Dale,1991)Because the IEP serves as a com-

munication tool between service pro-viders, parents, and the student with adisability, stating nutrition goals andobjectives in the IEP, when appropri-ate, "will facilitate instruction on di-etary needs and compliance" (Horsley,Allen, & White, 1991, p. 56).

Related Services underSection 504

Under the IDEA, a student must beenrolled in special education to be con-sidered eligible for related services.However, as was mentioned in the firstsection of this NEWS DIGEST , there isanother federal law, Section 504 of theRehabilitation Act of 1973 (P.L.112), which in many cases broadens astudent'seligibility for related services.

The Office for Civil Rights (OCR)is responsible for overseeing compli-ance with the Section 504 regulations.In order to ensure that the discussion inthis section is as accurate as possible,NICHCY asked OCR to examine indetail all information presented here inregards to Section 504. In accordancewith OCR's review, then, the followingdiscussion cites extensively from theSection 504 regulations, the basis fromwhich OCR oversees compliance withthe law and from which school districts,at times, must make decisions in re-gards to the eligibility of students toreceive related services.

According to Section 504 of theAct, State Education Agencies (SEAs)and Local Education Agencies (LEAs)receiving Federal funds cannot excludequalified individuals with disabilitiesfrom participation in or the benefits of

"Section 504 does not require a student to be enrolled inspecial education in order to receive related services."

any program or activity offered by theSEA or LEA. Regulations of the Actalso specify that a recipient of Federalfinancial assistance operating a publicelementary or secondary education pro-gram must provide a free, appropriatepublic education to each "qualifiedhandicapped person" within its juris-diction.

The Section 504 regulation definesa "handicapped person" as follows:

(1) "Handicapped persons"means any person who (i) hasa physical or mental impair-ment which substantially lim-as one or more major life ac-tivities; (ii) has a record ofsuch an impairment, or (iii) isregarded as having such animpairment...(2)(ii) "Major life activitiesmeans functions such as car-ing for one's self, performingmanual tasks, walking, see-ing, hearing, speaking, breath-ing, learning, and working.[34 Code of Federal Regula-tions (CFR) Section 104.3(j),1988]

Under the Section 504 regulation:

"Qualified handicapped per-son" means: ...[w]ith respectto ... elementary [and] sec-ondary ... education services,a handicapped person (i) of anage during which non-handi-capped persons are providedsuch services, (ii) of any ageduring which it is mandatory

understate law to provide suchservices to handicapped per-sons, or (iii) to whom a state isrequired to provide a free ap-propriate public educationunder Section 612 of the Edu-cation of the Haitdics.ppedAct. [34 CFR Secn104.3(k)(2), 1988]

The free appreprime public educa-tion must meet the individual needs ofstudents who are "qualified handicappedpersons" as adequately as the needs ofstudents without disabilities are met.Such an education, according to theSection 504 regulation, can consist ofeither regular or special education andmust include any related aids or ser-vices necessary to provide a free appro-priate public education designed to meetthe individual student's needs. The lawalso requires that recipients of Federalfunds operating public elementary orsecondary education programs evalu-ate any person who needs or is believedto need special education or relatedservices because of disability. Thus,Section 504 does not require a studentto be enrolled in special education inorder to receive related services.

Thc fact that the IDEA and Section504 of the Rehabilitation Act defineeligibility for, and entitlement to, re-lated services in different ways cancomplicate how a school district de-cides if a student is eligible for and/ormust be provided with services or not.School distriqs can fulfill the require-ments of certain sections of the Section504 regulation by complying with theEHA (now IDEA) (Daniels, 1988).'

'A school districi can satisfy the Section 504 regulation's "free appropriate public education" requirement by implementing an IEP develop( din accordance with the EH A [34 CFR Section 104.35(b)(2)]. Establishing a procedure consistent with the EH A for periodically reevaluatingstudents who have been provided with special education and related services is one way of complying with the Section 504 regulation'speriodic reevaluation requirement [34 CFR Stction 104.35(d)]. A school district can comply with the Section 504 regulation's proceduralsafeguards requirement by complying with Section 615 of the EHA (34 CFR Section 104.36).

8

However, it is possible for a schooldistrict to be in violatiqi of the Section504 regulation while still being in com-pliance with the IDEA. This can hap-pen when a school district denies ser-vices to an individual who has a disabil-ity not specified undPx the IDEA butwho is considered Adicapped" un-der Section 504. For example, there areschool districts that hay- iriled to ad-minister medication to :,...tt-,1.:nts withAttention Deficit Disorde kADD), be-cause ADD is not listed as a handicap-ping condition under the IDEA. How-ever, such students may be entitled tohave the school district administer medi-cation as a related service under Section504, if the student meets the Section 504definition of "handicapped person."

An individualized evaluation wouldneed to be made by a multidisciplinaryteam to determine whether the studentis "handicapped" within the meaning ofSection 504; that is, whether the studenthas an impairment which substantiallylimits one or more major life activities(e.g., learning). Once it is determinedthat a student is handicapped within themeaning of Section 504 and meets otherappl icab le el ig ibil ity requirements (such

as age requirements), public elemen-tary or secondary education programsreceiving Federal financial assistanceare required by Section 504 to providea free appropriate public education tothat student, without regard to the na-

ture or severity of the individual's dis-ability. The free appropriate publiceducation must include any related aidsor services, such as adm inistering medi-cation, that are necessary to meet theindividual student's needs.

Because the defmition of disabilityis broader under Section 504 of theRehabilitation Act than under the IDEA ,many parents whose children are ineli-gible for related scrv ices under the IDEAare filing complaints with OCR, alleg-ing that denial of related services de-nied their children a free appropriatepublic education. It should be notedthat when OCR investigates a com-plaint, it does so solely on the basis ofcompliance with the rules and regula-tions of Section 504. OCR does notmake findings of a school district'scompliance or noncompliance with theIDEA (Daniels, 1988). In addition, anOCR investigation focuses primarilyon the process used to idcntify, evalu-ate, and place students with disabilities,rather than on whether the programultimately chosen by the district wasappropriate. As the Appendix to theSection 504 regulation states:

It is not the intention of [OCR],except in extraordinary cir-cumstances, to review the re-sult of individual placementand other educational deci-sions, so long as the school

districtcomplies with the "pro-cess" requirements of thissubpart (concerning identifi-cation and location, evalua-tion, and due process proce-dures). However, [OCR] willplace a high priority on inves-tigating cases which may in-volve exclusion of a child fromthe education system or a pat-tern or practice of discrimina-tory placements or education.

An example of a pattern or practiceof discriminatory placements or educa-tion is a school district's refusal toprovide related services to any studentswho arc ineligible for such servicesunder the IDEA, even if those studentsare "qualified handicapped persons"under the Section 504 regulation.

Recent investigations have resultedin OCR rulings that individuals whohave disabilities not specified in theIDEA are often eligible for related ser-vices under Section 504. In addition toADD,other examples that may be handi-capping conditions under Section 504are: alcohol and drug addiction (al-though, under 1990 amendments to theRehabilitation Act, a student who isc urrentl y using alcohol or illegal drugsis no longer protected by Section 504when the school d istric t ac ts on the basisof such use); communicable diseasessuch as AIDS, and obesity (Cernosia,

Notice From the Office of Civil Rights:Applicability of Section 504 of the Rehabilitation Act of 1973

to Homeless and Drug-Exposed Children

The Office of Civil Rights (OCR) is concerned about twowidespread national problems that may seriously affect ourschooLs. One is the predicament of children whose families arehomeless. The other is the plight of children who are born tomothers who have been exposed to drugs. Children who arehandicapped in these groups arc covered under Section 504 of theRehabilitation Act of 1973.

Under the Section 504 implementing regulation, recipients ofFederal aid operating public elementary or secondary educationprograms must annually undertake to identify and locate everyqualified handicapped person residing in the recipient's jurisdic-tion who is not receiving a public education. Annually the schoolsystem must also take appropriate steps to notify handicapped

persons and their parents or guardians of its duty under theSection 504 regulation to provide a free appropriate publiceducation to each qualified handicapped person in its juris-diction.

Because of its importance, OCR included identification ofhomeless and drug-exposed student populations for specialeducation and related services as one of the priority educa-tional equity issues in the FY 1991 National EnforcementStrategy. OCR has planned compliance and technical assis-tance outreach activities in this area during the current fiscalyear. Persons needing additional information or technicalassistance arc urged to contact any of OCR's ten regionaloffices.

9 0

1991; "Georgia Challenges", 1990).Consistent with these rulings, schooldistricts must determine whether theeducational needs of students with suchdisabilities are being met to the extentthat the needs of students without dis-abilities are met (Daniels, 1988, p. 3).

The IDEA and Section 504 differ inanother, important aspect besides theirdefinitions of "disability." The IDEA:

...is a federal grant program,authorizing federal funds tostates to assist them in theprovision of special educa-tion and related services to"eligible" students. Section504 is a civil rights statute,prohibiting discrimination onthe basis of handicap. ("Geor-gia Challenges", 1990, p. 208)

Therefore, although school districtsmust comply with the regulations ofSection 504 if thcy want to retain Fed-eral financial assistance, they do notreceive Federal funds to pay for ser-vices provided to students with disabili-ties under Section 504.

Parcnts and professionals who areinterested in more information abouthow Section 504 regulations affect theprovision of related services should...ontact any of OCR's regional offices.If you need assistance identifying thcregional office nearest you, please con-tact NICHCY.

How Are Related ServicesObtained for Students?

Usually, the need for related ser-vices is identified during the process ofevaluating a studcnt for special educa-tion. Because far-reaching decisionsare madc based upon the evaluation ofa student with a suspected disability, itis useful to know that both the IDEA andSection 504 of the Rehabilitation Actstate that decisions about the educa-tional program of a student may not bebased solely on the findings of a single

evaluation instrument. Rather, datamust come from a variety of sources,including "aptitude and achievementtests, teacher recommendations, physi-cal condition, social or cultural back-ground, and adaptive behavior" [34 CFRSection 104.35(c),1988]. Furthermore,data must be collected in all areas re-lated to the student's suspected disabil-ity. This may include, where appropri-ate, "health, vision, hcaring, social andemotional status, general intelligence,academic performance,communicativestatus, and motor abilities" (Arena, 1989,p. 23). Federal law also requires that theevaluation must be conducted by amultidisciplinai y team, including at leastone teacher who is knowledgeable inthe area of the suspected disability.

not what the school district (local edu-cational agency) can provide" (Arena,1989, p. 15). Thus, the related servicesneeded by the student must be listed inthe IEP, regardless of whether the dis-trict currently makes the services avail-able. The IEP establishes the genuineneed to be met and must describe re-lated services according to:

the service(s) needed (e.g., occu-pational therapy)the type of service (e.g., direct ser-vice to the child; consulting ser-vices to teachers or others)the type of servic e provider(s) (e.g.,occupational therapist)thc frequency and duration of theservice (e.g., two 45-minutc peri-ods per week).

"The IEP details the educational goals and objectivesfor the student and lists the related services that arenecessary to help the student Wain those goals andobjectives."

The extensive nature of the evalu-ation process should provide decision-makers with the information they needto de term ine an appropriate educationalprogram for the student. It also allowsthem to identify the related services astudent will need. At this point, deci-sion-makers including the parentsand, whcre appropriate, the studentsit down and write an IndividualizedEducation Program (LEP) for the stu-dent. The IEP details the educationalgoals and objectives for the student andlists thc related services that are neces-sary to help the student attain thosegoals and objectives. It is useful to notethat related services personnel arc notrequired to participate in the !EP meet-ing. However, it ir Ippropriate for thcmto participate or otherwise take part inIEP development. The written findingsand recommendations of related ser-vices personnel should become part ofthe child's evaluation report.

"The 1EP...is formulated as a teameffort, based on what the child needs -

Thc IEP then serves as a writtcncommitmcnt for delivery of services tomeet a studcnt's educational needs. Thcschool district must provide all of theservices specified in the IEP, in theamount and degree specified. Changcsin the amount of services listed in theIEP cannot bc madc without holdinganother IEP nT nting. However, if thercis nn change in the overall amount ofser , ^ome adjustments in schedul-

./,'',ervices should be possible with-:.-A necessity of another IEP meet-

The above description of the evalu-ation process, IEP development, andthe specification of related services tobe delivered to a studcnt with a disabil-ity assumes that the student was foundeligible for special education and re-lated services. What happens whcnthings don't go so smoothly? For ex-ample, the school district may deter-mine, via its evaluation, that the studcntdoes not require special education and,thus, is inelL.ole under the IDEA for

101

111iMb.

related services. Or pethaps the parentsare dissatisfied with the way that relatedservices are being provided to theirchild or believe that their child needsrelated services that the school districtdoes not provide or feels arc unneces-sary. What happens then?

Here are some points parents maywant to bear in mind in such situations(Education Law Center, 1985; U.S.Department of Education, 1986):

1. The IDEA enumerates proce-dural safeguards that school districtsmust adhere to in thc delivery of educa-tional services (see Gerry, 1987). Thesesafeguards establish due processproce-dures through which parents and chil-dren with disabilities can resolve differ-ences with the school district (34 CFR§300.500 - §300.514, 1988). Amongthe procedures are: the right toan inde-pendent evaluation at public expense,the right to an impartial due processhearing, the right to an administrativeappeal and impartial review of the evi-dence, and the right to take civil action.

2. Therefore, if the school districtdetermines that a student with a disabil-ity does not require special educationand denies that student related services,parents may request that the distric t payfor an independent evaluation. If thedistrict should refuse this request, par-ents may ask for a hearing before animpartial hearing officer to resolve thisdifference.

3. The parents can also decide topay for the independent evaluation pri-vately. In this case, they should receivea written evaluation report specifying(a) the problem the child has; (b) pre-cisely how that problem affects thechild's ability to make progress towardthe goals of his or her IEP; (c) recom-mendations on the type of serviceneeded, the way it should be provided,how often and for how long, and thetype of personnel who should deliverthe services; and (d) a description of thegoals of the related service program thatis recommended. The school districtmust take the results of the privateevaluation into account when making a

Mom=

Photograph etatrtekt. of 71w Amerhan avumuumal Therapy .4mwiation. Ind .

decision about a student's eligibility forrelated services.

4. Parents may also wish to nego-tiate with the school disuict to see if thestudent is eligible for related servicesunder Section 504 criteria. If paren ts donot agree with the district's decision,again, they can ask that a hearing officerreview the evidence. As a final step,parents can also file a complaint withthe regional office ot the Office of CivilRigh ts (OCR). An OCR hearing officerwill also review the evidence and de-cide if the district is obligated to providethe related services.

5. When a student's need forrelated services is not linked to his orher ability to benefit from special edu-cation and is, therefore, not part of theIEP, parents have other options apartfrom the school system. For example,parents may seek services from reha-bilitation organizations, private thera-pists, medical organizations, clinics,and other agencies.

This latter point may be importantfor parents to consider when trying toobtain related services for their childwith a disability. Although parents dohave due process rights which they caninvoke when differences with the schooldistrict arise, thcyy should be aware theproblems can often be worked out infor-mally. "Due process can be expensive,

time-consuming, and frustrating"(Callanan, 1990, p. 286), so it is cer-tainly worthwhile for parents to try firstto resolve problems with the district ina less confrontational way. Many stateshave alternatives to the formal appealprocess, including conciliatory confer-'Aces, administrative reviews, and me-diation. Flexibility and reasonablenessare key factors in working out differ-ences, and compromise on the parts ofboth the parents and the school districtmay be necessary. There arc manybenefits to resol ving differences throughcompromise and mediation. Not onlyis time saved and the cost of litigationavoided, but the relationship betweenparents and the school district will re-main a working one, where communi-cation is still open, people are stilltalking, and future decisions are notmade impossible by past differences.

How Are Related ServicesDelivered?

The district decides how the ser-vices enumerated in the IEP will bedelivered to the student. The districtmay provide these services through itsown personnel resources, but if this isnot possible, they may contract withanother public or private agency, whichthen provides the services.

1112

"There must be communication between the IEP teamand the related service provider(s) to ensure that services

are being delivered as specified and that the student is

making progress."

There arc two kinds of related ser-vices interventions offered by schoolsto meet the range of student needs.These can be defined as follows (Asso-ciation for Retarded Citizens/Minne-sota, 1989, pp. 3-4):

Direct Therapy refers to hands-oninteractions between the therapistand the studcnt. These interactionscan take place in a variety of set-tings. The therapist analyzes stu-dent responses and uses specifictechniques to develop or improveparticular skills. The therapistshould also monitor the student'sperformance within the educationalenvironment and consult withteachers p.nd parents on an ongoingbasis, so that some strategics can becarried out through indirect meansat other times.Indirect Therapy refers to teach-ing, consulting with, and directlysupervising othcr team members(including paraprofessionals andparents) so that they can carry outtherapeutically-appropriate activi-ties. Trained assistants, such as acertified Occupational TherapyAssistant, arc sometimes employedto share in the delivery of relatedservices. Three essentials of indi-rect intervention are: (a) the inter-vention procedure is designed bythe therapist for an individual stu-dent; (b) me therapist has regularopportunities to interact with thestudent; and (c) the therapist pro-vides ongoing training, follow-up,and support to staff members andparents.One type of service intervention is

not necessarily better than the other.The type of service provided dependsupon the student's needs and educa-tional goals, and the skills and avail-

ability of school staff. Ellen Siciliano,a Parcnt Involvement Coordinator forthe Pennsylvania Depart. ^lit of Edu-cation, Bureau of Special Education,sees a trend toward indirect therapyinterventions for some related services.She says:

Some parents object to this,feeling that thcir childrenshould have the direct atten-tion of a therapist for all con-tact hours. My own opinion isthat indirect or consultativeforms of therapy arc useful.When my daughter was inschool, a therapist workedwith me, so that I could workwith my daughter, and thiswas beneficial. In ruralschools, this kind of servicemay be very important in en-suring that children receivethese services. (Siciliano,personal communication,September 20, 1990)In small and rural districts, often

there arc not sufficient numbers of eli-gible students to justify employing afull-time therapist, or requirementsacross schools in a district may add upto the need for one related service pro-vider. In such cases, the district mayemploy one specialist to move fromschool to school, or several districtsmay use a cooperative approach, pool-ing their resources to hire personnelwho travel among districts to provideservices. The term itinerant services isused to describe this type of serviceprovision, but it refers to the deploy-ment of personnel, not to a specific typeof service intervention.

How Are Related ServicesCoordinated?

The IDEA requires that amultidisciplinary team perform anevaluation of a student to determine hisor her eligibility for special educationand related services. Likewise, amultidisciplinary team mustbe involvedin any placement decisions. This teamgenerally consists of a representative ofthe public agency who is qualified toprovide or supervise the provision ofspecial education and/or related ser-vices, the student's teacher, one or bothof the student's parents, the student(where appropriate), individuais whoseinput is requested by either the parentsor the public agency, and a member ofthe evaluation team who is knowledge-able about how the evaluation was con-ducted and its findings (Arena, 1989).The student's IEP is developed throughthe joint efforts of these individuals,and necessary related services are speci-fied.

Obviously, the process of develop-ing an 1EP can be complicated, requir-ing many people to interact and coordi-nate their efforts. Many school districtsappoint a school staff member (such asa teacher, psychologist, or counselor) toact as coordinator or case manager ofthe IEP process for an individual stu-dent or for all children with disabilitiesin a school. This is not required by law,but it helps the school district managethe complicated task of evaluating stu-dents and developing IEPs. The kindsof activities that a coordinator or casemanager might do include:

coordinating the multidisciplinaryevaluation;collecting and synthesizing evalu-ation reports and other relevantinformation that might be neededto the 1EP meeting;communicating with parents; andconducting the IEP meeting (U.S.Department of Education, 1986).Beyond development, however,

there is implementation of the IEP.Depending on the nature of the related

services to be provided, many otherprofessionals may become involved onbehalf of the student with a disability.This may include one or more thera-pists, a special educator, classroomteachers, counselors, the school princi-pal, paraprofessionals, and others. Theseindividuals work not only with the child,but also with the family and communityresources. Furthermore, there must becommunication between the IEP teamand the related service provider(s) toensure that services arc being deliveredas specified and that the student is mak-ing progress. If the student is not pro-gressing as expected, adjustments in hisor her program must be made. The IEPteam would need to be involved in anysuch decisions, and the new plan wouldneed to be communicated to the relatedservices personnel.

Thus, it is highly desirable thatrelated services be delivered in educa-tional settings through a team approarh.Related services arc not to be isolatedfrom the educational program. Rather,they arc to be related to the educationalneeds of students (Association for Re-tarded Citizens/Minnesota, 1989). Theinteractions of professional staff, con-sultants, community, and family,brought together in the delivery of re-lated services for a student, underscorethe usefulness of a case managementapproach in which a team leader coor-dinates and orchestrates services onbehalf of the student.

How Are Related ServicesFunded?

Under P.L. 94-142 and its amend-ments, including the recently passedIDEA, students with &abilities arcentitled to a free appropriate publiceducation. State education agencies arcresponsible for assuming the costs ofthat public education, and no costs ofimplementing the IEP for school-agedstudents can be passed on to parents orguardians. This includes the provisionof related services, Students and their

families are entitled to receive theseservices at no cost to themselves.

Funding of related services, ofcourse, presents schools win an enor-mous fiscal obligation. While districtsreceive federal funds through the IDEAto assist them in providing special edu-

extensive and expensive. What otherfunding sources arc available, besidesthe IDEA, to pay the costs of specialeducation and related services? Sincethe enactment of the original EHA94-142), several new sources of fund-ing have emerged. The Medicare Cata-

"(Eligible) students and their families are entitled toreceive (relied) services at no cost to themselves."

cation programs and related services forstudents with disabilities, the costs cannonetheless become quite staggering.However, "nowhere in the law is therea provision that could be construed asrelieving a school system of its respon-sibility to provide a free appropriatepublic education even if sufficientfunds...arc not available" ("RelatedServices: Funding and Personnel", 1988,p. 3). Even before the passage of theEHA, the landmark case of Mills v.Board of Education of the District ofColumbia (1972) affirmed that schooldistricts arc responsible for meeting theeducational needs of students with dis-abilities. The school board in Millsargued that it could not afford to offer anappropriate education to all its studentswith disabilities. The court respondedthat whatever inadequacies existed inthe school system could not be allowedto impact more heavily on the excep-tional child than on a child withoutdisabilities.

Although courts appcar to becom-ing more aware of the costs involved inproviding related services, the tendencyis to consider the appropriatenels ofdifferent educational options and thecosts of each , as in the Clevenger v. OakRidge School Board(1984) case. There,the 6th U.S. Circuit Court of Appealssaid, "Cost considerations arc only rel-evant when choosing between severaloptions, all of which are for an "appro-priate" education. When only one isappropriate, then there is no choice."

Clearly, a school oistrices respon-sibility to students with disabilities is

strophic Coverage Act became PublicLaw 100-360 on July 1,1988. Althoughthis legislation primarily concernedMedicare and has been repealed, it alsocontained an amendment to the SocialSecurity Act that affects Medicaid(which is a joint federal-state programproviding health care services for low-income persons). The 1988 amend-ments authorize Medicaid reimburse-ments for Medicaid-covered relatedservices in the IEPs of Medicare-eli-gible students with disabilities. TheOmnibus Budget Reconciliation Act of1989, which further amended the fed-eral Medicaid statute, also provides thattreatment needs recommended throughMedicaid's Early and Periodic Screen-ing Diagnosis and Treatment process(EPSDT) "must include any servicesthat arc available under Medicaid, re-gardless of whether the state has optedto include such service as part of itsMedicaid state plan" ("Ca Medicaid",1990, p. 161). As a result, some schooldistricts arc now receiving funds throughMedicaid for certain related say sthat arc provided in the public schoolsAn example of this can be drawn fromthe case of Melissa, an eleven year oldwhose disabilities were so severe sherequired the services of a trained nursetwenty-four hours a day. She attendedpublic school under district funding and,by all accounts, not only benefitedgreatly herself but also provided a verypositive example to her classmates byhcr enthusiasm and her determinationto learn and succeed. Melissa's parentsought a federal court ruling to require

13 1

"Another potential funding source that has come intouse in the last decade is third-party billing."

the U.S. Department of Health andHuman Services (FIHS) to use Medic-aid funds to pay for the nursing servicesneeded by Melissa while she was inschool. HHS denied responsibility onthe basis that Medicaid regulations stipu-late that private nursing care was notcovered by Medicaid for locations out-side of a hospital, a nursing facility, ora recipient's home. However, the ap-pellate court found in favor of Melissa,saying that when Medicaid legislationwas enacted two and a hal f decades ago,the assumption may have been widelyaccepted that a person needing a privateduty nurse would be confined to thelocations mentioned in the regulations.Fortunately, that assumption is no longertrue in today's society. "Rather, privateduty nursing is today understood as"setting independent," referring to alevel of care rather than to specificlocations where the care can be pro-vided" ("Can Medicaid", 1990,p. 161).Thus, the cost of the private duty nurseneeded by Melissa while attendingschool was billable to Medicaid (Detselv. Sullivan, 1990).

Another potential funding sourcethat has come into use in the last decade

r

is third-party billing. Third-party bill-ing means that parents of students withdisabilities use their private health in-surance to pay for the individual evalu-ations or related services that their childreceives. The idea of third-party billingarose out of somewhat ambiguous regu-lations under both EHA and Section504 that state that insurers are not re-lieved of their obligation to "provide orpay for services provided to a handi-capped child" [34 CFR § 300.301(b),1988]. Third-party billing has beenseen as a promising way for schooldistricts to pay for related services, butit has also become controversial. Asearly as 1980, the U.S. Department ofEducation released a policy interpreta-tion stating that educational agenciescould not compel parents of a child witha disability to file an insurance claimthat would pose a realistic threat to theparents in terms of financial loss. Ex-amples of financial loss include, but arcnot limited to: (1) decreases in availablelifetime coverage or other insurancebenefits; (2) increases in insurance pre-miums; (3) discontinuation of the insur-ance policy; or (4) out-of-pocket ex-penses such as deductibles. However,

Photokruph uourteSt- of Ihe Amin-hull (A.( upationul Therapy Association, Inc.

the Department of Education did statethat districts may require parents to filean insurance claim when: (a) doing sowould not result in cost to the parents;and (b) the district ensures that parentsdo not have to bear even a short-termfinancial loss, such as paying a deduct-ible. In the latter case, the schooldistrict "may insist that the parents filea claim if it [the school district] pays forthe services and the deductible in ad-vance" (U.S. Department of Education,1980, p. 86390).

Many of the same points were reit-erated in a 19900SEP letter. This letteradds a point concerning the financialloss to parents that results when filingan insurance claim leads to increasedinsurance premiums. The OSEP letterstates that:

...if a public agency offers topay the increased premiums,the parent would incur no fi-nancial loss and, therefore,could be required by the pub-lic agency to file an insuranceclaim. A parent's refusal tofile an insurance claim, evenwhere doing so would resultin no financial loss, does notrelieve the obligations of thepublic agency to provideFAPE [free appropriate pub-lic education] to the parent'schild who is handicapped.(Newby, 16 EIILR 549)

The Office of Civil Rights (OCR)has also become involved in the contro-versy over third-party billing. OCRinvestigations into how some schooldistricts were using third-party billingto pay for diagnostic and evaluativeservices revealed that parents were riotadequately informed as to (a) the poten-tial consequences and costs of billingtheir insurance companies, or (b) theirright to refuse taking such action. BothOCR and OSEP -- and recently theOffice of Spccial Education and Reha-bilitation Services (OSERS) haveconfirmed the original Department ofEducation's policy that "without par-ents' voluntary consent to bill their

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insurance, districts cannot obtain reim-bursement through private insurancecarriers" ("Third-party Benefi ts", 1990,p. 5). Moreover, parents should beaware that a district may not terminateservices to a student with a disability ifparents refuse to file an insurance claim.

The policy interpretation issued bythe U.S. Department of Education in1980 does allow parents to voluntarilyuse their insurance benefits to pay forrelated services for their child. Thedistrict, however, must be able to provethat parents truly are cooperating vol-untarily, rather than because they feartheir child will otherwise not receiveneeded services.

Even where parents allow third-party billing, the district may still not beable to get reimbursed by insurancecompanies for providing related ser-vices. Some insurance policies specifi-cally exclude coverage of services thatthe insured can obtain free under fed-eral, state, or local laws. In a 1990 courtcase (Chester County Intermediate Unitv. Pennsylvania Blue Shield), parentsseeking reimbursement from their in-surance company claimed that the EHAforbids insurers from excluding cover-age for related services. The Court,however, found that the regulations ofthe EFIA (now IDEA) do not bind pri-vate instuers (16 Education ofthe Nandi-cappedLawReport[EHLR] 925). Thus,insurance companies are within theirrights to exclude from coverage relatedservices that should be provided free ofcost to students with disabilities underthe IDEA. Needless to say, this repre-sents another obstacle to school dis-tricts seeking to pay for related servicesthrough third-party billing.

Are There Shortages ofPersonnel for RelatedServices?

The answer is: Yes. The shortageof related services personnel is a recur-ring theme in state data on special edu-cation programs and related services.

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Photograph courwAr (11 Anwrican Ocupational 17wrapr A%sociation.

For example, in a survey conducted bythe University of Maryland (Smith-Davis, Burke, & Noel, 1984), 36 statesreported major shortages of physicaltherapists. In 1986, the number of statesreporting shortages in this area hadrisen to 47 (McLaughlin, Smith-Davis,& Burke, 1986). These results are notunusual. Personnel reported to be in theshortest supply are occupational thera-pists, physical therapists, psychologists,counselors, social workers, and speech/language pathologists (Office of Spe-cial Education Programs, Division ofInnovation and Development, 1990).The results of these and several otherrecent studies (National Eastcr SealsSociety, 1988; Nicholas, 1990; Smith,1990) attest to the problems that schooldistricts face in finding, hiring, andkeeping personnel in these importantrelated services areas.

Salaries, of course, are a factor inthese shortages, inasmuch as hospitalsand private agencies can often offergreater compensation than can schools.But other factors include the lack oftrained applicants for school positionsand competition with other agencieswho provide related services to the eld-erly population, infants at risk, and ac-cident trauma victims. Mr. Reynaud,Director of Special Education for thePark Hill School District and Presidentof the Council for Exceptional

Children's Council of Administratorsof Special Education (CASE), describeshow this very problem is affecting hisdistrict's ability to provide related ser-vices.

Over the years, our district hashad an arrangement with St.Luke's Hospital in Kansas Cityto obtain OT and PT serviceson contract from its commu-nity-based program. This sum-mer, St. Luke's called to saythat they could no longer con-tract with us, because they wereexperiencing difficulty find-ing OTs and PTs to meet justthe demands of their hospitalservices, not to mention theircommunity programs. Whcna big organization like St.Luke's says something likethat, you listen. (Reynaud,personal communication, Au-gust 3, 1990)Not only arc vacancies difficult to

fill in many districts, but the scarcity ofpersonnel leads to heavier case loads forthose who arc employed. To improveassessment and treatment, increase stu-dent contact hours, and allow moreservices for students who need themmost, additional personnel time is cer-tainly needed (Office of Special Educa-tion Programs, Division of Innovationand Development, 1990). There is also

". . . Personnel shortages impact greatly on the schooldistrict's ability to provide related services to studentswith disabilities."

a pressing need to hire school-employedrelated service providers, rather thanobtaining them through contractual ar-rangements with other agencies, as isoften the case at present. However,many therapists arc trained predomi-nantly for clinical work and often preferclinical rathcr than school settings. Asdemographics in the United Stateschange, the shrinking representation ofminorities in teaching and related ser-vices is also of concern.

All of these personnel shortagesimpact greatly on the school district'sability to provide related services tostudents with disabilities. "The worstimpact," says Dr. Lowell Harris, Direc-tor, Division of Exceptional Children'sServices for the North Carolina Depart-ment of Public Instruction, "is to knowthat children need services and the verydisturbing knowledge that services can'tbe provided appropriately, even thoughthere are funds to provide them." Headds,"The most poignant problem ariseswhen a therapist leaves. Then the pro-longed difficulty of finding a therapistbegins; children have already been re-ceiving services, but the services aretaken away. That's where the hearingscome in." (Harris, personal communi-cation, August 3, 1990).

By "hearing," Dr. Lowell is refer-ring to the legal fight of parents to lodgea complaint against a school districtwhen related services arc not beingprovided to their child. A hearing isconvened to review the evidence anddetermine if, indeed, the child is eli-gible.; to receive the disputed servicesand, if so, what has happened that theyarc not. It is clear from recent courtcases and investigations by the Officeof Civil Rights (OCR) that, regardlessof staffing difficulties, school districtsarc responsible for providing the ser-vices students need. For example, a

school district on Michigan's easternUpper Peninsula found itself unable tohire and retain qualified physical thera-pists and speech pathologists, due inpart to the district's isolated location.The district searched for candidatesthrough posting vacancy notices in news-papers and in college placement of-fices, and tried unsuccessfully to estab-lish a contractual agreement with aneighboring school district and a localsports medicine clinic to use their physi-cal therapist services. A complaint waslodged against the district for failing toprovide physical and speech therapy toa boy with cerebral palsy and otherstudents with multiple disabilities. OCRinvestigated the complaint and held thedistrict in violation of its requirements.OCR then ordered the school district "totake any measures available, such ascontracting for services outside the im-mediate geographic arca, to provideservices to the children" ("Related Ser-vices: Funding and Personnel", 1988,p. 2).

In Conclusion:Addressing the ProblemsTogether

Without a doubt, many school dis-tricts face very real problems in meet-ing their responsibility of providing therelated services needed by school-agedchildren with disabilities. Chief amongthese problems are a shortage of person-

nel to provide related services and ashortage of monies to fund them. Whileschool districts are required by federallaw to provide related services, con-structive action is needed on the parts ofparents, practitioners, and school ad-ministrators in order to improve thesituation. Here are some suggestionsfor action that can ease the budget andpersonnel crunch experienced by manyschool districts, without sacrificing thewelfare of students who require relatedservices in order to benefit from theireducation.

1. Write a complete IEP. Relatedservices needed by a student should belisted in the IEP. Not listing relatedservices in the IEP leads to inaccuratereporting of needed personnel in na-tional and state data collection efforts,which distorts the true picture of thesupply/demand problem. Therefore,the documentation of related servicesand personnel needs begins with the/EP. If that documentation is faulty,understanding of supply/demand be-comes skewed. Plans that arc madebased upon this documentation are simi-larly skewed, and the problem of per-sonnel shortages is perpetuated.

2. Walk in each other' s shoes. Theshortage of personnel and monies isreal. There are simply not enoughqualified related services personnifill all vacancies. At the same timnews is filled with reports of scdistricts that cannot pay for the educa-tional services they arc required by lawto provide. Parents, understandably,find it unacceptable that difficultiesmay exist in meeting their child's legiti-mate needs. The law, after all, guaran-tees their child's right to a free appropri-ate public education. Many parents

". . . Parents and school personnel need to develop amutual recognition of the facts of their own district,appreciate the frustration that all parties have in thispredicament, and work together rather than against eachother to develop services for children."

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may hold the view that the difficultiesfaced by school districts in tel .as ofpersonnel and funding are the schooldistrict's concern, while the child'swelfare is the parent's concern. Ulti-mately, however, the difficulties schooldistricts face impact most upon thoseindividuals who need the servicesnamely, eligible students with disabili-ties.

Addressing parents, Callanan(1990) cautions: "It's important to knowand safeguard your legal rights. It canbe a mistake, however, to misuse themor to view your relationship with pro-fessional educators as one-way, in whichthey give and you take... Positive par-ticipation on your part will further yourch ild' s education much more effectivel ythan a series of avoidable confronta-tions" (p. 249). Thus, parents and schoolpersonnel need to develop a mutualrecognition of the facts of their owndistrict, appreciate the frustration thatall parties have in this predicament, andwork together rather than against eachother to develop services for children.Both parties are interested in the wel-fare of the student with a disability, andso both parties need to concern them-selves with the issues of funding andpersonnel shortages.

3. Improve coordination of ser-vices and responsibility-sharing. Nosingle agency alone can handle the in-creasingly complex needs of children.There is a major and growing need forcoordination of services, for resourceand program sharing, and for new pat-terns of interagency collaboration andcooperative services involving schools,mental health, human services, wel-fare, health agencies, juvenile justice,homeless centers, and other services.Often, coordination and cooperation canbe achieved more effectively at thegrass-roots level, with the assistanceand involvement of concerned citizens,parents, and professionals, rather thanthrough state and federal mandates.

4. Become a creative networker.There are many ways of finding ser-vices and establishing opportunities thatgo beyond what the school district of-

fers to your child or youth w ith a disabil-ity. Be creative in building a team thatutilizes the many resources availablewithin your school and community.These resources can offer valuable learn-ing experiences for your child. Becomea networker. Talk to people such asreading specialists in the school, thechairperson of volunteer activities inthe school or community, club leaders,librarians, and individuals involved inschool or community sports programs.Explore what opportunities can be cre-ated for your child in recreational orafter-school activities. Many parentshave succeeded in networking withpeople within and outside of specialeducation who are willing to involvechildren and youth with disabilities inactivities offered by their club, organi-zation, or place of employment. Be-coming involved in school and commu-nity activities can give individuals withdisabilities the opporturfay to grow andlearn academically, vocationally, andsocially.

5. Take constructive action. Localparents, practitioners, and principalscan activate entire communities in plansto staff the schools with excellent people.Among the strategies thatcan be carriedout, both in rural and urban areas, are:

encouragement of local students toenter careers in special educationand related services;

roles for high school students astutors and aides;negotiations with higher educationinstitutions anywhere in the coun-try to place student teachers andinterns in the district;development of community-wideand school-based incentives and awelcoming atmosphere to attractnew personnel;planning with local businesses tooffer jobs to spouses of teacherswho might relocate;acquiring and/or raising scholar-ship funds for promising youngpeople who will return to the com-munity after completing profes-sional training;arrangements with higher educa-tion to deliver locally-based train-ing to increase the population ofaides and assistants in the schools,and to provide career ladderswhereby these personnel can ac-quire professional credentials;human-centered interagency coop-eration that can extend and enrichser. . :ces to all children;planned agendasof school improve-ment and community pride activi-ties that will make your town abelfz place to live and work.

Photograph courtesy of The Arnerkan Occupational Therapy Association, Inc.

.""mitermidil

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REFERENCES

Applestein, S. (1987). Speech pathology. In M.M. Esterson & L.F.Bluth (Eds.), Related services for handicapped children (pp.121-130). Boston: College-Hill Press. (This book has gone outo f print and may be available only through your public library.)

Arena, J. (1989). How to write an IEP (rev. ed.). Novato, CA:Academic Therapy Publications. (Available from AcademicTherapy Publications, 20 Commercial Boulevard, Novato, CA94949.)

Assistive technology. (1989). NICHCY News Digest , Nwnber 13,1-20. (Available from NICHCY, P.O. Box 1492, Washington,DC 20013.)

Association fur Retarded Citizens/Minnesota. (1989). A parentsguide to obtaining occupational and physical therapy servicesin the public schools. Minneapolis, MN: Author. (Availablefrom ARC Minnesota, 3225 Lyndale Avenue South, Minne-apolis, MN 55408. Telephone: (612) 827-5641.)

Bevin II. v.W right, 666 F. Supp. 71 (W.D. PA 1987). (See 1987-88Education of the Handicapped Law Report [EHLR) 559:122.)(EHLR citations are available from LRP Publications, 747Dresher Road, P.O. Box 980, Horsharn, PA 19044-0980.Telephone: (215) 784-0860.)

Black, G., & Dorsett, T.V. (1987). School health services. In M.M.Esterson & L.F. Bluth (Eds.), Relatedservicesfor handicappedchildren (pp. 69-77). Boston: College-Hill Press.

Blumberg, T. (1987). Parent counseling and training. In M.M.Esterson & L.F. Bluth (Eds.), Related scrvicesfor handicappedchildren (pp. 69-77), Boston: College-Hill Press.

Callanan, C.R. (1990). Since Owen: A parent-to-parent guide forcare of the disabled child. Baltimore, MD: The Johns HopkinsUniversity Press. (Available from the Johns Hopkins Univer-sity Press, 701 West 40th Street, Baltimore, MD 21211.)

Can Medicaid-reimbursed nursing services be provided in school?(1990, April 16). The Specia! Educator, Y(14), 159-161.(Available from LRP Publications, 747 Dresher Road. P.O.Box 980, Horsham, PA 19044-0980. Telephone: (215) 784-0860.)

Cernosia, A. (1991). Section 504 and IDEA: A comparison.Burlington, VT: Northeast Regional Resource Center. (Avail-able from Northeast Regional Resource Center, c/o TrinityCollege, Colchester Avenue, Burlington, VT 05401.)

Chester County Intermediate