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Education Advocacy for Physicians: Ensuring patient access to appropriate educational programming and services

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Title: Education Advocacy for Physicians: Ensuring patient access to appropriate educational programming and services


1
Education Advocacy for PhysiciansEnsuring
patient access to appropriate educational
programming and services
2
Training Objectives
  • Understand basic educational rights
  • Learn to screen patients for educational issues
  • Learn advocacy strategies to help families
    navigate the educational system and enforce their
    rights

3
Links Between Education and Child HealthWhen
children have access to a quality education . . .
  • Improved social and emotional competence
  • Decreased disciplinary problems
  • Increased graduation rates
  • Increased occupational success following school
  • School success and graduation rates tied to
    lifelong economic success
  • Links to improved health throughout life

4
Children have a right . . .
  • To enroll in school
  • To be timely evaluated for special education
    services and to receive appropriate services in a
    timely manner
  • To reasonable accommodations for medical and
    disabling conditions
  • To safety
  • To fair discipline

5
Key Terms
  • SPECIAL EDUCATION
  • Specifically designed instruction intended to
    meet the unique needs of a child with a
    disability.
  • Required by federal and state laws and is
    provided at no cost to the parent.
  • Children are eligible for special education
    services from age 0 through 21.

6
Key Terms
  • 504 PLAN
  • Required when a child with a mental or physical
    condition that substantially limits at least one
    major life activity (i.e. caring for oneself,
    walking, seeing, hearing, breathing, or learning)
    to allow full participation in school.

7
Key Terms
  • EARLY INTERVENTION
  • Provides evaluation and services to
    developmentally delayed children between the ages
    of zero 3.

8
How to identify a child in need of educational
services or accommodations
  • GABS (Grades, Attendance, Behavior, Services)
  • Is the child receiving poor grades? Did the
    child repeat any grades or was the child assigned
    to the next grade level?
  • Is the child repeatedly sent from the classroom,
    suspended, disciplined on a regular basis?
  • Does the child miss a lot of school because of a
    medical or mental health condition?
  • Does the child have a mental or physical
    condition which seems to be inhibiting her
    ability to learn and progress in school?

9
Case Scenario 1
  • Patient coming in because school says needs
    medicine
  • Behavior issues at school but not at home

What can you do?
10
Case scenario 1
  • Differential?
  • Remember Schools cant mandate medication for kids

11
Case Scenario 1 Next Steps
  • ADHD evaluation completed
  • Vanderbilt Teacher scale identify performance
    and hyperactive/inattentive symptoms
  • Vanderbilt Parent scale no performance or
    behavior issues identified
  • What is your next step?
  • Discussion

12
Response to Intervention (RTI)
  • Response to intervention (RTI) strategies are
    tools that enable educators to target
    instructional interventions to childrens areas
    of specific need as soon as those needs become
    apparent.
  • Response to intervention integrates assessment
    and intervention within a multi-level prevention
    system to maximize student achievement and to
    reduce behavioral problems.

13
RTI cont.
  • With RTI, schools use data to identify students
    at risk for poor learning outcomes, monitor
    student progress, provide evidence-based
    interventions and adjust the intensity and nature
    of those interventions depending on a students
    responsiveness, and identify students with
    learning disabilities or other disabilities.
  • RTI is not special education.
  • Developed to provide typical students with needed
    academic supports to reduce the over
    identification of students of color as students
    with disabilities.

14
RTI in Practice
  • Many local districts have developed Intervention
    Response Teams to provide RTI to students.
  • Only required as a tool in determining suspected
    eligibility for special education for students
    with a suspected specific learning disability.
  • May be appropriate for students with behavioral
    concerns who are not suspected as eligible for
    special education.

15
Case scenario 1
  • Patient returns follow-up
  • Per parent Nothing really has happened yet
  • School Performance behavior issues reported
    (multiple letters from teacher)
  • Two suspensions
  • Mom told child will likely fail
  • Mom says requested help at last parent-teacher
    conference
  • What to do?

16
Special Education Individuals with Disabilities
Education Improvement Act (IDEIA)
  • Federal law that mandates the provision of
    special education services.
  • Guarantees that a child who is disabled and in
    need of special education services receive a Free
    and Appropriate Public Education (FAPE).
  • Requires that children be served in the Least
    Restrictive Environment (LRE).

17
What does IDEIA (IDEA) get you?
  • Services that may be provided to a child
    receiving special education services can include
  • Tutoring
  • Behavior Intervention services
  • Counseling and Psychiatry services
  • One-on-one aide
  • Small class setting
  • Alternate testing
  • OP/PT services
  • Special equipment for school use
  • Transition services for children age 15 and up
  • Educational services until the childs 22nd
    birthday

18
Disabling Conditions under IDEIA
  • Cognitive Disability
  • Hearing impairments, deafness
  • Speech or language impairments
  • Visual impairments, blindness
  • Orthopedic impairments
  • Autism
  • Traumatic brain injury
  • Deaf-blindness
  • Learning Disabilities
  • Emotional Disturbance
  • Other Health Impairment includes chronic or
    acute health problems like a heart condition,
    sickle cell anemia, hemophilia, epilepsy, asthma,
    ADD, ADHD, etc.

19
Special Education Eligibility
  • Child must have a disabling condition and the
    condition must substantially impact the childs
    ability to learn in order to be eligible for
    special education services.

20
Special Education Eligibility cont.
  • Children age 0 to 3 may be entitled to Early
    Intervention services or an Individualized Family
    Service Plan (IFSP) if experiencing developmental
    delays in
  • Cognitive development
  • Physical development
  • Communication development
  • Social development
  • Adaptive development
  • Diagnosed physical or mental condition that has a
    high probability of resulting in developmental
    delay

21
Who can identify a child with a suspected
disability under IDEIA?
  • School staff (teacher, principal, nurse, school
    social worker, guidance counselor) Required to
    identify under Child Find
  • Parent
  • Pediatrician, child psychologist, social worker,
    counselor (medical staff)

22
The Special Education Evaluation or MFE
(Multi-Factored Evaluation)
  • Before a child can receive special education
    services, the child must be evaluated.
    Generally, a special education evaluation is
    called a Multi-Factored Evaluation or MFE.
  • A parent or legal guardian can request an
    evaluation to determine whether their child is in
    need of special education. The request should be
    in writing and should contain
  • statement of request for a special education
    evaluation of MFE,
  • statement of consent for the child to participate
    in the evaluation, and
  • statement regarding why the parent believes the
    child needs an evaluation.

23
Sample Parent Evaluation Request Letter
  • Date
  • Dear Special Education Coordinator/Principal/Coun
    selor,
  • I am writing to request that my child, child
    name, child date of birth, be evaluated for
    eligibility for special education services. I am
    the parent/legal guardian of child name. My
    child attends name of school.
  • I suspect that my child has a disability and may
    be in need of special education services because
    state the reasons for believing that your child
    may have a disability and need special education
    services. (If there are any supporting outside
    diagnostic assessments or medical records,
    reference here and attach to this letter.)
  • I understand that you have thirty days to
    respond to this request by either 1). meeting
    with me to obtain my informed consent for the
    multi-factored evaluation and to complete an
    Evaluation Team Report planning form, or 2) by
    providing me with a prior written notice
    indicating the districts refusal to initiate the
    evaluation, the reasons for the refusal, and
    informing me of my right to challenge the refusal
    to evaluate.
  • If you have any questions or would like to
    discuss this matter further, please contact me at
    phone number. The best time to reach me is state
    a time that you are usually available by phone.
  • Sincerely, Parent/Guardian Name

24
Deadlines for the school
  • School must respond to a parental request for an
    evaluation within 30 days by either obtaining
    informed parental consent for the evaluation or
    providing prior written notice explaining why
    the school is refusing to initiate an evaluation
    and providing the parent with information
    regarding how they can challenge the schools
    position.

25
Deadlines for the school
  • Once parental consent is obtained, school must
    complete evaluation within 60 days. School should
    then invite the parent to attend an Evaluation
    Team Report meeting to discuss the outcome of the
    evaluation and to make a determination about
    eligibility for special education services.

26
Deadlines for the school cont.
  • The school must provide the parent with a copy of
    the evaluation within 30 days of its completion
    and before an Individualized Education Program
    meeting (IEP).
  • If the child is determined disabled, an IEP must
    be held within 30 days of the completion of the
    evaluation and within 90 days of the date of
    parental consent.

27
(No Transcript)
28
Case Scenario 1
  • Parent comes back for follow up appt
  • Reports IEP in place
  • Physician How did the IEP meeting go?
  • Parent response Huh? They just had me sign the
    IEP!

29
Individualized Education Program (IEP)
  • The IEP should be developed by a team including
  • The childs parent or legal guardian
  • A special education teacher
  • A regular education teacher
  • A representative of the local education agency
  • An individual who can interpret the results of
    the MFE
  • Other individuals who have knowledge or special
    expertise (can include counselors and
    pediatricians) and
  • The child when appropriate (older children should
    be involved particularly when transitional
    services are being designed).

30
Individualized Education Program (IEP)
  • The IEP should contain
  • A statement of the childs present level of
    performance (PLOPS)
  • A statement of measurable annual functional and
    academic goals
  • A description of how the childs progress towards
    the goals will be measured
  • A statement of the special education and related
    services to be provided to the child

31
Important things to remember
  • An IEP should be specifically tailored to meet a
    childs unique and individualized needs. A
    standard IEP for children with a specific kind of
    disability is not appropriate.
  • The IEP should place the child in the least
    restrictive setting possible to promote the
    childs ability to interact with other students
    who do not have disabilities.
  • A parent can request an IEP meeting at any time.
  • Money is not an excuse! Public schools cannot
    limit services according to what resources are
    available.

32
Section 504 of the Rehabilitation Act
  • Section 504 is a federal civil rights law
    protecting the right of individuals with
    disabilities to equal treatment and equal access
    to opportunities.
  • Under Section 504, a student with a disability
    may be entitled to accommodations, modifications,
    and additional services at school.

33
Section 504 Eligibility
  • Section 504 protects individuals with a mental or
    physical impairment that substantially limits one
    or more major life activity. Major life
    activities include
  • Reading
  • Writing
  • Performing math calculations
  • Working
  • Caring for oneself
  • Performing manual tasks
  • Learning
  • Walking
  • Seeing
  • Hearing
  • Speaking
  • Breathing

34
Section 504 Eligibility
  • A school must evaluate a student to determine
    whether he is covered by Section 504.
  • The evaluation can simply involve a process of
    information gathering from different sources
    including reviewing tests and evaluations
    completed by various professionals.

35
504 Plan
  • If a child is determined to be eligible under
    Section 504, a 504 plan should be developed to
    provide for the necessary accommodations and
    modifications for the child.
  • Modifications and accommodations under Section
    504 can include
  • Schedule modifications
  • Assistance with health needs
  • Modifications to the school building, etc.
  • Preferential seating
  • Extra time to complete assignments
  • Alternate formats for work
  • Shortened assignments

36
Case Scenario 2
  • Allison, a 9-year-old patient with diabetes,
    comes to your office. She was found ineligible
    under IDEIA. Allisons mother is worried that
    Allisons school is not letting her drink juice
    when she feels she needs it and is limiting her
    opportunity to check her blood sugar.

What should you do?
37
Case Scenario 2 discussion
  • Child needs accommodations at school
  • What would you suggest?
  • School needs a Care plan?
  • What would you tell the family to do if it were
    at home?

38
The differences between Section 504 and IDEA
  • Section 504 protects student access to education.
    This is different from a students right to
    benefit from their education as required for
    special education students.
  • Providing access means providing students with
    disabilities the same opportunities as students
    who do not have disabilities.
  • For example, a child who needs a wheelchair may
    need ramps built in the school to allow access to
    classrooms. A child with an impairment that
    affects her ability to read may need additional
    time on tests.

39
The differences between Section 504 and IDEA
  • All students who receive special education
    services are protected by Section 504. However
    students protected under Section 504 are not
    necessarily entitled to special education
    services.
  • Students entitled to special education services
    generally have more severe impairments which
    affect educational performance and therefore need
    special education and related services.

40
Case Scenario
  • Child comes for follow up visit
  • Parent reports school performance issues
  • Keeps getting in trouble for not paying attention
  • Teacher wont allow the child to use the bathroom
  • Blood sugars been running high
  • How do you counsel the family?

41
School Discipline and Students with Disabilities
  • Children with disabilities have protections in
    school disciplinary procedures
  • Children whose behaviors are manifestations of
    their disabilities cannot be continuously
    disciplined and removed from school because of
    their disability under the IDEIA or 504

42
Suspension vs. Expulsion
  • SUSPENSION
  • A form of discipline which prohibits a student
    from attending classes for up to 10 consecutive
    days. Can be in school or out of school.
  • EXPULSION
  • May be used to remove a student for more than 10
    days when serious violations of the disciplinary
    code occur. A student may be expelled for up to
    1 year if the student brings a firearm or knife
    to the school. Under rare circumstances, a
    student can be permanently excluded from Ohio
    public schools (i.e. for murder or a deadly
    weapon on school property).

43
Students Rights when facing Suspension or
Expulsion
  • Right to Notice of reason for suspension or
    expulsion and of right to appeal (does not apply
    to in-school suspensions).
  • Right to Appeal
  • Right to Hearing challenging the suspension. For
    suspensions hearing is informal. For expulsions,
    formal hearing before the superintendent or his
    representative.
  • Right to an attorney or other representative.

44
Special Education students and Discipline
  • There are strong links between learning
    disabilities and anti-social/criminal behavior.
    Punishment and isolation from the school system
    worsens the problem. Children with learning
    disabilities need to be engaged through special
    education programs.
  • Abandoned in the Back Row, New Lessons in
    Education and Delinquency Prevention Coalition
    for Juvenile Justice (2001)

45
Special Education Students have additional
protections in disciplinary proceedings
  • Special education students must receive education
    services after removal for 10 school days.
  • For any removal over 10 days, the IEP team must
    meet and determine
  • If the students conduct was caused by her
    disability or
  • Whether the conduct resulted from the schools
    failure to implement the childs IEP.
  • If the answer to either is Yes
  • The child cannot be removed for the behavior
    unless involved serious bodily injury or bringing
    drugs or weapons to school, and
  • A Functional Behavioral Assessment (FBA) and
    Behavior Intervention Plan (BIP) must be done by
    the IEP team.

46
Behavioral Intervention Plans (BIPs)
  • Whenever a students behavior interferes with
    learning, the IEP team must consider appropriate
    strategies, including positive behavioral
    interventions and supports, to address the
    behavior.
  • The BIP should be developed by a team that knows
    the student well and should be based on a
    functional behavior assessment. The BIP should
    be included in the childs IEP!
  • First question to ask is Where is the students
    BIP? If there is no BIP and there is a history
    of past behavioral difficulties, then it will be
    harder for the school to remove the student.

47
The Pediatricians Role
  • Help identify when a child may be eligible for
    special education or school accommodations.
  • With some basic legal knowledge, help parents
    advocate for their children.

48
The Pediatricians Role
  • Help parents collect necessary medical
    information.
  • Write a letter to the school identifying any
    diagnosis that the child has which is impacting
    his ability to access or benefit from his
    education.
  • Refer the parent to the MLPC.

49
Resources


  • www.EdResourcesOhio.org
  • Ohio Department of Education, www.ode.state.oh.us
  • Ohio Legal Rights Services, www.olrs.ohio.gov
  • The Ability Center of Greater Toledo,
    www.abilitycenter.org
  • Lucas County Board of Developmental Disabilities,
    www.lucasdd.org

50
Speaker Contacts
  • Cathi Badik, Pediatric Program Director,
    Assistant Professor Pediatrics, University of
    Toledo College of Medicine
  • Email Cathi.badik_at_utoledo.edu
  • Phone (419) 383-4403
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