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Related Services For School-Aged Children With Disabilities

Part 2



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National Information Center
for Children and Youth with Disabilities



Contents

School Health Services

Transportation Services

Counseling Services

Speech-Language Pathology

Social Work Services

Parent Counseling and Training

Recreation Therapy

Assistive Technology Devices and Services

Artistic/Cultural Therapies

School Breakfast and Lunch Program

Related Services under Section 504

Under the Section 504 regulation:

Notice from the Office of Civil Rights



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School Health Services

School Health Services are necessary, because many children and youth with disabilities would be unable to attend a day of school without supportive health care. Health services are typically provided by a qualified school nurse or a specifically trained nonmedical person who is supervised by a qualified nurse. Some of the health services that school nurses or other qualified personnel provide to students with disabilities include:

  • special feedings
  • clean intermittent catheterization
  • suctioning
  • administering medications
  • planning for the safety of a student in school, and
  • ensuring that care is given in the classroom to prevent injury (e.g., changing a student's position frequently to prevent pressure sores) (Black & Dorsett, 1987).

A joint task force of members and staff of four associations -- the American Federation of Teachers, the Council for Exceptional Children, the National Association of School Nurses, Inc., and the National Education Association -- recently released detailed guidelines to help administrators, health care providers, and educators provide health services to children with special health care needs (The Joint Task Force for the Management of Children with Special Health Needs, 1990). The guidelines list "66 special health care procedures that some children may need to have provided in educational settings," as well as "the persons qualified to perform each of the procedures, who should preferably perform the procedures, and the circumstances under which these persons would be deemed qualified" (p. 9).

The same controversy that is coming to light about medical services is surfacing in regard to school health services. How far does the school's obligation to provide these services go? In the case of Bevin H. v. Wright (1987), the court decided that the school district was not responsible for providing a nurse to monitor Bevin's condition and assist her because of the intensive nature of her need. Other courts had found that schools were responsible for providing nursing care, but the students involved in those cases only required intermittent nursing care that could be provided by the school nurse, leaving the nurse free to care for other students. The "private duty" service that Bevin required distinguished her case from others previously heard. Thus, the court stated that placing the burden of the services Bevin required "on the school district in the guise of 'related services' does not appear to be consistent with the spirit of the Act and the regulations" (Bevin H. v. Wright, 1987-88 Education of the Handicapped Law Report [EHLR] DEC. 559:122, as cited in "Related Services: Daily Nursing Care", 1987, p. 3).

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Transportation Services

Transportation Services are provided to those students who need special assistance because of their disability or the location of the school relative to their home. Not all students with disabilities are eligible to receive specialized transportation services. Many are able to use the same transportation that students without disabilities use to get to school. However, for those who need special assistance, the school district must:

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

Most school systems have written guidelines to help make decisions about transportation services consistent from student to student. To be in compliance with the IDEA, a school district cannot require the families of students with disabilities to assume any portion of the costs of those transportation services deemed necessary to permit the students to benefit from their education.

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Counseling Services

Counseling Services are typically provided by school counselors who work with students to develop their career awareness, to improve their understanding of self, and to improve their behavioral adjustment and control skills. This, in turn, makes students with disabilities better able to participate in their educational program. In many schools, the counselor may also perform the functions of school psychologists (described above under Psychological Services). Additionally, school counselors may:

  • identify and refer students who may be eligible for special education;

  • secure parental permission for referrals;

  • provide advice concerning a student's level of functioning, affective needs, and appropriateness of the IEP;

  • provide student guidance and counseling in keeping with the IEP; and

  • provide supportive counseling for parents.

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Speech-Language Pathology

Speech-Language Pathology is a service provided by speech-language pathologists to address the needs of children and youth with communication disabilities, such as stuttering and impairments in speech, language, or voice. Typically, speech-language pathologists:

  • screen, identify, assess, and diagnose disorders of fluency, language, articulation, voice, and oral-pharyngeal function, and cognitive/ communication disorders;

  • provide speech and language services for the habilitation or prevention of communication disorders, including augmentative and alternative communication systems; and

  • refer the student for medical or other professional attention necessary for the habilitation of speech or language disorders.

It should be noted that a student with a speech or language impairment does not necessarily have to be manifesting academic problems in order to be considered eligible to receive related services under the IDEA. Effective oral communication is regarded as a skill basic to academic performance (Applestein, 1987).

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Social Work Services

Social Work Services are provided in order to address the whole welfare of the student with a disability - his or her life at home, in school, and in the community. Historically, social workers have been used in schools as early as 1913. The need for their services arose from "recognition of the need to consider factors beyond the schools that may be affecting a child's educational performance" (Tabb, 1987, p. 113). 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 may become necessary in order to help the student maximize benefit from the educational program.

In today's society, qualified school social workers have completed a two-year master's degree program in social work and generally have field experience obtained through placement in a public or private facility, where they worked under supervision. Their duties within schools typically include:

  • preparing a social or developmental history of a student with a disability;

  • providing group or individual counseling to the student and family;

  • working with the problems in a student's living situation (home, school, and community) that are affecting the student's adjustment in school; and

  • mobilizing school and community resources to enable the student to benefit from his or her educational program.

To develop an insightful social or developmental history of a student with a disability requires the school social worker to interact with both the student and the family. This allows the social worker to assess how family dynamics and the home environment are influencing the student's learning and behavior patterns. This information is useful for determining the student's educational placement and program, and also serves as a check against inappropriate labeling of a student because of test scores and school behavior. Through interactions with the family, the social worker may identify cultural or language differences that need to be taken into consideration as well (Tabb, 1987).

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Parent Counseling and Training

Parent Counseling and Training is an important related service, because it addresses the needs of the parents and the vital role they play in the lives of their children. The family is the "most powerful agent of change in the life of a child" (Blumberg, 1987, p. 70). The parents of a child or youth with a disability may have great need for counseling and training in order to understand their child's disability and how it may affect development. When necessary to help the child or youth with a disability benefit from the educational program, school counselors can:

  • assist parents in understanding the special needs of their child;

  • provide parents with information about child development; and

  • provide parents with referrals to parent support groups, financial assistance resources, and professionals outside the school system.

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Recreation Therapy

Recreation Therapy is included as a related service, because all children, with or without disabilities, need to learn how to use their leisure and recreation time constructively. For those students with disabilities who are judged to require recreation therapy in order to benefit from special education, the therapy can serve to improve socialization skills, as well as eye-hand coordination and physical, cognitive, or language development. In the case of children with severe disabilities, "recreation activities are necessary for the purpose of initiating greater pride and independence" (M.M. Esterson, 1987, p. 99). To this end, recreation therapists:

  • assess the student's leisure capacities and functions;

  • provide therapy to remediate functional difficulties that limit involvement in leisure activities;

  • provide leisure education for learning the skills, knowledge, and attitudes related to leisure involvement; and

  • help the student to participate in recreation, based on the student's need for assistance and/or adapted recreation equipment.

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Assistive Technology Devices and Services

Assistive Technology Devices and Services are not specifically listed in the law as a related service but are often provided as "other corrective or support services" necessary to help students with disabilities benefit from their education. The provision of assistive technology devices and services has changed over the years as technology has been developed and applied to the needs of individuals with disabilities. The EHA (P.L. 94-142) mentions that providing "related aids and services" may be necessary to help a student maximize the benefits of his or her educational program. The early interpretation of what qualified as a permissible related aid was controversial. "Generally, equipment such as glasses, wheelchairs, and hearing aids have been considered to be outside of the school districts' responsibility because these were individually prescribed and were used at home as well as during school" ("Districts Must Provide", 1990, p. 76).

As assistive technology has boomed, however, the scope of this related service has expanded. In 1988, Congress passed the Technology-Related Assistance for Individuals with Disabilities Act (P.L. 100-407), recognizing the enormous contribution that assistive technology can make to the lives of individuals with disabilities. The Office of Special Education Programs (OSEP) has issued a policy ruling stating that "consideration of a child's need for assistive technology must occur on a case-by-case basis in connection with the development of a child's individualized education program (IEP)" (Goodman, 16 EHLR 1317, OSEP 1990). The OSEP policy letter goes on to say that "assistive technology can be a form of supplementary aid or service utilized to facilitate a child's education in a regular educational environment. Such supplementary aids and services, or modifications to the regular education program, must be included in a child's IEP." Thus, when an IEP of a student with a disability is being developed or reviewed, the school district must assess his or her need for an assistive technology device, determine those devices that will facilitate the student's education, list them in the IEP, and then provide them to the student.

This policy letter, coupled with the passage of the Technology-Related Assistance for Individuals with Disabilities Act of 1988 and the IDEA, is expected to dramatically affect the level of district responsibility for providing related aids, devices, and technology-related services to students with disabilities.

The IDEA defines an assistive technology device as:

...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 functional capabilities of individuals with disabilities. [20 U.S.C. Chapter 33, Section 1401(25)]

The number of assistive technology devices in use across the United States is lengthy, and the list is growing longer by the day. A few examples of such devices are: electronic communication aids, devices that enlarge printed words on a computer screen, speech synthesizers, prosthetic devices, braille writers, and keyboards adapted for fist or foot use.

As more assistive technology devices become available to address the special needs of students with disabilities, districts are confronted with multiple challenges in that they must: (a) identify and acquire technology devices appropriate to the needs of their students with disabilities; (b) train staff in the use of the devices; (c) identify appropriate use of computers, communication devices, and other technology in the classroom; and (d) finance the cost of this related service. Additionally, districts must provide "assistive technology services" to eligible students with disabilities. Assistive technology services are defined by the IDEA as "...any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device" [20 U.S.C. Chapter 33, Section 1401(26)]. Thus, school districts are also responsible for helping individuals with disabilities to select and acquire an appropriate assistive technology device and train them in its use.

Fortunately, for parents and professionals alike, there are a number of organizations that provide information on the latest developments in assistive technology devices. Some are listed in the resources section of this NEWS DIGEST.

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Artistic/Cultural Therapies

Artistic/Cultural Therapies are specifically mentioned in federal regulations as other "supportive services" and include "artistic and cultural programs, and art, music, and dance therapy, if they are required to assist a handicapped child to benefit from special education"(34 CFR Part 300.13, Comment, 1988).

Dance therapy, for example, can develop and promote "good posture, discipline, concentration, coordination, agility, speed, balance, strength, and endurance" (Salyers, 1983). Art therapy provides individuals with disabilities with a means of self-expression and opportunities to expand personal creativity and control. Music therapy is used to foster similar personal growth. Its therapeutic aims are the restoration, maintenance, and improvement of mental and physical health (National Association for Music Therapy, 1988). This type of therapy can affect changes in behavior, social skills, perception, self-esteem, and physical mobility and skills.

Artistic and cultural therapies are designed by art therapists, dance therapists, and music therapists to address the individual needs of students with disabilities. These professionals:

  • assess the functioning of individual students;

  • design programs appropriate to the needs and abilities of students;

  • provide services in which movement or an art form is used in a therapeutic process to further the child's emotional, physical, and/or cognitive development or integration; and

  • often act as resource persons for classroom teachers.

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School Breakfast and Lunch Program

School Breakfast and Lunch Program is not a related service specifically listed in the IDEA. The program is discussed in this NEWS DIGEST because of its importance to those students with disabilities who have special nutritional requirements. Because many students with disabilities do have unique nutritional needs, they are unable to participate in the national meal program unless these meals are modified.

School meal programs are administered at the federal level by the United States Department of Agriculture (USDA). USDA reimburses schools for every meal served, at rates that vary according to family income. Children may receive meals free or at a reduced price if their families meet specific income criteria.

Under USDA's Section 504 and child nutrition regulations, schools participating in federal school meal programs are required to make a reasonable effort to provide, at no extra charge, special meals to students whose diets are restricted due to their disabilities [7 CFR Section 15b.26(d)(1)].

In order to be eligible for modified meals, a student must present a statement signed by a physician. The statement should include: (a) the disability of the student and how the disability affects the student's diet; (b) the major life activity affected by the disability; and the food(s) to be omitted from the student's diet and those that may be substituted [7 CFR Section 210.10(I)(1) and 7 CFR Section 220.8(f)]. Adjustments to meals may include changing the texture of food, modifying the calories, and substituting different foods for those listed on the school menu (Horsley, 1988).

In a recent floor statement, Senator Bob Dole of Kansas, Senate Republican Leader, expressed concern about the participation in school meal programs by students whose disabilities restrict their diets. Federal regulations, Senator Dole said, "put the burden on parents to request special meals. Yet many parents, school administrators, and teachers do not know these regulations exist" (Dole, 1991).

Thus, parents need to be aware that they are responsible for: (a) requesting modification of their child's meals, if appropriate; and (b) providing the school system with a doctor's statement certifying their child's disability and describing the child's special dietary needs. If officials at the school are not familiar with these regulations, parents should contact their State school food service director, who is usually employed by the State education agency. If parents have further questions or problems, they can contact the Child Nutrition Division of the Food and Nutrition Service of USDA at 3101 Park Center Drive, Alexandria, Virginia 22302 or call (703) 305-2620.

To address the special nutritional needs of students with disabilities, Senator Dole also recommended the following:

  • greater coordination between teachers, school food service personnel, and children's health care providers;

  • more training of school staff in the area of nutrition and meal modification;

  • greater dissemination of the many excellent manuals on special nutrition already available; and

  • greater attention to nutritional needs in the development of individual education programs (IEPs). (Dole, 1991)

Because the IEP serves as a communication tool between service providers, parents, and the student with a disability, stating nutrition goals and objectives in the IEP, when appropriate, "will facilitate instruction on dietary needs and compliance" (Horsley, Allen, & White, 1991, p. 56).

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Related Services under Section 504

Under the IDEA, a student must be enrolled in special education to be considered eligible for related services. However, as was mentioned in the first section of this NEWS DIGEST, there is another federal law, Section 504 of the Rehabilitation Act of 1973 (P.L. 93-112), which in many cases broadens a student's eligibility for related services. The Office for Civil Rights (OCR) is responsible for overseeing compliance with the Section 504 regulations. In order to ensure that the discussion in this section is as accurate as possible, NICHCY asked OCR to examine in detail all information presented here in regards to Section 504. In accordance with OCR's review, then, the following discussion cites extensively from the Section 504 regulations, the basis from which OCR oversees compliance with the law and from which school districts, at times, must make decisions in regards to the eligibility of students to receive related services.

According to Section 504 of the Act, State Education Agencies (SEAs) and Local Education Agencies (LEAs) receiving Federal funds cannot exclude qualified individuals with disabilities from participation in or the benefits of any program or activity offered by the SEA or LEA. Regulations of the Act also specify that a recipient of Federal financial assistance operating a public elementary or secondary education program must provide a free, appropriate public education to each "qualified handicapped person" within its jurisdiction.

The Section 504 regulation defines a "handicapped person" as follows:

  1. "Handicapped persons" means any person who (i) has a physical or mental impairment which substantially limits one or more major life activities; (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment...

  2. (ii) "Major life activities means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working. [34 Code of Federal Regulations (CFR) Section 104.3(j), 1988]

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Under the Section 504 regulation:

"Qualified handicapped person" means: ...[w]ith respect to ... elementary [and] secondary ... education services, a handicapped person (I) of an age during which non-handicapped persons are provided such services, (ii) of any age during which it is mandatory under state law to provide such services to handicapped persons, or (iii) to whom a state is required to provide a free appropriate public education under Section 612 of the Education of the Handicapped Act. [34 CFR Section 104.3(k)(2), 1988]

The free appropriate public education must meet the individual needs of students who are "qualified handicapped persons" as adequately as the needs of students without disabilities are met. Such an education, according to the Section 504 regulation, can consist of either regular or special education and must include any related aids or services necessary to provide a free appropriate public education designed to meet the individual student's needs. The law also requires that recipients of Federal funds operating public elementary or secondary education programs evaluate any person who needs or is believed to need special education or related services because of disability. Thus, Section 504 does not require a student to be enrolled in special education in order to receive related services.

The fact that the IDEA and Section 504 of the Rehabilitation Act define eligibility for, and entitlement to, related services in different ways can complicate how a school district decides if a student is eligible for and/or must be provided with services or not. School districts can fulfill the requirements of certain sections of the Section 504 regulation by complying with the EHA (now IDEA) (Daniels, 1988).1 However, it is possible for a school district to be in violation of the Section 504 regulation while still being in compliance with the IDEA. This can happen when a school district denies services to an individual who has a disability not specified under the IDEA but who is considered "handicapped" under Section 504. For example, there are school districts that have failed to administer medication to students with Attention Deficit Disorder (ADD), because ADD is not listed as a handicapping condition under the IDEA. However, such students may be entitled to have the school district administer medication as a related service under Section 504, if the student meets the Section 504 definition of "handicapped person."

An individualized evaluation would need to be made by a multidisciplinary team to determine whether the student is "handicapped" within the meaning of Section 504; that is, whether the student has an impairment which substantially limits one or more major life activities (e.g., learning). Once it is determined that a student is handicapped within the meaning of Section 504 and meets other applicable eligibility requirements (such as age requirements), public elementary or secondary education programs receiving Federal financial assistance are required by Section 504 to provide a free appropriate public education to that student, without regard to the nature or severity of the individual's disability. The free appropriate public education must include any related aids or services, such as administering medication, that are necessary to meet the individual student's needs.

Because the definition of disability is broader under Section 504 of the Rehabilitation Act than under the IDEA, many parents whose children are ineligible for related services under the IDEA are filing complaints with OCR, alleging that denial of related services denied their children a free appropriate public education. It should be noted that when OCR investigates a complaint, it does so solely on the basis of compliance with the rules and regulations of Section 504. OCR does not make findings of a school district's compliance or noncompliance with the IDEA (Daniels, 1988). In addition, an OCR investigation focuses primarily on the process used to identify, evaluate, and place students with disabilities, rather than on whether the program ultimately chosen by the district was appropriate. As the Appendix to the Section 504 regulation states:

It is not the intention of [OCR], except in extraordinary circumstances, to review the result of individual placement and other educational decisions, so long as the school district complies with the "process" requirements of this subpart (concerning identification and location, evaluation, and due process procedures). However, [OCR] will place a high priority on investigating cases which may involve exclusion of a child from the education system or a pattern or practice of discriminatory placements or education.

An example of a pattern or practice of discriminatory placements or education is a school district's refusal to provide related services to any students who are ineligible for such services under the IDEA, even if those students are "qualified handicapped persons" under the Section 504 regulation.

Recent investigations have resulted in OCR rulings that individuals who have disabilities not specified in the IDEA are often eligible for related services under Section 504. In addition to ADD, other examples that may be handicapping conditions under Section 504 are: alcohol and drug addiction (although, under 1990 amendments to the Rehabilitation Act, a student who is currently using alcohol or illegal drugs is no longer protected by Section 504 when the school district acts on the basis of such use); communicable diseases such as AIDS, and obesity (Cernosia, 1991; "Georgia Challenges", 1990). Consistent with these rulings, school districts must determine whether the educational needs of students with such disabilities are being met to the extent that the needs of students without disabilities are met (Daniels, 1988, p. 3).

The IDEA and Section 504 differ in another, important aspect besides their definitions of "disability." The IDEA:

...is a federal grant program, authorizing federal funds to states to assist them in the provision of special education and related services to "eligible" students. Section 504 is a civil rights statute, prohibiting discrimination on the basis of handicap. ("Georgia Challenges," 1990, p. 208)

Therefore, although school districts must comply with the regulations of Section 504 if they want to retain Federal financial assistance, they do not receive Federal funds to pay for services provided to students with disabilities under Section 504.

Parents and professionals who are interested in more information about how Section 504 regulations affect the provision of related services should contact any of OCR's regional offices. If you need assistance identifying the regional office nearest you, please contact NICHCY.

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Notice from the Office of Civil Rights: Applicability of Section 504 of the Rehabilitation Act of 1973 to Homeless and Drug-Exposed Children

The Office of Civil Rights (OCR) is concerned about two widespread national problems that may seriously affect our schools. One is the predicament of children whose families are homeless. The other is the plight of children who are born to mothers who have been exposed to drugs. Children who are handicapped in these groups are covered under Section 504 of the Rehabilitation Act of 1973.

Under the Section 504 implementing regulation, recipients of Federal aid operating public elementary or secondary education programs must annually undertake to identify and locate every qualified handicapped person residing in the recipient's jurisdiction who is not receiving a public education. Annually the school system must also take appropriate steps to notify handicapped persons and their parents or guardians of its duty under the Section 504 regulations to provide a free appropriate public education to each qualified handicapped person in its jurisdiction.

Because of its importance, OCR included identification of homeless and drug-exposed student populations for special education and related services as one of the priority educational equity issues in the FY 1991 National Enforcement Strategy. OCR has planned compliance and technical assistance outreach activities in this area during the current fiscal year. Persons needing additional information or technical assistance are urged to contact any of OCR's ten regional offices.

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