Delivering Related Services (page 5)
As was described in Part I, once a child has been evaluated and found eligible for special education and related services, the IEP team develops an individualized education program (IEP) for the child. This will include specifying the special education and related services that the child will receive as part of his or her free appropriate public education (FAPE). Beyond specifying the related services, however, is the delivery of the services. This section looks briefly at how school districts typically provide children with disabilities with related services.
Who provides related services?
Providers of related services in the schools typically include (but are not limited to) professionals such as: school counselors, school psychologists, school social workers, school health professionals, speech-language pathologists, and occupational and physical therapists. The training and credentialling of these professionals will vary from State to State.
IDEA requires that related services are provided by qualified personnel. However, neither the law nor the regulations specify the levels of training that an individual needs in order to be considered “qualified.” It is the State that establishes what constitutes “suitable qualifications for personnel providing special education and related services” [§300.136(a) (1)(ii)]. This includes establishing the “highest entry-level academic degree needed for any State-approved or - recognized certification, licensing, registration, or other comparable requirements that apply to a profession or discipline” in which a person is providing special education and related services [§300.136(a)(2)].
The IDEA also permits, but does not require, the use of paraprofessionals and assistants who are appropriately trained and supervised to assist in the provision of special education and related services. The use of paraprofessionals and assistants is contingent upon State law, regulations, or written policy giving States the option of determining whether paraprofessionals and assistants can be used to assist in the provision of special education and related services, and, if so, to what extent their use would be permissible (U.S. Department of Education, 1999, pp. 12561- 12562).
Apart from the requirements of the IDEA ‘97 and standards of training that individual States establish as “suitable qualifications” for their various related services providers, a number of professional organizations exist and publish standards as well. These groups can be a valuable source of information to parents and professionals alike. We have provided the contact information, including Web sites, for many of these professional associations at the end of this News Digest.
While States may consider the recognized standards of professional organizations in deciding what are “appropriate professional requirements in the State,” there is nothing in the statute or the regulations that requires States to do so (U.S. Department of Education, 1999, p. 12560; see also §300.136(b)(3)].
How are related services generally delivered?
A school district must ensure that all of the related services specified in the student’s IEP are provided, including the amount specified. The district usually decides how the services listed in the IEP will be delivered to the student. For example, the district may provide the services through its own personnel resources, or it may contract with another public or private agency, which then provides the services. Contracted service providers must meet the same standards for credentialling and training as public agency service providers do.
Generally, there are two basic kinds of related services interventions offered by schools to meet the range of student needs. These are:
1. Direct Services. Direct services usually refers to hands-on, face-to-face interactions between the related services professional and the student. These interactions can take place in a variety of settings, such as the classroom, gym, health office, resource room, counseling office, or playground. Typically, the related service professional analyzes student responses and uses specific techniques to develop or improve particular skills. The professional should also:
- monitor the student’s performance within the educational setting so that adjustments can be made to improve student performance, as needed, and
- consult with teachers and parents on an ongoing basis, so that relevant strategies can be carried out through indirect means (see below) at other times.
2. Indirect Services. Indirect services may involve teaching, consulting with, and/or directly supervising other personnel (including paraprofessionals and parents) so that they can carry out therapeutically- appropriate activities. For example, a school psychologist might train teachers and other educators how to implement a program included in a student’s IEP to decrease the child’s problem behaviors. Similarly, a physical therapist may serve as a consultant to a teacher and provide expertise to solve problems regarding a student’s mobility through school (Dunn, 1991). Good practice is generally thought to include the following aspects:
- The intervention procedure is designed by the related service professional (with IEP team input) for an individual student.
- The related service professional has regular opportunities to interact with the student.
- The related service professional provides ongoing training, monitoring, supervision, procedural evaluation, and support to staff members and parents.
One type of service intervention is not necessarily better than the other (American Occupational Therapy Association, 1999) as long as the safety of the student is not compromised. In most school systems student needs are addressed through a combination of direct and indirect services (Smith, 1990). The type of service provided depends upon the individual needs of the student and his or her educational goals. Decisions about direct or indirect service delivery, therefore, are made on an individual, case-by-case basis.
It is not uncommon for districts to employ certified or trained assistants— such as a Physical Therapy Assistant, a Certified Occupational Therapy Assistant, or a Speech-Language Pathology Assistant—to assist in the delivery of related services. In fact, in recent years there has been an increased emphasis on team members (e.g., teacher, therapist, and family member) delivering services under the supervision of an expert rather than only having an expert deliver direct services to a child (American Occupational Therapy Association, 1999). As stated previously, the final regulations for IDEA ‘97 make clear that nothing in the statute or regulations prohibits the use of paraprofessionals and assistants who are appropriately trained and supervised to assist in the provision of special education and related services, in accordance with State law, regulations, or written policy [§300.136(f)].
Where are related services provided?
In recent years, there has been a significant shift in where related services are provided. Rather than providing services in a separate room, as was the more common practice in years past, schools are emphasizing providing some services to students in natural activities and environments. Today it is not unusual to find speechlanguage services integrated into instructional activities in the regular education classroom, or occupational or physical therapy provided during physical education classes in gyms. As an example, asthma medication or glucose monitoring (as a school health service) may be done in the classroom or wherever the student with a disability happens to be. Thus, services may be delivered in a regular education class, a special education class, a gym, a therapy room, or in other locations in the school, home, or community.
Of course, there may be some services that need to be delivered in a separate setting such as a counseling room or office in order to assure confidentiality for the student and family. Such services may include individual and group counseling, parent counseling, and, frequently, consultation with staff and parents about individual students.
It is interesting to note that this shift in location accompanies a lesser focus on the traditional medical model of related services and greater attention given to an educational- results model. The medical model, typically found within a hospital or clinical setting, focuses on identifying and treating the particular illness, trauma, or deficit in a clinical setting. The educational model stresses the importance of the student’s attaining IEP goals and objectives as well as addressing the capabilities and challenges presented by the particular disability (Hanft & Striffler, 1995).
How are related services coordinated?
Depending on the nature and type of related services to be provided, many professionals may be involved with, or on behalf of, the student with a disability. This may include one or more therapists, a special educator, a regular educator, counselor, a school psychologist, social workers, the school nurse or other health services staff, paraprofessionals, or the school principal. Clearly, there must be communication between the IEP team and the related service provider(s) to ensure that services are being delivered as specified in the IEP and that the student is making progress. If the student is not progressing as expected, adjustments in his or her program may be needed. The IEP team would need to make any such decisions. When a student’s IEP includes related services, it may be appropriate for related services professionals to be involved in the review of student progress and any decision to modify instruction or reevaluate the student’s needs. Furthermore, if adjustments are made in the IEP, each teacher, related service provider, and other service provider who is responsible for implementing the revised IEP must be informed of:
- his or her specific responsibilities related to implementing the child’s IEP; and
- the specific accommodations, modifications, and supports that must be provided to the child in accordance with the IEP. [§300.342(b)(3)]
The IEP team may determine that it is highly desirable that related services be delivered in educational settings through a team approach. As mentioned above, related services are not isolated from the educational program. Rather, they are related to the educational needs of students and are intended to assist the child in benefitting from the educational program. In order to ensure the integrated delivery of services, some school systems use a case management approach in which a team leader coordinates and oversees services on behalf of the student. In some schools, this person might be the child’s special education teacher. In other schools, supervisory school district personnel may assume this responsibility.
How are related services funded?
State and local educational agencies are responsible for assuming the costs of public education, including the cost of special education and related services. Under IDEA ‘97, students with disabilities are entitled to a free appropriate public education (FAPE) and are entitled to receive these services at no cost to themselves or their families.
Part of the monies to finance special education and related services comes to States and local educational agencies (LEAs) through Federal funding of IDEA. What other funding sources are available to States and LEAs, besides the IDEA, to help cover the costs of special education and related services?
Interagency agreements or other arrangements. One of the primary methods for ensuring services, strengthened through IDEA ‘97, is the establishment and use of interagency agreements between the public agency responsible for the child’s education and other noneducational public agencies in the State or locale. States may engage in other mechanisms that result in interagency coordination and timely and appropriate delivery of services [§300.142(a)(4)]. Pertinent noneducational public agencies, according to IDEA ‘97, are those:
...otherwise obligated under Federal or State law, or assigned responsibility under State policy...to provide or pay for any services that are also considered special education or related services...that are necessary for ensuring FAPE to children with disabilities within the State... [§300.142(b)(1)]
This includes the State Medicaid agency and other public insurers of children with disabilities. A noneducational public agency, as described above, may not disqualify an eligible service for Medicaid reimbursement because that service is provided in a school context [§300.142(b)(1)(ii)].
In order to receive funds under IDEA ‘97, the State Education Agency must have in effect agreements or other mechanisms with such agencies in order to define the financial responsibility that each agency has for providing services to ensure FAPE to children with disabilities [§300.142 (a)(1)]. Moreover, the financial responsibility of each noneducational public agency comes before the financial responsibility of the local educational agency (or the State agency responsible for developing the child’s IEP) [§300.142(a)(1)].
Public insurance. Insurance is another potential source of funding for related services. With certain limitations, “the public agency may use the Medicaid or other public insurance benefits programs in which a child with disabilities participates to provide or pay for services,” as permitted by the public insurance program. Limitations include:
- The public agency may not require parents to sign up or enroll in public insurance programs in order for their child to receive FAPE under Part B of IDEA.
- The public agency may not require parents to incur an out-of-pocket expense, such as the payment of a deductible or co-pay amount incurred in filing a claim for services. The public agency, however, may pay the cost that the parent would otherwise be required to pay.
- The public agency may not use a child’s benefits under a public insurance program if that use would (a) decrease available lifetime coverage or any other insured benefit; (b) result in the family paying for services that would otherwise be covered by the public insurance program and that are required for the child outside of the time the child is in school; (c) increase premiums or lead to the discontinuation of insurance; or (d) risk loss of eligibility for home and community-based waivers, based on the sum total of health-related expenditures. [§300.142(e)]
Private insurance. The IDEA ‘97 final regulations state that a public agency may access a parent’s private insurance proceeds only if the parent provides informed consent [§300.142(f)(1)]. Each time the public agency proposes to access the parent’s private insurance proceeds, it must obtain the parent’s informed consent and inform the parent that his or her refusal to permit such access to private insurance does not relieve the public agency of its responsibility to ensure that all required services are provided at no cost to the parents [§300.142(f)(2)].
However, IDEA ‘97 states that “nothing in this part relieves an insurer or similar third party from an otherwise valid obligation to provide or to pay for services provided to a child with a disability” [§300.301(b)]. When parents voluntarily access private insurance to pay for related services, an insurance company cannot refuse payment by claiming that the school district is required under IDEA ‘97 to provide the services. Moreover, there can be no delay in implementing a child’s IEP, because the payment source for providing or paying for special education and related services to the child is being determined [§300.301(c)].
Reprinted with the permission of the National Dissemination Center.
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