MGH Community News

PSYCH GRAND ROUNDS: INTRODUCTION TO SPECIAL EDUCATION

Psychiatry Grand Rounds for November featured Eileen Hagerty, JD, of the law firm of Kotin, Crabtree & Strong, LLP. She spoke on the special education process, applicable laws and the roles health care providers may play. Eileen Hagerty is somewhat of an expert on special education law, having represented and given counsel to many families and having 2 special needs children of her own.

What Is "Special Education"?
"Special education" is specially designed instruction that is offered at no cost to parents, to meet the unique needs of the eligible student with a disability. Specially designed instruction means adapting classroom content, methodology, or delivery of instruction, as appropriate to the needs of a special education-eligible child. Special education is also the "related services" necessary for the special needs child to access the general curriculum. Related services may include, occupational and physical therapy, recreation, counseling services (as provided by qualified social workers, psychologists, guidance counselors, etc.), transportation, and any other developmental, corrective, or supportive services required to assist a child with a disability to benefit from special education.

Special education refers to educational services provided between age 3 and age 22, or upon graduation from high school, whichever happens first. Children who are under 3 years old, and have been identified as having a disability or who are "at risk" due to birth or environmental circumstances, may receive services from Early Intervention (EI) programs. Adults who have turned 22 and/or have graduated from high school may be eligible for 'transitional services' to assist them with employment, etc. This is generally provided through the Mass Rehab. Commission, or depending on the type of disability, by DMR, DMH, Mass. Commission for the Blind or Mass. Commission for the Deaf and Hard of Hearing. (All of these are listed in IRis).

Besides age, a child must meet 3 other conditions to qualify for special education services:

First, the child must have a disability or disabilities. A 'disability' includes autism, mental retardation, brain injury, ADD, emotional impairment, a specific learning disability, communication impairment, among many others.

Second, the student must not be making effective progress in school as a result of the disability or disabilities.

Third, the student must require special education in order to make effective progress in the general curriculum and/or require a related service to access the general curriculum.

The Special Education Process
The process to obtain special education for a child takes about 45 school working days to come to completion. Many different health care and teaching professionals may be involved in determining a child's eligibility and developing the most appropriate special education program. All cases are different. The process is made up of 4 major steps:

Referral
Teachers, guidance counselors, physicians, psychiatrists, social workers, day care providers, or any person in a caregiving or professional position concerned with the student's development may refer a child to special education.
Evaluation
Within 30 days of the referral, evaluations of the child's special need/s must be performed. Teachers, psychiatrists, social workers, etc. may evaluate the student to determine what, if any, needs exist. Evaluations may include visits to the child's school and participation at Team meetings. Re-evaluations must be done every 3 years, to assess how the child's needs have changed and how programs and services need to be adapted.
Team Meeting
The child's Team determines his/her eligibility for special education. Members of the Team may be faculty of the school and the health professionals who evaluated and/or who regularly treat the child. If the Team determines that the child is eligible for special education, they begin developing the child's IEP (Individual Education Plan). This IEP will suggest the types of programs, placement, services, and goals and objectives of the child's special education. The Team has 15 working days to develop this.
Parents accept or reject IEP, or it is determined that the child does not have a special need
If the parents accept the IEP, it is implemented and re-evaluated every 3 years. Parents may also choose to reject the IEP. They may reject certain parts or the IEP as a whole. If the parents and the Team cannot agree on an IEP, the parents may resort to the BSEA (Bureau of Special Education Appeals). They may choose to dispute the IEP via a formal hearing, the outcome of which is legally binding, or a mediation, which is not legally binding. Whichever they choose, they have the right to 'stay-put' in their special education program (if the child is already enrolled in one) until the hearing is settled. If it is determined that the child does not have a special need, parents may submit additional information and reopen the subject at any time.

Roles Health Care Providers May Play in the Special Education Process
As a health care provider, you may find yourself:

Referring, or suggesting a special education referral
Performing evaluations of the student in question (in school and/or at home)
Attending Team meetings
Working with attorneys or advocates
Providing support to parents and children

"Providing support to parents and children" is a very important aspect of assisting a family in the special education process. Dealing with a disability can be difficult and parents and children experience a lot of physical and emotional stress. Parents may be confused about the eligibility determination process and how to provide for their child's needs. Year after year, parents must renegotiate the IEP, so many parents are engaged in a constant battle to initiate and/or maintain their child's access to special education. The parents themselves may have disabilities, lending even more stress and confusion to their situation. Dealing with the child's disability requires a lot of time, energy and patience. Parents often experience feelings of anger, denial, disappointment, grief, and guilt. The disabled child may feel similar emotions including low self-esteem, confusion, shame and frustration. The perception of 'difference' from the other children at school can socially isolate them. Sometimes depression or other behavioral issues develop as a result of their physical and emotional stress.

Effective ways to help families who are stressed can be to educate the family and/or the rest of the Team about the child's disability in general and about the needs of the child in particular and to suggest additional resources. Suggest professionals who can and will perform more evaluations and provide information on support groups and legal advocates. Be a responsible and thorough evaluator. If you are performing an evaluation, be aware that the process may take a significant amount of time and careful documentation and may require you to be a part of legal proceedings. Let the family know how involved with them you are able to be.

Overview of Special Education Law
Many federal laws affect children with disabilities and their rights to special education. The abbreviated list below gives a short description of a few im-portant federal laws:

IDEA (Individuals with Disabilities Education Act) - assures a child's right to special education. It is the policy of the United States to provide financial assistance to States, so that they may improve the quality of education for children with disabilities, by making it law that a child receives the individualized services s/he requires because of her/his special need.
Americans with Disabilities Act - prohibits discrimination on the basis of disability in employment and in programs and activities provided by state and local government such as in courthouses and public libraries. The ADA also prohibits discrimination on the basis of disability by over 6 million private establishments such as restaurants and movie theaters.
FERPA (Family Education Rights and Privacy Act) - assures parent's rights to view and inspect their children's educational records and rights to keep private financial and/or medical records, as they pertain to a child's education.
Part C of IDEA (Early Intervention) - assures an infant/toddler's right to early intervention services. It is the policy of the United States to provide financial assistance to States, so that they may expand opportunities for children under 3 years of age who would be at risk of having substantial developmental delay if they did not receive early intervention services.

Many state laws also affect children with disabilities. The abbreviated list below gives a short description of a few important Massachusetts state laws:

"Chapter 766" (M.G.L. c. 71B) - assures a child's right to special education in Massachusetts.
"Chapter 688" (M.G.L. c. 71B, 12B) - assures 'transitional services' to Massachusetts special needs adults who are turning 22, and thus aging out of eligibility for special education services.
Massachusetts Education Reform Act - the goals of this act are to ensure all students achieve high standards, enhance the quality and professionalism of teachers, support excellence and accountability in all schools, streamline and ensure compliance with state and federal regulations, and to create a state-wide infrastructure of support for schools.

CRC Addendum
Though a good introduction, anyone who's ever dealt with special education knows that this is a great simplification of the process and that, unfortunately, it is often an adversarial process. A great resource for families is The Federation For Children with Special Needs (which is listed in IRis) (617) 236-7210, (800) 331-0688 or www.fcsn.org. They regularly offer workshops for parents on various aspects of special education rights and processes. They also work on a public advocacy level. As you may be aware there are a couple of hot topics currently in special ed. As of January 1, 2002 the state standard of service will be changed from the current "maximum possible development" of the child to the federal "free appropriate public education" standard. According to the Federation "The effects of thithis change could be devastating to children with disabilities as many school districts will likely try to interpret this change in the standard to mean they can reduce essential services to children across the board." The Federation is supporting legislation to halt or delay this change. Also recent test results have shown that children enrolled in special education as a group have done very poorly on the MCAS tests that will soon be a graduation requirement. Whether the tests are fair and appropriate for this group of students and whether they will be allowed to receive a diploma rather than some type of alternate certificate are still being debated.

You can view the applicable state laws at:
Mass General Laws, Section 71B
http://www.state.ma.us/legis/laws/mgl/gl%2D71b%2Dtoc.htm

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