Journal Issue: Children with Disabilities Volume 22 Number 1 Spring 2012
Education Services for Children with Disabilities
Once a child is deemed eligible for special education services, a team that includes the child's parents and representatives of the public education system is charged with developing an individualized education program that outlines academic goals and incorporates all the services and supports necessary to meet the child's unique needs. Services and supports can include transportation; speech-language pathology and audiology services; psychological services; physical and occupational therapy; therapeutic recreation; counseling services including rehabilitation counseling, orientation, and mobility services; medical services for diagnostic or evaluation purposes; school health services; social work services in school; and parent counseling and training.
Within schools and classrooms, special education students can benefit from a variety of approaches and supports, including curriculum modification, small-group or individual instruction, and teachers who are especially skilled in motivating students, adapting instructional materials, teaching reading skills and language arts, and managing student behaviors. Specific accommodations might include tutors or aides, more time for students to take tests, alternative tests or assessments, modified grading standards, slower-paced instruction, shorter or different assignments, more frequent feedback, a reader or interpreter, a peer tutor, or special behavior management approaches and programs.
IDEA requires states to identify, locate, and evaluate all children from birth to age twenty-one who are in need of early intervention or special education services. In practice, children enter the program in many different ways, and they are also often assessed, identified, and then served quite differently. Two groups of students who have received more systematic attention by researchers and program planners are those who struggle with reading and those with behavioral problems. We describe recent innovative approaches for intervening successfully with these students. Because the importance of children's experiences before they reach school age (whether or not they have a disability) is also well established, we also discuss the types of services preschool-age children can receive through the Part C special education system before they start their formal schooling.
Response to Intervention
The reauthorization of IDEA in 2004 changed the law about how children with specific learning disabilities could be identified by allowing an approach known as response to intervention (RTI). Rather than identify learning disabilities by documenting a discrepancy between a student's ability (usually measured by IQ) and his or her academic achievement (usually measured by grades and standardized test results), RTI calls for a tiered process of instruction in which schools identify struggling students early and then deliver a variety of appropriate instructional interventions.16 In theory, RTI should benefit all students (including those who previously did not qualify for special education services) because it requires that all essential components of reading instruction be delivered as part of the core curriculum.17 Schools using RTI must deliver scientific, research-based reading instruction to all students in the general education classroom; screen all children early to determine if they are at risk for learning disabilities; monitor the progress of all at-risk children to determine if they are benefiting from instruction; and use programs or curricula correctly and as intended.
Like many aspects of the special education system, RTI is still being developed and refined, and its effectiveness in reducing the number of students with specific learning disabilities remains unproven. At best, it may be an effective driver of schoolwide instructional improvement, one that also prevents the misidentification of learning disabilities (poor instruction sometimes leads to children being identified as having a disability) and that allows schools to intervene early with students with true learning disabilities. But some observers are concerned that school districts can use RTI to delay and limit access to full-blown special education services. Because RTI often takes place over a number of years, with new teachers and approaches each year, it has the potential to serve as a bureaucratic means for delaying a full evaluation and identification of a learning disability. Districts' desires to contain high special education costs lend credibility to this viewpoint (more on this point later). These tensions reflect a more general discussion within education circles about the need to improve teaching by differentiating instruction for all students and to limit special education services to a smaller number of students with more disabling conditions.18
Positive Behavioral Interventions and Supports
Can and should students with behavioral problems and other disabilities be disciplined? This question has been a major focus of special education law and regulations, in part because schools are struggling with how to manage disciplinary problems, which appear to be increasing among students with disabilities, and in part because these students are most likely to be negatively affected by zero-tolerance discipline policies and other high-stakes testing and accountability measures. IDEA requires that disabilities be taken into account when students are disciplined. Schools must also conduct functional behavioral assessments and use positive behavioral supports with students who are at risk for expulsion, alternative school placement, or suspension of more than ten days. Positive behavioral support is a general term that refers to the application of behavioral analysis to achieve functional behavior changes; positive behavioral interventions and supports are often based on functional behavioral assessments and involve long-term strategies designed to reduce inappropriate behavior, teach more appropriate behavior, and provide supports necessary for successful outcomes.19
Originally an alternative to traditional behavioral approaches for students with severe disabilities who engaged in extreme forms of self-injury and aggression, positive behavioral interventions and supports are now used both schoolwide and for individual students with and without disabilities.20 Schoolwide interventions can include evaluating the school environment—classrooms, hallways, cafeteria—to determine where and when problems are likely to occur; creating strategies to prevent the identified problems; teaching all students rules and routines to encourage desirable behavior; responding to inappropriate student behavior with correction and reteaching procedures; establishing behavior support teams to monitor effectiveness of prevention strategies; and using data collection (direct behavioral observation, office discipline referrals, interviews with staff and family members) and analysis to identify students who are at risk for school failure. More intensive, individualized interventions include drawing on functional behavioral assessments to monitor and modify behavior plans as necessary (the responsibility of behavior support teams); ensuring that all adults in the school understand what skills these students are learning so that all settings in the school environment can be arranged in ways that reduce problem behavior and encourage appropriate behavior; and delivering effective instructional strategies, aggression replacement training, counseling, and classroom supports. Students with chronic or intense behavioral problems might also receive "wraparound" services that coordinate services and input from home, community, and school.
Early Intervention and Transition to Schooling
Early intervention is based on the now widely accepted idea that identifying children's needs and providing services early in their lives can avoid or alleviate future service needs by lessening the effects of a disabling condition and in some cases actually reducing the occurrence of additional disabling conditions. Early intervention services include screening, assessment, referral, and treatment and tend to be less specialized, intrusive, and costly than "higher order" services.
Early intervention services are provided to children with disabilities through several public programs. In addition to Part C of IDEA, states offer early intervention services under Title V of the Maternal and Child Health program and the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) component of Medicaid. Part B of IDEA also provides services to children aged three to five. The group of children receiving early intervention services through Part C includes infants and toddlers with diagnosed medical conditions (many of whom had low birth weight) that put them at risk for developmental delay and toddlers who are showing developmental delay, meaning a gap between their actual development and age-appropriate expectations.21 In 2005 about 2.4 percent of the population under age three and their families were receiving services through Part C. It is unclear what fraction of the eligible population this represents, since each state has different criteria and to date no study has estimated the numbers of eligible children.
Other programs that provide educational services to low-income preschool children with disabilities include Head Start (three- and four-year-olds) and Early Head Start (under age three). About 12 percent of Head Start students have disabilities, half of which are identified during the program year and half before joining the program. Almost all of these children receive special education and related services.22 A similar percentage of children in Early Head Start has disabilities.
Despite the widespread recognition of the value of early intervention, the programs face several challenges to their effectiveness: reaching eligible children is difficult (often the neediest children are hardest to reach), resources are limited, needed services are not always available for eligible children, and transitioning from programs serving young children to those serving preschool and school children can be complicated and uneven. Evidence shows that high-quality early intervention at young ages can provide long-term cost savings.23 However, because these savings accrue over time and across public programs (such as education, health, or criminal justice), the full impact of long-term savings may not be taken into account in individual program decisions.
Eligibility, services, program structures, and access to early intervention programs vary greatly from state to state. Under Part C, for example, states must serve all eligible children and families but have a great deal of latitude in setting eligibility criteria. State choices in developing their eligibility criteria are influenced by concerns over numbers of eligible children and costs. For example, states are allowed to serve children who are at risk of a developmental delay, but only four states have opted to do so, in part because of funding concerns.24
Identification and access to screening services constitute another challenge. Each state is responsible for implementing a Child Find program that locates, identifies, and refers all children in need of early intervention or special education services. Each Child Find program is required to include procedures for screening child health and development. Screening is also mandated under Medicaid's EPSDT Program and is required of pediatric health care providers who deliver routine health supervision services such as preventive care and well-child visits. For low-income children with disabilities, screening through EPSDT is a potentially powerful tool because it mandates coverage for certain medically necessary health care services identified through the screening. But many families do not have access to these screening services. A recent report found that, in nine states, four of ten Medicaid-enrolled children eligible for EPSDT did not receive any of the required screenings and that the screenings were incomplete for nearly 60 percent of those who did receive them. This record comes despite requirements that all eligible Medicaid recipients be notified within sixty days of enrollment about available EPSDT services and amid multiple other forms of state outreach activities and provider incentives. According to the states, barriers to completing screenings include cultural or family beliefs that screenings are not necessary, the unwillingness or inability of families to take time off work to take their child to the screening, limited access to providers, and incorrect contact information for beneficiaries.25
Finally, transitions for young children from early childhood programs to preschool to school are not always smooth.26 When a child receiving Part C services reaches age two and a half, IDEA requires a meeting between the Part C service agency, parents, and the local education agency to determine continuing eligibility for special education services and to ensure a smooth effective transition to preschool. Disconnects can and do occur, however, because of the number of agencies involved in determining eligibility for preschool special services, the number of agencies in the community (private, nonprofit, for profit, and Early Head Start programs) involved in providing these services, and the variety of ways and settings in which young children receive early intervention services.27 Similar challenges occur when children with disabilities transition from the preschool setting into the school system or move from one state or school district into another.