DOCUMENT RESUME

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TITLE1 Alliances in-Health and Edudation for DisabledChildren and Youth: Directions for the 80s. A Forum(Arlington, 'Virginia, March 25-27, 1982).

INSTITUTION American Association of Colleges for Teacher'r Education, Washington, D.C.; American Society of

Allied Health Professions, Washington, D.C.SPONS AGENCY 6ffice of Spec -ial Education and Rehabilitative

Services (ED), Washington,,DC.PUB DATE 83GRANT 451-CH-00233NOTE 58p.PUB TYPE" Collected Works Conference Proceedings (021) --

Information Analyses (070) -- Viewpoints (120)

EDRS PRICE MF01/PC03Plus Postage.DESCRIPTORS *Agency Cooperation; *Allied Health Occupations;

Cooperation; *Cooperative Programs;., *Disabilities;Education; _Elementary Secondary Education;Interdisciplinary Approach;. State of the ArtReviews

.ABSTRACTSelections from proceedings of a 1982 forum on

collaboration between health and education groups serving disabledstudents and their families include an overview of the state of theart and suggestions for future cooperative ventures. In the keynoteaddress, Senitor.L. Weicker, Jr., cites damaging effects of cutbacksin federal funds for special education and rehabilitation. Papers byM. Reynolds, H. Hickey, and H. Richirdson, Jr.,,address the currentstatus of educatfon, allied health, and pediatrics. Responding to thestate of the art papers area consumer, E. Ellis, and a parent, J.Wittenmyer. Four papera describe cooperative program initiatives thatemphasize sharing-responsibilities with and communicating informationto other disciplines.-Prior to summary comments froD,the perspectivesof education and allied health, forum issues and 'commendations areconsidered in terms of'obstacles to'coordination and-policyrecomniendations for na.t.tonal, state, and local.efforts. (CL),

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.8. DEPARTMENT OF EDUCATIONN TIONAL INSTITUTE

OF EDUCATIONED ATIONAL ilESOURrES INFORMATIONCENTER (ERIC)/Th document has been reproduced astec wed horn ihe person or organization

ori na twig it.

Min r changes have been made to improvereps 'action quality,

Point of viewor opinions stated in dills docu-ment o not necessarily

represent official NIEposit Or policy..

A Forum sponsored by the American Society ofAllied Health Professions in cooperation

the American Association of Colleges fo. Teacher Education

March 25-27, 1982Arlington, Virginia

"PERMI SION TO REPRODUCE THISMATER AL HAS BEEN GRANTED BY

TO THE EDUCATIONAL RESOURCES. INFORMATION CENTER (ERIC).:'

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° 1983 by the American Society of Allied Health Professions, One Dupont Circle, A., Suite 30b, Washington;D.C. 20036.

This publication is based upon work performed pursuant to Gront Nk451 CH 00233 from the Office of Special,Education and Rehabilitative Services, U.S. Department of Education. The points of view expressed herein arethe 'authors and do not necessarily reflect the position or policy of the U.S. Department of Education.

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CONTENTS'Page

PROJECT STAFF AND ADVISORS 2

FOREWORD 3Carolyn M. Del Polito

BACKGROUND AND LEGISLATIVE FRAMEWORK 5

KEYNOTE ADDRESS 7Honorable Lowell P. Weicker, Jr.

STATE OF THE ART PAPERS: MEETING THE NEEDS OF CHILDREN AND YOUTH WITH DISABILITIES

The State of the Art in Education 10Maynard C. Reynolds

The State of the Art in Allied Health 17Helen K. Hickey

The State of the Art in Pediatrics 22H. Burtt Richardson, Jr.

A RESPONSE TO THE STATE OF THE ART

A Consumer View 29Ethan B. Ellis

A Parent's View 32Jayn Wittenmyer

COOPERATIVE PROGRAM INITIATIVES

The Role of Interinstitutional Relationships in Responding to the Needs of America's Handicapped:A Model 35

Keith D. Blayney and Janice Hawkiris

MULTICLINIC: An Interdisciplinary Team Approach 35Clyde R. Willis

Roles and Responsibilities of Allied Health Professionals in Providing Services to Individuals withDisabilities and their Families

Carolyn M. Del Polito and Anthony S. Bashir

Interdisciplinary Initiatives: Some Model Approaches 42

FORUM: ISSUES AND RECOMMENDATIONS

- Barriers to Coordination 44

Policy Recommendations 45

CLOSING REMARKS 9 ' 4Summary Comments: A Perspective from Education 48

Dean C. Corrigan

Summary Corhments: A Perspective from Allied Health 49Polly A. Fitz

FOLLOW -UP ACTIVITIES so

APPENDIX A: ABOUT THE ALLIED HEALTH PhOFESSIONS 55

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ALLIED HEAL -FIND AND ADVOCACY PROJECT

M, Del Polito, Directorns, Project Specialist

is Wolfe,Administrative AssistantsBarbara Kb

A14117ISORY COUNCIL'

Helen K. Hickey, Associate Dean, Sargent eAllied Health Professions, Boston University and

-Consultant, Waltham,MassaChusetts

Richard J. Dowling, Executive Director, TheAmerican Society of allied Health 7ofessionS

Elizabeth Britten, Director, Southwest Ohio Coalitionfor Handicapped Children

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Katherine G. Butler, Directoi., Special Education andRehabilitation, Syracuse University

Patricia R. Cole, Co-Director, Austin Speech,Language and Hearing Center

Harry Douglas, Associate Dean, College of AlliedHealth Sciences, Howard University

Frank Filemyr,Sta)f Specialist, Division of SpecialEducation, Maryland State Department of Education

Polly A. Fitz, Dean, School of Allied_Flealth Pro-'fessions, University of Connecticut

Vicki S. Freimuth, Project Evaluator, CommunicationAssociates, Upper Marlboro, Maryland

J. Rholctes Hagerty, Dean, College-of Allied HealthSciences, Georgia State University

'Lee Holder, Dean, School of Allied Health Pro-fessions, University of Oklahoma Health ScienceCenter

Susan E.- Knight, Psychotherapist and Consultant,San Francisco, California

John, Melcher, Supervisor of Early Childhood Pro-

Tams,Wisconsin Department of Education

Bert Sharp, Professor of Education, University ofFlorida

FORUM STEERING COMMITTEE

.Keith D. Blayney, Dean, School of Communityand Allied Health, University of AlabamaBirniingham

Polly A. Fitz, Dean, Schpol of Allied Health Pro-, fessions, University, of Connecticut

William Healey, Assistant Dean for Research andGraduate Studies, College of Education...Universityof Arizona'

AiThur F. Kohrman, Director, La Rabida Children'sHospital, Chicago

William Schipper, Associate Director, NationalAssociation of State Directors of Special Education

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Foreword

In March 1982, the AmeriwrSociety of Allied Health.Professions (ASAHP),'in cooperation with the AmericanAssociation of Colleges for Teacher Education (AACTE),convened a forum for chief administrators of alliedhealth and teacher educatiOn training programs. The

"' focus of the forum was an ekcploration of the health andeducational needs and rights of yfoungsters with ,dis-abilities and their families as they relate to:personnelpreparation: The allied health and teacher educationadministrators (including deans, directors, and othersresponsible for curriculum develbpment) were joined byadministrators of medical training programs as well asrepresentatives from state and federal health: aideducation agencies.

For the first time, teams of chief administrators fromone institution or communitY joined With similar teams

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from,other paints of the country to explore:. Trends in Health and Education for Meeting

the Needs of Youngstdrs with Disabilities andTheir Families;Strategies for Improving the Quality of Person-nel Preparation to. Meet New Roles and Re-sponsibilities;Implications for Developing Cooperative Pro-grams in Health and Education; andStrategies for Building Alliances and CreatingNew Organization Patterns for CooperativePrograms.

The following pages contain selections from the pro-ceedings of that forum including major papers, partici-pant recommendations;cooperatiVe program initiatives,and some of the follow-up activities resulting fromthe forum.

In publishing this document, the American Society ofAllied Health Professions (ASAHP) hopes to further thetheme of the forum, Le.; collaboration among the manyhealth and education groups serving youngsters withdisabilities and their families. The society is pleased toprovide the following material 'froill the foruFnoffers both a theoretical framework and some very prac-tical approaches for health and education professionalsproviding services and, in a special way, for thoseadministrators who are in a position to effect cur-riculum changes.

The materials contained in this document are theresultV the expertise and dedication of a number ofpeople, \ncluding the Advisory Council, Staff, Faculty,and Resource Consultants of the Allied Health Child-

, Find and Advocacy °Project. The Project's AdvisoryCouncil-and Steering Committee provided the concep-tualization for thelorum's content and design, while theProjeCt Staff identified, obtained, and assembled materialsused by the participants in their deliberations, includinga 350-page Resource Manual. .

With sincere appreciation to each of Our contributors,I wish to acknowledge particuarly'the hours contributedby project staff including Mirdza Kains, Project SpecialistEducation Policy Fellow; Cecilia Wolfe, AdministrativeAssistant; Jennifer Edson, PrOject Assistaht; JessicaSamuels, and Jacqueline Smalls, Graduate Interns fromHopard University; Janet Coscarelli, Project Consul-tant; and Ann Dunleavy, Editorial Consultant.

Carolyn M. Del Polito, Ph.D.Director

Allied Health Child-Fin'd andAdvocacy Project

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ALLIANCES IN HEALTH AND EDUCATION "FORDISABLED CHILDREN AND YOUt1-1:

. DIRECTIONS FOR THE 80s ,

Sponsored bythe American Society of Allied Health Professions (ASAHP)

in cooperation with .

the American Association of Colleges for Teacher Education (AACTE)

March 25-27, 1982'Arlington; Virginia

BACKGROUND AND LEGISLATIVEFRAMEWORK

The Forum: Alliances in Health and EdUcation forDisabled Children and Youth is part of a three-yeargrant awarded in 2.)80 to the American Society of AlliedHealth Professions by the Office of Special Educationand Rehabilitative Services (OSERS). The grant's pur-pose has been to involve allied, health professionals inefforts to meet the education and education-relatedhealth needs of children pith handicaps. These needswere addressed in two significat* pieces of legislatidn,i.e., Public Law 94-142 (1975) and Section 504 of theRehabilitation Act of .1973 (as amended in 1977). 4i

ASAHP believes that an understanding of and re-sponse to this legislation is vital to the health pro7 .

fessional's role. In a recent ASAHP publication, Alliancesin I-iealth glad Ethication; Serving Youngsters with Spe:cial Needs, the implications of the law for health prosfessionalp are discussed at length.'

Participants at the 'Forum were provided detailed

einformation legislation: Some of the Ng-Nights

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Public Law 94-14Z the Education fbrAll Handicapped s'Childr,en Act* assures all handicapped children a free

-appro e public education which emphasizes specialedu =tion a d related services ,designed to-meet theiruni tic need . Within, the Jaw, the following deft-

. niti ns maint n:2

'Edited by CarOlyn M. Del Polito, Ph.D. and JoseRiline G. Barresi,MA., "Alliances in Health and Education: Serving Youngsters withSpetial Needs" contains sixeuoits and an Instructor's Guide. Forfurther information, write ASAHP, Suite 300, One Dupont Circle,WashingtOn, DC 20036 .

rTo obtain a copy of RL. 94-142, Zritet13,your member of theHouse of Representatives, or to one of your U.S. Senators. To obtain acopy of the final regblations for P.L. 94..),42, get a copy of the FederalRegistr fad'. Tuesday, August 23, 3977 from the Superintendent ofDocuments, 1U.S. Government Printing Office, Washington, D.C.20402. Bice $ MO' To obtain a copy of the finaltiegdations-ror Sec-tion 591 of P.L. 93-112, get a copy of the Federal Register for Wed -nesday,` ay 4, 1977.

-Handicapped Children: Those youngsters whdare mentally retarded, hard of hearing, deaf,Orthopedically impaired, other health impaired,speech impaired, visually handicapped, seriously 1emotionally disturbed, or children with specific

'learning disabilities who, by reason ithereof,require special education and related ser-vices.

Special. Education: Specially 'designed instruc-tion, at no cost td parents or guardians, to meetthe unique needs of a handicapped child,including classroom instruction, instruction inphysical education home instruction, andinstruction in hospitals and instilutions.iRelated Services: Transportation, and suchdevelopmental, corrective, and other support-,ive services (including speech pathology andaudiology, psychological services, phygical andoccupational therapy, recreation,, and medicaland counseling services, except that such medi-cal services shall be.for diagnostic and evalua-tion purposes only)as may be required tb assista handicapped child to benefit from specialeducation, and includes the early identificationand assessint of hgndicapping conditionsin children.LeasfRestrictive Environment: Each state mustestablish procedures to ensure that:

. To the maximum extent appropriate, handi-capped children, 'including children in public orprivate institutions or other care facilities, areeducated with children who are not handi-capped, and that special classes, separateschooling of other removal of handicappedchildren from the regular educciational environ-ment occurs on ly when the nature or severity ofthe harKlicap is such that 'education in regularclasses with the use of supplementary aids andservices cannot be achieved satisfactorily.

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4Section 504 of the Rehabilitation Act of 1973 assures

that: "No otherwise qualified handicapped individual inthe United States as defined by Section 7(6) shall solelyby reason of his/her handicap, be exclUded froin theparticipation in, bt denied the benefit of, br be subjectedto discrimination under any program or activity receiv-ing Federal financial assistance."

Taken together: Public Law 94-142 and Section 504,guarantee the following rights and protections toAmerica's children whoare identified as "handiCapped"under the law:

A free 'appropriate public education for allchildren and yoUth requiring special educationand related services; -Comprehensive nondiscriminatory assessmentprocedures;Individualized education programs (IEPs) includ-ing parental iniiolvement in planning and deci-sion making;Education in the least restrictive environment(L E). that is, education with nonhandicappedc ildren to the maximum extent appropriate;nd

Procedural safeguards:.

Further, the ,legislation guarantees to parents. guar-dians, or surrogate parents the right to:

Examine records:Obtain independent evaluations;Assign a surrogate parent;

, Receive written prior notice of school actions, intheir native language;(Note: Regulations require written permissionbe obtained in addition to notice.)

46Present co plaints;Receive -. impartial due-process hearing withfurther rights to:

Representation by counsel:Present evidence;Cross examine and compel the atten-dance of witnesses;Obtain a written or electronic record;

-,- Receive written findings of facts and' de-cisions; \.

Appeal to the state and;\ --= Initiate civil action in court..The child remains iyi current educational placement dur-

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ing a hearing unless the ,parents'nd school agreeotherwise.

The Education for All Handicapped Children Act has'existed for seven years; yet still today there are largenumbers of American yOungsterS with har)dicappingconditions who are not receiving appropriate edu-cational and related health services. While some alliedhealth prolessionals (e.g., audiologists, .occupational'and physical therapists and speech-language,, pa-thologists) have Jong heen :involved in initiatives forchildren and youth with handicaps, most.have not. TheAmerican Society of Allied Health Professions (ASAHP)believes professionals who work in health-care settingshave special access to majority of these children, andcan positively impa& local, state, and national efforts inidentifying the unserved youngsters in this country andensuring their referral to appropriate educationalsettings.

ASAHP's promotion of "alliances 1n advocacy" hasfocused on all the related-health professions, not merelyon those, like speech-language pathologistsand physi-cal therapists, whose work 'regularly involvq personswith handicapping conditiqns. The Society's initiativehas involved such others as 'physician and nurse assis-tants, dental hygienists, dieticians, and medical recordsprofessionals whose health-care setting roles bring theminto regular. often very early contact with children withhandicaps. ASAHP recognizes all ,health professionalsmay not" possess the- technical expertise to assistyoungsters and their families; it also recognizes, how-ever, as professionals in the health-care system. they willbe perceived to possess such. competence and, there-fore, need to be prepared.

Given the hard realities of the econotriic situation fac-ing administrators in higher education, particularlythose who direct professional training programs, andgiven the increasing difficulties associated with provid-ing cost-effective, quality services for youngsters withdisabilities and their families, ASAHP's Forum came at amost appropriate time.

As evidenced in the data which follow, the need fornew and refocused leadership in building and implement-ing collaborative models for cooperatiouamong pro-fessipns, _among academic programs, and amonginstitutions and agencieswas reinforced throughoutthe Forum's deliberations, and seen as an essentialingredient for addressing the inadequacies of the servicedelivery system in meeting the needs and 'rights ofyoungsters with handicapping conditions.

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KEYNOTE ADbRESS

The honorable Lowell P Weicker, Jr. of Connecticut provided the following keynote address at the American Societyof Allied Health Professions' (ASAHP) first National Forum an "Alliances in Health and Education for Disabled Childrenand Youth: Directions for the 80s."

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Meeting the Needs of PisibledYoungsters: A Shared Responsibility

Senator Lowell P.-Weicker, Jr.

Senator Weick serves on the Labor and HumanResources Commi0e where he chairs the Subcammi-tee on the Handicapped. Along with, his advocacyinitiatives for disabled persons, Senator-Weicker is wellknown for his championing of energy development andconservation, individual'rights, ethics in governmentand a vigilant attention to the Constitution. His politicalcareer has been marked by drafting of legislativeanswers to challenges as diverse as ocean developmentand urban redevelopment.

As a member of the Senate Appropriations Commit-tee, Senator Weicker is Chairman of the Subcommitteeon State, Justice, Commerce and the Judiciary, playinga key role in determining the budgets of those gOvern-ment agencies. He ranks second on the influentialDefense Subcommittee, reviewing the nation's militaryPrograms, and on supcommittess with responsibilityover the budgets of the Departments of Education,Health and Human Services, Housing and. UrbanDevelopment (HUD) and the District of Columbia.

In addition, he is the Chairman of the Senate Com-mittee 6n Small Business. A member of the Senate

WEnergy and Natural Resources Committee, Senatorficker is a long-time proponent of decontrol and

mandatory conservation, and is the Chairman of theSubcommittee on Energy Conservation mid Supply. Inrecognition of significant contributions in health andeducation for disabled persons,..ASAHP 'awarded its1982 Distinguished Service Award to the Senatorfollowing his presentation.

Good evening and thahk you very much for invitingme here tonight. Meeting the needs of disabledoungstersis, above a , a shared,responsibility. Once we

past that hurdl , the rest follows naturally. Fordecades, the chief ncern handicapped children andtheir families had was to make society as a wholerecognize its responsibility to share the burden oftheir disabilities.

Meeting these needs was, until very recently, a lonelyproposition. Disabled children were committed toinstitutions or, in some cases, left to fend for themselves.Or else the burden fell entirely upon the individual'sfamily.

In Sunday's Washington Post, columnist George Willtold the story of 75-year-old Mary Denny and her sonJohn, who for the last 14 years has received nothing inthe way of community services even though he frequently

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suffers as many as six seizures a day. Will rightly de-scribed John Denny as "part of the unfinished agenda ofAmerican `justice," Of Mary Denny, he wrote: She js amarvel of courage who has been more self - reliant, longer,than any citizen should have to be." This from a coluen-

Inist Who considers himself conservative.The fact is that this country is full of John and Mary

Dennys. And there would be many more of them, if notfor Public Law 94-142. In hearings leading up_ to thatlegislation, witness after witness detailed how local andstate school policies relegated handicapped kids to thesidelines of life. More than one million were found to beshut out completely and less than 50 per cent werereceiving what could be called a quality education. Stand-ards varied widely from state to state.

Passage of the Education for AU Handicapped ChildrenAct promised handicapped kids a chance to move intothe mairtstream by way of a free, appropriate publicgducatioz in a normal setting, with an individualized-education plan. Last year, the General AccountingOffice concluded that many school boards had notmade good on that promiseand that it would takeseveral more -years for them to do so.

Instead of blowing the bugle to rally us all to redoubleour efforts on this front, the Reagan Administrationchose to sound the retreat. First, it tried to repeal PublicLaw. 94-142 and consolidate special education fundinginto a block grant: When Congress, aided and abetted byhandicapped advocate'g, balked at that, the Administra-tion then threw its weight behind its proposal to cut the,handicapped budget by 25 per cent,. But, again, thecoalition on behalf of the disabled held fast. And insteadof a 25 per cent cut in the special ed budget, we endedup with a $70 million increase. That's nothing to crowabout, to be sure, but it was.a case of making the best of abad situation.

The story was muc the same for the rehabilitationand developmental isabilities programs: proposedconsolidations were efeated and categorical fundingmaintained.

This is no time, however, to rest on our laurels. TheAdministration, which promised to come back."againand again" to achieve the budget cuts and policy shifts itwants, is proving true to its word. This year, it is recom-mending a.rescission of 31 per cent in 94-142's statt',grant funds for the 82-83 school year. Ten special pur-pose programs would be consolidated into a singlefundamong. these the deaf-blind centers, programsfor the severely' handicapped, early childhood educa-tion and special ed personnel development. I would justnote here your own release of earlier this week -whichunderscored the manpower shortage in special educa-tion and rehabilitation. Cutting back on funds to develop -

personnel in these fields is no way to meet the needs ofthe handicapped.

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Yet, it is proposed that in the rehab services budget,funding for training, service projects and independentliving centers be consolidated into a so-called SpecialPurpose fund beginning in 'FY 83. And within thedevelopmental disabilities program, funding for univer-sity affiliated facilities and special projects is to betransferred to an account entitled Social Services Dis-cretionary Activities, along with child welfare researchand child abuse projects. In all cases, smaller budgets areprojebed for the consolidated piograms than theyreceived categorically.

Now, the Administration claims, as it did last year, thatthese consolidations will lighten the administrative loadand save enough money to keep services at currentlevels. Well, you know better than I that that is a bill ofgoods if ever there was one.

The National Association of Statepirectors of Special-Education recently surveyed .24 states to assess theimpact of proposed rescissions for special ed and Title Ifunding for institutionalized handicapped children inFiscal year 82 and the proposed funding level for specialed in Fiscal 83. Their findings dramatically illustrate thedisastrous cutbacks the Administration's budget wouldtrigger.

The Association estimates that in New Jersey, forinstance, about 4,000 handicapped students wouldreceive fewer bkino services and 453 teaching positionsin kindergarten through 12th grade would be lost. Theproposed cuts in federal funds would also wipe out thestate's ability to assist local eduCational agencies by sup-porting residential costs, individualized transportation,extended school year programs, in-service training forregular classroom teachers, pre-school education, careerand vocational training.

In Illinois, the cuts would mean the firing of 839 pro-'fessionals and aides in the special ed program. Approx-imately 12,500 childcen aged 3 through 21 would riotbe served, and 29,000 others would have their level of,services cut. In the Public Law 89-313 program forinstitutionalized disabled children, 86 professionalswould lose their jobs, affecting 17,254 students.

Total staff cuts in Illinois of more than 1100,wouldprimarlly diminish services to the mildly retarded, thehearingfdisabled and speech handicapped, reducingservices to 88,000 and possibly eliminating services to26,000. So, we are not talking about a few children hereand there. We are talking about thousands whoseeducation will suffer, and with it, their hopes I& thefuture. This year, as last, the budget debate is riddledwith irony and paradox. On the one hand, the Adminis-tration preaches self-reliance and individual achieve-ment, while on the other, it seeks to cut federal programswhich promote independence and accomplishment onthe part of the handicapped.

Then there is the irony of having Mrs. Reaganschedule a photo session with Easter Seal poster child,Mary Sacco, while the President is cutting the very pro-grams that ,have helped Mary thus far. As Dr. EmilRosenber6,-*ead of the program for special needs inMary's hometown of Milton. MA.. points out: "All thethings that have enabled Mary to grow physically andnot to face life in ewheelchair were funded by federalmonies. Future Marys are really at risk."

Easter Seals itself, es the Boston Globe's Ellen Good-mannotes, receives anywhere from a fourth to a third o

its funds-from the. government. Says Ease& Seals direc-tor John Garrison:."1 don't think it's within'the capacityof the non-profit sector to piCk' up all the services."

Then there is the greatest irony of all: our bloateddefense bildget. SOme of the best work- on theparadoxes it present's has been done by the Children'sDefense Fund. They. have found that If the Departmentof Defense ceased sending routine, non-priority messages

,bsitelefype, it could save, accOrding to GAO, $20 millioneach year. This much mon0 could go a long way towardrestoring programs for handicapped children..

I the Defense Department did away with the, personalse nts it provides to 300 senior officers at the Pen-tagon, rre-fulidscould b.e used to rehire 160, homemak-ing aides in Virginia Who helped 'elderly, blind andotherwise disabled persons and fikmilies with Nandi-capped children before they were laid off by budget cutslast year.

And if the Pentagon no longer furnished shots andother veteripary services for pets of military personnel,$1.4 million would* be freed up to immunize 35,000poor children who were dropped from the childhoodimmunization4program last year.'1'

Now I happen to believe that Congress is not going togo along with this Administration's attack on the 'handi-capped budget any more than it did last year. In Feb-ruary, 59 Senators co-signed :a letter I sent to thePresident urging full funding for 94-142 and opposingany change that would weaken the law. We remindedthe President that at a recent press conference he .hadpresented th4 dramatic example of a chi ill childin Iowa who could be treated at home for $1,000 a month,instead of in a hospital for $6,000 per month inMedicaid. And we pointed out that many disabledAmericans are in a similar situation.

We also reminded him that as a Presidential candidatein 1980 he called Public law 94-142- perlws thegreatest stride made to date toward a workable plan forthe education of handicapped children.

In addition to the fifty-nine members of the Senate, amajorily-fi the members of the Labor and Human

, ResourMs Committee has gone on record in support offull funding for special edand that's no mean feat thisearly in the/ game.

So I think we have reason to hope. However, 94-142is seriously threatened by the proposed revision of itsregulations, which is now in draft form. Not long ago Iobtained a' copy of a memo from Assistant Secretary forSpecial Education and Rehabilitation Services JeanTufts to Secretary sell. This memo, which outlines theproposed changes, is nothing less than a how-topamphlet for sowin#dissent in the ranks of the handi-capped community. But it is being passed off asregulatory reform. The changes it proposes would cutoff parental involvement, cut back on services, de-emphasize integration and do.away with proceduralsafeguards. And it would do these things in a mannerthat would curry favor with some state and local officialsat the expense of handicapped kids and theiradvocates.

5One proposed change would eliminate the require-ment that parents be given a copy of their child'sindividualized *Teducation program (IEP). NoW, as youknow, the IEP isin many respects the fulcrum of 94-142.Itevaluates the child's level of educational performance,

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sets goals and outlines specific services to h43 the childreach those goals. It also establishes the exteht to whichthe child can participate in regular classes and how longhe or she will need special education. Parental participp- 3

tidn has been a key factor in the IEP's,effectiveness:. T.

Parents are by law equal partners in decisions affectingtheir children. To take parents out of the equation would.be to strike at the heart of the program.

Elsewhere in the memo, other changes such as doingaway with data collection ,and reporting requirementsare described as non-controversial to professionalgroups like the Council of Chief State School Officersand the National Association of State Directors ol Spe-cial Education but controyersial to advocacy groups like -the Children's Defense Fund. So the strategy of thisAdministration, when all else fails, is to divide and con-quer. Nibble. away at the law until there is nothingleft.

We must not iet that happen-Refuse to be taken in by

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- yik .....,_' .asrepeal disguised regulatory refor . Join forces with

state and local officials and parent organizations .toinsure that this nation goes on meeting the needs of 0handicapped children. The children are what is impor-tant. The programs deserve oi:Ir vigilance because theygive those children a chance. Let's not get things turnedaround. As your agenda reminds us, our focus must bethe handicapped youngster and what will happen to himor .her in this decade and theones ahead. And that, myfriends, is what makes our cause so strong. For 8 theChildren's Defense Fund has noted: "We have so muchmore to fight for and with than Mr. Stockman. All he hasis numbers that don't add up. We have the lives ofmillions of children who need our help if the9 are togrow up healthy, educated, unctipplea and with afamily."° They need us, we neeethem and this nation needsthem. Let's all do our best on their behalf.

Thank you; ....

, STATE OF THE ART PAPERS

The f wing three'papers presentthe state of the art in meeting the needs of youngsters with disabilities from theperspectives of education, health, and pediatric medicine. They-were delivered to forum petictpants as a stimulus forfurther discusion.

Meeting the NeedS of Children andYouth with Disabilities:The State orthe Art in EducationMaynard C. Reynolds, Ph.D.

Maynard C. Reynolds is Professor, Department ofPsychoeducatioal Studies, University of Minnesota,and Director of the National Support Systems Project(NSSP) for Dean's Grant Projects (DGPs). DGPs aregrants given to Deans of Education to support efforts ordevelopment of improved preservice teachgr prepara-tion with emphasis on education for handicappedchildren. In 1981-82 there are 127 DGPs; over the pastseven years there have been about 225 such projects inall parts of the nation. The National Support SystemsProject provides technical assistance in various formsdirectly to projects, organizes regional and national'conferences, develops publications in support of DGPsand, in various other ways, attempts to serve the needs\_____,,of Dean's Grant Projects. Reynolds also. serves as co-principal investigator for a special project to develOpmaterials and systems for nation-wide inservice educa-tion of school psychologists. Both NSSP and the schoolpsychology project are supported by the Division of Per-sonnel Preparation, Special Education Programs, U.S,Deporfinent of Education.

The New Policies and Their ImpactIt- happened just 11 years ago. A small group of

parents sued the chief school officer in the State ofPennsylvania for failure to admit their retarded childrento the schools. They based their case on the equal pro-

-Jtection clause of the Fourteenth Amendment to the U.S.Constitution. Settlem,ent was reached when the StateSecretary of Education entered into a consent agree-ment with the parents rather than to fight the case, andthe court gave its approval. A number of: particulars wereincluded in that agreement: Henceforth public schoolswould (a) 'admit literally all retarded school-agedchildren and youth; (b) actively seek out or identify suchchildren and assure their .attendance; (c) provide pro-grams that were "appropriate". or adapted to the uniqueneeds of each retarded student; (d) work with p'arents toformulate educational plans and follow "due process" \

- principles, including the right of parents to appeal to ahigher authority and the courts; if necessary, anyeducational decision with which, they disagreed; and (e)provide, when feasible,. the appropriate programs forretarded students in regular classrooms in preference toplacement in special classes, special schools, or residen-tial inpitutions. This ordering of administrative ar-range&ients, giving preference to regular classroom andregular school placeme'ntembodies the concept of the

10

"least restrictive environment" or, as it. is popularlyknown, mainstreaming. The Pennsylvania suit, whichbecame a jziicial. landmark, is known as PARC(Pennsylvania 'Association (or. Retarded Children) v.Commonwealth of Pennsylvania:

Shortly afterthe consent agreemenewas -announcedin Pennsylvania, the attorney for the San Diego (Califor- .

nia) School District, who was well outside Ihe official.jurisdiction of the Pennsylvania 4igrict federal court \which had accepted the agreemerit, reported that thecase was "persuasive," and that the new principlesincluded in theagreettient were only "slightly off shore"for all school districts in the nation. He was correct. In

,1972, the case of Mills. vs. Board of Education inWashington, DC, accepted and extended the PARCagreement to all -handicapped children; and, in 1975,the Congress passed and ,President Ford signed_PublicLaw 94-142, The Education for All HandicappedChildren Act, .whiCh encompassed all the concepts andprinciples outlined in the PARC and Mills cases.Regulations for Public Law 94-142 were issued in 1977and became effective as of October 1977..

_ Thus the judicial and legislative actions of the firstof the 1970s established the constituti nal right t free,public, appropriate education for al capped .

children. Previously, state laws had made school atten-dance mandatory for children but the schoots had nomandate to accept and teach all children. In fact, thee'schools. had considerable discretiolf in what childrenthey would accept, what kinds of educational programsthey would proiiide, What children they would suspendor expel for whatever rea4ons, and what informationthey would pass on to parents. P. R. Dimond, in TheHastings Lad, Journal in 1973, characterized thechange in, public educational policy as "the quietrevolution."

Some dramatic changes have occurred in the opera-tion of schools as the result of the new policy

1. Many seriously handicapped children have beendeinstitotionalized. In many states, enrollments in spe-:.cial schools, hospitals, 'and institutions for retarded,deaf, blind, and emotionally disturbed children havebeen halved or more. The education of these highlyneedful children is now the responsibility of local schools.A surprisingly large percentage of this formerly insti-.tutionalized population is able to live at home or insmall-group homes and to attend neighborhood schools.'-The local school officials are responSible for making spe-cial ai-rangements for children whO cannot benefit fromlocal, school attendance. The arrangements, however,must be made on an individual basis and reviewedregularly. The focus is on the' needs of the individualrather than the convenience of the institution:

2. rany mildly and moderately handicapped stu-dents have been moved out of special day classes and

12

schools and returned to regular classrooms. In the past,few classroom teachers-were prepared to work with suchchildren. Hence states began retraining programS forteachers in service. However, teacher-education de-partments and colleges are under tremendous pressureto revKe their programs to prepare their graduates toundertake new roles. The necessary training and retrain-

'ins of .teachers is accomplished only in. part at this. tirrie.

. .

The direct service activities of special educationteachers arsgiving way to. indirect services, for example,consulting with and ;supporting classroom teachers.Most special teachers are unprepared for these roles.

4.' School psychologists, schoorsoctal workers, speech-language pathologists, audiologists, 'Ohysical therapists,occupatiOnahherapiSts and other specialists have been'redeployed to serve exceptional students in decen-tralized settings. Many such specialized workers, in thepast; :were isolated from 'classrooms. (New concep-

. tualiiations of.their.functions are essential.)5. Virtually all forms of school demissions (excuses,

exclusions, sisperisions, and expulsions) have beeneliminated except, when due process is observed fullyand alternative methods of satisfying.the right to educa-tion principle:'Oe adoPted. 1-

:6. Parents': of handicapped pupils must be formally-involved in assessment, placement, and planningaCtivities. Due prOcets must be observed in all edu-

--cNonal. decisions. Special safeguards for the rights ofparents are detailed in Public law 94-142. Nicholas

(1978) noted that for school personnel to start-working with parentspay be somewhat like rediscover-

, trig Niagara Falls. .

7: Regular classroom teachers are required to par-ticipate in the plannin4 and writing of explicit In-dividualized Educationalliiilans (IEPs) for handicappedstudents. Teac ers havenOt been prepared for this taskuntil recently, and eVen now the. IEP require t pre -serits many difficulties. More than 4 million I are nowbeing written each year by the schools of a nation.

8. Most. important; edUcational goals a programsfor exceptional students must be deteimi d on thebasis of specifigi:individual learning needs r er than

. -gross categories Of exceptionality. .

It is truly notable that the schools of the, net4sttkiivebeen given the responsibility to locatie every haifflicappedChild, arrange a mUltidisciplinary diagnostic; study. of

',each such child, mirk with parents in educa06nal plan-ming for the child, and furnish the:least restrictive settingfor that education. In Many pang of the world most respon- .sibility for Persons withdiSabilities'are carried by:healthor, perhaps, broad, family oriented agencies, It is

interesting to speculate onthe

the primary. respon-sibility here was assigned to the schools.- Obviously, fullunderstanding of,a child with problems and the child's:family depends upon the partiCipation of health pro-fessionals as well as educators, social service personnel,and other specialists; but achieving the necessary coor-dination of^servicesIS still a problem.

It shoUld be noted that Public Law 94-142 Was..based.

on the belief that the percentage of children With handicap-ping conditions in otir nation runs about 10-12% of thetotal child population. The federal government pass to .each state a bit over $200 for each identified handicappedchild bilt not exceeding :124. ofthe state's total goy

tion of children. In fact, the percentage reported , bystates is nearer 10% than 12% at this time. Only about 3-4% of children can be judged to have distinct andchronic handicaps; thus the remainder - up to 12% atany one time - is made up mainly of children who displayrelatively mild and moderate - and often transient -handicaps, such as learning, speech, or behavior prob-lemi, or mild mental retardation. During the period fromkindergarten through sixth grade,--as many as 40% ofchildren may manifest such problems at any one time oranother and be of significant concern to their parents orteachers, but if they are given the right kind of help at theright time, most of the problems vanish. Note, therefore,that when one includes more than the chronic handicaps,the incidence rates for handicapping conditions go upmarkedly and vary greatly with the time intervals usedfor counting incidence: 12% on one day expands to 40%of the population over seven years.

The. Changing Administrative Structuresof Special Education

The administrative arrangements for special educa-tion in most schools of the nation well into the 1960sand, for many school systems, even into the 1970s, canbe described in terms of a "two-box" structure. inthisview, there were two kinds of classrooms (regular andspecial), two general classes of children (regular classchildren and special education children), and two sets ofteachers (regular teachers and special education teachers).In effect, two separate-school systems Were operated,each with its own supervisoty staff and funding system.

tinder the "two-box" arrangement, if a child wasobviously disabled in some significant way or showeddifficulty in a regular classroom, he or she was referredby the teacher to a psychologist or other specialist forstudy. Should the child meet the standards for somecategory of handicap, he or she would be placed in aspecial clags or special school. Most children who were"referred" eventually were taken away from normalenvironments and sent to special places. It was notunusual for a large elementary school operating underthe "two-box" theory to have perhaps 24 regular "boxes"or classrooms and 3 or 4 special `:boxes" that servedretarded children, learning- disabled children, and per-haps others. In addition, there likely would be in thesChbol system such itinerant workers as speech andhearing therapists, school psychologists, social workers,teachers of braille, and other specialists. They suppliedpart-time services. The average school system operatedabout seven or eight different kinds of special educationboxes and employed an equal number of different kindsof special teachers.

"The.:Orighial Continuum ModelA somewhat more complex administrative model for

the organization of special education programs began toemerge in the 1960s. If is sometimes described as a cas-cade ,or continuum of administrative arrangements asopposed to two kinds of "boxes." However, this modelwas still, oriented mainly'to the places or administrativestructures of special education. .Some of its distinct'features are shown in Fig.41:

.1. It propo,sedsupPtirts to regular. classrooms as onemeans of meeting the special needs o handicappedchildren Who are maintained. there.

Fig. 1. The Special Education Cascade

FullqirneResidential .

SchOol

Special bay school

Full-time Special Class

Regular Classroom plus Part-time SPecial Class

The Regular Classroom plusResource Room help

The Regular Classroom withAssistance by Itinerant Specialists

The Regular Classroom with Consultati e 4

Assistance

The Regular Classroom

Move students this direction only as far as necessary

Return students as soon as feasible

Limited Educational EnvironmentsOutside of the School

Special Treatment &Detention Centers

4

Hospitals

-Home-bound" Instructors

414

2. It proposed that. children not be classified andgiven special placements on a permanent basis but,rather, that they e moved to spe al stations oT for aslong as, nettssary, that they be returned to regularclassroorps as soon as feasible. N indelible labels needbe involved therebP. The total num er of children servedover time in speciaLsettings greatly exceeds the number/erved at any given, time.

3. It proposed that tie boundary -lines bdtween, spe-cial education and regular edutation-be enegotiatedand opened, so that students could pass back and fortheasily, as dictated by their educational needs:

4. It proposed that regular and special education staffmembers become more interactive or collaborative intheir daily work; for example, sharing responsibilities forstudents, rather than to remain isolated in their separatecent rs and classrooms.

It proposed that careful justification be requiredwhenever a child was removed from the regular schoolenvironment, and especially when the removal took thechild from both home and school environments forplacement in a residential center.

A visitor to the schools today is likely to encountersomething like this broad continuum or cascade ofinstructional arrangements, but it is not only .childrenwho are being moved about within-the cascade arrange-ment; specialized personnel move also. (See Fig. 2.) Asshown in Figure 2-staff memberi are coming down tothe regular classroom ba e of t e cas e_to providetheir services. There is a g recognition that no! -allspecialized instruction n o in special places and, infact, that it is likely to .dvantageous to confinechildren in special places mited environments forlong periods of time.

Fig. 2. The changing cascade: Fewei specialized places, more diverse "regular" places.

Removal of architectural variables

Braille,rd mobility instructionfor the blind

Classroom sOcial strosture becomes criLX(1Cc:operative"

Recurring specialized diagnostic appraisal

Total communication for the deaf

Individualized contingency management systems

Effective management of acoustic environment

Individualized instructional management *terns

Broad team approaches to planning

Regular classrooms, shops and laboratories with supportive services

Resource rooms

Special classes and schools

Move specialized instructional systerry4 and staff toward the mainstream as rapidly as feasible

12 14

Under these new arrangements, regular classroomteachers increasingly find themselves joined with re-source teachers, speech clinicians, school nurses, andother specialists in serving handicapped students. Theclassroom teachers cannot just refer such students to'others, and thus, transfer responsibility for them. Whena child is identified as handicapped or in need of specialhelp, efforts must be made first to meet the child's needsin the regular classroom and school. Thus, consultationis required to work out how an accommodation to thechild's meeds might be made in the mainstream setting.Only if that approach proves to be totally unpromisingmay the child,be dig`placed to a special setting,,and thenonly on preseription - the IEP - and only for a limitedperiod of tidre.

Emerging ProblemsSo far, I have been structuring the background for our

consideration of a number of problems and issues thatchallenge both educators and health professionals. Ishall discuss briefly only a few problems and then I shalldescribe briefly some important role changes that areindicated for the personnel who serve handicappedchildren.

1. Communication. Over the past two years I havehad the opportunity to conduct, with Dr. RichardNelson, a pediatrician at the Minnesota. State Depart-ment of Health and head of the program for handicappedchildren, several short conferences for primary carephysicians on the subject of health-school collaboration.

\ We used the following case studys the springboard:Erick, age 5, is observed by his kindergarten teacher

to be immature in language and social abilities, somewhatawkward physically, and quite often distracted or inat-tentive when other children are "on task." The obsevations were made in November of the school year. 0parent-teacher conference had been held in September.At that time, Erick's parents had not indicated any spe-cial concern, but the teacher had expressed the inten-tion to observe Erick closely. Now another parentconference is in the offing, and Erick's progress calls fora report of "unsatisfactory." The teacher has told theschool principal of a growing belief that Erick may havea significant problem. He may be in need of specialeducation and related services. (Reynolds & Birch,1982, p. 61)

Short as this case study is, it holds a number of ques-tions that require communications between edricatorsand health professionals.

1. What sequence of steps should be taken topursuethis situation and by whom? Should a specialeducator or school psychologist be consulted?

2. Does the school have a legal responsibility to iden-tify Erick as a handicapped child, if indeed he is,and to write an IEP for him?

3. AsstAing that Erick has not had a recent medical.check-up, how should a thorough examination besecured ,for him? Who should pay for it? Shouldthe physician be told of the teacher's concerns?

4. Who should be responsible for integrating all theinformation gathered on Erick and for consulting/planning with his parents?

5. How should the procedures differ if Erick is

bilingual or a minority group child? (Reynolds &Birch, 1_982..p, 61)

2. Related Services. Under Public Law 94-142 the.schools are responsible for spdsfal education andrelated services. Whet are related services? The law lists"transPortation. .dkvelopmental, corrective and hersupport services." 111.:::e language "other support er-vices" holds muchdifficulty for school systems. There isno question that the phrase covers the services ofaudiologists and psychologists, but what about spe-cialists who provide recreation, psychotherapy, parentcounseling and medical services? In one midwesterncommunity "equestrian therapy" (horseback ridinglessons) became an issue. The provision of physicaltherapy, occupational therapy, and corrective physicaleducation progr'ams has increased rapidly in someplaces, not just in special schools but in mainstream set-tings; under, the aegis of "related services." These ser-vices are initiated sometimes on the basis of diagnosesthat are made without the participation of physicians.Sometimes perfunctory approvals may be given to suchprograms by physicians who may not have much back-ground for this kind of program. Should the schools bethe setting for a movement by some allied health pro,:fessions to forge new degrees of independence, inpractice?

,Judicial interpretations of the related services con-cept have tended to broaden rather than limit its applica-tion. Some observers feel that this broadening is not dueentirely to Public Law 94-142, but also the expandedconcept of the purposes of education that is associatedwith the enrollment of literally all child'ren,. includingthose with severe and profound handicaps. Obviously,such develOpments involve the schools in teachingchildren to walk, feed themselves, attend to'their toilet-ing needs, and oth,er such basic behaviors in addition toteaching reading, writing, and arithmetic.

It was not too long ago that one of the de facto testsused to determine which handicapped children wereeligible forradmission to public schools was whether a j.

child was toilet trained. When children were admitted toschools, it often was on condition that the parents pro- ,,,

vide the help the children needed to use the toilets.Should we interpret the term "other support services" toinclude such specific interventions as changing a child'ssoiled clothes? taking another child to the toilet?catheterizing a child with kidney problems? making sure'a child's hearing aid is functioning properly?

Obviously, the area of "related services" is a potentials.,,source of problems for school curriculums and budgets,It raises many questions about the relations of health .

and educational responsibilities and even of relationswithin the family of health professions; it is sure toreceive continuing attention. 4-

3. Money. Our schools do not have sufficient fundingto cover all the services now required of them and thesitualtion is getting tougher every week. In addition, thefunds for children with special needs tend to flow inmany narrow streams, each with its own proceduralrequirements, time lines, and bureaucracy, so the struc-ture of funding systems is also a problem. As Man-stream teachers have assumed the responsibility formore children with special needs, a kind of backlashagainst the whole array of procedural requirementsassociated with funding is in the making.

It is unfortunate that Public Law 94-142 becieffective at the time that the national economy Eld

115

taken a downturn. Suddenly the schools were requiredto enroll thousands of children who, heretofore, had notbeen in the education system. There ,were but' littleincreases in corresponding funding. In effect, the re-sponsibility for the treatmeint of many handicappedchildren was transferred without the tompensatorytransfer of funds.

A particularly worrisome aspect of the current reduC-tion of education budgets. is that the agenties thatshould be cooperatityg to serve handicapped-childrenand their families actually may be draWing apart, In onemid-size city funds and seNices amounting to 'a value of$500,000 per s1ear were Withdrawn recently by severalhealth and United Fund agencies from a large publicschool operation for handicapped students. The argu-ment was that, because the schools face the legalimperatives, let them provide the money: That's a hard-nosed decision but a kind we may see more frequentlywhen all agencies experience a decline in resources andever-expanding demands for services. Unfortunately,that eventuality takes us expctly in the wrong direction.We should be creating more means of coordinationacross health, education and social service lines to assisthandicapped persons and their families.

Interprofessional Communication. One of the mostinteresting and' challenging problems we face

Itcen-

ters on interprofessional communication. t is oftenassumed that studies and plans for handicappedchildren are more valid if they are undertaken by severalprofessions rather than one alone. Yet we often dostrange things in these cooperative engagements. Cer-tainly it is not uncommon these days for as many as fourto eight different ptofessional specialties to be representedin a school conference with parents to make plans forone child's educational program. In such situations,good communication is a rarity because, perhaps, wehave 'not( learned to work together.

In staff conferences I believe it is important to be clearabout the nature of the decisions that must be made andthen to discipline ourselves to seek only the informationthat is relevant to those decisions.

Teachers; for example, tend to function within theframework of a curriculum for teaching basic skills in

" language, arithmetic, social behavior, life maintenance,and career development, including, especially, theability to make etonomMilly valued contributions topupils' life situations. These are the cultural imperativesfor schools, the areas in which children must learn basicskills in order to survive and to negotiate for a place forthemselves in our complex culture. As progress is madein the imperatives, teachers move attention to electivesin particular subject fieldsthe arts, recreation, andvocatiorkills. When teachers need help it usually is inmaking instructional decisions and in creating manage-able and productive social situations for the groups ofstudents in the classrooms. Teachers hope that healthprofessionals will work with pupils and their parents tohelp develop healthy, benergetic learners for the class-rooms.

There is some tendency, when teachers discussclassroom difficulties with other professionals, for theteachers to be drawn to topics which are of first concernto them as teachers. For example, when a teacher dis-cusses a learning problem with a psychologist, the lattermay draw the teacher's attention to presumably under-

14

lying psychological or cognitive processes such as per-ception, memory, or attention. The speech languagepathologist may 'draw the: problem back to The psy-cholinguistic processes thoughtto be predispositional toproblems inireading or spelling which were the concernof the teacher. Should a neurologist join the conversa-tion, he or she might consider all edu"cation problemS tobe embedded in neurological dysfunctions. In Suchfashion; the teacher's instructional -prbblem can be

. transformed into a series or,order of presumed predis-positional 'states which are not a part. of 1?er ordinarylesson plinning. Teachers even maybe advised to directtheir instructional Nrograms to the level of, children'spresumed predispositionalAficiencies. For .example,when a child has difficulty learning to read, the teachermay be urged to stress basic perceptual training orvisual-motor sequencing or visual -motor coordination.In some places, even more drastic treatments are pre-scribed, such as special classes for "brain damaged" or"perceptually handicapped" children.

Unfortunately, many interpretations of educationalproblems in terms of their presumed dfspositional'statesare based on a very thin knowledge base .and are notuseful. And it appears that when one teaches directly forsuch abilities, even if we make progress in the directlyemphasized predispositional domains,. there may be notransfer to the level of the curriculum where the teachermust function. For example, in a meta analysis of studiesconcerning psychdlinguistic abilities, as measured bythe Illinois Test of Tsycholinguistic Abilities, Kavale(1981) concluded that training directed to these'abilitiesis effective. Unfortunately, other researchers have foundthat training in psycholinguistic abilities does notimprove academic performance (Arter & Jenkins,1979). .

The point of this excursion into some of the problemsof interprofessional dialogue is to stress the, importanceof ,better communication across professional' lines.Good and full communication will not occur to a largeextent until we examine closely the logic and domains ofdecisions and the validity of the knovjledge bases whichrelate to the diagnosis and treatment of children, andsort out very carefully how our decisions can be madeefficiently. It has been suggestedkthat in .multi -professional discussions one profession must be giventhe focus of attention. Otherwise, each professional willfocus on the diagnostic variables and classifications,decisions, and treatments which he or she knows bestrather than to work cooperatively and effectively toanswer given questions. It is very clear, of course, thatteachers wish for their pupils'to be healthy, energeticlearners and this requires good help from health pro-fessionals. It is when we, get to the more particular topicsthat our limited ability to communicate becomesobvious.

Implications for Professional PreparationThe new imperatives for the education of handicapped

pupils were addressed to educators who were at bestpoorly prepared to respond effectively. Efforts areunderway to correct that failing, but the task is a verylarge one.

The new policiesIthemselves are the essential sourceof structure for the required efforts to improve the prepara-

.

16

how of teachers' For example, it is clear that regularteachers need help on such unfamiliar topics as use ofcohsultation, family life; managing diverse social struc-tures, writ' g explicit individualized educational plans,and due process principles. Each is appearing inteacher- eparation programs as a new area of study.However, more emphasis is -also needed by_old topicssuch as teaching basic 'skills, classroom management,,and individualized assessment.

SpecN istsfor. example, social.wOrkers, nurses, andpsychologistswho work in the . schools alSo haveexperienced new demands. First is t call that theyhave experienced to come to classroalis and to carryout their duties in that mainstream environment. In themainstreamed classroom they find themselves engagedin ,collaborative work with teachers in diagnostics, inconsultation, and in direct intervention. It is theirprimar9 duty these days to help make that envirOVmentmore powerful in dealing with human difference, andthis mandates the change in work scene for manyspecialists.

It will take the work of a decade or more to make sub-stantial progress in changing the roles of school person-nel and revising the university programs that prepare thepersonnel. Teachers and other front-line educators feeldirectly the policy changes and the' new legal im-peratives. University personnel who conduct(prepara-tion programs for educators are a big step removed, andit is hard to get their attention fb develop the necessarypriorities for program change. Perhaps the same thing istrue in some of the health-related professions as well.But ideas for the task are emerging; the detailed mapsfor changes in curricula are coming into the professionalliterature, and at least a few colleges are beginning-to doa first-rate job in revising their preparation programs. Atthe top of the list of work to be done always.isthe aware-ness of the need to change, then comes the faculty-development work, the changes in curriculum at specificlevels; and, finally, the major programinatic change.

Ore way that the training problems of educators hasbeen dealt with is through the Dean's Grant Projects(DGPs). Since 1975, about 225 colleges and univer-sities have received these grants - average amount pergrant about $45,000 - from the Special Education Pro-grams unit of U.S. Dept. of Education. The purposeof the grants has been to help in the revisions of prepara-tion programs for teachers and other educators, takinginto account the new policies concerning education forhandicapped students. Only deans of education havebeen eligible to receive the grants.

Many things have been learned in the process ofseven years'. work on DGPs. For example

1) that deans can be effective programmatic leadersif they invest themselves deeply in projects;

2) that just "adding another course" is not the wayto go in meeting important new, thrusts incurriculum development; very often there areimplications for many aspects of existingcurricula;

3) that change in higher education programs is dif-' ficult and that it pays to be systematic about

change processes;4) that networks of institutions working on similar

kinds of change can be very helpful, through

exchanges of idea, materials and supports ofother kinds;

' 5) that often we do not have sufficient "life space" oracademic space to dci a thorough job of entry-level preparation.

In the process of working through 225 DGPs a verygood set of ideas about curricular change has emergedand a number of outstanding examples of revisedteacher preparation have been created. The field ofteaches education now has a reasonably good leader-'ship structure, a fair literature' on the new topics, a largenumber-of committed professionals and general readi-ness to carry on to completion the important work in thisfield. The accrediting agencies, both national and state,are moving in parallel with the developing programs andnow adds goading poWer for developments in allinstitutions that prepare teachers.

In education, the new policies relating to the educa-tion of handicapped children are being viewed asamong the amost important ever established in educa-tion as a whole". Potentially, these policies affect not onlyhandicapped children but all children: fox how can youconduct a program adapted to the individual needs ofonly some children, or prepare explicit public plans forthe education of only some pupils, or negotiateeducational plans with only selected parents?

But Won't WAR Go Away?. .

In 1981, President Reagan proposed to repeal PublicLaw 94-142 and to "block" the funds provided underthe law with some other categorical support programs.Although his effort failed then, the same ideas are beingforwarded again and the future is precarious: However,even if we lose Public Law 94-142 the many layers oflaw and ju decisions at both state and federal-levelswill continue to uphold the same principles. Mandatesfor deinstitutionalization and the trimming down ofenrollments in special schools have occurred faster thanchanges in training programs. In a sense, we are playingcatch-up baseball with fundamental, hard changes ineducation. I believe that our moral development hasbeen raised a degree as we have confronted the prob.Irs.of handicapped children in the schools these pastfew years. Increasing numbers of school people havehad to face up to the potentially catastrophic experienceof rejection that some handicapped children and theirfamilies have experienced as they were turned awayfrom,regular schools. More and more educators realize,I think, that it is our duty to model in the schools the kindof inclusiveness now emerging in a deinstitutionalizedsociety. We have no reason to expect concern with,decency toward, and genuine helpfulness for peoplewho are different in our society if children have noexperience with those sentiments during their schoolyears.

Nor is it enough for educators to face these problemsalone, just as it is not enough for teachers to meet asstrangers their colleagues in nursing, physical therapy,occupational therapy, speech, psychology, audiology,

Persons wishing to know more abdut the developing literature in"mainstreamed education" are invited to write to the National SupportSystems Project, 350 Elliott Hall, 75 East River Road, University ofMinnesota, Minneapolis, MN 55455.

15

7

and medicine when they get into -the-schools.-Univer-sities supposedly, are settings where communicationacross all disciplinary and Oefessional boundaries isencouraged, but it is not so. Each of us tends to report tohis or her own enclave. Sarason' has said thait411specialists tend to create environments that ohlyspecialists can manage. We as specialists create ourspecialized, very comfortable environments and socializeour clients, patiers, or pupils to accommodate to thoseenvironments. But things are changingradicallyin

the schools. We are being called Into the mainstreamenvironmentshomes and regular schoolsand askedto help make those environments more powerfulresources for children. As Sarason (1978), again, hasput it, mainstreaming is not just an education issue'orproblem; "it is a reflection of the nature of and changesin larger society, if only because the definitions of

- deviancy, atypicality or handicap arise out of societalnorms" (p. 17). Wein education and in healthshould do more of the necessary work together,.

ReferencesMills v. DC Board of Education. 348 F. Supp. 866 (D. D. C.1972).

1. Arter JA, Jenkins JR: Differential Diagnosis - Prescriptive Teach- 5.ing: A Critical Appraisal. Review of Educational Research 49:517-555, 1979.

2. DiMond PR: The Constitutional Right to Education: The QuietRevolution. The Hastings Law Journal 24:1087-1127. 1973.

3. -Hobbs N: A Critical Perspective of the Papers on "The Futures ofEducation." In Reynolds MC (ed.): Futures of Education for Excep-tional Students: Emerging Structures. Reston. Virginia, The Coun-cil for Exceptional Children. 1978, pp. 197207.

4. Kavale, K: Functions of the Illinois Test of Psycholinguistic Abilities(ITPA): Are They Trainable? Exceptional Children 47(7): 496.510,1981.

0

16

6. PARC (Pennsylvania Association for Retarded Children) v.

Pennsylvania. 334 F. upp. 1257 (E. D. Pa. 1971).

7. Reynolds MC. Birch JW: Teaching Exceptional Children in AllAmerica's Schools (rev. ed.). Reston. Virginia, The Council forExceptional Children, 1982.

8. Sarason 5: Mainstreaming: Dilemmas, Opposition, Opportunities.In Reynolds MC (ed.): Futures of Education for ExceptionalStudents: Emerging Structures. Reston, Virginia, The Council for_Exceptional Children, 1978, pp. 3-39.

18

A_

. -Meeting the_Neecbl of Chill:ken-andYouth with Disabilities: The State.Of theArt in Allied :Health . . .

*

Helen Hickey

Helen Hickey is the Associate Dean e SargentCollege oAAllied Health Professions, and an associateprofessor at Boston University. A leader in the AlliedHealth fields, she served as the 12th prggident ofAmerican Society ofAllied Health Professions (ASAHP),and is currently Chairman of the Advisory Council tothe Allied Health Child-Find and Advocacy Project,sponsored by ASAHP. Ms. Hickey is a trained physicaltherapist and is active in the Am'erican PhysicalTherapy Association.

BackgroundAccording to the National Commission on Allied

Health Education,' allied health practitioners comprisemore than one-third Of all full-time hospital employees,between one-half and two-thirds of all full-time employ-ees of Health Maintenance Organizations and othergroup practices, over tfiree-fOurths of all non-physiciansemployed in physicians' offices, over two-thirds of allemployees of mental health facilities, over three-fourthsof all laboratory employees, and over three-fourths of allpractitioners in community health clinics and agencies.At least three-fifths of all providers of health-care ser-vices in the United States are members of the alliedhealth professions. Appendix A describes the alliedhealth work force.

With the advent of the Education for All HandicappedChildren Act of 1975 (Public Law 94-142), mandatingthe provision of a free appropriate education for all handi-capped children, increasing numbers of allied healthpractitioners found themselves delivering services ineducational settings for the first time. Because many ofthese practitioners had not been prepared directly forthese roles and responsibilities, new training needs wereidentified, and educational programs developed throughboth higher education institutions and professionalorganizations.

The extent and diversity of the allied health pro-fessions make it impossible to provide a, detailed "Stateof the.Art" discussion for each of the professions in alliedhealth working to meet the needs of youngsters with dis-abilities. This paper, therefore, will be limited to:(a) summarizing the major allied health initiative forthese youngsters (of which this Forum is a part), and

1National Commission on Allied Health Education, The Future ofAllied Health Education, San Francisco: Jossey-Bass Inc., Pub-lishers, 1980(

(b) showipg how three of thallied health professions.'!are prEipaing their ,rnembers.'to megf the - needs of

youngSters with handicaps i?1* the schools.

The Allied Health Child Find and AdvocacyPraject2

In JUne 1980, the American Society of.Allied HealthProfessions, was awarded a three year grant from theU.S. Office of Special Education and Rehabilitati r-vices (OSERS) to involye :allied health professiefforts to meet the education and education-health needs of children with handicappinditions.

The challenge of 'the Allied Health Child-Find andAdvocacy Project has been to design Curricula, instruc-tional strategies, and advocacy models which encourageall allied' he,alth professionals to become proactive inadvocating for the rights and needs of youngsters with dis-abilities and their families. The specific components ofthe Project have included work-shops and conferencesdesigned and conducted for three separate audiences,targeted for their Unique potential in affecting change inthe .roles allied- health professionals Play in theimplementation of PL 94-142. The activities include:

Regional Workshops designed for a cadre of fiftyexperiended allied health professionals in each ofthe ten Department of Education Regions;Workshops for national allied health professionalorganizaticAs as part of their annual conferences;andInvitational Conferences. for chief administratorsof schools and programs of allied health andeducation.

Through these activities, ASAHP has initiated a num-ber of innovative activities and has gegerated much sup-portin the cobrclination of training, service delivery, andadvocacy, for youngsters with handicapping conditionsat both the .tegional and national levels.

The profession's involved thus far have included:Audiology/Speech-Language PathologyCorrective TherapyDental Assistance & Dental HygieneDieteticsHealth Education & Admtlistration

'Medical Assistance,,,-,;.1cifeclical Technology

' Medical Record Administration

nals inelated

con-

21nformation regarding the Allied Health Child-Find and AdvocacyProject is adapted from ASAHP's Continuation Application for GrantNo. G009001409. /

althA dm nistrati onRehabilitation\CounselingSocial WorkNutritionOccupational TherapyPhysical TherapyNursingPhysicia'n Assistance

Ilk Recreational Therapy',,During each of the ProjM's redlonal workshbps and

'conferences, participants'working in 'small groups haveidentified the roles and responsibilities all health pro-fessionals should assumewhether or not they interactdirectly peconsistently with youngsters who have handiicapping. conditions. Five major responsibilities haveemerged repeatedlyacross working groups and acrossRegions They include:

1. To communiciaTaffectively with individuals with\ disabilities and their families; i.e., to adapt messages

and paten actively to disabled yoUngsters andtheir families;

2. To understand state and federal legislation inorder to assiAt families in solving problems relatedto the child/youth's condition;

3. To recognize, accept, and implement one's pro-fessional responsibilities in identifyirig, referring,and advocating for youngsters with disabilities and

. their families;4. To help coordinate efforts of health, education

land related services, and5. To develop and/or modify educational standards

to create access rather than-barriers to disabledindividuals who wish to enter the allied health,education, and medical fields.

Mille these roles and responsibilities have been ian-tified specifically for allied health professionals, theirrelevancy for other professionals who pPovide servicesto disabled yoUngsters and their families (e.g., specialeducators, regular educators, physiCians, nurses, school

. volunteers, etc.) are obvious, and would be well-worthconsidering as all groups develop and evaluate pre-

,' - service and in- service education programs.For the allied health professionals involved in the Pro.

ject's activities (as well as for the resource persons andfaculty), the overriding issue of providing efficient, cost-

, effective care in meeting the mandates of PL 94-142 hascontinually pointed to the needfor coordinated effortsof health, education, and the related health services withan emphasis on developing adaptive programming forthe life span of the youngster.

While some training programs in allied health addressthese roles and responsibilities, many do not. Leaderswithin the allied health professions generally recognizethe lack of training their students receive to preparethem for meeting their responsibilities for handicappedyoungsters. Further substantiation has come directlyfrom Regional Workshop participants throughout thecountry. They concur with and reinforce ASAHP'sunderlying position: related health professionals work-ing in clinical settings possess (a) special access tochildieR and youth with handicapping conditions; and

lbrlittle;lf-any,-prepcn (Ai on-for-meeting-their-roles- andresponsibilities to assure these. youngsters ottain theirdue educational ri.shts.

Through this project, ASAHP is developing importantalliances with medical and education personnel andorganizations concerned with disabled youngsters,.including the American Kcademy of. Pediatrics; theAmerican Association of Colleges for Teacher Educa-tion, the National Association _of State Directors of$pecial Education. and the member organizations ofASAHP. Communication, cooperation and collabora-tion amontheseand related organizations augur well inthe promotion of this advdcacy initiative` as well as assur-ing delivery of needed, services for these youngsteis.

18

STATE OF THE ART=4HREE ALLIEDHEALTH SERVICES

While the first part of this paper has shared!ASAHP'sinvolvement with PL 94-142 through the Allied HealthChild-Findiand AdvoCacy Project, this section will focuson the current status and arcern of three allied healthservices, namely occupational therapy, physicaltherapy, and speech-languag,2 pathology and audiology,spec' d in the regulations as "related services."

OCCUPATIONAL THERAPYTraditionally, occupational therapists have served

children in health Care settings for many years. Providingservice invducational settings is a later development inpractice and is tied to the profession's goals of earlyintervention, service on interdisciplinary health careteams, provision of service from birth,, and care in themost advantageous setting for the patient/client.

In 1978, number of school-based occupational thera-pists grew from 950 to.2500. Torneet thetraining needsof tbe school-base-d therapist, the American °cal:pational Therapy Association (AOTA) designed a proj-ect, "Training Occupational Therapy EducationalManagement in Schools" (TOTEMS). Partially fundedby the Bureau of Education for the Handicapped, theTOTEMS Project provides eight modules of competency-based advanced inservice training "to teach the oc-cupational therapist better.ways to initiate and manageoccupational therapy programs as defined by the ser-vice delivery' patterns and ethical practices of theoccupational therapy profession and the rules andregulations of the school district that the therapist serves."A rich resource from TOTEMS is the four-volume train-ing manual covering the content of the five pilot pro-grams. The comprehensiveness of the four volumes isimpressive and the adaptability of much of their contentto other health professions and related services issignificant.

Recognizing a further training need, the AOTAdeveloped a subsequent projet, "Faculty DevelopmentWorkshops: In grating Material"to School Based Prac-tice in Occupa ional Therapy Curricula," again, withpartial support of the U.S. Department of Education'sSpecial Education Program. The areas of practice andeducation at the basic entry level in occupationaltherapy have been enriched and strengthened by thesetwo Projects and the materials produced by them.

In addition, continuing education programs on PL 94-142 and related content are offered for occupational

2 0

therapy practitioners by:a variety of sponsors, e:g., stateaffiliates of the. AOTA, school systems, ASAHP. Theproblems in providing adeq.u,ate occupational therapyservices in educational settings are shared with physical ,

therapists: there simply are not enough therapists to fillall of the faculty positions in occupational and physicaltherapy'educational programs. A second problem, alsosiiVar to physical therapy, concerns-role identity-. Mostindividuals gnter occupational therapy with a desire togive direct service to patiehts/clients,,while most of .theservice given, to-students in an educajional setting is0i-direct/The occupational therapist in the school systemaccomplishes change rn,the pupil's status through heintervention of others: thet,teacher,-,the teacher's al e,the parents. This kind of change does not bring the same -satisfaction to some occupational therapists as the directcare tendered in a healthcare setting where the therapisthas control over the child's therapeutic program. Manytraining programs are nbt yet designed to prepare

- students to appreciate the career satisfactions that canbe derived from serving as a consultant in providing the

- lorig-term, indirect care relevant to the education andlifetime career goals of the youngster with a disability.

PHYSICAL THERAPYAmong the physical therapy services pro ided in

educational settings for disabled students are evalua-tion; program planning;. consultation to fa lilies andschool personnel and/or communihjagenc ; classroomor, building modification; ,direct service to disabledstudents; construction management and use of adaptiveequipment; assessment and provision of fire and safetyprocedures; assessment and management of transpor-tation systems; collaborative activities as a member of aninterdisciplinary team, including participation in thepreparation of Individual Educational Prdsrams; recordkeeping..and reporting; budget planning and manage-ment; supervision of support personnel; and planningfor inservice training programs for other health Okieducation professionals, students and/or assistivepersonnel.

It is estimated that about 2700 physical therapists arecurrently employed in school settings. Data from a sur-vey conducted by the American Physical TherapyAssociation (AFTA).in 1981 indicated more than 60%of the respondents (N-612) were employed Aill-time inregular schools: This represents a significant change inemployment settings for physical therapists. Traditional-ly, physical therapists employed in school settingsfunctioned in special schoolS or classrooms for theorthopedically handicapped.

Most activities to prepare physical therapists for thesenew roles and responsibilities haveteen carried out atthe state and local level by therapists already employedin school systems, by State Chapters of the AmericanPhysical Therapy Association, and/or by faculties ofbasic entry level or graduate educational programs.Although the need has been recognized, no organizednational efforts exist tarevisecurricula to prepare physi-cal therapy students for these functions. Continuingeducation programs have 'been offered to familiarizepractitioners with PL 94-142 or to help them manage.these newer roles and responsibilities. But, and this is awell recognized phenomenon, more needs to tie done in

curriculum revision: in raising awareness of manypublics to the contribution's physical therapists can maketo disabled students in classrooms, and in helpingcurrent physical therapists gain knowledge and skills tofunction effectively in these environments.*Traditionally, physical therapists have delivered direct

service to patients in medical/health care facilities. Theyhave had considerable control over what they adminis-

. tered to patients and when. This has been true of mainyhealth care practitioners, including- occupational. there-piSts. In the past, school-based physical therapists dealt."generally withStudents with 'blatant orthopedic and/or ,neurological problems: An today's "'least restrictiveenvironment" they will work With students with otherprolllems, e.g., developmental :delays, fine and grossmotor deficits, sensory disturbances, learning dis-abilities, clumsiness and awkwsrdness, and geneticabnormalities. -

In addition to whatever expertise practitiofters bringto the classroom setting, they need to bring special skillsas coorditiators, managers and consultants. Thus,faculties of educational programs must be equipped toprepare students for these new roles and functions inhese new settings. Curriculum revisions must include

mo emphasis on interpersonal, management andcom unications skills. Sftkcients in physicak therapy, aswell as. occupational theihapy, must be prepared toachieve their patient's treatment gdals and objectivesthrough a new group of support personnel differentfrom those found in a more t aditional hospital or healthcare setting.

The supervAlemployer relationship is also differentfor both the physical and occupational therapist. Insteadof supervision from another related health care pro-fessional, the overseer may be a special educator, schoolprincipal or similar educational administrator. curriculashould emphasize communication skills to help studentswork effectively with their educator colleagues-Manament skills training must be given equal. eruPhasis widevelopment of professional. skills. -Sensitivity to theemotional and cognitive needs of the able-bodied childin the classroom with disabled children must bedeveloped to greater depth. Further emphasis is neededon how to cope with varying learning 'styles andbehavior problems.

Physical therapists in school systems fa anotherproblem due to their policy of deliverifig service onmedicalreterral. The problem is twofold: not all schoblsystems have physicians on the scene; not all schoolphysicians know what physical therapists can contributeto disableil children in the classloonl. Each State has aphysical- therapy practice act which binds physicaltherapists to medical referral. Currently the Americ'anPhysical Therapy Association is studyingthe ethical andlegal implications of its rfembers engaged in autono-mous practice. OccupatioN therapiSts;Can delive,r theirservices on either medical or health status referrals sothey do ,cot face this particular problem.

In some states, school-based physical therapists, likeother related - service providers in the schools, mustcomplete additional preparation through continuingeducation. In others, it is required that they meet teachercertification_requirements. It would appear to be moreefficient 'and cost-effective to revise basic entry levelcurricula to include appropriate course work and field

19 2.i I

experiences to provide adequate preparation for servicein these environments.

SPEECH-LANGUAGE PATHOLOGYAND AUDIOLOGY

Speech - language pathologists and audiologists havebeeNimporiant members of educational teams for manyyears, and are'familiar with sewing in roles as'direct ser-vice providers, supervisors, coordinators, adminis-trators, and as classroom pr clinical teachers in trainingprograms. Through the American Speech-Language-Hearing 'ASsociation (ASHA), the rnemberscontritutedsignificantly to the design and passage of PL 94-142.

While speech-language pathologists and audiologistsare accustomed to working with teachers, teacher aides,special educators and educational administrators, theadvent of PL 94-142 finds them serving as interdisciplinary team members with physical therapists, oc-cupational therapists, social workers, psychologists, andphysical educators. Thus, they too have.a different andexpanded role for students with communication disor-ders to ensure theft I.E.P. goals are supplemented andcomplemented by other health practitioners. Speech-language pathologists and audiologists are finding itnecessary to,epend more time in team building and inusing supportive personnel.

New patterns and areas of service deliver;/ include the`severely disabled (who are new in the clpssroom), thenon-vocal, and the .bilingual youngster. A significantchange in the disorders found in the populations to beserved einerged with the implementation of PL 94-142;from those with primarily articulation, voice, or stutter-ing disorders to those with developmental and dyslexiadisorders. As a result, emphasis in educational curriculai§ on language rather than speech. Thus, acquisition oflanguage as socialization, conceptualization, and writing processes is receiving much more attention, alonwith the importance of prenatal influen

[Icesand famil

health histories.There is an apparent need for entry-level curricula in

Speech-Language Pathology and Audiology to stressnewer roles; e.g., less emphasis on consultant andmanagement skills to gr,gater emphasis on the new pop-ulations its graduates will, be serving.

In 1982, ASHA conducted an impact study of 100supervisors to obtain a profile.of their members workingin public schools.

The data show that PL 94-142 has had an impacton speech-language pathology and audiologyprograms in schools. The mandate to provide.appropriate education for all handicapped childrenhas facilitated the move toward lower. caseloadsand increased employment.

Continuing education opportunities for specialists incommunication disorders would probably be mosteffective and contributory if they were concentrated onimproving knowledge, sltills 'and attitudes toward thenewer populations being seen in the classroom: theseverely disabled, the nonvocal, the bilingual. Teambuilding techniques are another-area of concern whichlend themselves to effective continuing educationefforts.

Speech-language pathologists and audiologists appear

20

to be strong in understanding school systems' advocacyroles and evorking collaboratively with educational per-sonnel from a variety of job levels. It appears they needto transfer these skills and abilities to theirnewer arenawhich now includes other health firactitioners.

SOME CONCLUSIONS BASED ON THESTATE OF THE ART IN ALLIED HEALTHRoles and Functions

As noted for each of the professionsiscussed above,all the related-health professions need to be involved ina concerted effort to clarify the roles and functions ofhealth prbfessionals serving youngsters with handicap-ping conditions, define them, agree on them, promulgatethem, and design curriculum offerings that develop thecompetencies needed to carry them out.

Allied health practitioners tan make a significant dif-ference in the lives of children and youth with disabilitiesand their families. Theyt can contribute meaningfully tothe satisfaction teachers, principals, and other educationpersonnel derive from their jobs. Allied health pro-fessionals can help the educators develop realisticexpectations regarding the performance of studentswith disabilities and modify educational _settings toassure optimum learning environments. Further, theycan help educatprs and parents become aware of assistivedevices and techniques to use at home to complementand supplement what is taught in the classroom, andalso to be aware of gencies, service groups a,pd otherorgdnizations in the ommunity which may be of assis-tance to them and to their students.

While individual disciplines have conducted researchon the results of school-based activity, interdisciplinaryresearch has not yet had the attention it needs to:1) substkitiate best approaches to program planning;2) document cost-effective programs; and 3) differen-tiate the effectiveness of those factors in educationalplanning procedures (e.g., the Individualized Edu-cation Program).

Allied health practitioners must take full responsibilityfor seeing that PL 94-142-and related legislative acts arefully financed and implemented at federal, state andlocal levels. As noted earlier, this means assumption ofroles as advocates not just for the children they are serv-ing, but foythe school personnel and systems, forparents and for service rograms. Allied health pro-fessionals must be politic beings in the positive sensewith a healthy respect for t can be accomplished bymobilization of an informed group to bring aboutdesired action. Part of this political activity must includeeffective publicity and public relations so tliat there isappropriate understanding of the law, of the need toeducate this special group of children, of the kinds ofprograms and resources needed to provide appropriateservices, of the allied health practitioners', professionalresponsibilities for children with special needs, theirfamilies, and other interdisciplinary team members, andof the benefits to be derived from these efforts by thecommunity and the larger society.

When necessary to assure adequate and appropriateservices, the allied health practitioner must be ready andequipped to help change restrictive and outmodedbehaviors, dictums, and laws. Further, the allied healthpractitioner must work in the present with a sensitivity,

22

keenness, and an anticipation of the future. The Childrenbeing served in the classroom todu are the workers andcontributers to the society of tomorrow. Their futureneeds for service, assistance, modifications, and supportmust be kept in mind when Arming today's programs.

Educational PreparationMuch mock needs to be done to help all practitioners

who deliver services to disabled children, to develop..skills in management, team building, use of resources(human and financial), and in understanding the:sys-tems in which they, are employed.. Allied health -prac-titioners must work with new populations, with newresponsibities, in new settings. You cannot do today'sjob with yesterday's tools and remain in businesstomorrow." Direct care for and/or daily control over thechild to be served-may not be appropriate to his/hereducational needs. -Allied health practitioners mustdevelop and refine their consultation, skills and acceptthe philosophy that effective management means get-ting things done through others.

More specifically, three kinds of educational changeneed attention: (1) revision of basic entry level curriculaso students are taught competencies needed to functionin school settings. This includes content taught inclassrooms and provision of a clinical affiliation ex-perience in a classroom setting; (2) development of anall-out effort to provide current allied health prac-

1. Gilfoyle, E. M., Editor. Training Occupational Therapy EducationalManagement in Schools: A Competency Based Educational Pro-gram. 4 Volumes; and The Final Report of the Faculty Develop-ment Workshops: "Integrating Material Related to School BasedPractice in Occupational Therapy Curricula," are available from:American Occupational Therapy Association, 13838iccard Drive,Rockville, MD 20850

titioners educational opportunities to update theirknowledge, skills and attitudes so they can functioneffectively ''serving youngsters with disabilities ineducationaWlfigs. In addition to-workshops and inclu:sion of conter*in annual conftrences of membershiporganizations., educational media such as interactivevideo tapes apd audio-cassettes should be developed;(3) recruitment and preparation c>f faculty (classroomand cliriical) must be given' a higher priority of attentionand action in allied health prolesion.61 meiTibershiporganizations and tn ASAHP: Until we fill teachingopenings, efforts. to prepare praclitionvs for new set-tings, and to revise and updAe curricula will bethwarted; \

sr.

The FutureWhat happens to PL 9'4-142 and related legislation is

in our hands and others like us. Congress. had'tb passlaw to give sorrie of our children the right to learn, to betaught, to go to public schOol, to socialize with the able -'bodied in a classroom setting. As allied health pro-fessionals, we have a vital role to play. ,

What w.g do-in-this arena to help youngsters with handi-capping conditions achieve their due rights to a freeeducation has great significance to our country, to ourcitizens and to ourselves. Let us all not only be committedto the goal, but equal to the task.

ferences2. Karry. Susan T., Editor, Governm to ffairs Review. July 1981

Supplement. Nov. 1981 Vol. 2, No, 3, a ilable from AmericanSpeech-Language-Hearing Association, 1 1 Rockville Pike,Rockville, Maryland 20852. .

3. Del Polito, Carolyn M., Editor, Continuation Grant Ap lication forthe Allied Health Child-Find and Advocacy Project, AmericanSociety of Allied Health Professions. One Dupont Circle. Suite300, Washington, D.C. 20036

21 3

Pediatrics, and DevelopmentalDisabilities: The Stat f the Artin Pediatrics e

H. Burtt Richardson, Jr., M.D.

H. Burtt 'Richardson is a pediatrician with extensivebackground and specialization in child developmentand developmental disabilities, including-mental ?eta?dation, cerebral palsy, learning disabilities, and autism.His diverse experience includes positions as MedicalDirector of Project Hope, 4ssistant and then AssociateProfessor of Child Health and Development at GeorgeWashington University and as Associate Director of theProgram for Learning Studies and the pediatricresidency program at Children's Hospital NationalMedical Center in Washington, D.C.

Moving to Maine in 1978, Dr. Richards_on has con-tinued his work in child development and haridicappingconditions as chairman of the Committee on the'Handicapped C f the Maine Chapter of theAmerican Rea emy of Pediatrics and is co-instructor ofthe course New Directions in the Care df theHandicapped Ch't1 which is taught to pediatriciansand their special education colleagues throughout thestate. In addition to serving as a member of the MainePlanning and Advisory Council on Developmental Dis-abilities, he is, consultant to the special educationdepartments of 8 load School-systems. Dr. Richardsonis co-editor of the book Pediatric Education and theNeeds of Exceptional Children (University Park Press,1980) as well as the author of several articles and chap-ters on general and developmental pediatric subjects.

Pediatrics differs from most other medical specialtiesin its focus on the comprehensive and continuing healthcare of the people it serves rather than limiting its con-cerns to a particular organ system, set of diseases ormethod of care.' The goal of the American Academy ofPediltrics, membership in which now exceeds 20,000pediatricians, is "The attainment by all children of theAmericas of their full potential for physical, emotionaland social health."'

The approaches toward the Acadenv's goal havechanged dramatically over the past few decades. Prioraccomplishments leading to improved nutrition andfeeding practices, modern sanitation, wider use of

'routine immunization against infectious diseases, andappropriate use of antibiotics and other chemo-therapeutic agents have led to a remarkable reductionof infant and child mortality.' For instance, mortality inthe 1 to 4 year-old age-gtoup has fallen from 987 per100,000 population in 1920 to 70 per 100,000 in

22

1976; and accidents, not illness, currently account foralmost half of all deaths in this age-group.'

In the past one or two decades, the emphasis has shiftedfrom the treatment of life-threatening conditi?ns to thepromotion of physical, emotional and social health ofthe highest possible quality for each child. At the sametime, as part of the enlightened awareness of the righisand needs of disabled people, pediatricians havedemonstratedincreasini interest and involvement withbehavioral and developmental variations in childrenand, in cooperation will colleagues from a number ofother disciplines, are making significant contributionsort behalf of disabled children and youth. The nature ofpediatricians' contributions, settings for service delivery,the status of current educational and research efforts,and some 'opportunities for cooperation betweenpediatrics, special )education and related service dis-ciplines will be reviewed.

o }e)'THE PEDIATRIC CONTRIBUTION

Prevention of Disabilities. Before surveying thepediatricians' contributions to the identification, assess-ment and management of disabled' hildren and youth,the fields' greatest contribution, that of prevention, willbe summarized. Along with obstetric and family practicecolleagues, pediatricians carry out most genetic coun-seling regarding inherited or congenital metabolic (e.g.phenylketonuria), chromosomal (e.g. Down syndrome),dengenerative (e.g. Tay-Sachs disease), and structural(e.g. spinal bifida) disabilities. Their efforts in initnuniza-tion against rubella have greatly reduced the incidenceof congenital rubella syndrome. In recent years, againwith the support of obstetricians, pediatricians havecounseled against the use of alcohol and smoking duringpregnancy to avoid the resulting intrauterine growthretardation and develOpmental consequences. In addi-tion, it has been pediatricians who have initiated andoverseen newborn screening for phenylketonuria, glac-tosemia and hypothyroidism and have instituted theappropriate dietary or hormonal therapy Which pre-vents subsequent retardation from these disorders.'

Most of the pediatricians' efforts in the perinatalperiod and throughout infancy and childhood are aimedat preventing or. minimizing the severity of developmentaldisability. At the time of delivery, reduction of fetal anoxia,birth trauma, and neonatal infections have resulted fromthe appropriate use of fetal monitoring and Ceasariansections. Advances in the care of prematures, in addi-tion to more effective prevention of premature delivery,have led to a marked improvement in recovery withoutdisability following respiratory distress syndrome, new-born jaundice, hypoglycemia and sepsis. Efforts to pro-mote bonding between the infant and both parents lead

24

to improved language development' and reduction inchild abuse.'

Beyond the neonatal period, the pediatrician is dallyconcerned with the prevention of disabilities. Withoutfanfare, it is primarily the pediatrician, along with lypractitioners, who oversee the administrationtines against polio, whooping cough, dipth'en-measles and mumps. The virtual eliminationdiseases, particularly polid,and measles with d-ing paralysis and brain-damaging encepamide a rriajOr impact on tie incidence of ddisabilities.' In addition, pediatricians areffective advocates of home and.eutomome ,fety forchildren, care daily for phildren with eat infections, andremain constantly alert to therisk of bacterialmeningitis,preventing serious developmental sequellae with promptand appropriate treatment.

Developmental Screening. The best opportunityfor routine Nelopmental screening of infants andpre-school children is during their healt1 care visits.There are three rincipal impediments to the imple-mentation of unive dis-abilities in prima health care settings. First is the

screening for developmental dis-

adequac9 of screening instruments. By far the beststandardized and most widely used developmentalscreening instrument is the Denver DevelopmentalScreening Test.° Nonetheless, specificity and sensitivityof the instrument, evert in the hands of its de-velopers," 12 is not sufficient to meet the needs of mostpediatric practitioners. False positive results are par-ticularly costly in over-utilizing already limited referralresources. Other screening tests have been proposed,but none is adequately standardized to 'justify generaluse at the presele time. The second impediment toscreening is its cost in phySician and staff time. Neitherparent nor third parties (medicaid or in ante com-panies) re willing to pay for the 15 to 2 i minis the minimum required for adequate screpeated several times during infancy and childh

The third impediment to universal developmescreening is the most important and is influenced tleast by pediatricians. The problem of inadequascreening instruments and limited funding for screeni gwould be quickly overcome if effective diagnostic andintervention programs kere widely available. It is likelythat once special educators and speech, occupationaland physical therapists provide documentation of theeffectiveness of their approaches, there will be appro-priate referrals. It is frustrating for the pediatrician toread a special educator's admission that "Lack ofobjec-tive support f6r the effectiveness of various educationalstrittegies being used with yoUng handicapped childrenis a serious problem." It is also frustrating to havealmost every child referred to an occupational therapistdiagnosed as having sensory integration problems witha self-serving plan for sensory integration therapy'recommended. .

In spite of the failure of pediatricians to carry out stan-dardized developmental screening on a broad scale forthe reasons, cited above, the entire process of routinewell-baby/well-child care includes screens for develop-mental disabilities. The physical examination identifieschromosomal and other developmental syndromes,examination of the eyes and ears picks up early sensory

asental

deficits, and clinical observations and developmental.history provide data on motor, language, cognitiOe andsocial development.8 s

Diagnosis and f?ssessment. The degree of pediatricinvolvement in the diagnosis and assessment of de- , .

velopmentally disabled children depends on the pedia-trician's degree of interest and training in developmergalpediatrics." Even practicing pediatricians -with' no spe-cial interest in developmental disabilities carry outexaminations, that identify medical problemslhat mightunderlie or aggravate a child's difficulty. Hearing orivision defects, chronic illness, relevant deformities andactive or progressive neurological diseases or seizures.should be uncovered' Further assessment of the dis-ability itself, however, is referred to other disciplines.

The practitioner with a special interest and furthertraining in developmental pediatrics is in a position to .carry out a much more extensive contribution todiagnosis and assessment. A comprehensive medical,family, social and developmental history, combined witha physical and neurological examination, can oftenelucidate factors that may have contributed to the child'sdisability. These may be pre-natal; pen-natal or post-natal and include chromosomal, genetic/metabolic,infectious, nutritional, hypoxic, traumatic, toxic andpsycho-social factors. In addition to the search for con-tributing factors, a neuro-developmental assessmentcan add a valuable perspective to the sessments ofother disciplines. Fine and 'gross \m for function,language, both oral and written and eceptive andexpressive, and socio-emotional func ion includingattention, attitude, motivation and inte ersonal skillscan be assessed.

The pediatrician's functional assessment of an iden-tified child serves as a collation of the observations ofothers supported by clinical observations in eachfunctional area. Data can be obtained from parents,teachers and other consultanti, such as psyphologists,speec and language clinicians, special educationaldiagn sticians, and occupational and physical thera-pists. n.example of an observation protocol for assess-ment f the child, reflecting a wide range of functions, isthe , ediatric Examination of Educational Readinessdeveloped by Levine, et al.' The Pediatrician is oftenin the unique position of being able to bring together themany sources of information about the child's functionand view the child in the context of the particular familyand school setting.

In addition to pediatric practitioners, with a specialinterest in developmental pediatrics, there are a growingnumber of full-time pediatric sub-speCialists in.the field,mostly affiliated with medical school adacemic depart-ments. Their assessments may be more detailed, par-ticularly within the area of their own training andexpertise (e.g. learning disabilities, cerebral palsy, ormental retardation), but they are often

isremoved

from the family and community than is the pediatricianin general practice.

Interdisciplinary Process: The pediatrician's contribu-tion to the interdisciplinary process depends in largepart on the deg,ree of expertise in developmental pediat-rics as discussed previously. At the community level,.thepediatrician may be .simply a contributor to the multi-

s.

disciplinary assessmegnt or may participate on an fer-disciplinary team which formulates a complete diagnosisand outlines a plan. In either role, the pediatrician maybe the case manager with responsibility for carrying outor overseeing the team's recommendations. This isoften true for the handicapped infant or child under age

,.three but is rarely the case for the school-aged child.'In the academic setting, the pediatric faculty member

yeho sub-specializes in developmental_pediatric's has anumber of interdisciplinary responsibilities in addition toparticipation on an interdisciplinary,child developmentteam for diagnosis and4ganagement of referred children-,These might include interdisciplinary consultation in thenewborn nursery, on the hospital inpatient services, andin speciality clinics serving children with birth defects,neuromuscular disorder, or genetic or metabolic prob-lems. In addition, the developmental pediatrician maysell/gas a team member for teaching as well as service inpediatric neurology and child psychiatry clinics.

For both the practitioner and the academician theschool is an important site for interdisciplinary con-tributions. Among New England pediatricians surveyedby Dworkin, et al.," between 60% and 70% repoed atleast monthly interaction with

rta school nurse and a

learning disability specialist.and between 40% and 50%had monthly contact with psychologists, guidance coun-selors. classroom teachers and speech pathologists. Thepediatrician's contributions in the school setting mayinclude up-to-dateinformation about medical problemsor medication as well as the results of the diagnosis andfunctional assessment as described in the previoussection.

Management. The pediatrician's management. rolefor children with developmental disabilities usuallyinvolves a degree of coordination and oversight of otherspecialists' efforts on behalf of the child. On-goingmanagement of health maintenance is more crucialthan for the non-disabled child as complicating medicalproblems arise more often. Coordination of surgicalintervention for hearing or visual defects or congenitalanomalies and use of appropriate medications forsage control or hyperactivity are other examples ofmedical management. Many pediatricians who functionas members of multidisciplinary or interdisciplinarydiagnostic teams continue their involvement by' Mon-itoring the response toteam recommendations for inter-vention. As the child grows, communication betweenthe early intervention staff members and the pediatri-cian should continue regarding medical as well asdevelopmental observations.

The pediatrician's most crucial management 'role,'perhaps, is in providing support to the parents."'" Theinitial informing of the parent about the child's handicapsets the stage for a po-sitive relationship between parentand child. Pediatricians can guide the parentsb withunderstanding during their grief reaction to their beinginformed of their child's disability, can point out thechild's strengths and can help parents develop realisticexpectations, avoiding both over-protection and disap-pointment. As the results of on-going diagnoSis andtherapeutic interventions become known, the pediatri-cian can serve as an interpreter of findings and can dis-cuss the implications of disabilities. Further, the.frequentcontacts with parents allows an opportunity to explore

otk

,feelings and assess the adjustment of parents andsiblings to the child's problems." Other managementroles for the pediatrician with the parents includegenetic counseling and guidance in behavioral issuessuch as toilet-traini g or temper tantrums.

A final pediatric anagement role, particularly withthe school-aged po ulation, is as advocate for thespecitcchild and family as well as for disabled childrenin general The physician's position outside the schoolsystem as well g geperal, level of professional respect

4 len weight to opinions favoring a program in the child'sst interest. There is kyirtually always a team member

lh-frome school (classtoom teacher, special educator, ortherapiSO with an appropriate 'recommendation, butconflicts of interest regarding staffing or funding some-times lead to expedience over-ruling the tearrmember'ssuggestion. The pediatrician's support of the educator's

.:.appropriate recommendation is often effective in direct--ing the program back toward the child's best .intefests',

24

SETTINGS FOR PEDIATRIC SERVICES

The great majority of pediatricians (about20,000 inall) are in general practice with most of the remainingp,000 in pediatric sub-specialties (such as cardiology orneonatology), administration, research and/or teach-ing.2° Pediatricians currently provide medical.care to overtwo-thirds of all children in the United States; theremainder being provided by fani-ilif or general prac-titionerS. Most medical services to developmentally dis-abled children and youth are in primary care officesettings, but other settings have becomelincrgasinglyprominent in the past two decades.

Since the mid-1960's, federally supported ChildDiagnostic Clinics have been staffed by a number of dif-ferent disciplines usually, including a pediatrician. Theseclinics usually have been administered by city, county orstate health departments and generally meet to evaluatereferred children on a weekly, by-weekly or monthlybasis. The pediatrician serving on the team is often ingeneral pediatric practice with a special interest in de-velopmental disabilities. In some such clinics, the pedia-trician is on the full-time staff of the sponsoringhealth department.

A wide variety of speciality clinics serving handicappedchildren are found in teaching hospitals affiliated withthe approximately 120 U.S. medical schools. As men-tioned earlier, these may include newborn intensive carefollow-up clinics, birth defects clinics, genetic/metabolicclinics, school learning problems clinics and others.These clinics are frequently staffed by pediatriciang onthe full-time medical school faculty. Approximately 50medical schools are the sites of university affiliatedfacilities for interdisciplinary training, research and ser-vice in the area of -mental development. The greatmajority of these programs have developmental pediat-rics sub-specialists on their sfaffs. Theircaslqad andreferral network depend on teaching and researchinterests as well as service needs.

The final setting for the provision of pediatric servicesis the school or residential institution. In some states,residential institutions for retarded per-Sons are staffedby full-time pediatricians although the trend is to reducethe number of gsidents in such institutions by returning

26

(Or keeping).thetn in commlinityfacilities..Pediatrit con-.sultants to schools 'are usually either private Practitioners or full-time health' departmtnt or medicalschool staff, members. School-based consultation affordsthe pediatrician the opportuVity to observe the child inthe:leamins environment as ell as to meet more con-veniently with involved educators and related serviceteam members.

Isp-ite of the many opportunities for pediatricians tocontribute to the initial and on-going evaluation ofchildren with developmental disabilities, there areseveral impediments 'currently to `their fuller involve-Ment .on multi-disciplinary or interdisciplinary teams;paiticUlarly at the.communitY level; First, the nature ofpediatric practice is generally brief visits with a relativelylaage.pumber of patients (twenty to thirtY per day i theoffice). In Visits lasting an average of about' enminutes; it is difficult to deal with the complexissues fac-ing handicapped childr.en and their parents except in asuperficial way. Scheduling can be controlled, of course,and as more pediatricians work in group practices flex-ibility is possible, with onemember of the group cover-ing theroutine illnesses and follow-6s while the otherschedules longer appointments fo,r the eValuationandmanagement pf developmentally disabled'patients.

A second.constraint, related to the first, is the difficultyof obtaining adequate compensation foretitne spent inthe care of handicapped. children., Although parentsindicate a willingness to pay for eXtra time of the pedia-

,trician in the management of behavioral or develop-mental problernS,21 often they. are unable to pay. theadditionalcosts of a complex problem. Further, mostprivate insurance companies provide no coverage forphysician tune SPent although they readily pay for °unnecessary laboratory and x-ray studies such as CATscans. Medicaid for,thejndigent patient prpvides as set.fee (usually low) for each visit, thereby encouragingmany brief visits. Overhead .costs in a pediatric office

lange:frorn $30 to $60per, office hour so that the usualconsuitation,fee ($35 to $50 per hour) may leaye the

. physician with a loss; Only. ;by scheduling consultationsat particular times can this problem be overcome. Fund-ingfor.thealtematives of health department or teachinghospital Clinics is alsO in jeopardy.

Nthird'constraint on:general pediatric participation indeVelopniental disabilities team consultation is a fre-_quent lack Of traininCn interdisciplinary diagnosis andmanagement 'during :Medical school and residency. In1979 'a survey of residency prograins22 :indicated thatglthOugh the majority of programs offeled.:training indevelopmental diiabilities, most were elective and.fewwere systematically organized. Dworkin and his -col,leagues" found that 50% of practicing pediatriCians, de-scribed medical school as having been of no value as asource of knowledge 'in developmental pediatritS and20% indicated residency was of no value. In alai-ger sur-vey of 7,600' recent graduates of pediatric residency'programs," over 50% stated that their residencyexperience was insufficient inthe areas of psycho-socialand behavioral problems and over 40% had similar dis-satisfaction in the area of chronic cerebral dysfunctions.Remedial efforts in pediatric education at the medicalstudent, resident, practitioner, and sub-specialist levelare discussed in the following,section.

° °

,PHYSICIAN EDUCATION

increased emphasis on developmental disabilities in...-children and youth' is evident at all levels of physician

edutation,22.23 with : particular recent activity at thePediatric resident, developmental pediatrics fellowship

- and pediatric practitioner.level. The four years Of .medi-cal school generally offer from one to three -mOnths of*pediatric experience for most medical studeryei. ThoSeplanning on pediatrics asa career ay have the oppor-tunity of taking additional elective

rn

ective months in their fourthyear. Fewer. than 50% of medical school 'pediatricdepartments offered training in developmental orhehavioral pediatrics to their students in 1,979.24

Training in pediatrics after medical school requires ,athree-Year residency program, the first of which (for-merly "internship) usually emphasizes :thecareof seriously ill hospitalized infants and children.' The:'second and third years of residency offer more .eXT,perience in ambulatory pediatric care often with one -:month rotations, either required or elective, in. 'de-velopmental and/or behavioral pediatrics.22 For pedia-tricians wishing to 'sub-specialize in developmentalPediatrics, ,one to three yearpost-residency fellowship.:progranis are Offerect.at a nutribet of sites; often as part-of a university:. affiliated facility." 'Pediatricians Who:intend to practice may tame only one year.of fellpvishiptraining whereas, those intending, to continue in aca-,.demic .careers and research take two three years.Once in practice', a wide variety,of continuing education "

:.opportunitiei exist from one two day Courses20, to aOne-month "mini - fellowship" or its equivalent

MedicaCStudenttEdocation in DevelPpmental Dis-abilities. The .content of the fitst two years of medicaschocil focuses on the basic sciences, such as anatomy,physiology, biochemistk -Pathology, -bacteriology andpharmacology.:De,veloprnental psychology .deserves .a

I :

place ainong these basiC sciences, -and behavioral' andphysical disorders (such as eticoPresis',Qr dysmorphie.syndrome)' might be integrated into the 'pathologycurriculum' Experience with normal childien in publicschools alid offers an opportunity to teach the spectrun);jiof cognitive, social and physical development between'.and within age: groups."

The third .and fourth years of medical school are. . devoted to increasing exposure to and independent.:

experience with clinical problems. This is the Oppor- .

tunitY to, teach all future physicians, regardless of theirultirnate specialty,' the .development and behaVioral

7., functioning of 'each child they see, Eachpatient can be abrief developmental, case- study; Senior students con

'spgdalization- in neurologY, .orthOpedicg,chiatry ophthalmolOgy, oforhinolaryngology (ENT) andphysical medici,neand rehabilitation as well aipediatrics.and family medicine should'be encouraged to have elec....tive experience with the interdiSCiP4narY evaluation &pc!management of handicapped children as this Will Makeup a significant prbportion of their ultimate practice:

.c

Pediatric Resident Training in Developmental Dis-abilities. The first year of pediatric residency shouldoffer the opportunity to review the resident's knowledgeand interviewing skillsin developmental and behavioralpediatrics. The core; residency curriculum may beintegrated into the entire three years but is more com-

2'75

monly taught as a "block rotation", full-time assignmentto a developmental or behavioral pediatric service for aone -month period or longer. During the Core rotationthere should be an initial exposure to the evaluation andmanagement of the major handicapping conditions e.g.mental retardation, learning and communication disor,.dens, cerebral palsy and -major psychopathologicalstates. As wide a spectrum: of clinical experience as pos-sible is desirable; not only should the resident beinvolved in the management of children with differentconditions but a range of,ages should also be included.The attitudes, knowledge and clinical skills necessary tocare, for an infant with Down syndrome are totally dif-ferent frorn.those needed for the care of a teenager withthe same condition..

The essential, resources for resident training are theavailability of interested residents and faculty, clinicalopportunities, and supplementary learning oppor-tunities such as lectures, seminars, readings, audio-visual programs and visits to schools, day-care settingsand institutions. An available curriculum in develop-mental pediatrics emphasizing the developmental frame-work, attitudes, knoWledge of handicapping conditions,screening, diagnosis, assessment, interdisciplinary plan-ning, parent informing, management, community ser;vices and controversial issues has been implemented ineight residency programs this year and will be used inseveral additional sites next year."'

Sub-Speciality Training in Developmental Pediat-rics. Fellowships in developmental pediatrics provide anextension of the knowledge and skills introduced duringthe residency years. They are characterized by exten-sive, in-depth clinical experience with a large number ofdevelopmentally disabled children with varying con-dition) and ages." The setting is almost always an inter-disciplinary diagnostic team with faculty from a numberof different:disciplines. The opportunity for longer' termfpllowup (two to three years) further extends the fellow'sunderstanding of fhe natural history and varyingmanagement of each condition.29

Continuing Education for Pediatricians. Because ofthe intense life and death issues characteristic of theclinical experience of pediatric residents, it is often notuntil the pediatrician enters practice that the frequencyand complexity of developmental problems is realized.For that reason pediatric departments and residencytraining programs are often relied on to provide continu-ing education for pediatric practitioners. The content ofsuch teaching is not unique; review of the core residencycurriculum with focus on recent advances and selectedknowledge and skills from areas of the fellowshipcurriculum are offered. What is unique is the setting anddelivery of such a curriculum.

Several formats have been develied. By far the mostcommon Cs the one-to two-day workshop or course.26,"Practitioners- free themselves from practics., respon-sibilities tla devote full-time to such acti5ities. The.limitations;'of cotlIse are that only a Moderate amountofiliformation can be presented in such a short time;and even more importantly, the presentations are didac-ticiandIthe learni stfy passive. There is effective-nss in this methodology, wever, for two reasons: firstthe interest level of practition nd their sense Oi con-.

26

\,fidence in dealing with developmental conditions. areraised, leading them to pursue fur,ther learning throughselected reading. Secondly, they are encouraged to.investigate children in, their practice more thoroughly,thUs allowing them to gain more clinical experirce withdevelopmental disorders. Supervision of such ex-perience is oten limited, but the brief exposure to theworkshop faikilty is often enough to create a consulta-tion linkage which is used subsequently.

Another method of continuing education is for thepractitioner to spend a scheduled period of time as aparticipant on an established interdisciplinary team.Usually a half day a week or two full days a month Wouldbe devoted to such a program. The curriculum in such asetting is rarely well-defined, but there is the opportunityto cover specific objectives sufficiently well to offer theprogram as a "mini-fellowship"." Improved skill in func-tion as a member of an interdisciplinary team is the mostvaluable outcome of such a continuing educationexperience.

RESEARCHResearch in developmental disabilities is an approach

to one of society's most chMenging questions. How canintelligence and competence best be fostered in eachperson? Biological variations offer science uniqueopportunities to unravel normal processes. Further, ashas been mentioned before, the clinical state of the art ofdevelopmental pediatrics, if not in its infancy, has cer-tainly not paised beyond the toddler stage. A host oopportunities for original and substantiating researchaie available to developmental pediatricians and theircolleagues from other disciplines.

An example of the importance of pursuing astuteclinical observation is the rediscovery, about ten yearsago, of the ,fetal alcohol syndrome." Not only has thefinding led to programs to prevent a major cause ofdevelopmental disability, but it has broadened aware-ness of substance abuse in general and its impact. Othermajor research issues concern the relationship between,violence and child-rearing (e.g., exposure to T.V.),screening and assessment of developmental disabilities,dietary and drug influence on the legrning process, andmany others.

OPPORTUNITIES FOR INTERDISCIPLINARYCOOPERATION

A review of the clinical contribution of pediatricians inthe care of developmentally disabled children, as v./4asthe current status of educational and research efforts indevelopmental pediatrics, has presented innumerableopportunities for collaboration between pediatriciansand special educators or colleagues from the related ser-vr irp. disciplines such as occupational, physicati andspeech therapy. In spite of such opportunities, a'st,i.rVeyof maj ©r special ecilucation textbooks carried' out in1979" indicated viAittle said about collaboration be-tween. special edLeafors and medical professionals;most centered only on .specific medical problems ofhandicapped children. Similarly, a review of three majorspecial education journals (The Journal of SpecialEducation,. Exceptional Childrewnd The American

,r;' 9 4

Journal of Orthopsychiatry) from 1970 to 1979,revealed no articles specifically concerned with thecollaboration (e.g. mutual training efforts) or com-munication (e.g. involvement in the team process) be-tween physicians and special educators."

The fact that such collaboration was seldom writtenabout in the special education literature duringthe lastten years does not mean, of course, that it did not occur.Indeed recently, a course for master's level specialeducation students taught by a special educator and apediatrician has been described." There are as wellmany opportunities for special. educators and membersof related service disciplines to teach medical studentsand pediatric residents, particularly in universityaffiliated facilities. Furthermore, over the past two years,a national continuing education course for pediatriciansand other primary care physiciansentitled "New Direc-tions in Care for the Handicapped Child" has beentaught in each state by an instructor team made up of aspecial educator and a pediatrician." In Maine, thephysicians attending the course are asked to invite spe-cial education colleagues (preferably the director of spe-cial etigication in the school system of the community inwhich they practice) to take the course with them. In thismanner, a working relationship can be established asthey participate together in the course.

Cooperation between pediatricians and special edu-cators or others from related disciplines is even more fre-quent in multi-disciplinary or interdisciplinary diagnosticsettings. The past infrequency of mutual trainingexpeOnces has hampered the effective team participa-tion cif pediatricians with members of other disciplines.Impediments to effective interdisciplinary fUnctioninginclude both excessive expectation of the value of thephysician's contribution in some instances and defenseof disciplinary territory with rejection of the pedia-trician's suggestions in others. Developmentally dis-abled children will benefit from a resolution of theseproblems with more effective communication, under-standing and role-definition among the disciplines.

There are several steps necessary to achieve effectiveinterdisciplinary cooperation. Special educators andcolleagues from other disciplines who wish to workmore effectively with medical colleagues should seek apediatrician in their community, agency or universitywith prior training, interest or experience in work withdevelopmentally disabled children. Although there arenotable exceptions, sub-specialty interest and training inthe broad discipline of developmental pediatrics islimited to pediatricians. Consultations with neurologistsor pSychIptrists should be undertaken at the suggestionof or with the support of the pediatric member of theteam.

Once a pediatric colleague is selected with whom toteach or work, establishment of an effective team-working relationship must be undertaken. Educatorsand members of related service disciplines areoften sur-prised that pediatricians turn out to be neit4i arrogantin their omniscience nor totally ignorant of developmentaland educational issues 'he discovery of a pediatrician'shumanness and limited but valuable contribution occursthrough spending time together planning, learning,wotking, talking and;eVen playing, As in any group work,issifds of age, sex, race and authority must be confrontedopenly and sensitively.

CONCLUSIONS

The past two decades have seen rap d advances inpediatricians' involvement with and coritn, ution to thecare of developmentally disabled chilcifen and youth.Interdisciplinary efforts in prevention, screening,diagnosis, assessment and manageme4of children withdisabilities as well as joint educational and researchefforts are occurring with greater frequency. The sub-specialty of developmental pediatrics is receivingincreased emphasis within medical apd pediatric educa-tion and is becoming more clearly defined as a partici-pant in interdisciplinary research: The future forproductive alliances between health and educationaldisciplines appears bright, particularly if the pastimpediments to effective collaboration between pedia-tricians and their colleagues in. Special education andrelated se ce disciplines are confronted sensitively andovercome.

REFERENCES1. Vaughan, V,C., III: The field of pediatrics. In Vaughan, VC., III,

McKay, R.J., and Behrman. R.E.: Nelson Textbrook of Pediatrics.11th ed. Philadelphia, W.B. 'Saunders Co., 1979

2. de la Cruz, F.: Pediatric caren'd training: a paradox? In Tjossem,T. D. (ed.): Intervention Strategies for High Risk Infants and -Young Children. Baltimore. University Park Press, 1976.

F3. Sells, C.J., and Bennett, .C.: Prevention of mental retardation:the role of medicine. Am.tSJ! Mental Deficiency. 82:117.129,1977.

4. Council on Scientific Affairs. A.M.A.: Electronic Fetal Monitoring.J.A.M.A. 246:2370.2373, 1981.

5. Klaus, M.H., and Kennell, J.H.: Maternal-Infant Bonding; TheImpact of Early Sepatation or Loss on Family Development. St,Louis, C.V. Mosby, :1,976.

6. Gray, J.D., Cutler. C.A., Dean, J.G., and Kempe. C.H.: Predictionand prevention of child abuse and neglect. Child Abuse andNeglect International Journal. '1:1.14, 1977.

7. Bennett, F.C.: The pediatrician and the interdisciplinary process.Exceptional Q4-iildren. 48:306-314. 1982.

8. Smith, R.D.: Pe use of developmental screening 'tests byprimary-care Physicians. J. Pediat. 93:524.527, 1978.

9. Frankenburgy.,W.K., Fandal. A.W., Sciarillo, W., and Burgess, D.:The newly abbreviated and revised Denver DevelopmentScreening Test. J. Pediat. 99:995-999. 1981.

10. Frankenburg, W.K., Dodds, J.B., Fandal, A.W., Kazuk, E., andCohrs, ME: Denver Developmental Screening Test: ReferenceManual. Denver, U. of Colorado Med. Center. 1975.

11. Frankeilriurg, W.K., Camp, B.W., and Van Natta. P.A.: Validity ofthe Denver Developmental Screening Test. Child Dev. 42:475,,1971.

12. Camp. B.W. , van Doominck, W.J., Frankenburg, W.K., and Lampe,J.M.: Preschool developmental testing in prediction of schoolproblems. Clin. Pediat. 16:25.7, 1977.

13. Bricker, D., Sheehan. R., and Littman, D.: Early Intervention: APlan for Evaluating Program Impact. WESTAR Series Paper#10. Monmouth, Oregon. WESTAR, 1981.

14. ' Levine, M.D.: The child with school problems: an analysis ofphysician participation. Exceptional Children. 48:296.304,1982.

15.. Levine. M.D., Oberklaid, F., Ferb, T.E.. Hanson, M.A., Palfrey,J.S., and Aufseeser, C.L: The pediatric examination of educationalreadiness: validation of an extended observation procedure.Pediatrics 66:341.349, 1980.'1.: N

16. Meltzer. L., Levine, M.D., ' Palfrey; J.. Aufseeser, C., andOberklaid. F.: Evaluation of a multidimensional assessmentpro-cedure for preschool children. J. of Dev. and Behay. Pediat. 2:67-73, 1981.

17. Dworkin, P.H., Shonkoff, J.P., Leviton, A.. and Levine, m.b.: Train-ing in developmental pediatrics. Am. J. Dis. Child. 133:709-712, 1979.

18. Howard, J.: The role of the pediatrician with younggxceptionalchildren and their families. Exceptional Children. 48:316-322,

, 1982.

2729

19. Wolraich, M.L.: Communication between physicians and parentsof handicapped children, Exceptional Children. 48:324.329,1982.

20. Morgan, B.C.: Projecting physician requirements for child healthtare - 1990. Pediatrics 69:150-158, 1982.

21. ,The Task Force on Pediatric Education. The Future of PediatricEducation. Evanston, II., American Academy of Pediatrics,1978.

22. Guralnick, J.J., Richardson, H.B., Jr., and Heiser, K.E.: Acurriculum in Nandicapping conditions for pediatric residents'Exceptional Children. 48:338-346, 1982.

23. Guralnick, J.J., Richardson, H.B., Jr., and Kutner, D.R.: Pediatriceducation and the development of exceptional children. InGuralnick, M.J., and Richardson, H.R., Jr., (Eds.): PediatricEducation and the Needs of Exceptional Children. Baltimore,University Park Press, 1980.

24 Richardson, H.B., Jr., and Guralnick, M.J.: Physician education indevelopmental-behavior pediatrics. In Levine, M.D., Carey, W.B.,Crocker. A.C.. and Gross, R.T. (Eds.): Developmental-BehavioralPediatrics. Philadelphia, W.B. Saunders Co., (to be published).

25 Capute. A.M., and Accardo, P.J.: A fellowship program on theneeds of exceptional children. In Guralnick, M.J., and Richard-son. H.B., Jr. (Eds.): Pediatric Education and the Needs of Excep-tional Children. Baltimore, University Park Press, 1980.

26. Powers. J.T.. and Healy A.: Inservice training for physicians serv-ing handicapped children. Exceptional Children. 48:332.336,1982.

28

27. Vanderpool, N.A., and Parcel, G.S.: Interacting with children inelementary schools: an effective approach to teaching childdevelopment. J. Med. Ed. 54:418-420, 1979.

28. Bennett, Heiser, K., Richardson, H.B., Jr., and Guralnick,M.J.: A Curriculum in Developmental Pediatrics for Residents.In preparation.

29. Delaney, D.W., Bartram, J.B., Olmsted, R.W., and Copps, S.C.:Curriculum in handicapping conditions: Implications for residen-cy, fellowship, and continuing education of pediatricians. In ,Gurlanick, M.J., and Richardson, H.B., Jr., (Eds.): PediatricEducation and the Needs of Exceptional Children. Baltimore,University Park Press, 1980.

30. Frankenburg W.K., and Cohrs, M.E.: Continuing education ofphysicians in developmental diagnosis. In Guralnick, M.J., andRichardson, H.B., Jr., (Eds.): Pediatric Education and the Needsof Exceptional Children. Baltimore, University Park Press,1980.

31. Jones, KL., Smith, D.W., Ulleland, C.N., and Streissguth, A.P.:Pattern of malformation in offsprIng of chronic alcoholicmothers. Lancet, 1:1267-1271, 1973.

32. Levine, M.D., Cary, W.B., Crocker, A.C., and Gross, R.T., (Eds.):Developmental-Behavioral Pediatrics. Philadelphia, W.B. SaundersCo. (to be published).

33. Freund, J.H., Casey, P.H., and Bradley, R.H.: A special educationcourse with pediatric caliponents. Exceptional Children. 48:348-351, 1982.

*4.

30

A RESPONSE TO THE STATE OF THE ART

Two formal responses to the state of the art papers were presented. The first was delivered by Ethan Ellisa consumer-advocate and the second by Jayn Wittenmeyer, a parent.

Meeting the'Needs of Children andYoung People With Disabilities:A Consumer View of the State of the Art

Ethan B. Ellis, M.A.

Trained as a vocational rehabilitation counselor,Ethan B. Ellis directed vocatival services and managed asheltered workshop at Bird S. Coler Hospital in NewYork City for five years. In the early sixties, hedeveloped vocational and social studies curricula, forhigh school dropouts at a prototype antipoverty pro-gram on the Lower East Side and later directed theS(ate of New Jersey's technical assistance unit for 0E0funded community organizations. In 1976, he joinedthe staff of the Office of Advocacy for the Developmen-tally Disabled at the New Jersey Department of thePublic Advocate, and now serves as Deputy Director ofthat program. He also serves as President of theNational Association of Protection and Advocacy Sys-tems and current faculty workshop presenter for theAmerican So'ciety of Allied Health Projessions' AlliedHealth Child-Find and Advocacy Project. I

P.L. 94-142 and the changes in social policy which led.to its enactment ate causing basic and far-reachingchanges in the way in which children with disabilities areeducated, in the kind of health services they receive, andin the manner in which all of those services aredelivered. It is fitting that those who prepare the pro-fessionals to deliver those services gather to discuss theimpact. of these changes on their curricula. It is fitting,and quite in keeping with the forces which broughtabout these changes in social policy, that such a discus-sion have input from the consumers those services aredesigned to benefit. The sponsors of this discussion areto be commended for seeking thit input.

The widening bald spot on the top of my head and the-, gray in my. beard belie my ability to provide that input, -*

directly. Its proper authors sit in fourth grade classroomstoday, having entered school when P.L. 94-142 was firstimplemented in October, 1977. As he and she progressthrough the education and health service systems whichthat law made available to them and gain the wisdom toarticulate their impact, I hope that you will consult withthem more directly. In the meantime, let me try to act astheir surrogate, extrapolating from my experience asone who grew up with a disability at an earlier time andas one who now serves as an advocate for them andtheir parents.

The papers presented by Hickey, Reynolds, andRichardson remind us once again of what sweepingchanges P.L. 94-142 called for in the delivery of *educa-tion and health services to children with disabilities.

They also remind us of how unprepared the deliverers ofthose services were to provide them to the degree and inthe new settings which the law rather suddenlyrequired.

It is clear from what they write that each professioninvolved in those interwoven delivery systems has hadto rethink its' role in those systems. They make it equallyclear that this redefinition of roles has just'begun and willtake sometime to complete. They give us a glimpse of acomplex process which begins at the work site, is filteredthrough informal discussions with colleagues, becomesformalized in the investigations of professional societiesand academia, and finally results in modification of thecurricula of classroom and experiential instruction. Themultiplicity of feedback loops imbedded in that processare Shard to trace, le alone calculate.

They also accurately portray the impact which thelaw's requirement for teamwork among professionalsfrom different disciplines has had on each discipline'sefforts to red fine its role. They describe how that team-work has cauled communication probl s across dis-ciplines. They touch upon the ways n which thesecommunication problems are complic ted by interdis -.

ciplinary rivalries and by the politi of traditionalhierarchies within the service delivery ystems whichmay no longer apply but which still leave.their marksor at least their scars. They deicribe several pilot pro-grams which address these problems in the field andseveral efforts to fertilize the curricula in the classroomwith. the knowledge gained from them.

It is useful to the professional advocate to be remindedof the sweeping changes required by P.L. 94-142 and tobe exposed to the complex processes by which theseintertwined delivery systems of health and education are .attempting to accommodate themselves to those changes.We ordinarly see only the delays and dysfunctions in thedelivery systems themselves. We are seldom exposed tothe processes which cause them or the steps being takento address them. To us, they appear as personal failureson the part of the individual educator or health pro-fessional or as citimb.lecalcitrance by an impenetrablesystem.

This knowledge is useful, however, only if it assists usin understanding how to make those systems work moreeffectively and in diverting the energy which might bewasted in anger at the persons involved. It should notstand as an excuse to lessen our demands for the ser-vices which the children we 'represent need now or todeflect us from bushing the educators of professionals toeffect the changes in the training and retraining requiredto improve those service delivery systems and makethem more responsive more quickly.

By and large, I found the problems identified in thesepresentations valid and interesting. They checked out

against my experiences with the educators and healthprofessionals who share them. I found my interestdrawn and held by the solutions the authors proposedfor them.

This seduction suddenly stopped when I realized thatnone of the identified problems dealt with the re-lationship between the professional and the child withthe disability, him- or herself. While a discussion ofchanging interdisciplinary roles and the communicationproblems which may result from them is legitimate inthis forum, it is not the only relationship which P.L. 94-142 and the consumer movement by persons with dis-abilities has changed and will continue to change' intothe foreseeable future.

It is mythesis that the introduction of great numbers ofchildren with disabilities into America's classroomsrequires that the educators who teach then ond the

. health professionals.who provide them with t15'grapiesreexamine the impact which they can and should haveon the lives of these children. Let me expand on thatthought for the balance of this paper.'

There are Only a few basic themes which run throughthe course of every human life, beginning in infancy and

e.leing played and replayed in different keys throughoute.ch person's lifetime. One of those basic themeS maybe stated as the question: "How much control can I exertover my physical and social environments and how can Iexert it?" Each of us has asked this question since we

iwere in o r cribs and we continue to ask it now no matterwhat our ges.it gets asked more often in infancy andchildhood and the answers received then tend to limitthe contexts in which it will be asked later, tend to setlimits on the asker's perception of his or her own abilityto control those twin environments_ and thus, on his orher potential.

Infants and childrgi with disabilities ask, that samequestion, although their ability to control either theirphysical or social environment may be severely cir-cumscriVed by their disabilities. In the past, societyshowed little concern as to how their question wasanswered since it was primarily concerned with theirmaintenance, not with their abilities or potential.. Poten-tial and abilities have limited, if any, meaning for a per-son who is to be kept in a dependent state.,

The movement for independence for persons withdisabilities has legitimated that question for such per-sons. P.L 94-142 has specifically legitimated that ques-tion fof children with disabilities.

Because that question is asked most often itrchildhaod,the 'educators who teach children with disabilities, andthe physicians and other health professionals who treattheir disabilities have an inordinately large role in shap-ing the answers to it. Since the question is seldom askeddirectly or consciously; educators and health pro-fessionals may be unaware that it is being asked at,all orthat they are answering it.

From what I can tell, there is very little in their pro-fessional training .which specifically prepares them toanswer it, to structure their experiences so that theiranswers will become more cogent as that -experienceaccumulates, or to make them aware that their mostimportant interaction with the disabled child and his orher family is about the business of answering thatquestion.

Because the question is so crucial to the therapeutic

and educational relationship, let me restate it, identifysome of the critical junctures at which it is asked, andth n-examine some of the consequences of recognizinghov critical it is.

he question: "How much control can I exert over myphysical and social environments and how can I exertit?"

It is generally first asked on behalf of the child,by itsparents when they first learn of his or her disability. It isoften phrased in terms of limits. "What will my child beable to do?", meaning what won't my child be able to do?The question is most often asked of physicians initiallywhen they bring the news of a newly discovered disabili-ty, but the questio C Ps also repeated in different forms tomost of the health' rofessionals and educators-Who seethe parer duting the child's early years.

Unfortunately, the question in that form is asunanswerable as it is legitimate. Few if any -can predictthe limitations that a disability will have on the life of ayoungster at the point of disability or for quite some timethereafter. It is a question that the child will spend alifetime answering and any answer given then can onlylimit the parents' perception of, the child's potential andtherefore limit their willingness .to allow him or her toexplore that potential fully.

...fr. At the same time, that child with a disability, let us callhim John, has begun to collect his own answers to thequestion. The answers all children get are mixed and fullof contradictions. The answers which Johu gets aremore mixed than most. His attempts to control his physi-cal and social environments trip over his physical ormental limitations. John imitates what others do to.con-trol their environments and the imitation often fails.

It is in this state of honest but still unselfconscious con-, fusion that John is led into the therapeutic setting and

the classroom. These twin environments, the classroomand the gym occupational therapy room/speech therapyroom are theoretically jusrwhat he's been looking for,places where he can test the current limits of his controlover his physical and social environment and sys-tematically expand' his control over both.

All too often they are not. They are places where he isput through a series of physical and mental manipulationswhich are designed to help him reach his objective buthe doesn't know it. Nobody bothers to tell him. As aresult, what happens in those rooms remain for John aseries of mechanical irnanipulations. He may see thebenefit of them in retrospect. While they are going on, heis Irkely to remain a passive participant in them.

I suggest that the professionals who use these rooms'must redefine them as places where the child with a dis-ability learns how much control he exerts over his physi-cal and social environment and must redefine their rolesin terms of their responsibility to assist that child in learn-ing the limits of his current control and in learning how toexpand that control. To do that, they must also redefinewhat goes on in that room in terms of learning andexpanding that control. Most ,importantly, they mustmake those redefinitions in terms that are meaningful tothe child, in tterms which assure him that he and theteacher/therapist are engaged in a search for the answerto the same questionhis question.

30

There is a cogent reason for suggesting this redefini-tion which grows directly out of the nature of disability -

but one which may not be apparent at first glance. Aside

3?

from a curiosity about their minds and bodies whichintensifies from time to time as they develop, nonhandicapped children take their minds and bodies more orless for granted. The child with a disability does not. Herather consistently questions how and whether they willbe allies in his attempt to control his environment. As hegrows oldeifitand they fail him in pliblic situations, thatquestioning takes on social as'well as personal meaningand intensifies.

This suggests that therapeutic and educational processes must not only assist the child with a disability inlearning to use his mind and body to control his environ-ment, they must also assist him in understanding howthose toolS work in terms that he can understand. I amsurprised by how little we reach children with disabilitiesboth about those disabilities and about how the rest oftheir human apparatus works,when I consider how fier-cely they will contend with that apparatus as theygrow up.

There are some advantages to the redefinitions I amrecommending which accrue to the child with a disabili-ty, his teachers and therapists, and his parents. Ifimplemented, they would engage the child with a dis-ability as an active participant in educational andtherapeutic processgs which make sense to him in termsof his own needs. BV giving him an active role in his owndevelopment and by defining that development in terms'of expanded control over his environment, they better

f

prepare him to live more independently as an adult.These redefinitions unify the separate skills and

approaches of the various professionals who treat that'child by setting a commonly defined goal for theirefforts, Hopefully, this will provide a focus for theirinteraction and simplify their communication with oneanother. It also may provide a framework in which toredefine their own roles more effectively.

In 'redefining the educational and therapeutic pro -cesses as a means by which a child with as disability learnsand expands his control over his environment, parentsare given a role which is more intelligible to them. Theycan more easily evaluate specific educational andtherapeutic objectives in terms of that goal.and thus par-ticipate mere effectively in setting, and achievingthose objectives.

In suggesting this redefinition of the educational andtherapeutic process in terms of the child with a disabilityand his need to control his environment, I haveborrowed from many schools of thought. In order toavoid injustice to any of them, I have dressed up thoseborrowings in language ordinarily foreign to them. It isalso not the language commonly spoken by eithereducators or health,professionals. I have done this self-consciously in the hopes that you will look afresh at theideas the language contains . . . and carry them to con-clusions far beyond those set forth here.

3133

Meeting the Needs of Childrenand Youth with Disabilities:A Parent's View of the State of the Art

Jayn Wittenmyer

An active advocate for persons with disabilities, JaynWittenmyer serves as Executive Director for the Wis-consin Council on Developmental Disabilities. Herprimary interest is obtaining services for handicappedpersons through the political and administrative arena.A former teacher, Jayn Wittenmyer is parent to threedaughters. one of whom is handicapped. It is because ofher interest in securing qieaningful services for herdaughter that Jayn becaine involved in the volunteerwork of the Association for Retarded Citizens. She hashad local, state and national involvement in the volun-teer movement.

Jayn also serves as a faculty workshop presenter forthe American Society of Allied Health Professions'Allied Hedlth Child-Find and Advocacy Project.

Introduction-

My paper could be titled "To Be or Not To Be," as thepast nineteen years have been a series of successes (tobe) and struggles (not to be) as our daughter Amy hasmade her way through the medical, allied health andeducational systems.

During my years as Amy's case manager, and as anadvocate at the local, state and national levels for otherpeople who are disabled,1 have become more and moreaware of one missing piece of the system puzzle. In theState of the Art papers from your notable colleagues, itwas evident also. That piece relates to pre-service train-ing education for professionals before they are in thecommunity and working with persons who are disabledand their families.

Before I react specifically to the three state of the artpresentations, I would like to share with you a shortstory.

Last week I received a frantic call from a foster par-ent caring for a child who is severely retarded and hasa congential heart defect. The previous week the child ,

started having breathing problems and the fosterparents rushed her to the hospital. At the hospital,oxygen was administered and within'a couple of daysthe child responded and was sent home. The doctor toldthe foster parents that if this should reoccur, the childshould not be brought to the hospital but should be leftto die. The foster parents talked to the nurse and weretold they could do nothing. They talked to their caseworker and again were told thdy could do nothing. Theytalked to a friend who was a judge and again were told

32

that if the doctor told them not to bring the child to thehospital, they must comply. The call to me was a lastresort.

Needless to say I think there can be another course forthe foster parents and the child they have in theircustody.

I am sure this story raises many questions in yourmind. Some are simple, such ashow much informa-tion do the foster parents have about the medical/healthcondition of the child? What is the medical prognosisand what is appropriate health care? Is there anotherdoctor in the town where these folks live? ,

Other questions are more complex: What is society'sresponsibility to a child with serious medical problems?What are the moral and ethical rights of the child? Whogets to play God?

My use of this 1982 story as the start of my reaction tothe medical, allied health and education papers is oneway of saying, "Yes, we've come a long way because ofP.L. 94-142 and other significant state and federallegislation, but we haven't really arrived." One majorreasonwe cannot legislate a change in attitude.

Reaction in Pediatric MedicineSurprisingly, I agree with most of Dr. Richardson's

analysis of the pediatricians' contributions, and, in par-ticular, his reflections on the impediments to multi-disciplinary teams and the limitations in physicianeddeation.

My, remarks reflect across the physician populationbecause most parents with a child who is handicappedmustrelate fo a variety of physicians. Our first contact,and usually the bearer of "bad" news, is the obstetricianor family ptactitionerthat is, unless he "passes thebuck" to the pediatrician or specialist.

Our range of contact with physicians for Amy hasincluded her pediatrician, who went into ad.blescentmedicine as his "kids" became teenagers; an oph-thalmologist, for her severe near-sightedness; anorthopedist, due to Amy's developing scoliosis and lor-dosis which required a Milwaukee brace for two years;her dentist for continuous preventive care complicatedby several medications; and currently we have added acardiologist due to the increasing severity of Amy's con;gential heart condition.

As I've analyzed my feelings about the medical profes-sion, I find what I guess is only naturalthat I bear someresentment toward the person who mu§t tell me some-thing negative about someone I love very much. In spiteof my initial and sometimes continuing negative feelings, Imust say that Amy has had some great, caringphysicians over the pastnineteen and a half years. Shealso has had some whose bedside manne /left somethingto be desired.

34

As Dr. Rithardson noted, in physician education, Verylittle pre-training time is spent on developmental 'andbehavioral functioning of children.

My recommendations for*ysician education are: (1)to increase training fOr all medical students in the follow-ing areas: (a) relating to children with developmentalproblems, (b) working with parents of children andadults with handicapping conditions, (c) working withsiblings of children with disabilities; (2) to raise the levelof understanding between physicians and related pro-fessionals, particularly allied health and education; (3) tocontinue research at all levels on the prevention of handi-capping conditions, and (4) to continue to update pre-training and inservice training to include the latestprograms, resources and medical techniques for work-

ing with persons with handicaps and their families.

Reaction in Allied HealthHere, again, I agree with the analysis on Allied Health

as presented by Ms. Hickey. The five major areas of re-sponsibilities that have emerged from the Regional'Workshops of the Allied Health Child-Find andAdvocacy Project could be incorporated into pre-training curricula and/or continuing education for alliedhealth professionals. I have thoroughly enjoyed theopportunity toparticipate in the Project and have gainedmuch insight awl knowledge from the broad array ofprofessionals wliOhave attended.

Our family experience with allied professionals hasbeen varied also, as Amy has related to psychologists,nurses, social workers, occupational and physicaltherapists, adaptive physical education personnel, X-rayand laboratory technicians, and others. These experi-ences have produced both good and bad effects. Lucki-ly, through continued communication among myself,Amy, her two sisters, and her father, we have been ableto weather the storm.

My recommendation for the allied health pre-trainingcurricula-is to ,incorporate the findings and summariesfrom the Regional Workshops of the Child-Find andAdvocacy Project.

Specifically, the allied health pre-training shouldinclude:

1. Assistance in communicating effectively withchildren and youth who are disabled andwith theirfamilies.

2. Encouragement to recognize, accept and imple-rhent professional responsibilities- in identifying,referring and advocating for youngsters who aredisabled and for their families.

3. Assistance in anderstanding efforts of other pro-fessionals in health, education and relatedservice fields.

4. Assistance in understanding state and federallegislation in order to assist families.

5. Encouragement to develop and/or modify edu-cational standards to create access rather thanbarriers to persons who are disabled and wish toenter the health, education or related fields.

Reaction in EducationDr: Reynolds' paper on the State of the Art in Educa-

tion was particularly interesting to me as I have spent the

last twelve years working to assure that Amy9has anappropriate education. Nine of those years were spentconvincing the school system that she could learn in thesame building as he younger sister Adriene. I wasn'table to get her in the, same building with ,tier oldersister Andrea.

We moved from a rural area of Indiana to Wisconsinto provide Any with what we perceived to be bettereducational services. In-our area of Indiana, Amy wasn'tallowed in a school building. In Madison, children whowere moderately to severely retarded were allowed intocity schools, even though the children were segregated.However, when we enrolled Amy, we found that all isnot always greener on the other side of the street. As Dr.Reynolds stated in the beginning of his presentation, "asmall group of parents" in Madison got together andstarted working with the school administration. I

appeared so frequently before the school board that theSuperintendent asked who I was in hopes that I was oneof his teachers aid could fire me,..

Mandatory special education legislation was pasSed inWisconsin the year before P.L. 94-142, and as stated byDr. Reynolds, many children with handicapping con-ditions have been provided educational opportunitiesmany of us parents thought we would never see.

In addition to a special eciaation teacher, Amy hasworked with language development specialists, a mobilityspecialist, pre-vocational and vocational counselors,daily living coordinators, and numerous others. TheIndividual Educational Plan (IEP) with the multi-disciplinary team (M-team) can work. What makes the

, process work? The key link is a parent who acts as advo-cate and case manager and who consistently makes surethat the educational and medical needs of a son ordaughter are being met. One thing I learned from work-ing with professionals over the years is that we all areable to leam if we all learn to listen and com-municate.

SummaryI shifted into my summary section with that last phrase

and I think it bears repeating. The most important pointyou as trainers of professionals can teach to yourstudents, no matter what area of the human servicesfield they are entering, is to LISTEN. The one complaintI hear the most from parents, family members and per-sons with handicapping conditions is that the pro-fessional didn't jisten, didn't appear to hear what I said,didn't' pay any attention to what I want for my child.

Second, encourage more information in pre-trainingcurriculum about handicapping conditions and avail-able resources.

Next, encourage and support discussions about howto talk to parents, siblings, children and adults who., aredisabled and other family members.

Fourth, encourage cross-discipline knowledge andcommunication.

Last, support and encourage research and continuedlearning of new techniques in working with children withhandicaps. Medical research has done a tremendous jobof developing life-Saving techniques. We have trauma,centers with highly technical staff who get to the scene ofan accident quickly. Two specific examples come tomind: the teenager in a car accident with severe head

33 35

injuries or the two-year old who falls in the backyardswimming pool. We know how to 'revive or sustain life.However, we have not done adequate research into thesocial and personal resources these children and theirfamilies need. The number of individuals in these twocategories is increasing at slarming rates, and the alliedhealth or educational professionals are not prepared forthe kinds of problems these.persons and their familiesare experiencing.

111

34

In conclusion, let me say that with early identification,coordination among professions, communication \andcooperation with parents, dollars for 'resources andresearch to continue learning and preventior4 we couldmake this a better world for our children and ourchildren's children.

36

COOPERATIVE PROGRAM INITIATIVES

The following summarizes three cpncurrent sessions presented to Forum participants as case studies of collaborativeefforts. Summaries of additional collaborative efforts follow.

The Role of InterinstitutionalRelationships in Responding to the

ik Needs of America's Handicapped:A Model

Keith D. Blayney, Ph.D.Janice Hawkins, M.A.

Dr. Keith D. Blayney is Dean ofiand Mrs. Janice Haw-kins is a faculty member in the School of Communityand Allied Health, University of Alabama in Bir-mingham, Birmingham, Alabama.

Administrators, teachers, parents and Others respons-ible for the provision of services. to handicappedstudents recognize the need for inter-agency com-munication and cooperation. If services are to beintegrated into an effective continuum, an effort must bebegun to organize and promote programs throughoutthe states to serve a wide spectrum of handicappedindividuals. In the ,absence of 'base funding to provide'stability for this continuum of services, the, quality anddegree of programming is attainable only throughagency coopeiation.

One example that best characterizes what is possiblethrough interinstitutional cooperation isthe relationshipshared by the School of Community and Allied Health(SCAH), University of Alabama in Birmingham (UAB),and the Alabama Institute, for Deaf and Blind (AIDB).

SCAH's first major involvement on behalf of thehandicapped came as a direct result of a multi-yeargrant fun'ded by the Bureau 'of Health Professions in1976. The purpose of the project was to integrate hear-ing and visually impaired students into some of its pro-grams.- For the first time allied health programs,traditionally closed to the majority' of_handicappedstudents, were offered ',as potential training oppor-tunities for the sensory impaired. The objective of thegrant was to identify problems and obstacles 'whichmight thwart enrollment and to identify solutionswhereby sensory impaired students could function inthese programs. During the term of the project, 23'students were enrolled in .the technical and clinicalphases of allied health programs at SCAH. Of that num-ber, 21 were considered to have severe to moderatevisual or hearing problems. Ten of these 23 students_ultimately graduated from the programs anpl are present-ly employed in their respective fields. Fiv students arein the process of completing their clinical training andwill graduate within the next year. Eight studentsdropped from the program due to health problems, per-sonal problems, academic problems, or a transfer toother institutions.

Of the ten graduates, six had hearing losses, four hadvisual impairments. These ten graduates finished in

eight different programs. Eight students received.Associate. Degrees and two have received Master'sDegrees. The five students presently enrolled in technical clinical training are exploring three additional areasOf study. Thus, data collection on the total fifteenstudents relates to eleven different allied health pro-grams. It should be noted that ALL the students whocompleted the programs are working in their re-spective fields.

Lessons learned froth this experience include thefollowing:

1. Reliable and well informed referral sources are .imperative.

2. Counseling and career exploration with the prospec-.0 tive student should take place as early as possible.

This can best be accomplished through pro=fessional services offered by personnel trained inrehabilitation counseling and through on-site clini-cal experience.

3. The Allied Health Program Directors teachinghandicapped students need support :and 'en-couragement at all levels, but particularly at theadministrative level. Also, interaction with success-ful handicapped persons is valuable as the Pro-gram D,irectors experience attitudinal changesregarding the ability of handicapped persons.

4. No student, whether handicapped or not, can doeverything well. The handicapped' studerit shouldbe given the ,opportunity to try rather thanautomatically excluded due to the often falseassumptidn that he or she cannot succeed intraining.

5. The identification of as many resources as possiblefor faculty and students on the local and nationallevel must be accomplished.

6. Occasionally, handicapped students may require,additiortal time for course cdmpletion.

7. Students who. are successful in Mainstreamed,environments, or the most part, demonstratefunctional independence, good personal skills,'resourcefulness, initiative and 'persiitence.

In the process of grant development and in the recruit-ment of students, a cooperative relationship was .established between the School of. Community:andAllied Health and the Alabama Institute for Deaf andBlind (AIDB).

Th4AIDB is located in Talladega, Alabama, approx-imately miles from Birmingham, and is one of theworld's most comprehensive facilities serving the deaf,blind and deaf-blind multihandicapped from birththrough age 65. The nature of the Institute is such tha,tconsiderable attention is focused on the health aspectsof the various populations served,. A number ofinterinstitutional relationships exit between the.Institute and the UAB .Medical Center. Perhaps, theoldest relationship is with the School of Optometry.

353 7

Through this arrangement, examination services as wellas low-vision services and training are offered tostudents and blind employees of the Institute. This pro-gram has served to benefit both student interns at theSchool of Optometry and the students and blindemployees of the Institute through service delivery.

Initial interinstitutional efforts with the School ofCommunity and Allied Health included the delivery ofstaff development programs by faculty of SCAH for thepurpose of upgrading AIDB houseparents. The goal ofthis staff development program was to provide intensive .

training in' areas which would better equip houseparentsto perform their jobs. To accomplish this goal, SCAHfaculty taught a variety of ctourses, including an orienta-tion to occupational therapy (OT), physical therapy (PT),and family relationships. The program culmin'ated in theawarding of certificates of completion to the house-

. parents by the School of Community and AlliedHealth.

The next phase of SCAH/A1DB involvement was acomprehensive evaluation of AIDB programs by SCAH'sOT and PT faculties, followed by an indepth evaluation

.

by SCAH's Nutritional Sciences Department. The work-ing relationship between the School of Community and

a

Allied Health, UAB, and the Alabama Institute for Deafand Blipd holds great promise for each partner in thiscollaborative process. For SCAH, student interns havethe benefit of training with a student ,gtopulation that isunique. For the Institute, the ability to expand servicesfor its unique populations is desirable and, in fact,necessary.

The role of interinstitutional relationships in meetingthe needs of the handicapped in future years willdeserve increased attention. Due to funding constraints,coupled with a need to reduce unnecessary duplicationwhile expanding_ resources, it is felt that Alabama'sinterinstitutional consortia offers a viable and valuableexample which could be replicated at comparableinstitutions located throughout the ,United States.

Institutions such as the Alabama Institute for Deaf andBlind recognize all too clearly that they must avail them-selves of a "critical mass" of resources, such as thosewhich exist at SCAN,. in order to assure comprehensiveand continuous availability of services required in serv-ing handicapped students. Shared relationships proveto be mutually satisfactory and mutually beneficial;hence,the watchword of the future will be the ability to "capital-ize through collaboration."

36

Multiclinic: .An. InterdisciplinaryTeani.Approach

Clyde R. Willis, Ph.D. ,

Dr, Clyde R. Willis is Director for the CentertphHUman Services at Western Michigan University inKalarpazOo, Michigan.

Clinical diagnosis of children and youth with multiplehandicaps has been improved significantly throughinterdisciplinary activities. While many service programshave contributed to this trend, our clinical education andtraining programs failed to keep pace. Academic pro-grams, lumbering under policies that tend to resistchange, arefrequendy protective of disciplinary bounda-ries; in many, team approaches are not popular andoften rejected -as part of a clinical student's basic..curriculum. TO adequately meet the needs of childrenand youth with handicapping conditions or chronicillnesses, our academic programs must emphasize more 1strongly the special training needed for team care.Innovative approaches to clinical teaching must beexplored.

One such apprOacti is Western Michigan University'sMULTICLINIC. This interdisciplinary diagnostic clinicfor multiply handicaPPed.individUals was initiated morethan a decade ago thelOarnpus in Kalamazoo. Thispresentation will.VArhari,20 the .cleVelopment of theMULTICLINIC atterript:tozanaktie'some of the

;possible reasons for .its- success. : r";."Western Michigarl'UniverSity'as a' long and dis-

tinguished history as a institutibri outstandiqgclinical prograMS, Its speech language and hearing pro-gram and its oCcupational therapy prograrnwere amongthe first of theirkind in the Country...Both haVe inter-national reiitations. In addition, Western's programs inblind rehabilitation, reading disabilities and psychologyare exceptional. New programs, for physician assistants,music therapists, and SpeCiaC educators also enjoy astrong clinical:teputation, it may also be important topoint out that Western has, no medical school.

In 1972;..ahandfulbf faCulty from st5me of these pro-grams met to, discuss Ways that cross- disciplinary clinicalteaching might be :irnproved at Western. Team-taughtcourses and other strategies had been tried in the past.All met with thesaitie fate:. .disinterest, nonsupport andelimination. A new approach:, would have to be faculty-supported, cost- .effective 'anti clinically effective. Thedecision was made to utilize television. MULTICLINICwas born. ,

Each month.: clieht with multiple handicaps wasselected from the clinical pools of themarious programs.The faculty, all VOlunteer§, would meet at lunch to dis-cUss, tlie case' and tO.Plan a two-hour diagnoStic evalua-

. would be televised. Emphasis would be placed

on those clinical activities most important to the students'whci. would be watching. FolloWing the television' pro-duction, faculty would be available to students for a dis-cussion of the clinical proceedings and to answer

?-questions.. The experiment was an immediate success. Students

Were impressed by the obserVation of not only their ownfaculty, but of faculty from other health and human service clinical programs; the adMinistration was impressedby the fact that the activity had been initiated by thefaculty at virtually no additional cost to the institution;clients and their parents reacted favorably to the comprehensive, interdisciplinary evaluat4c*,-.

Most important, perhaps, was the reaG clion& of'the par-ticipating faculty. Not only did they feej someownershiPof the program, but their participation became a refresh,ing variation in their routine, provided them with anopportunity to interact with clinical faculty from otherdepartments and yielded a teaching videotape thatwould b.e.4seful in their respective classrooms. Later,theOvca.i1O 'find that participation would have advan-tages with respect to tenure and promotion reviews, pre-sentations professional meetings and teseatfli.endeavors;'

In 1981, ten years after the initial voduction, thseMULTICLINIC was awarded Second'Orize in the Inter-natiOnal Rehabilitation Film Festival held at the United,NatiOnS- in honor of the International Year of the Dis-abled:r'Presentations on the MULTICLINIC have beenmade:tO. the Council on Exceptional. Children, theAmeriCaii Occupational Therapy Association, the.American's Speech-Language-Hearing Association, theAmerican Association of Physician Assistants, theAmerican SoCiety of Allied Health Professions, theAmerican Association of Educational Broadcasters theCouncil on SOCial Work Education, the Health Educa-tion Media AsSociation and several other organi-zations.

Why has.it..vAllied? There are no clear answers, butSeveral possibilities comdto mind. First, the MUL-TICLINIC originated with iiie;faculty:dad,is maintainedby the faculty. Although adminiStrative responsibilityhas been assigned to the Center for Human Services in.the College of Health and Human Services at Western,the MULTICLINIC preceded both and remains virtually ,/'autonomous. It has an executive committee comprised/of faculty who elect their own chairperso nd establishtheir. own policies. Second, the MULTICLI is costeffective. The faculty whiE.., participate do so on a volun-teer basis. The pay-off 'Conies in the form of recognition,interaction with other clinicians and access to outstand-ing clinical material rather than monetary compensa-tion. Since no one is assigned to the MULTICLINIC,

, those who participate do so willingly and enthusiastical-:11so,:othe videotaped prpductions provide a bank ofpauable instructional material. Finally, the MUI.;.r.,

TICLINIC has been accepted by ;the. community as aservice-by the University. As such it has increased theinteraction among and support by the community agen-cies and institutions; a condition strongly endorsed bythe University administration.

Students froth the clinical programs continue to rep-resent the most significant outcome. As a result of theMULTICLINIC they have been able to observe outstand-

4

ing CliniCal work ,a rid' the team a proach in action. Asclinicians; they Will.be much betteepiepared to respondto the complexities of the multiply handicapped. A Smallstep;,' perhaps, but one that heads us all in the light'direCtion.

form Ore information on the MULTICLINIC, write Dr:Clydell Willis, Director, Center for Human Services,Weiteri Michigan University, Kalamazoo, Ml 49008.

40

CP.

s

. '

Roles and Responsibilities of AlliedHealth Professionals in ProvidingServices td Individuals with Disabilitiesand Their Fathilies.. . ,

Carolyn M. Del Polito; PhD.Anthony S. Bashir, PhD.

Dr. Carolyn M. Del Polito is the Director for ASAHP'sAdvocacy Initiative for Persons with Disabilities andcoordinator of the Forum. Dr. Anthony S. Bashir is

.Chief, Speech-Language Pathologist at Boston's. Children's Hospital. Dr. Bashir also has participated as

a faculty member for the Society's Advocacy. Workshops...

A ity of the Advocacy Initiative for Dis-abled as been the implementation of regionalworkshops, esigned for cadres of experienced relatedhealth professionals in each of the Department ofEducation regions. Participants for each of the six

- Workshops' were identified by their profesSionalorganizations as leaders within their professions andtargeted for then' unique potential in affecting changeboth within and outside their work erivironments. In

:.-addition to the significant professional and..persOnalalliances and advocacy initiatives developed duritig thewOrk.;hops; a major outcome was the: identification -of

° specific roles and responsibilities all healthrObtessiOnalsshould assume whether or not theVititeraet directly orconsistently with :Voungsters,.who haVe disabling con-ditionsAmportantly, the rotesand responsibilities reported

. below emerged repeatedly across working groups andacross regions., .-

The role's anrespOnsibilities'resquired by allied healthprofesSionals to meet the ri6eds of, persons with dis-abilities and their families: may 'appear extensive;however, they are nounlike the roles and respon-

,sibilities needed for_ serving any client. The emphasisand implementation of these roles and responsibilities.wiltyary from time to time,cletermined primarily by the.contextof one's professional practice, personal motiva-tion and enVironniental and organizational con-straints::

Clearly the competencies suggested by this list ofroles and :responsibilities are important for all related

!Reglohal workshops were Conducted in California, Mirinesota,Marylaiapirnorit, Tennessee, and Colorado.'

partleTpatitig in:th:e workshops have represented theprofessions:of Audiology /Speech - Language Pathology, CorrectiveTherapy, ,Deotal. Asststatice & Dental Hygiene, Dietetics, HealthEducation &Adminiitration, Medical Assistance,Nedic.al Technology,Medical Recorct Administration, Rehabilitation Counseling, SocialWork, NuiriiiOn, OcCupational-Therapy,.;PhYsical Therapy, Nursing,Physician:Assistance,!Psychology, and Ricreational Therapy.

b

health. PrOfessionals and should not be perceived aslimitect to those professions which treat children andyouth' for their handicapping conditions., As indiCatedearlier,: as professionals in the health-care system, allrelated health professionals will be expected to possesssuch comPetenCe and, therefOre, need to be pre-pared.,

1. Roles:.-and. Responsibilities Related to Legal andReiulatorY. [skies, .

To underitand 'State and Federal legislation inorder to assist farniiies iii solving problems relatedto the child/youth's condition; that is:1. To facilitate the provision of appropriate ser-

vices for the youngster with a- handicapping.condition;

2. To facilitate parents' understanding of case.management procedures for the child/youth;

3. To facilitate identification of an appropriatecase manager for the youngster;

4. To recognize and provide accurate informationto parents;

5. To assist parents in understanding their legalrights;

6. To assist parents in defining and accepting their .roles and rights; and

7. To proinote self-advocacy skills amongyoung-sters and .parents.

2. Roles and Responsibilities Related to SOCietal andProfessional Attitudes

1. To recognize and accept the needs and rights ofdisabled youngsters.

2. To recognize the need to be sensitive to andunderstand the influence of cultural differencesin -the ; identificatiOk leferral, and treatmentprpcesses,

3.,,Tocre'eoSnite the prevalent* forms of prejudice,stereoVping, and tokenism, and understandhow myths and stereotypes contribdte to thedevaluation of people with disabling conditions.

3. Roles and Responsibilities Related& ProfessionalPracticeGeneral

To provide effective and competent services '.forwhich one is trained; that is:1. TO recognize the indicators of handiCapping

conditions for severe, mild-moderate, and high-dsk children and youth;

2, To provide 'appropriate screening programs soas to identify chIldren and youth with possibledisabilities and make appropriate referral forassessments;

3, To provide appropriate assessments of in-dividuals with disabilities; and

4'. To participate in he planning, deSign,4,andr.4

implementation of programs for individualWith disabilities as ;appropriate, to .One's pro -

fessional concern and practice.To Understand; implement; and .pr methodsfor identifying apprOpiiate referral.sources.To maintain accurate records of assessments,treatments, and:progress.To.maintain and use current technologies to shareinformation about clients and their conditions(e.g., computer networks).To understand the effects of current treatments onthe future performance of the client and to com-municate this understanding to parents andclients.

.. To educate one's self, parents, colleagues, em-ployers, and communities about the needs andrights of individuals with disabilities and theirfamilies and the roles the various professionalsperform in providing services.To disseminate accurate information to the publicconcerning:1. the nature of disabling conditions;2. the needs and rights of individuals with dis-

abilities;3. the roles health, education, and medical pro,

fessionals assume in the rehabilitation ofindividuals with disabilities; and

4. the qualifications for providing services.To promote ,excellence in the qualify of service'delivery amonvne's own and others' professions(e.g., eliminate time constraints and scheduling.barriers,,develop peer review systems).To rectnize the need for and participate inactivities ithat will ensure continued professional

.:,grOWth and competency, that is:v participate actively in one's professional

organization;2: To advocate for the needs of individuals with

disabilities and their families within one's ,

profession;3. To participate in various activities that will facjIt-:;;-

tate continued growth of professional kntx41.-edge; and

4. To promote appropriate interdisciplinary train-ing of allied health professionals so as to,meetthe needs of and ensure the rights of individualswith disabilities.

RoleS :and Responsibilities Related to ProfessionalPracticeCoordination

To help coordinate efforts of health, education,and related services; that is:1.. To, understand other health, education, and

related services professionals' roles;2. To work' cooperatively with other professionals

concerned' with the services provided forchildren and youth;

3. To be sensitive to and actively participatecoordinated and adaptive health-care planningfor the life span of the youngsters;

4. To promote interdisciplinary pre- service team-ing opportunities (e.g., shared curricula andfield experiences);

5. To promote and, as appropriate, conductresearch pertinent to clinical practice;

6. T,o' rea&and publish in the journals of otherdiSciplines;

7. To help- de.VOdp.effectiVe; alliances betweenvarious professional organizations and existingparent and consumer coalitions td promote theneeds and rights of youngsters -with dis-abilities; and

8. To advocate for funding from appropriate local,state, and federal agencies to train .healthprofessionals.

To help develop and provide cost - effective pro-grams and services.To identify and help implement: creative ap-proaches to funding programs for persons withdisabilitierS (including community and businessresources and consultants);To improve existing approaches to the delivery ofhealth and education services through researchand dissemination.

5. Roles and Responsibilities Related to ProfesSionalPracticeAdvocacy

To promote advocacy initiatives on behalf ofyoungsters with disabilities with other pro-fessionals.To promote and advocate for prevention of dis-abling conditions (e.g., pre-natal care; geneticcounseling, etc.). '

To understand and be able to ¢-xplain 'the dimen-sions and limitations of personal.and professionaladVoeacy and its intimate elationship withappropriate identification and referral pro-cedures.To assist in consumer/client and parent involve-ment in advocacy efforts.To exert pressure for enforcement of existing lawsat local, state, and federal levels.To promote regulation, legislation, and litigationon behalf of youngsters with disabilities andtheir families.To understand the political process and theimplications of advocacy within one's work setting,community, state, and professional organization.To help establish and maintain geographical net-works to promote access' to services in underserved areas (e.g., transportation networks, ruralservice delivery networks, etc.).To help develop and/or modify educational stan-dards to create access rather than barriers tOfindividuals with disabilities who wish to enter thee'health, education, and medical professions.

6. Roles and Responsibilities Related- to ,COmmuni-,cation

To communicate effectively with individuals withdisabilities and the families; that is:1. To convey information clearly and listen

actively to individuals with disabilities andtheir families;

2. To adapt messages according to the needs ofthe individual with a disability ar(d his/her fami-

Nly; and3. To be sensitive to and adapt to the verbal and

nonverbal cues which indicate: concerns orproblems related to the handicapping condi-

40

tion, whether expressed by parents, siblings, orthe individual with a disability. ": .

To facilitate and effedt, appropriate inter-professional communication.To facilitate and effect appropriate inter- and intra-agency communication.To facilitate and effect appropriate comniuniea-tion between university/college training programsin health, special education, and regular idu-,cation.To facilitate andeffect appropriate communica-tion with and betWeen various state and/or federalagencies and governing bodies.

' I

4143

44-

INTERDISCIPLINARY INITIATIVES

The following groups have begun interdisciplinary efforts in the service of youngsters with disabilities. They have listedtheir initiatives with the American Society of Allied Health Professions and information on their .programs was sharedwith Forum participants. A brief summary of the program, participating groups, and contact persons follow. For moredetailed information, please contact the person(s) listed for a particular program.

Program Title Description

Child DeVelopment Clinic Interdisciplinary model for trainingprofessionals in human services

Children's Center

Cooperative agreement for under-graduates in special education

val

COUNTERPOINTnewspaper, cable link, hand-crafted books, electronicnetworking

Masters Degree in Special Ed.for Therapists Working inEducation Settings

Parent Training Program

Interdisciplinary and discipline-. specific training to students within

the allied health professions andother related fields

A major in education for thevisually impaired, multiply-tihandicapped and a minor in speechand hearing.sciente to supplementa generic special education major

Newspaper: an interface amongspecial education, regular education,and related disciplines concernedwith education and special edu-cation; Linking allied healthprofessionals with cable television;Featuring information on alliedhealth on SPECIAL NET

Training a new educationalspecialist for the public schoolwho can train school personnel toperform the specialized functionof the therapist.

Enabling parents to play aninformed and active role in obtain-ing public education and relatedpublic educational services for theirhandicapped children

42

44

Sponsoring Unit/Contact

James Madison University and theVirginia Department of Health &Bureau of Maternal & Child Health

Contact: Dr. A. Jerry Benson, ChildDevelopment Clinic, James Madi-son Univ., Harrisonburg, VA 22807703-433-6484

Louisiana State U. Medical Centerand School of Allied HealthProfessions

Contact: Patsy Poche, Children'sCenter, LA State U. Medical Center,1100 Florida Ave., Building 119,New Orleans, LA 70119504-948-6881

Vanderbilt Univ. and TreveccaNazarene Colitge

Contact: Thomas Rosbrough/Ralph G. Leverett, Trevecca College,Nashville, TN 37203615-248-1200

Counterpoint CommunicationsCompany

Contact: Judy Smith, CounterpointCommunications Co., 3705 SouthGeorge Mason Drive, Suite C-4,Falls Church, VA 22041 .703-931-4432

George Peabody College ofsVanderbilt Univ.

Contact: James R. Lent, VanderbiltUniversity, George Peabody College,Dept. of Special Ed., Box 328,Nashville; TN 37203615-322-8265

Southwestern Ohio Coalition, ParentInformation Center

Contact: Joanne Queenan, South-western Ohio Coalition forHandicapped Children, 3025 BurnetAve., Cincinnati, Ohio 45219513-861-2400

4056

Project C.H.I.L.D. Coordinated help for infants withlagssin development

Role of InterinstitutionalRelationships in Responding tothe Needs of America's Handi-capped: A Model

Special Child Clinic Program

Special PT /OT Project

Speech-Language Pathology

Service Coordination for Pre-School Handicapped Children

el

Cooperative interinstitutional rela-tion between the School of Corn-munity and Allied Health and theAlabama Institute for Deaf andBlind

Increasing participation of medicaland health community in evaluationand program planning for handi-capped youth served by SpecialEducation

Develop and implement a state-wideplan for the effective integration oftherapists into school settings

Related findings and recommenda-tions of speech-language pathologywith other professional disciplines,schools and parents.

Techniques developed for localcoordination of services, 4 needsassessment, and action plan forcoordinating services for pre-school handicapped children.

4543

Michigan Dept. of Mental Health,Developmental Disabilities GrantsUnit and Kalamazoo County Com-munity Mental Health Board

Contact: Clyde Willis, Western-Michigan University, Center forHuman Services, Kalamazoo, MI49008616-383-4941

School of Community and AlliedHealth, Univ. of Alabama inBirmingham

Contact: Keith D. Blayney,School of Community an'd AlliedHealth, U. of Alabama in .

Birmingham, University Station,Birmingham, AL 35294205-934-3527

Kansas Crippled Children's Pro-gram; Kansas State Departmentsof Education, Health andEnvironment

Contact: Joan Watson/ElizabethHusband, Box 1308, Emporia, KS66801316-343-6978

U. of NC, Chapel Hill and StateDept. of Public Instruction, Div.of Exceptional Children

Contact: Dianne Lindsey, PT /OTSpecial project, 267-A Trailer #11,Craige Trailer Park, Univ. of NC,Chapel Hill, pie 27514

Speech and Hearing Clinic, MinotState CollegeContact: David. K. Williams,Minot State College, Speech andHearing Clinic, Box 46, Minot, ND58701701-857-3030

Georgetown University HospitalContact: Phyllis Magrab, Director,Child Development Center,Georgetown University Hospital,3800 Reservoi Rd., N.W., Wash-ington, D.C. 20008202-625-7676

FORUM: ISSUES AND RECOMMENDATIONS

With the materials presented thus far in this documentforming the background for small group workingsessions, the 125 administrators present at the forum.responded to the following questions:

FOCUS: In what ways can allied health and educationtraining programs coordinate their efforts in preparingtheir respective students to meet the demands andchallenges of both new and existing work environmentsrelated to youngsters with disabilities and their families?

Discussion Questions:

Why is cooperation nee4d/desirable; i.e., What'swrong with the current situation?Where are the critical junctures where coopertiveefforts are neededWhat appear to be the obstacles for cooperation?What resources are available?

What expertise does each individual bring tothe conference?Whatresources.doeseadi conferee have at his/her disposal?.

'What experfise is available from the institution/,community (e.g., Rehabilitation CounselorsParent Coalitions, School Nurses,.Social'Agen-cies, etc.)? .

Other professional networks/reSources?Other personal networks/resources?

What strategies can be utilized to overcome theidentified obstacles?How should these interventions be prioritized at thelocal level? State level? National yvel?r

Within the small-group working sesshns, the chiefadministrators in allied health and education identifiedthe need for new and refocused leadership in buildingand implementing collaborative models'for cooperation

among pro essions, among academic programs, andamong instit tions and agencies. Specifically, theadministrators. outlined the major barriers to inter-professional and interagency alliances as well as thepolicy recommendations which follow.

B. Parochialism in professional training programs;including:1. Traditional missions and roles of various train-

ing programs and faculty;2. Emphasis on skill acquisition vs. philosophical

and problem-solving approaches;3. Absences of common. clinical settings for train-

ing; isolation of service delivery sites;4. Maintehance of traditional territorial spe-

cialization; and5. Fragmentation of service delivery and re-

sponsibility.

C. Low priority given to interdisciplinary "oatacademic institutions; including:1. Little recognition among Many,- programs/

institutions that a problem related to cdordina-tion among health and education trainingprograms actually exists;

2. History of separateness between health andedUcation, both physicaVarid philosophically;

3. Few unlyertity mechanisms' 4vailable whichfacilitatetor lieward in t er nary activity; infact; ,Many interfere (e:g.,"negaliVe impact ofloint 6ppointmenls for:faculty tenure Cleciiionsand :program accountability (F E's)

4. Credentialing and licensure procedures whichmandate specialization' and, therefore, weakeninter-professional activities;

5. Competition for time and space in already over-packed curricula for students and faculty; and

6. Perceptions of limited resources.

D.. Financial constraints, including:1. Lack of funding for training and service delivery,

producing competition among the training andservice delivery institutions for availableresources;

2. Funding and control of related services byagencies separate from education agencies(e.g., occupational therapists funded by a StateHealth Department); and

3. Influence of third-party payment eligibility forpractice and health care derveq intervention.

E. Parochialism in service delivery e., no one acceptsresponsibility for the whole person), including:1. Perceived fragmentation of responsibility for

the provision of services -among agencies andamong professionals;

2. Limited incentives' for interdisciplinary ap-proaches;

3. "Turf" disputes;4. Limited appreciation of each professional's

expertise or contribution in the management ofthe youngster

Barriers to Coltirdination

A. Communication problems between and amongprofessional groups, academic units, educators, ser-vice providers, consumers, and advocates: in-cluding: T .-

1. Philosophical differences (e.g., discipline basedvs. systemic approaches); and

2. Complexity of institutions and institutionaltypes.

44 46

5. Conflicts in agreeing on who will make manage-ment decisions and coordinate the young-ster's program;

6. Failure to prioritize service needs; and7. Difficulty in recognizing each others' perspec-

tive relative to the child's (e.g., a physicaltherapist can explain what he/she is doing forthe child but may not recognize or address theclassroom teacher's needs in managing the,same child).

F. Leadership issues, including:1. Absence of a shared philosophy among leaders

within and across professional groups; and -2. Absence of effective coalitions within the

groups to influence policy and administrativedecision making.

f. Governmental and regulatory issues, including:1. Differences between the social/political realities

of academia as compared to the social/politicalrealities of service delivery practice;Influence of accreditation regulations of pro-fessional societies on inter-agency collabora-tion and cooperation among professionals;

+' 3. Influence of tenure and prcernotional regu-lations and institutional rewards systems forcooperation and interdisciplinary programs for

prepating professionals; and4. Influence of the disjuntive and incremental

development of policy and regulations govern-.

** resources and services for a comprehensivepolicy for persons with handicapping con-ditions.

Policy Recommendations)4

As key innovators within the health care and edu-cational systems, chief administrators- in allied healthand teacher education have much to contribute to thedesign and implementation of local, state, and hational,initiatives for youngsters with disabilities, their families, -

and their service providers. The policy recommen-dations emerging from the Forum's problem-solvingsessions and the preamble, repeated here, clearly illus-trate the collective vision maintained by the 125 par-ticipants. This vision encourages, guides, and supportsnew collaborative initiatives and models for personneltraining programs.

Preamble

We believe the goal of educatiOn is, to prepare eachindividual to function effectively and productiveras aself-sufficient and contributing member of the society.Provision of an appropriate education becomes a keyprinciple upon which educational programs are de-veloped. It is important, therefore, to:

1. Provide a comprehensive and coordinated sys-tern of services to children and youth withhandicapping conditions;

2. Coordinate and share responsibilities amongthe allied health, regular education, and specialeducation professions for planning and deliver-ing services;

3. Develop new coalitions among local, state andfederal agencies, the private sector, collegesand universities, and professional organizationsfor developing education and health caredelivery programs which are based upon astrong, comprehensive policy and are sup-ported by adequate resources (financial, per-sonnel, etc.) for meeting the needs of personswith handicapping conditions;

4. Disseminate successful and cost-effective mod-els of senAce delivery to service agencies,educational institutions, and the public;

5. Develop new and stronger alliances amonggovernmental agencies,*Ivocacy groups, fami-lies, clients, educators, and'the allied health pro-fessions for implementing effectivemodels and

' other successful practices;6. Increase the awareness pf the various publics as

well as members of the education mid relatedhealth services professions to the needs ofchildren and youth with handicapping con-,ditions; and

7. Encourage and facilitate university systems to(a) examine critically the roles and respon-sibilities of education and health care providersfor meeting the needs of youngsters with disabilities, and (b) develop appropriate curriculafor personnel preparation programs to addressthe'expanding roles and responsibilities.

A. National Recommendations1. Promote a national priority for education and

health alliances for children and youth withdisabilities.

2. Establish a coalition among national associ-ations .and disciplines to (a) identify and utilizefunctional models of training and servicedelivery, and (b) piomote alliances among thedisciplines, professional associations, andfederal agencies.

3. Advocate for the 6iaintenance of strong federallegislation , on beharbf individulls with dis-abilities and their families. A uniform policy forall states Is essential if persons with handicap-ping conditions are to have adequate edu- Icational and health care services.

4. Advocate for the provision of adequate fundingfor implementing federal legislation andregulations.

More specific recommendations include:5, Through ASAHP's Interdisciplinary Task Force,

with representatives from national professionalassociations concerned with meeting the needsand rights of youngsters with disabilities, (e.g.American Society of Allied Health Professions,American Association of Colleges for TeacherEducation, Council for Exceptional Childrenand other appropriate allied health, education,and medical professional organizations, as wellas parent and consumer organizations), thefollowing agenda items should be pursued:(a) Encourage professional associations to

adopt policies and/or endorse positionssupporting interdisciplinary education, train-

45 4 7

ing, and service delivery for persons withdisabilities.

(b) Assist interested, individuals (at local andstate levels) in instituting specific efforts forinterdisciplinary training (pre-service andin-service).

(c) Identify and disseminate information oneffective interdisciplinary models and pro-grams via eXisting! avenues (e.g., nationaland state association journals, newsletters,meetings, ASAHP's, expertise exchange,etc.).

(d) Promote administrative support for inter-s departmental cooperative efforts in educat-

ing allied health and education professionals(e.g., invite ASAHP, AACTE, CEC, andperhaps others to write a joint letter toappropri$e chief administrators in alliedhealthand teacher education training pro-grams, emphaSizing the importance of suchinterdepartmental cooperative training ef-

. .:forts; OSERS Deans,:grant's resarch ancttoModels should fia. 'COrigulted as vell)..

(e) ' evelop diisernInate a brochure illus-trating interdisciplinary .rhanagerrient ofservices (rather thari a partiaillar. pro-fesSiori'g isolated contribution).; The designand dissemination of the brochure: should:involve all appropriate professionS. 'Promote the recruitment of individuals with,handicapping conditions into the variousprofessions.Promote researcANficient, cost-effectiveapproaches toOfiring and delivery of.

(I)

(g)

services. o

(h) Promote the hbeAlictr each profession todevelop and/or mairftain a comprehensiveplan to raise consciqusposs among mem-bers of theiprofessiakalgiut the needs andrights of irt,,dliiid4als Witil disabilities.Promotg; tOrripatiblii, . theoretical basesamcreg..th.g imoteSio -=or at least anun kistanding of professions' theo-

. atases.0Y- m

Aa a atiOn :(recognition of" eps :understanding of

the roleS of other dis-cijii$10,t,hr8 ghlratrOgIriStittitions, stateagelictes atUVRrofessic)041; organ z atio ns.

(k) t4rrirriitrhe nts fromgate:. kreep,6:e4 adminis-tratrotr: -a0dr4$40AsiCinal.; associations inwOrkiii%thWar,4! thelalai.41'eritified in the

='.

B. State Recommen#Optis,' ;

1`. Work with state legislatqcs tc3,.ionnulate strong,.

state-supporte4,010es ao, - assisb;youngsters.with disabilities, ( ages

2. Prof-note the 'eStaliiliSiiin'ekC of form4i, agree-ments among thaSer44504010 fOrilprOvklingservices to chilOrehandwotith'wIth handicap-ping conditionS; lOoalit; educationagencies, stateagencie,s,ltegforial.lioards; reitnbursement agendie4!and Ocadernicinstitiinions;

I1* !','

(I)

to ensure coordinated, comprehensive, andappropriate plans for (a) the delivery of educa-tion and related health care services, and, (b)preparing service providers.

3. Encourage states to gather, analyze, and dis-seminate data, including needs assessmentinformation, for training and service deliveryneeds.

4. Encourage institutions to design appropriatecurricula to prepare administrators of healthand education progra4 for managing andcoordinating comprehensive systems of servicedelivery.

5. Ecourage states to establish certification re-quirements (or similar stap,clairds) which man-date adequate and appropriate preparationrequirements for all persons serving childrenand youth in schools; i.e., regular teachers, spe-cial education personnel, and allied healthpersonnel-

More specifically:6. Encourage interdisciplinary and cornprehen-

- sive planning among agencies providing educa-tion and related health services by convening ameeting of the agencies' key administrators atboth state and local levels.

C. Local Recommendations (Note: Many of the Nationaland State Recommendations also are appropriatefor implementation at the local level.)1. Encourage, collaboration and develop new

coalitions within academia (both between andamong disCiplines and institutions) and acrosssystems (between and among public sector,private sector, academia, parent and consumergroups, employers, and legislative; and regu-latory bodies).

2. Encourage and promote formal agreementi:-,among the .providers of sehildesilodaltion agencies, and pkiblicand'J-Pritiate agenciesto ensure appropriate services for ed4Cation,health care, and other 14:heeds for ailfdretiand youth with disabilities:

3. Promote the delivery of education and health-related services which are based according tolocally coordinated and compreheniiiie:-.4lails;.,

4. Promote and develop appropriate :constitiOnsfor professional practice for allffealth andeducation personnel.

5. Revise curricula to reflect the expanding rolesand responsibilities of health and educationprofessionals to meet the needs of youngsterswith disabilities and their families, that is,.curricula should be revised to include:a. Content and instructional strategies to pro-

duce health and education professionalswhckan interface with one another to servethe youngsters with whom they mutuallyinteract.Core curricula across disciplines, includinggreater emphasis on: (1) communicationand decision-Thaking skills, (2) ethics; (3)laws and regulations; (4) individual rights;

48

and (5) organizational and communityresources.

c. Strategies to facilitate interaction amongfaculty, students, clients, and professionsfor program decision-making, planning,and implementation.

d. Shared traini,rig and practice opportunitiesamong disciplines.

e. New content areas (e.g., psychology ofhuman sexuality, interpersonal and smallgroup communication, organizational/systems change strategies, etc.)

f. New technologies to demonstrate interdis-ciplinary activity.

6. Encourage and promote acceptance of ashared philosophical approach for servicedelivery arid, training among the professions(e.g., a philosophy which centers upon needs ofthe client).

7. Facilitate and develop new organizationalarrangements within and among academicinstitutions and programs to:a. Include clinical faculty on academic cur-

riculum committees;

b. Include consumers, advocates, and em-ployers in program planning;

c. Facilitate faculty exchanges; i.e., academic,clinical, and school-based faculty;

d. Formalize information sharing betweendisciplines and institutions;

e. Provide continuing education oppor-tunities for health and education pro;fessionals to meet their expanding rolesand responsibilities; and

f. Design an action plan which wouldinclude:

a needs assessment;review of existing curricula;review of clinical practice and field sites .

and placement;review of philosophy and missionstatemepts of professional programs toreflect current needs for appropriatepractice;review of local resources; anddevelop collaborative initiatives amongthe health and education professions.

0.

CLOSING REMARKS

The folloCuing comments were delivered by Dean Corrigan, President of the American Association of Colleges fotTeacher Education and by Dean Fitz, President of the American Society of Allied Health Professions at the closing ofthe Forum.

Symmary ComMents: A PerspectiveFrom EducationDean C. Corrigan, Ed.D.

, Dean .C: Corrigftn is serving currently as Professorand Dean of the College of Education, Texas A&MUniversity". Being an active leader in the educationfield, he holds the position of President of the AmericanAssociation of Colleges for Teacher Education.

A distinguished speaker and prolific writer, Dr. Cor-rigan has presented at many national and stateeducational functions and has. authored over 70articles dealing with a variety of educational issues. Hehas received recognition 'cicirds including the Dis-tinguished Teacher Award from theVational Associa-tion of Teacher. Educators and the Educator of the YearAward from. the Maryland Association of -TeacherEducators, as well as scholastic awards from ColumbiaUniversity.

The most vivid truth that emerges from the delibeptionsat this conference is that the time to stand and fight forthe rights of the handicapped is now. We must not fold ateach gust of discontent. The rights of minorities aiealways hard to achieve but the future of this country restson the-response we make to those in need. We haveraised the expectations of the handicapped in all of theagencies represented at this meeting. We must not dashtheir hopes again,

The times call for leadership and the situation calls forcollaboration across a variety of educational sites.

A new kind of leader will be needed in colleges ofeducation to, respond positively and promptly to thechallenge of preparing educators for non-school set-tings. The new leaders will need to know how "to, WOrkeffectively not only within the setting of theit owninstitutions, but with diverse groups in unconventionaleducational settings emerging in many places for peopleof all ages.

Versatility, imagination, a sense of social purpoe, afutures orientation, clear theoretical frameworks, in-structional and administrative ingenuity will all benecessary professional strengths.of the new leaders forthe expanded education: profession. But the mostimportant characteristic of the new educational leaderswill be tp ability to develop collaborative relationshipswhich. link *organizational ,units with similar educa-tional purposes.

The name of the game for leadership today iscollaboration. Modem society puts a premium onorganization. on system, on cooperation between unitshaving common purpose or overlapping interests. It is aday of "calculated interdependence," of "involvement,"of "planned togetherness." Life today is made possibleby cooperation,.by arranging interlocking complexities,

48

by consciously making things more complicated. Andthe reason is simple. The complexity of modem societyrequires a pooling of knowledge and a sharing of resourcesto achieve mutual goals.

Academic leaders can no longer preside over theirinstitutions in splendid isolation. Constructive rela-tionships must be established with the federal govem-ment; with private educational institutions, With publicagencies in such fields as health, environment, welfare,housing, community planning, libraries, television, theperforming arts, business, industry and other settingswhich have up to now stood on the edges of the formalteaching, learning and social servic,es processes. Col-leges of education and allied health are now called uponto educate researchers, teachers, counselors and adminis-trators and other education specialists for the federalgovernment, regional educatiOnal laboratories, re-search and development centers, television councils,special programs to -help the aging, the poor and thehandicapped in community action centers and socialservice agencies, industrial establishments like Xerox,IBM, and Time-Life, and other agencies developingcurricular materials and instructional systems. These arejust some new interlocking complexities with' whicheducation and social service leaders must cope, and forwhich their educational preparation and previousexperience has probably not prePared them. The newera then is on&of "going steady." Educational leaders nolonger walk alone.

In order to respond to this new eri new designs forprograms to prepare education and ocial service pro-fessionals must be developed. As demonstrated in thealternative models-presented at this conference, a cen-tral feature of these new designs is collaboration amongagencies operating at different phases of the edu-cational spectrum.. The fact. that education in theschools, social agencies, and other non-school settings,and the university and its colleges are interrelated andinteracting components of one educational delivery sys-tem for the "learning society" must be recognized andreflected inlplans for the future. Elementary and second-ary, schools and colleges are now part of a complex ofcontinuing education for a large majority of. America'speople. Colleges can become obsolete, or they canbecome the training and research arm of this new,expanding education delivery system.

The time is right to seize the initiative in broadeningthe parameters of the education profession in the1980's by developing collaborative unified programswith colleagues in the allied health professions andacross all of the settings which employ educators.

Let's build this new coalition and put the full force ofthe professions to work for persons with handicaps inevery community service setting in every part of thiscountry.

50

6

Summary Comments: A PerspectiveFrom Allied Health

Polly A. 'Fitz, M.A.

Polly A. Fitz, Dean of liversity of Connecticut'sSchool of Allied Health Professions and President ofASAHP, is also an Advisory Council Member for theAllied Health Child-Find and'Advoe'acy Project, whichis sponsoring ASAHP's 1982 Conference for the ChiefAdministrators of Allied Health and Education. Alongwith participating as a synthesizer for this conference,and chairing the &tional Forum on Allied HealthAccreditation, Ms. Fitz also provided leadership for anumber of ASAHP and other professional organi-zations' Councils and Committees. With wide experiencesin education and administration, her backgroundincludes teaching and consultancies in Dietetics andAllied Health Education generally.

Many of the humanistic changes in he th and educa-tion come from the consumers and/or he parents.Therefore, I believe it is important to focu initially onthe parents and the persons with disabilities. Let usreflect on the comments of Jane Wittenmeyer andEthan Ellis.

Listen to the parent. It is important that we talk face toface. It is important that we provide more informationand meaningful experiences in pre-training curricula sothat practitioners know how to talk to and listen to per-sons with disabling conditions. Further, the cross dis-cipline knowledge and knowledge of cross disciplineprograms are most important. This knowledge will helpto bridge gaps between practitioners and services. Last-ly, it is important to further the cause of research so thatthere always will be hope and a future.

-Ethan Ellis helped us to be,sensitized to the personwith et disability. His advice becomes an important goalto us: 'To build relationships between the allied healtheducator and the teacher. It is also important that webuild toward independence, toward an understandingof how mind and body impact on the individualc's life, sothat persons don't separate mind and body. C.

As I. participated and listened in many of the groups, Isaw people beginningko worry about cost and financialconcerns and then move to discussion of resourcesthe quality of the product the quality of the service. Isaw people beginning to talk about control who hasresponsibility for what, and who should be designatedand who has the approRriate title? As they moved,through the conference, participants felt a release. Peo-ple began to talk about mutual collaboration, tie pro-vision Of services, and the generation of new ideas.

Another observation: people began to talk aboutcommunication. What were the channels? Who com-

municated to whom? How it was done in written terms?How it was done in terms of legal responsibilities?Gradually, through the conference, I saw developing inthe group a move from communication to relationships...how can we join together . . . not only to channel ourwords and actions; but rather to change those words andactions into ideas and meaningful programs.

My last observation is that I saw the many conferenceparticipants high in, the area of creativity. They broughtthis characteristic as a wonderful resource to theirgroups. And gradually, through the sharing and ideageneration in those groups, they began to move towardrenewal. . . a most precious commodity in terms of thefuture for PL 94-142.

I believe all of these moves from cost to resources,rol to release, communication to relationships,

eativity to renewal are the moves to both a.pro-activeante and a coalition between allied health education

and service. I believe that we now have the alliance be-tween two important sectors: education and health.

I am humbled by the persons I have met in this con-ference and that are present in this room. I also reflect

Nokthe pride of the Board of Directors of the AmericanSociety of Allied Health Professions in both the projectandthe project director, Carolyn Del Polito.

The challenges of the .conference are many. The twoforemost are the need for strong legislation and thenecessary funds. Additionally,

9 5

We need to have our states address certificationissues and the beginnings of formal agreementsbetween the providers of services; .

the American Society of Allied Health Pro-fessions is charged with developing a. jointcommittee of allied health professionals andeducators. Such a joint committee will utilizeexisting coalitions, and will use the expertiseexchange established by the new initiatives ofthe American Society of Allied Health Pro-fessions. A joint committee will provide forinitiating change at fhe local 'level throughoutindivideral committe% Members;We need' to develop eli'rochure that is child.:centered; one that can emphasize the inter-disciplinary aspect of service delivery;Deans and other administrators need to bealerted to coordinating efforts between ASAHPand AACTE;We need to establish target groupisat the locallevel. Deans of education and allied health mustform alliances within their own universities.Furthermore, these universities must formalliances with school systems and parents, andwith reimbursement secfors;

Deans must take the responsibility to assist inthe creation of an environment that will sen-sitize faCulties to their roles and responsibilitiesfor persons with disabilities. Our curricula, themajors and. riiinOrs, must be examined with aneeds analysiS:bf the community as a basis forre- designs: Focus will be on team efforts and thecoordination of clinical experierices..A role ofstaying fie4lthy will be an important aspect ofour cur-rid/101We need to:recruit persons with disabilities intothe allied:health professions and thus, increaserepresentation, This will assist us in' fOrmulatingfuture g6*'We need.tO prcide for. in-service and pre-service programs;We must all work toward a unified policy forall states.

The new coalitions consisting of allied health pro-fes als, educators, special gducatorS; universityadmin strators and faculties can ltiriphasize and beginplanni g for this future. This, will be The new alliance.Throu this we must work on adequate funding, formalagre ents, certification, merging of departments,requi ite activities, and leadership.

To romote the, national alliance between educationand allied health werneed to first, develop the networks,ceitlitions and alliances at the state and national level. Itwill be across-syStems and expanding beyond ourselvesto the consumer. Members of- these groups must re-examine educational philosophy, health disciplinephilosophy and training: Second, they must developalliances with the leadership in education, so that thepolicy makers can promote the study of methods and 14.

techniques to further advance the curricula. Third,political action must follow, so that people who are mak-ing policy recommendations will know of our intent andthe necessary goals and future directions.' The role ofASAHP in promoting and participating in the initiative isto further the alliance between education and alliedhealth and to work with the national and state perspec-tive. Fourth, we must get the sanction andapproval from thigher education leadership. We need to get action forthe programs initiated from both departments and prac-titioners. Getting our act together will enable us toinfluence policy. Fifth, the social. scientist support net-works need to be tapped, so that follow-up is our mostimportant action.

We need to begin with ourselves and our respectivespheres of influence. After all, leadership is nothingmore than being out front and being a risk taker.' Inmeetings we must raise awareness, put forth proposals,be ready with priorities, and now is the time for suchaction... let's not lose the value.of 94-142 or the transi-tion to a hOlistic idea!

I accept the charge to the American Society of AlliedHealth Professions to form the joint committee to keepthis initiative alive, as we continually re-examine ourpriorities. I look for advice from the advisory committee.We have many opportunities in our regional symposiaand local projects through the Kellogg initiative. We canfoster legislative initiatives as a priority of our members.I'd like to end with a quote from Lowell Weicker frorri

50

one of his recent .TY shows regarding the institu-tionalization of the handicdpped. I quote:

"There is a. broad spectrum of opportunity, but it ismost important to go in the direction Hof maximumopportunity."

I believe that that is the statement, to carry usforward:

FOLLOW-UP ACTIVITIES

To implement the Forum's national, state, and local. policy recornrraendations, participants urged the Ainerican

Society6{Allied Health Professions (ASAIIP) to con-tinue its leadership role, expanding on the work accom-plished thus far, and establish an Interdisciplinary TaskForce to (a) review the F rurn's odtcomes and (b) iden-tify nextteps to p oteand implement the Krum'srecorn rile n s on behalf of youngsters with dis-abilities,a d their far4les2ASAHP's-Board of Directors -approved the establishment of such a Task Force andidentified members and organizations for participation.A meeting of the Task Force was held January 27-28,1983 in Washington, D.C. Members include represen-tatives from the following:

American Society of Allied Health Professions': "(ASAHP)American Academy of Pediatrics (AAP)

'la American Association 'of Colleges for TeacherE ducation (AACTE)

..

AmeriCanAssociation of Community and JuniorColleges (AACJC)American Association of SchoolAdministrators(AASA)Council for Exceptional Children (CEC)National Association - for Protection andAdvocacy (NAPA)National Association of State Directors of Spe-cial Education (NASDSE)National Council on Developmental Disabilitiecs(NCDD)Parent CoalitionsUniversity Affiliated Facilities (UAF)Education in Allied Hearth

) Education in MedicineEducation in Special Education

.- In its deliberations, the Ti.sk, Force focused on the..:critical issues in the design of qualify personnel prepara-tion programs, resources, and data needs, and iden-tified future 'directions to meet , the service deliverydemands of the 1980s. Importantly, Task Force mem-bers reitterated and emphasized ale need for interdis-ciplinary training and collaboration among allied health,regular education, and special education' with theCHILD as the focus. kir all provision of services.

As 'Task Fone. members poignantly, reviewed, pro-fessional in health and education areunaware of one,

;-

another'S roles and responsibilities in providing:servicesto youngsteis with) handicapping conditions. Collabora-tive, interdisciplina training programs which' address.the concerns identi ied during the Forum do.' exist;however, dissemin ton of effective practices and wide-spread implementation do not exist. Task Force mem-bers cited the critical need to:

1. Identify, document, and disseminate current-.2model programs and practices;

, Promote research to obtain the quantitative andqualitative data required to support "quality"trainirig programs; and

3. Encourage and promote collaboration amongall existing training programs preparing serviceproviders in allied health, regular education,and special education.

The following summarizes, in outline form, the TaskForce's ,deliberations on:

I. Critical IssUes in Personnel PreparationCrileria forQuality Training Programs

III. Data N,eeds. .

!V.,' Available ResourcesV: Desired Outcomes and, Future. Directions.

1. CRITICAL ISSUES. The following issues were iden-tified as critical for meeting the needs of youngsterswith handicaps as they impact the design of qualitytraining programs in allied health, regular educa-tion, and special education.

A. With the passage of Public law 94-142theEducation for all Handicapped Children Act

: health and education services for yoUngsterswith handicapping conditions hatie changedradically. Educational approaches and systemssimilarly have changed, impacting the youngsters,their familie their teachers, and their classmates.The han s in services require professionalsin specia eclucation, relate1:1 services, andregular edkcatiop to assume new and expand-ing responsiblities, demanding further changesin training programs both pre-service and in-service preparation programs.

B. The focus of all provision of services should beon THE CHILD. Professionals serving the child,should recognize and accept the responsibilityto ADVOCATE for the entire child; that is, toadvocate for full, total care adapted to the life-long needs of the youngster.

C. .Allied health must help to ensure appropriate,total care for the child. While many youngsterswith handicapping conditions are in clinical set-tings, the majority of these youngsters are in theschoolssome receiving duplication of ser-vices; some receiving inappropriate "services;others receiving no services. The schools needallied health to assist in identification, referral,and advocacy of appropriate services.

D. Professionals in health and education areNotunaware of one anothers' roles and respon-

sibilities in providing services to youngsters withhandicapping conditions.

Related services professionals (e.g., PTs

arid' Ts) meet for the first time over theboc.1 .of the youngster with a handicap.

. Re, .tea Services professionalS and edit!.cator'meet for the firgt time-over the mind.of the yotIngster With a :handicap. ..,:

Exposure to ..:ithere,-: roles is not - Included/available in training programs, with. the grotind

,ritieS worked out in itheinainstream. Accordingtdlask Force member, Ethan Ellis, "It's 6national Crime." .. , .k: . . : .

Attitudes of health and education professionalsworking with persons *with disabilities are morediscriminatory than '. other . Persons not soinvolved. 'Health professionals, particularly,tend to perceive the youngster only in relationto the disability; not aS a'Whole person, Out-come: generalizations and stereotypes, provid-.ing model behavior for peers and others:

F. SetviCe providers are operating Under; currentPL 94-142 regulations. The Education De-

partment's Special , Education Prograin.:haSreceived snUnierous comments regarding thepropOsed revisions of PL 94-142. The out-.iornes 'of the ED /SEP ;analysis VA impact allWoups: youngSter.S, their families, and theireducation.-and health service-providers.

, ..

G. Budgetary cutbacks at' fedeial and state levelsreinforce the IdArpriOrity giVen to training: needcooperation and collaboratiOn'.in training pro-grams; need cohesion in proVision of services.

H. Advocates,' whether in allied health, ,education,or medicine (pediatrics)," generally are not inpositions of power to affect over-riding changes

. ,in training programs..,.

.;'J: States tend to view the State Education Plan as.'.a` compliance document for ED/SEP, rather

than as a method for identifying:..rieeds, par,titularly in related services. ;. .:

. Redesigning personnel preparation programsto meet the.needs of youngsters with disabilitiesand chronic illnesses is a timely .issue (e.g., an.issue for Maternal and Child Health, SurgeonGeneral, and ED/SEP); however, We need toideytify training priorities, evaluate effective-ness of current programs, and target fundsappropriately.

II. CRITERIA FOR QUALITY TRAINING PRO-GRAMS. These criteria were considered essentialfor all training programs preparing servjce,providers(allied health, regular education, and special educa-tion providers) for their expanding roles and respon-sibilities for youngsters with handicaps and theirfamilies.

A. Program Design: -

Functionally-based: focused op the needsof the child and family.Interdisciplinary: pre-service, ipiatticuin,and in-service programs designed' col- .'laboratively byallied health, regular editca;:,tion, and special education.Community-based: desigriedcollabOratiVelYwith local education and social :service

51 5

agencies, higher education institutions,clients, and families:

B. Curriculum Content:The education, related health, an psycho-social. needs of the youngttpis with ha, ap-ping canditions and theirfamilies.Attitudes: toward persons with disabilities,toward' other professionals, and towardcollaboration, in the delivery :of health andeducation services:Role definition and delineation; com-plimentary and individual professional re-ponsibilities and practices for youngsterswith disabilities and their families. ..s

Interdisciplinary team and case manage-ment responsibilities in 6Ianning fot the lifefspan of the youngster.Governance, monitary, and:informal con-

. trol .systems of laCal and state education 'and social service agencies.Advocacy responsibilities and rights as pro-fessionals in health and education.Realistic practicum experiences, with com-petent, model faculty and practicum super-.visor's. . N..

C. Trainee PopUlaticin.::: Special EduCatorsRegular Educatcirs

ElementarySecondaryVocational

Allied Health ProfessionalsOccupational TherapistsPhysical TherapistsAudiologists and Speech-LanguagePathologistsRehabilitation CounselorsNutritionists and:DietitiansCorrective TherapistsSocial WorkersPhysician AssistantsSchool 'and Clinical PsychologistsRecreational TherapistsChild-Life Specialists(NOTE: All related health professionalsshould be aware of their advocacy re-sponsibilities as professionals in thehealth care syStem.)

- MediCal ProfessionalsNurses (school, clinical, and community-based nurses)PediatriciansFamily Practice Physicians

tProtocol/Clinical Practices

- Appropriate/necessary servisesAppropriate providers of servicesCredentialling needsDuplication and limitations of services

(Example: For Functional Need X, the youngstermay require the Sevicesof Prbvider A and B orC independently.),

B. Types and "effectiveness" of interdisciplinaryand profession-specific (a) training programs,

,* (b) practice;, and (c) service delivery. '.C. Supply and demand data for health and educa-.

tibn services..D. Definitions and delineations of "related. ser-

vices," "education," and "medical" seryices.ED Competencies and skills required of health and

education professionals to determine need forand impact on all levels-and forms of training:technical schools, community and junior college's,lour-year programs, and graduate and postgraduate programs.

F. Fin dal implications of service delivery;.chanisnis for.Ibcal and state education' and

s ial service agencies.

Once iden ified; these-data need.to: be shared with allappropria programs and agenciei concerned withtraining, research, and delivery of services - foryoungsters with handicapping conditions.

IV. AVAILABLE RESOURCES: The resources iden-tified by Task Force members included (a) sourcesfor model, quality training programs; and (b) leadingorganizations, agencies, and persons who should beinvolved in helping to effect change in the design ofpersonnel preparation programs in allied .health,regular education, and special edUcation.

A. Model Interdisciplinary Pracare rind TrainirigPrograms:

University Affiliated Facility (UAF) Pro-, grarns:t

{1) InterdiSciplinary Council. of UAFs. e(2) Community Development training pro-

grams.Contact: AMerican'AssociatiOn of Univer-'sity Affiliated Programs (AAOAP).

. State CriPpled .Children's -OfficesSpecial Education Training and ResourceCenters (SETRC) in 11ew York State.National Associatian of State Directors ofSpecial' Education's (NASDSE), ED/SBPForum Contract with state agencies; andthe West Virginia Interagency, CollabOra-flan Model.Interagency Collaboration Sitia-es'in twelve .

'states funded by Maternal and Child Health(MCH).,.in some cases incoordination withED/SEP. ' - '.. - ,Pre-schobl Proje4-gthPaitcQirectors, Of.Maternal and Child Heah.Interdisciplinary pre:servtce training pro-

> gram for pre-school youngsters with hancti-4.

III. DATA NEEDS. Members identified specific:lin-1i-.

tations in our current knowledge base which need tobe: addressed to design "quality" training`programsresponsive to the needs of youngsters with handl.caps and their families. Quantitative and qualitative.'data are needed to determiner;A. Functional needs of youngsteis with handl-

Gaping cOnditions and their families to identify:

.52 54

fr oar..

caps for allied health profesilonals (Louisiana*.Slate University MeditniCenter).

41,',..-American Society a:Allied Health Pro-, fessions' (ASAHP) Clearinghouse on col

laborative training prdgramp in allied healthand education.University of Minnesota Model for inter-:.agency collaboration using an innovatiVe

-.financial plan. .

,cOlorado Interagency collaboration in healthand education with focus on local corn-mutinies. Contactr.t..Council for Extep-tionalChildrenConsortium planning ,amond all agenciesproviding serviceilti youngsters with haridicapping conditions in six states: New Jer-sey, Colorado, California; Missouri, SouthCarolina, and Iowa. Contact: AmericanAcademy of Pediatrics'' (AAP).. ,

B. Led'ding Organizations, . Agencties, and In-dividuals

American Society of Allied Health Pro-fessions (ASAHP). Contact: Carolyn Del...Polito.

Delineation of roles and respon-..'7..

sibilities foA allied health professionalsin serving. youngsters with handicap=ping conditions. -',Network `Of-leaders in allied health and .

education concerned with interdit'!,,ciplinary traiOig.and service delivery.

National Association Of Stitt Directors ofSpecial Education (NASDSE). Contact:Beverly Osteen.

Special Netcomputerized tiationalnetwork of persons concer;-dd withspeCial educatiin issues at local-enhd

' state ley els.S. U.S. EduCition Department, SI)ecial Edu-

cation PrOgram; Division of .PgrtonnelPreparattori 14c:1/SEP/DPP). COntatit Her-man Saettler.-

Z% Discretionary Grant Program.Comprehensive System of PersonnelDeveloptnerii..; 4(espD) Section .ofStates plani,Reports on Direction Services ac-tivitieS.

Natiorial Association4 of Deveff;pmentalCouncils (NADDC) "arid 54

State Council .affiliates. Contact: "SusanAmes-Ziezman.

Training prograMs for developmentaldisabilities professionals and Councilmembers.Developmental Disabilities ElectronicVail Network.

American Association of Colleges forTeacher Edueation (AACTE). Contact:

,Diane Merchant.Conference for Deans' Grant Directors;February 20-21, 1983, focusing onmaintaining linkages for quality per=sontiel preparation programs.

Resource materials. on collaborativetraining' Programs In regular arid spe-

, dal education,CoUricil for Exceptional Children (CEC). .Conta"ct Alan Abesori.-*

Netv, proposed standards for specialeducators, as develoPed by CEC, include

, intra- and interpersonal coordinationof services whiCh are responsive to the4'neeos of exceptional children.Re-training project funded by ED/SEP,

1.1' American AsSdciation of Community and .

, Junior CollegeS (AACJC). Contact: Con-.,thie Sutton.

Assists in working with' community t1:

colleges to design appropriate tfainingprograrnifor (a) paraprofessionals, arid:

..(b) bridging.tWo-year programs with'',st.indr-yearl 'pr4grams in allied healthV

and education.U.S. DepartmenGO! Health and HumanSen;,ices, Maternal and Child Health(HHS/MCH). Contact: Merle McPhearson:

Funding a number of interagencycollaboration studies (see IV A.).National Public Policy Conference onChronically III Children (VanderbiltStudy), Spring, 1983.Report. on the Surgeon General'sInvitational Workshop on Childrenwith Handicaps and their Familie.s, SPi7ing, 1983.

All otherorganizations listed on TaskfOrce.:.:,to w'O*withASAHP in follow-up and .

seminatiOnC. eiclditional Resources

AD: Direction Services (OSERS).New Jersey Training Project with rehabilita-tion counselors by persons with disabilities...Contact: Elhan Ellis.Educational Resources Inforrnation Center(ERIC) Network.Ea0- Childhood Programs. Contact:U.S.Department of Health and Human 'Ser-vices, Maternal and Child Health.

( I*UTCOMES AND FUTURE DIRECTIONS. Mem-bers identified (a) specific Outcomes for a national

**fort in designing' quality personnel preparationprograms in allied health, regular education, andspecial education, arid (b) specific, limited activitiesto be conducted durrng the remaining three monthsof the Allied He4lth Child-Find and'Advocacy Pro-ject by the American Society of Allied Health Pro-

::.yfessions (ASAHP).

A. National Effort tiPromote policy statements by professionalorganizations which identify:.(1) Professionals' rights and respon-

a sibilitiesas explicit eXtensions of PL 94-142 and: Section 504 of the Re-

' habilitation Act (i.e., what constitutes` appropriate professional responsibili-

ty); and,

53 . ,

(2) Clear description of professional ad-vocacy role (i.e., what constitutes ap-'propriate advocacy).

Design and obtain funding for demonstra-.tion efforts in interdisciplinary "personnelpreparation designed in compliance with `the Task Force recommendations herein.Capitalize on national alliance concept byidentifying alliance teams and coordinatorsat ASAHP/AACTE member institutions.Design, promote, and support coordinatedtraining and service delivery with local andstate education and social service insti-tutions and agencies. Emphasize con-tinually the functional needs of the client.Design, promote, and support public com-mitment activities among all appropriateconstituencies, 4i5,1 effective, coordinatedtraining anti service delivery for youngsterswith handkaiPs and their families.,

B. ASAHP EffortDevelop a Policy Statement reflectingASAHP's commitment to' interdisciplinarytraining programs and service delivery inallied health, regular education, and specialeducation.Develop a Position Paper to support andexpand ASAHP's policy statement on pro-

' fessional training and practice for meetingthe needs of youngsters with handicaps andtheir families. The Position Paper. shouldemphasize the professional, economic, andpractical implications of interdisciplinary

training and service delivery in healthand education.Disseminate ASAHP's Itoticy Statementand accompanying Pbsitiori Piper to ailappropriate local, state, and national pro;fessionbl organizations, agencies, and teliglet.education institutions for adceptance, sup-,port, and use with their conititUencies.For example, allied health and educationtrained will be ablb to useothe documentsfor designing etnd supporting new protgrams, as well as for use with students in Ephclass discusgions.4 * q

Plan a keynote panel program for ASAHP'sannual meeting!Pshowctsing model inter-.disciplinary training programs. Invite TaskForce members toparticipate.Coordinate data collectkonand dissemina-.tiOn of Interdisciplinary personnel ptepara-ti6n programs through the society's Centerfor Continuing Education.

As evidenced throughout these proceedings, effi-cient, cost-effective, quality care for pers'ons withabilities%and chronic illneSSes is jeopardized by the lackof coordination of health-and education services. For .

personnel preParationoprograms, the implications areclear: while many times difficult to initiate and maintain,interdisciplinary, cIlaborative training approaches (pre-service, .practicum, and in-service) must be embracedand promoted by professional organizations, creden-tialling and most importantly, by those educatingour providers of services in the 1980s.

a

4

a

About the Allied Health Professions

As knowleciphnd technology in the health fieldshave grovii, so have the numbers and types of pro-fessions reqiiirgcl to deliver effective hearth services. In alifetime, to avtgage American is likely to benefit fromthe specircompetencies of health professionals in over150 different ations. Eath of these occupations isessential in *Ratting disease and disability andsaving lives.

The Alliesi health prOfess s include about 140 ofthese occupations and ov r half the health workforce.The concept of ealth4" developed about 15years ago as a way; of promoting teamwork andcollaboration. With. so many differEnt health pro-fessions, teamwork would be discouraged if all wereeducated in isolation. Colleges and divisions of alliedhealth professions were established in 'postsecondaryeducation institutions across the country to create anenvircinmelit where those who will one day worktogether can study together and develop the rnutuarappreciation which- is necessary for efficient and effec-tive health care.

The allied health Professions are extremely varied inthe level of education they require (from short-termtraining through the doctorate) and in the services theyprovide. Examples of such services are:

emergency services (e.g., emergency medicaltechnicians, emergency /disaster specialists, physi-cian assistants);(reception and screening (e.g., medical or dentalsecretaries, medical office assistants);initial evaluation and dietgnosis (e.g., physicianassistants, dental hygienists, mental health tech-nologists, medical social workers);continued.assessment as part treatment (e.g.,Physical therapists, occupational therapists, .res-piratory therapists, snech-lwagg pathologists,audiologists, dietitians);

APPENDIX A

test medical laboratory personnel, radio-I is technologists, ultrasound technical spe-ialists, nuclear medicine personnel, cardiology

equipment personnelY;acute care therapy (e.g., operating room ch-nicians, obstetrical assistants, surgeon's as-sistants);long-term care therapy (e.g., occupational, physi-cal and .other therapists; .personnel in mentalhealth, social services, counseling, speech-language'pathology, audiology, nutrition);medical, instrumentation (e.g., radiation and res-.piratory therapists, dialysis technicians, car-diopulmonary technicians, ophthalmic dispensers,dental laboratory technicians);community health promotion and protection(4g., nutritionists, dental hygienists, populationand family planning specialists, health educators,school health educators, medical librarians, healthwriters);control and elimination of hazards in an in-stitutional or industrial setting (e.g., audiologists,health physicists, health, care facilities houge-keepers, industrial hygienists); andresearch and development (e.g., biomedical engi-neers, biostatisticians, epidemiologists, tox-icologists, public health scientists, and researchersin every occupational category).

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ABOUT ASAHP

The American Society of Allied Health Professions(ASAHP) is a national nonprofit scientific and pro-fessional organization formed to serve the needs ofallied health educators, practitioners, professional in-stitutions and organizations, and others interested ipimproving health care and health-care education.ASAHP has as its ultimate goal the best possible trainingand utilization of all allied health professionals.'As ameans to that goal, the Society provides a vital forum inwhich allied health educators and practitiOnerstheireducational and clinical institutions and their pro-fessional associationscan address and act on mutualconcerns.

Established in 1967, ASAHP.now serves 118 educa-tional institutions, 23 national professional organi-zations, and over 1,300 individual members.

The Society's role in serving the interests of these con-stituent groups is twofold. First, it provides a forum forsharing concerns and solutions that relate to significant,mutually relevant allied health issues. Second, ASAI-[Pserves as the vanguard of the allied health movementan organization which forcefully and effectively rep-resents positions of overreaching allied health sig-nificance to government, other major health-educationand health-care system elements, and the public.

ASAHP's office headquarters are located at. OneDupont Circle, N.W., Suite 300, Washington, D.C.20036. Telephone (202) 293-3422.

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