A Closer Look At Specific Related Services

Assistive Technology Devices and Services

Assistive technology (AT) refers to various types of devices and services designed to help students with disabilities function within their environments. Many areas are covered under the umbrella of assistive technology, including computers, adaptive toys and games, devices to improve positioning and mobility, devices designed to help individuals with disabilities communicate (called augmentative communication devices and electronic aids to daily living (RESNA Technical Assistance Project, 1992).

An assistive technology device means "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability" (§300.5). Assistive technology devices may be used for personal care, sensory processing of information, communication, mobility, or leisure. For young children, assistive technology may involve adaptive toys or simple computer software games to stimulate eye-hand coordination (Derer, Polsgrove, & Rieth, 1996). For other children, it may involve adaptive eating utensils, electronic augmentative communication devices, or a voice-activated word processing software program.

An assistive technology service means "...any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device" (§300.6). School districts are responsible for helping individuals with disabilities select and acquire appropriate assistive technology devices and for training them in their use, if doing so is necessary for them to receive FAPE (§300.308). Such services include:

• evaluating a child's needs, including a functional evaluation in the child's customary environment;
• purchasing, leasing, or otherwiseproviding for the acquisition of assistive technology devices by children with disabilities;
• selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
• coordinating and using other therapies, interventions, or services with assistive technology devices (such as those associated with existing education and rehabilitation plans and programs);
• training or technical assistance for a child with a disability or, if appropriate, the child's family; and
• training or technical assistance for professionals (including individuals providing education or rehabilitation services); employers; or other individuals who provide services to, employ, or are substantially involved in the major functions of that child. (§300.6)

Rothstein and Everson (1995) suggest several guidelines for decision making regarding assistive technology, including:

• look for simple solutions;
• consider the learning and work style of the student; consider the long-range implications of the student's disability and the device;
• look at each device for ease of use and maintenance, timeliness, adaptability, portability, dependability, durability, and technical support needed;
• investigate all options;
• compare similar devices from different manufacturers, and
• purchase devices only after consulting with a professional.

Consideration of a child's need for assistive technology devices and services occurs on a case-by-case basis in connection with the development of a child's IEP. Thus, when an IEP of a student with a disability is being developed, reviewed, or revised (if appropriate), the IEP team must determine his or her need for an assistive technology device or service, determine those devices that will facilitate the student's education, and list them in the IEP. The public agency must then provide them to the student at no cost to the parents.

May a child use a school-purchased AT device in his or her home or other setting? According to the IDEA '97's final regulations, the answer to this question would be determined on a case-by-case basis. Such use in nonschool settings would be "required if the child's IEP team determines that the child needs access to those devices in order to receive FAPE" [§300.308(b)]—for example, to complete homework. Question 36 of Appendix A of the regulations adds that "the parents cannot be charged for normal use, wear and tear. However, while ownership of the devices in these circumstances would remain with the public agency, State law, rather than Part B [of IDEA], generally would govern whether parents are liable for loss, theft, or damage due to negligence or misuse of publicly owned equipment used at home or in other settings in accordance with a child's IEP" (U.S. Department of Education, 1999, p. 12479).

Audiology

Audiology includes:

• identifying children with hearing loss;
• determining the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing;
• providing habilitative activities, such as language habilitation, auditory training, speech reading (lip-reading), hearing evaluation,and speech conservation;
• creating and administering programs for prevention of hearing loss;
• counseling and guidance of children, parents, and teachers regarding hearing loss; and
• determining children's needs for group and individual amplification, selecting and fitting an appropriate aid, and evaluating the effectiveness of amplification. [§300.24(b)(1)]

Some schools have hearing screening programs and staff trained to conduct audiologic screenings of children. Others may participate in regional cooperatives or other arrangements that provide audiological services. Those school districts that do not have diagnostic facilities to evaluate students for hearing loss and related communication problems or central auditory processing disorders may refer students to a clinical setting, such as a hospital or audiology clinic, or make other contractual arrangements (American Speech-Language-Hearing Association, personal communication, August 1, 2000).

Counseling Services

Counseling services, according to the American School Counselor Association (1999), focus on the needs, interests, and issues related to various stages of student growth. School counselors may help students with personal and social concerns such as developing self-knowledge, making effective decisions, learning health choices, and improving responsibility. Counselors may also help students with future planning related to setting and reaching academic goals, developing a positive attitude toward learning, and recognizing and utilizing academic strengths. Other counseling services may include parent counseling and training and rehabilitation counseling (that is, counseling specific to career development and employment preparation) (Maag & Katsiyannis, 1996).

Counseling services are services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel [§300.24(b)(2)]. A school counselor is a certified professional who meets the State's certification standards. In some schools, the counselor may also perform some functions similar to those of the school psychologist as described below under Psychological Services

Medical Services

Medical services are considered a related service only under specific conditions. By definition, the term "means services provided by a licensed physician to determine a child's medically related disability that results in the child's need for special education and related services" [§300.24(b)(4)]. Thus, medical services are provided (a) by a licensed physician, and (b) for diagnostic or evaluation purposes only.

Occupational Therapy

Occupational therapy (OT) services can enhance a student's ability to function in an educational program. These services are "provided by a qualified occupational therapist" and include:

• "improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;
• improving [a child's] ability to perform tasks for independent functioning if functions are impaired or lost; and
• preventing, through early intervention, initial or further impairment or loss of function" [§300.24(b)(5)].

Occupational therapy services in schools may include such services as:

• self-help skills or adaptive living (e.g., eating, dressing);
• functional mobility (e.g., moving safely through school);
• positioning (e.g., sitting appropriately in class);
• sensory-motor processing (e.g., using the senses and muscles);
• fine motor (e.g., writing, cutting) and gross motor performance (e.g., walking, athletic skills);
• life skills training/vocational skills; and
• psychosocial adaptation.

Orientation and Mobility Services

According to Hill and Snook-Hill (1996), orientation involves knowing where you are, where you are going, and how to get to a destination by interpreting information in the environment, while mobility involves moving safely through the environment. IDEA '97 added orientation and mobility (O&M) services to the list of related services specified at §300.24.

O&M services "services provided to blind or visually impaired students by qualified personnel to enable those students to attain systematic orientation to and safe movement within their environments in school, home, and community" [§300.24(b) (6)(i)]. This includes teaching students the following, as appropriate:

• "spatial and environmental concepts and use of information received by the senses (such as sound, temperature, and vibrations) to establish, maintain, or regain orientation and line of travel (e.g., using sound at a traffic to cross the street);
• to use the long cane to supplement visual travel skills or as a tool for safely negotiating the environment for students with no available travel vision;
• to understand and use remaining visual and distance low vision aids; and
• other concepts, techniques, and tools." [§300.24(b)(6)(ii)]

Attachment 1 to the regulations discusses why O&M services are not appropriate for students with disabilities other than visual impairments and draws a distinction between O&M services and what is commonly referred to as travel training.

[S]ome children with disabilities other than visual impairments need travel training if they are to safely and effectively move within and outside their school environment, but these students (e.g., children with significant cognitive disabilities) do not need orientation and mobility services as that term is defined in these regulations. 'Orientation and mobility services' is a term of art that is expressly related to children with visual impairments, and includes services that must be provided by qualified personnel who are trained to work with those children. (U.S. Department of Education, 1999, p. 12549)

Thus, children with disabilities other than those with visual impairments who need assistance in learning how to safely navigate a variety of settings would generally not receive O&M services but, rather, travel training. Travel training is defined in the IDEA '97 final regulations at §300.26(b)(4), as part of the definition of "special education." The term means "providing instruction, as appropriate, to children with significant cognitive disabilities, and any other children with disabilities who require this instruction, to enable them to

(i) Develop an awareness of the environment in which they live; and

(ii) Learn the skills necessary to move effectively and safely from place to place within that environment (e.g., in school, in the home, at work, and in the community)." [§300.26(b)(4)]

Parent Counseling and Training

Parent counseling and training is an important related service that can help parents enhance the vital role they play in the lives of their children. When necessary to help an eligible student with a disability benefit from the educational program, parent counseling and training can include:

• Assisting parents in understanding the special needs of their child;
• Providing parents with information about child development; and
• Helping parents to acquire the necessary skills that will allow them to support the implementationof their child's IEP or IFSP" [Individualized Family Service Plan]. [§300.24(b)(7)]

The last aspect—that of helping parents acquire necessary skills to support the implementation of their child's IEP or IFSP—is new in IDEA '97 and was added to:

...recognize the more active role acknowledged for parents...[as] very important participants in the education process for their children. Helping them gain the skills that will enable them to help their children meet the goals and objectives of their IEP or IFSP will be a positive change for parents, will assist in furthering the education of their children, and will aid the schools as it will create opportunities to build reinforcing relationships between each child's educational program and out-ofschool learning. (U.S. Department of Education, 1999, p. 12549)

Physical Therapy

Physical therapy means "services provided by a qualified physicaltherapist" [§300.24(b)(8)]. These services generally address a child's posture, muscle strength, mobility, and organization of movement in educational environments. Physical therapy may be provided to prevent the onset or progression of impairment, functional limitation, disability, or changes in physical function or health resulting from injury, disease,or other causes. Qualified providers of these services may:

• provide treatment to increase joint function, muscle strength, mobility, and endurance;
• address gross motor skills that rely on the large muscles of the body involved in physical movement and range of motion;
• help improve the student's posture, gait, and body awareness;
• and monitor the function, fit, and proper use of mobility aids and devices.

Psychological Services

Psychological services are delivered as a related service when necessary to help eligible students with disabilities benefit from their special education. In some schools, these services are provided by a school psychologist, but some services are also appropriately provided by other trained personnel, including school social workers and counselors. Under IDEA '97 regulations, the term psychological services includes:

• "administering psychological and educational tests and other assessment procedures;
• interpreting assessment results;
• obtaining, integrating, and interpreting information about a student's behavior and conditions relating to learning;
• consulting with other staff members in planning school programs to meet the special needs of children as indicated by psychological tests, interviews, and behavioral evaluations;
• planning and managing a program of psychological services, including psychological counseling for students and parents; and
• assisting in developing positive behavioral intervention strategies." [§300.24(b)(9)]

IDEA '97 requires that, in the case of a child whose behavior impedes his or her learning or that of others, the IEP team consider, if appropriate, strategies (including positive behavioral interventions, strategies, and supports) to address that behavior [§300.346(a)(2)(i)]. These interventions and strategies may focus not only on the result of an absent, inadequate, inconsistent, or negative behavior blocking learning but also on the curricular and instructional issues that may trigger problems (Dwyer, 1997). Positive behavioral interventions and supports involve a comprehensive set of strategies aimed at providing a student with a disability an improved lifestyle that includes reductions in problem behaviors, changes in social relationships, an expansion of prosocial skills, and an increase in school and community inclusion (Fox, Vaughn, Dunlap, & Bucy, 1997).

Psychologists and school social workers may be involved in assisting in developing these positive behavioral intervention strategies. However, as the U.S. Department of Education (1999) notes: "[T]here are many other appropriate professionals in a school district who might also play a role...These examples of personnel who may assist in this activity are not intended to imply either that school psychologists and social workers are automatically qualified to perform these duties or to prohibit other qualified personnel from serving in this role, consistent with State requirements" (p. 12550).

Recreation

Recreation services generally are intended to help students with disabilities learn how to use their leisure and recreation time constructively. Through these services, students can learn appropriate and functional recreation and leisure skills (Schleien, Green, & Heyne, 1993). According to the IDEA '97 final regulations, recreation as a related service includes:

• assessment of leisure function;
• therapeutic recreation services;
• recreation programs in schools and community agencies; and
• leisure education. [§300.24(b)(10)]

Recreational activities generally may fall into one or more of the following classifications: (1) physical, cultural, or social; (2) indoor or outdoor; (3) spectator or participant; (4) formal or informal; (5) independent, cooperative, or competitive; or (6) sports, games, hobbies, or toy play (Moon & Bunker, 1987). Recreational activities may be provided during the school day or in afterschool programs in a school or a community environment. Some school districts have made collaborative arrangements with the local parks and recreation programs or local youth development programs to provide recreational services.

As part of providing this related service, persons qualified to provide recreation carry out activities such as:

• assessing a student's leisure interests and preferences, capacities, functions, skills, and needs;
• providing recreation therapeutic services and activities to develop a student's functional skills;
• providing education in the skills, knowledge, and attitudes related to leisure involvement;
• helping a student participate in recreation with assistance and/or adapted recreation equipment;
• providing training to parents and educators about the role of recreation in enhancing educational outcomes;
• identifying recreation resources and facilities in the community; and
• providing recreation programs in schools and community agencies.

Rehabilitation Counseling Services

Rehabilitation counseling services are "services provided by qualified personnel in individual or group sessions that focus specifically on career development, employment preparation, achieving independence, and integration in the workplace and community.... The term also includes vocational rehabilitation services provided to a student with disabilities by vocational rehabilitation programs funded under the Rehabilitation Act of 1973, as amended." [§300.24(b)(11)]

The role of the rehabilitation counselor, according to the Council on Rehabilitation Education (1996), is to provide students with disabilities "assistance to their vocation, social, and personal functioning through the use of professionally recognized interaction skills and other appropriate services" (p. 36). To this end, rehabilitation counseling services generally may include:

• assessment of a student's attitudes, abilities, and needs;
• vocational counseling and guidance;
• vocational training; and
• identifying job placements in individual or group sessions.

School Health Services

School health services under the IDEA '97 final regulations means "services provided by a qualified school nurse or other qualified person" [§300.24(b)(12)]. These services may be necessary because some children and youth with disabilities would otherwise be unable to attend a day of school without supportive health care. School health services may include interpretation, interventions, administration of health procedures, the use of an assistive health device to compensate for the reduction or loss of a body function (Rapport, 1996), and case management.

Typically, school health services are provided by a qualified school nurse or other qualified trained person who is supervised by a qualified nurse. In some instances, if a school nurse is not employed by a school district, health services may be provided and/or coordinated by a public health nurse, a pediatric home care nurse, or a hospital- or community- based pediatric nurse practitioner or specialist. States and local school districts often have guidelines that address school health services. State agency guidelines that address school health services for special health care needs may address staffing requirements, infection control, medication administration, nursing procedures, classroom modifications, transportation, and policies (Porter, Haynie, Bierle, Caldwell, & Palfrey, 1997).

Possible school health services include:

• special feedings;
• clean intermittent catheterization;
• suctioning;
• the management of a tracheostomy;
• administering and/or dispensing medications;
• planning for the safety of a student in school;
• ensuring that care is given while at school and at school functions to prevent injury (e.g., changing a student's position frequently to prevent pressure sores);
• chronic disease management; and
• conducting and/or promoting education and skills training for all (including the student) who serve as caregivers in the school setting.

Social Work Services in Schools

Issues or problems at home or in the community can adversely affect a student's performance at school, as can a student's attitudes or behaviors in school. Social work services inmay become necessary in order schools to help a student benefit from his or her educational program. Social work services in schools includes:

• "preparing a social or developmental history on a child with a disability;
• group and individual counseling with the child and family;
• working in partnership with parents and others on those problems in a child's living situation (home, school, and community) that affect the child's adjustment in school;
• mobilizing school and community resources to enable the child to learn as effectively as possible in his or her educational program; and
• assisting in developing positive behavioral intervention strategies [§300.24(b)(13)]

Speech-Language Pathology Services

Speech-language pathology services are provided by speech-language professionals and speech-language assistants in accordance with State regulations, to address the needs of children and youth with communication disabilities. Under the IDEA '97 final regulations, these services include:

• "identification of children with speech or language impairments;
• diagnosis and appraisal of specific speech or language impairments;
• referral for medical or other professional attention necessary for the habilitation of speech or language impairments;
• provision of speech and language services for the habilitation or prevention of communicative impairments; and
• counseling and guidance of parents, children, and teachers regarding speech and language impairments." [§300.24(b)(14)]

Transportation

Transportation as a related service is included in an eligible student's IEP if the IEP team determines that such a service is needed. Transportation includes:

• travel to and from school and between schools;
• travel in and around school buildings; and
• specialized equipment (such as special or adapted buses, lifts, and ramps), if required to provide special transportation for a child with a disability [§300.24(b)(15)].

Public school districts must provide transportation to students with disabilities in two situations. These are:

• if a district provides transportation to and from school for the general student population, then it must provide transportation for a student with a disability; and
• if a school district does not provide transportation for the general student population, then the issue of transportation for students with disabilities must be decided on a case-by-case basis if the IEP team has determined that transportation is needed by the child and has included it on his or her IEP (Office of Special Education Programs, 1995).

If the IEP team determines that a student with a disability needs transportation to benefit from special education, it must be included in the student's IEP and provided as a related service at no cost to the student and his or her parents (Office of Special Education Programs, 1995).

 Not all students with disabilities are eligible to receive transportation as a related service. As Attachment 1 of the Federal regulations for IDEA '97 points out:

It is assumed that most children with disabilities will receive the same transportation provided to nondisabled children, unless the IEP team determines otherwise. However, for some children with disabilities, integrated transportation may not be achieved unless needed accommodations are provided to address each child's unique needs. If the IEP team determines that a disabled child requires transportation as a related service in order to receive FAPE, or requires accommodations or modifications to participate in integrated transportation with nondisabled children, the child must receive the necessary transportation or accommodations at no cost to the parents. This is so, even if no transportation is provided to nondisabled children. (U.S. Department of Education, 1999, p. 12551)

A student's need for transportation as a related service and the type of transportation to be provided must be discussed and decided by the IEP team. Whether transportation goals and objectives are required in the IEP depends on the purpose of the transportation. If transportation is being provided solely to and from school, in and around school, and between schools, no goals or objectives are needed. If instruction is provided to a student to increase his or her independence or improve his or her behavior during transportation, then goals and objectives must be included in the student's IEP (Office of Special Education Programs, 1995).

Back to Part 1: An Overview of Related Services Under IDEA

Continue to Part III. Delivering Related Services

Continue to Part IV:  Section 504 of the Rehabilitation Act