Related Services For School-Aged Children With Disabilities

by Judy Smith-Davis and William R. Littlejohn

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National Information Center
for Children and Youth with Disabilities

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Abstract

The Individuals with Disabilities Education Act (IDEA) mandates that "all children with disabilities have available to them...a free appropriate public education which emphasizes special education and related services designed to meet their unique needs..." (Section 601[c]). In accordance with the IDEA and other federal laws, more than 4.5 million children with disabilities across the nation received special education and/or related services in the 1989-90 school year.

This issue of NEWS DIGEST focuses upon the provision of related services to school-aged children with disabilities. As defined by federal law, related services are intended to address the individual needs of students with disabilities, in order that they may benefit from their educational program. Occupational and physical therapy, school health services, and special transportation assistance are just some examples of related services that can help eligible students with disabilities participate more fully and successfully in the learning process.

This NEWS DIGEST provides an overview of the related services enumerated in federal law, with a focus upon those services provided to school-aged children with disabilities. The personnel associated with delivering each service are identified, and their major duties are described. Readers are also given an overview of how related services are typically obtained for students, as well as how school districts deliver, coordinate, and fund the related services they provide. Also discussed is one serious problem confronting school districts, namely a shortage of personnel to deliver related services needed by students. Recent court cases, due process hearings, and the specifics of federal law are mentioned throughout this NEWS DIGEST, where relevant, to help readers understand the nature of -- and limits to -- school districts' responsibilities to provide related services. A list of readings, organizations, and other sources of further information concludes this issue.

Several important federal laws have been passed in recent years to address the rights and educational needs of children and youth with disabilities. One such law, passed in 1975, is The Education of All Handicapped Children Act, otherwise known as EHA or Public Law (P.L.) 94-142. Recently reauthorized and renamed the Individuals with Disabilities Education Act, or IDEA (P.L. 101-476), this law mandates that special education and related service programming be made available to all children and youth with disabilities who require them. The law also makes available federal funds to help state and local governments establish and maintain special education programs for students with disabilities, as well as provide the related services these students need in order to benefit from special education.

But what are related services? The IDEA defines "related services" as:

...transportation, and such developmental, corrective, and other supportive services (including speech pathology and audiology, psychological services, physical and occupational therapy, recreation, including therapeutic recreation and social work services, and medical and counseling services, including rehabilitation counseling, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a disability to benefit from special education. [20 U.S.C. Chapter 33, Section 1401(17), 1991]

Although the IDEA has become law, at the time of this writing regulations for the Act have only been issued in proposed form. Final regulations, written to correspond to the changes made to the EHA by the IDEA, will be published after an extensive public comment and review period. Until the final regulations are available to guide implementation of the IDEA, the regulations of its predecessor, the EHA, are being used by school districts to determine how and to whom related services will be delivered. The regulations of the EHA (P.L. 94-142) list thirteen related services that students with disabilities may require to benefit from their special education programs. These are:

• audiology;
• occupational therapy;
• physical therapy;
• psychological services;
• medical services for diagnostic or evaluation purposes only;
• school health services;
• transportation services;
• counseling services;
• speech-language pathology;
• social work services;
• parent counseling and training;
• recreation therapy; and
• early identification and assessment of disabilities in children. [34 Code of Federal Regulations (CFR) Section 300.13 (b)(1)-(13), 1988].
  
  

Clearly, the regulations define a wide variety of services that must be provided to children and youth with disabilities identified as needing such services to maximize the benefits of their special education. However, the law also states that this long list of services is not exhaustive and may include other developmental, corrective, or support services "as may be required to assist a child with a disability to benefit from special education" [The Individuals with Disabilities Education Act, 20 U.S.C. Chapter 33, Section 1401(17)]. It is through this provision in the law that many school districts are providing students with disabilities with assistive technology devices and services. Furthermore, as states respond to the requirements of federal law, many have legislated their own related service requirements, which may include services beyond those specified in federal law. For example, some states also include mobility training, dance therapy, and artistic and cultural programs as related services that should be provided as necessary to help a student with a disability benefit from his or her special education program.

Because states are required to provide the related services that are necessary for each individual student with a disability to benefit from his or her special education, related services can be quite unique. An example of this exists in the 1981 case of Espino v. Besteiro. As a result of an automobile accident, the student in question could no longer function in a classroom that was not temperature-controlled. Initially, the school system met this student's need by providing him with a portable cubicle that was air conditioned. However, the court ruled that, in order for the student to benefit from special education, air conditioning qualified as a related service and ordered the school system to air condition the entire classroom. The cubicle was not satisfactory, because it did not permit the child to fully interact with the teacher and his classmates (Esterson & Bluth, 1987).

Although related services can be quite expensive, school districts may not charge families of students with disabilities for the cost of the services. Just as special and regular education must be provided to a student with a disability at no cost to the parent or guardian, so, too, must related services. As a result of federal law, it is the state's responsibility to provide a free, appropriate public education to all students with disabilities, and that includes any related services necessary to ensure they benefit from their education.

Under the IDEA, P.L. 101-476, the student must be enrolled in special education to be considered eligible for related services. However, there is another federal law -- the Rehabilitation Act of 1973 (P.L. 93-112) -- that, in many cases, broadens a student's eligibility for related services. The implications of this law will be discussed later in this NEWS DIGEST (see the section entitled "Related Services under Section 504" on page 8). First, however, let us take a look at examples of related services and who is typically responsible for providing each one.

What Are Some Examples of Related Services and Who Provides Them?

Perhaps the best way to develop an understanding of what related services are is to take a look at the types of personnel who are involved in the delivery of services and what responsibilities each of these people typically has in the process. Given the range and diversity of disabilities, this list is quite lengthy. Therefore, the information presented about each related service is intended only as an introduction to that service and the personnel associated with its delivery. It is not the intent of this document, just as it is not the intent of the law, to exhaustively describe each related service. Many variations in service delivery are possible. Readers are encouraged to make use of the resources listed at the end of this NEWS DIGEST to find out more about the related services of relevance to them. (Early identification and assessment of disabilities in children is not discussed in this NEWS DIGEST, because it falls outside of this document's focus on related services for school-aged children.) It is important to read about all the services and personnel in order to know what related services are most commonly provided to students with disabilities and their families.

Audiology Services

Audiology Services are generally provided by audiologists who screen, assess, and identify children with hearing loss. Additionally, they:

• determine the range, nature, and degree of the hearing loss;
  
  
• make referrals for medical or other professional attention for the habilitation of hearing;
  
  
• provide language habilitation, auditory training, speech reading (lip reading), speech conservation, and other programs;
  
  
• determine the child's need for group or individual amplification, select and fit an appropriate hearing aid, and evaluate the effectiveness of amplication.
  
  

Many school systems do not have the diagnostic facilities necessary to assess the extent of a student's hearing loss, and so they refer students in need to a clinical setting, such as a hospital. Based on the results of the hearing assessment, related services are then provided by school-based audiologists or, in school systems that do not employ audiologists, by other professionals such as speech pathologists or educators (Friedrich, 1987).

Occupational Therapy

Occupational Therapy is provided by therapists who concentrate upon assessing and treating children with disabilities that impair their daily life functioning. Areas of daily life functioning upon which an occupational therapist might focus are:

• activities of daily living, such as eating and dressing;
  
  
• school and work skills, such as writing, using scissors, managing books and papers, and sitting effectively in class; and
  
  
• play/leisure skills, such as participating in art or physical education class or playing with children at recess.
  
  

When occupational therapy is provided as a related service, it is meant to enhance a student's ability to function in an educational program. By focusing upon the skills of daily living, occupational therapists can often help individual students to function in the least restrictive environment. Generally, occupational therapists:

• provide treatment to strengthen and develop fine motor functions;
  
  
• focus on treatment of the small muscles, primarily those of the face, upper trunk, arms, and hands; and
  
  
• improve the student's ability to perform tasks necessary for independent functioning, such as chewing, swallowing, placement of the tongue and mouth for speech formation, eye-hand coordination, and manual dexterity.
  
  

Physical Therapy

Physical Therapy is provided to a child or youth with a disability following referral from a physician and, in some states, from school nurses, teachers, occupational therapists, and other professionals. Physical therapists:

• provide treatment to increase muscle strength, mobility, and endurance;
  
  
• focus on gross motor skills that rely on the large muscles of the body involved in physical movement and range of motion;
  
  
• help to 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 also delivered as a related service when necessary to help students with disabilities benefit from their education. Often, the potential need of a child with a disability for psychological services is raised during an Individualized Education Program (IEP) meeting of teachers, school personnel, and parents. Members of the IEP team may have noticed that a student has become withdrawn and that his or her grades have dropped. Or parents may be concerned that their child is reading far below his grade level and want to know if he has a learning disability. School psychologists, then, become responsible for delivering psychological services. Some of their primary duties are to:

• administer and interpret psychological and educational tests and other assessment procedures to determine if, indeed, the student has a disability;
  
  
• obtain, integrate, and interpret information about a student's behavior and conditions for learning. Sources of information may include observations of the student and interviews with teachers, parents, and the student;
  
  
• consult with school staff and assist in planning an educational program to meet a student's special needs, as indicated by psychological tests, interviews, and evaluations of behavior; and
  
  
• plan and manage programs to provide psychological services, including counseling for students and parents.
  
  

It is important to know that, by law, "no single assessment procedure can be used as "the sole criterion for determining an appropriate educational program for a child" (Code of Federal Regulations [CFR]: Title 34: Education: Part 300.532, 1988). The anticipated regulations for the IDEA are not expected to change this approach to student assessment. One of the school psychologist's most challenging duties, then, is to gather information about the student from a variety of sources and interpret that information, so that an educational program appropriate to the needs of the student can be developed.

Medical Services

Medical Services are considered a related service only under specific conditions. By definition, medical services:

• are provided by a licensed physician to diagnose a child's disability, determine the need for special education, and determine the type and extent of related services that may be needed; and
  
  
• are permitted for diagnostic reasons, but do not include direct, on-going medical treatment by a physician.
  
  

Just how far does a school system's legal requirement to provide medically-related services go? This has become quite an area of controversy as schools enroll and place students with severe and often life-threatening disabilities. Do the constant medical needs of these students qualify as supportive services a school is obligated to provide or as on-going medical treatment, which is specifically excluded as a related service? Decisions can only be made on a case by case, student by student basis. However, the trend emerging from recent court cases appears to be:

• If the supportive service must be performed by a licensed physician and is not for the purpose of evaluation or diagnosis, the school is not obligated to provide it.
  
  
• If the service can be provided by a lay person, such as the teacher, with minimal training, the school must provide it.
  
  
• When the service requires some degree of medical insight, such as what to do when an emergency arises, then court decisions can go either way. "The more medically sophisticated the decisions about how to treat the child, the more that service is excluded and the school's obligation disappears" (McKee & Barbe, 1990, p. 199).
  
  

Credits

NEWS DIGEST is published three times a year. NICHCY disseminates other materials as well and can respond to individual requests. Single copies of NICHCY materials and information services are provided free of charge. For further information and assistance, or to receive a NICHCY Publications List, contact NICHCY, P.O. Box 1492, Washington, DC 20013, or call 1-800-695-0285 (Toll-free, Voice/TT) or (202) 884-8200 (Local, Voice/TT).

NICHCY thanks our Project Officer, Dr. Sara Conlon, at the Office of Special Education Programs, U.S. Department of Education, for her time in reading and reviewing this document. We would also like to thank Alice Wender, Technical Assistance Branch, the Office of Civil Rights, for providing her expertise in reviewing this manuscript. The assistance of Mary von Euler at the Office of Civil Rights was also timely and valuable. We also thank the many professional organizations that shared information and guidance about the services they provide to school-aged children with disabilities. Finally, we thank the American Occupational Therapy Association, Inc. for permission to reprint the photographs used in this issue.

Project Director: Suzanne Ripley
Editor: Lisa Kupper

Principle Authors: Judy Smith-Davis, Fairfax Station, Virginia
William R. Littlejohn, Indiana State University

Contributing Author: Lisa Kupper

This document was originally developed in 1991 by Interstate Research Associates, Inc., pursuant to Cooperative Agreement #H030A00002 with the Office of Special Education Programs of the United States Department of Education. The contents of this document do not necessarily reflect the views or policies of the Department of Education, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

The updating of resources listed in this document and the document's reprinting were made possible through Cooperative Agreement #H030A30003 between the Academy for Educational Development and the Office of Special Education Programs of the U.S. Department of Education.

The Academy for Educational Development, founded in 1961, is an independent, nonprofit service organization committed to addressing human development needs in the United States and throughout the world. In partnership with its clients, the Academy seeks to meet today's social, economic, and environmental challenges through education and human resource development; to apply state-of-the-art education, training, research, technology, management, behavioral analysis, and social marketing techniques to solve problems; and to improve knowledge and skills throughout the world as the most effective means for stimulating growth, reducing poverty, and promoting democratic and humanitarian ideals.